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Science Anatomy Complete Subject Reference Gross anatomy, neuroanatomy, surface landmarks, vascular territories, lymphatic drainage, fascial planes, and every clinical correlation across the full scope of human anatomy."},"1":{"title":"Anatomical Terminology & Planes","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s1","snippet":"Anatomical Terminology & Planes All anatomical descriptions reference the anatomical position : body upright, feet together, arms at sides, palms facing forward (supinated). This universal convention eliminates ambiguity regardless of the patient's actual posture. Mastery of directional terms and bo...","sourceLabel":"Section in Anatomy"},"2":{"title":"Embryology Essentials","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s2","snippet":"Embryology Essentials Understanding embryologic development explains congenital anomalies, anatomical variants, and the logic of adult structural relationships. Key developmental events occur during weeks 3-8 (the embryonic period), when all major organ systems are established and the embryo is most...","sourceLabel":"Section in Anatomy"},"3":{"title":"Histological Tissue Types","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s3","snippet":"Histological Tissue Types The human body is composed of four fundamental tissue types. Recognition of tissue architecture is essential for pathology interpretation and understanding how anatomy relates to function at the microscopic level. Figure 6 - The Four Fundamental Tissue Types. All human tiss...","sourceLabel":"Section in Anatomy"},"4":{"title":"Shoulder & Arm","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s4","snippet":"Shoulder & Arm The shoulder is the most mobile joint in the body (ball-and-socket) but sacrifices stability for range of motion. The glenohumeral joint has a shallow glenoid fossa deepened by the fibrocartilaginous labrum . Stability depends primarily on the rotator cuff muscles (SITS: supraspinatus...","sourceLabel":"Section in Anatomy"},"5":{"title":"Forearm, Wrist & Hand","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s5","snippet":"Forearm, Wrist & Hand The forearm contains 20 muscles organized into anterior (flexor) and posterior (extensor) compartments separated by the interosseous membrane. The anterior compartment is innervated primarily by the median nerve (superficial muscles) and anterior interosseous nerve (deep muscle...","sourceLabel":"Section in Anatomy"},"6":{"title":"Brachial Plexus & Upper Limb Nerves","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s6","snippet":"Brachial Plexus & Upper Limb Nerves The brachial plexus (C5-T1) innervates the entire upper limb. It forms from ventral rami that merge into trunks, divisions, cords, and branches: \"Robert Taylor Drinks Cold Beer\" (Roots, Trunks, Divisions, Cords, Branches). The plexus passes between the anterior an...","sourceLabel":"Section in Anatomy"},"7":{"title":"Hip & Thigh","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s7","snippet":"Hip & Thigh The hip joint is a ball-and-socket synovial joint with much greater inherent stability than the shoulder, owing to the deep acetabulum (deepened further by the labrum), strong capsular ligaments (iliofemoral, pubofemoral, ischiofemoral), and powerful surrounding musculature. The iliofemo...","sourceLabel":"Section in Anatomy"},"8":{"title":"Knee, Leg & Foot","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s8","snippet":"Knee, Leg & Foot The knee is a modified hinge joint (allows flexion, extension, and slight rotation) and the largest synovial joint. Stability depends on four major ligaments: ACL (prevents anterior tibial translation; most commonly injured knee ligament), PCL (prevents posterior tibial translation;...","sourceLabel":"Section in Anatomy"},"9":{"title":"Lumbosacral Plexus & Lower Limb Nerves","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s9","snippet":"Lumbosacral Plexus & Lower Limb Nerves The lumbar plexus (L1-L4) forms within the psoas major muscle. The sacral plexus (L4-S3) forms on the piriformis muscle in the pelvis. Together they supply the entire lower limb. Figure 17 - Lumbosacral Plexus. The lumbar plexus (L1-L4) forms within the psoas m...","sourceLabel":"Section in Anatomy"},"10":{"title":"Vertebral Column & Spinal Cord","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s10","snippet":"Vertebral Column & Spinal Cord The vertebral column comprises 33 vertebrae : 7 cervical, 12 thoracic, 5 lumbar, 5 sacral (fused), and 4 coccygeal (fused). It protects the spinal cord, supports the body, and allows movement. The spinal cord extends from the foramen magnum to the conus medullaris at a...","sourceLabel":"Section in Anatomy"},"11":{"title":"Thoracic Wall & Diaphragm","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s11","snippet":"Thoracic Wall & Diaphragm The thoracic cage (sternum, 12 pairs of ribs, thoracic vertebrae) protects the heart, lungs, and great vessels while allowing respiratory excursion. The intercostal neurovascular bundle (vein, artery, nerve - VAN from superior to inferior) runs in the costal groove along th...","sourceLabel":"Section in Anatomy"},"12":{"title":"Abdominal Wall & Inguinal Region","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s12","snippet":"Abdominal Wall & Inguinal Region The anterolateral abdominal wall consists of four muscle layers: external oblique (fibers inferiorly and medially, \"hands in pockets\"), internal oblique (fibers superiorly and medially), transversus abdominis (fibers transversely), and rectus abdominis (vertical, wit...","sourceLabel":"Section in Anatomy"},"13":{"title":"Heart & Coronary Arteries","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s13","snippet":"Heart & Coronary Arteries The heart is a four-chambered muscular pump (~250-350 g) located in the middle mediastinum , resting on the diaphragm. Two-thirds of the heart mass lies to the left of the midline. The heart is enclosed within the pericardium (fibrous pericardium and serous pericardium with...","sourceLabel":"Section in Anatomy"},"14":{"title":"Great Vessels & Aortic Branches","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s14","snippet":"Great Vessels & Aortic Branches The aorta is the largest artery in the body, originating from the left ventricle and distributing oxygenated blood to every tissue. It is divided into the ascending aorta, aortic arch, descending thoracic aorta, and abdominal aorta. Branches of the Aortic Arch From ri...","sourceLabel":"Section in Anatomy"},"15":{"title":"Fetal Circulation & Congenital Variants","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s15","snippet":"Fetal Circulation & Congenital Variants Fetal circulation has three shunts that bypass the non-functional lungs and liver: the ductus venosus (umbilical vein &rarr; IVC, bypasses liver), the foramen ovale (right atrium &rarr; left atrium, bypasses lungs), and the ductus arteriosus (pulmonary trunk &...","sourceLabel":"Section in Anatomy"},"16":{"title":"Airway, Lungs & Pleura","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s16","snippet":"Airway, Lungs & Pleura The conducting airways begin at the nose/mouth and proceed through the pharynx, larynx, trachea, bronchi, and bronchioles. Gas exchange occurs in the respiratory zone (respiratory bronchioles, alveolar ducts, alveolar sacs). The adult lung contains approximately 300 million al...","sourceLabel":"Section in Anatomy"},"17":{"title":"Mediastinum & Thoracic Lymphatics","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s17","snippet":"Mediastinum & Thoracic Lymphatics The mediastinum is the central compartment of the thorax, bounded laterally by the pleural cavities, anteriorly by the sternum, and posteriorly by the vertebral column. It is divided into superior (above sternal angle/T4) and inferior (anterior, middle, posterior) m...","sourceLabel":"Section in Anatomy"},"18":{"title":"Brain: Cerebrum & Cortical Areas","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s18","snippet":"Brain: Cerebrum & Cortical Areas The cerebral cortex is organized into four lobes: frontal (motor, executive function, personality, Broca area), parietal (somatosensory, spatial awareness), temporal (auditory processing, memory, Wernicke area), and occipital (visual processing). The cortex is suppli...","sourceLabel":"Section in Anatomy"},"19":{"title":"Brainstem, Cerebellum & Cranial Nerves","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s19","snippet":"Brainstem, Cerebellum & Cranial Nerves The brainstem (midbrain, pons, medulla) contains cranial nerve nuclei, ascending/descending tracts, reticular formation (consciousness), and vital autonomic centers (respiratory, cardiovascular). The cerebellum coordinates movement, balance, and motor learning....","sourceLabel":"Section in Anatomy"},"20":{"title":"Spinal Cord Tracts & Lesion Syndromes","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s20","snippet":"Spinal Cord Tracts & Lesion Syndromes The spinal cord contains ascending (sensory) and descending (motor) tracts organized in white matter columns surrounding the central gray matter (butterfly-shaped). Understanding tract anatomy is essential for localizing spinal cord lesions. Major Spinal Cord Tr...","sourceLabel":"Section in Anatomy"},"21":{"title":"GI Tract & Hepatobiliary System","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s21","snippet":"GI Tract & Hepatobiliary System The gastrointestinal tract extends from the mouth to the anus, with each segment having specific histologic, vascular, and innervation characteristics that determine its clinical pathology. The GI tract is divided embryologically into foregut, midgut, and hindgut - ea...","sourceLabel":"Section in Anatomy"},"22":{"title":"Renal & Urogenital Anatomy","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s22","snippet":"Renal & Urogenital Anatomy The kidneys are retroperitoneal organs at T12-L3, with the right kidney slightly lower than the left (depressed by the liver). Each kidney is ~11 cm long and weighs ~150 g. They are surrounded by (from inside out): renal capsule, perinephric fat, Gerota fascia (renal fasci...","sourceLabel":"Section in Anatomy"},"23":{"title":"Reproductive Anatomy","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s23","snippet":"Reproductive Anatomy Male Reproductive Anatomy The testes develop retroperitoneally and descend through the inguinal canal into the scrotum (guided by the gubernaculum), bringing their blood supply (testicular arteries from the aorta at L2), lymphatic drainage (para-aortic lymph nodes, NOT inguinal)...","sourceLabel":"Section in Anatomy"},"24":{"title":"Skull, Face & Scalp","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s24","snippet":"Skull, Face & Scalp The skull consists of the cranial vault (calvaria: frontal, parietal x2, temporal x2, occipital) and the skull base (anterior, middle, and posterior cranial fossae). The bones are joined by sutures: sagittal (between parietals), coronal (frontal-parietal), lambdoid (parietal-occi...","sourceLabel":"Section in Anatomy"},"25":{"title":"Neck Triangles, Fascial Planes & Vasculature","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s25","snippet":"Neck Triangles, Fascial Planes & Vasculature The neck is divided by the sternocleidomastoid (SCM) into the anterior and posterior triangles. These triangles organize the understanding of deep neck structures, surgical approaches, and the spread of infection. Figure 39 - Neck Triangles. The sternocle...","sourceLabel":"Section in Anatomy"},"26":{"title":"Surface Anatomy & Landmarks","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s26","snippet":"Surface Anatomy & Landmarks Surface anatomy translates deep structures to palpable or visible landmarks on the body surface. These landmarks are essential for physical examination, procedural guidance, and surgical planning. Thoracic Surface Landmarks Landmark Level Clinical Significance Sternal ang...","sourceLabel":"Section in Anatomy"},"27":{"title":"Clinical Correlates & Surgical Anatomy","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s27","snippet":"Clinical Correlates & Surgical Anatomy This section integrates anatomical knowledge with common clinical and surgical scenarios encountered across specialties. High-Yield Nerve Injuries Nerve Injury Mechanism Motor Deficit Sensory Deficit Axillary (C5-C6) Anterior shoulder dislocation, surgical neck...","sourceLabel":"Section in Anatomy"},"28":{"title":"High-Yield Review & Reference Tables","pageTitle":"Anatomy","pageUrl":"/foundational/anatomy","url":"/foundational/anatomy#s28","snippet":"High-Yield Review & Reference Tables This section consolidates the most frequently tested anatomical facts for board examinations and clinical practice. Muscle Innervation Quick Reference Action Muscle(s) Nerve Root Shoulder abduction (0-15&deg;) Supraspinatus Suprascapular C5-C6 Shoulder abduction ...","sourceLabel":"Section in Anatomy"},"29":{"title":"Histology","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology","snippet":"Foundational Science Histology Complete Subject Reference Tissue architecture, microscopic anatomy, epithelial types, connective tissue, muscle, nervous tissue, organ-specific histology, staining techniques, and every cell type, tissue feature, and pathologic correlate across the full scope of medic..."},"30":{"title":"Overview & Significance","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s1","snippet":"Overview & Significance Histology is the study of microscopic anatomy -the structure and organization of cells and tissues that compose every organ in the human body. Understanding tissue architecture is foundational to pathology, since nearly every disease process produces identifiable changes at t...","sourceLabel":"Section in Histology"},"31":{"title":"Tissue Processing & Preparation","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s2","snippet":"Tissue Processing & Preparation Proper tissue processing is essential for producing high-quality histologic sections. The standard workflow involves fixation , dehydration , clearing , embedding , sectioning , and staining . Each step introduces potential artifacts that the histologist must recogniz...","sourceLabel":"Section in Histology"},"32":{"title":"Staining Techniques","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s3","snippet":"Staining Techniques Stains transform colorless tissue sections into interpretable images by selectively binding to cellular and extracellular components. The hematoxylin and eosin (H&E) stain is the cornerstone of histologic diagnosis, but hundreds of special stains and immunohistochemical markers e...","sourceLabel":"Section in Histology"},"33":{"title":"Simple Epithelia","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s4","snippet":"Simple Epithelia Epithelial tissue lines body surfaces, cavities, and tubes, and forms glands. All epithelia rest on a basement membrane (basal lamina + reticular lamina), are avascular (nourished by diffusion from underlying connective tissue), and exhibit polarity (apical, lateral, and basal domai...","sourceLabel":"Section in Histology"},"34":{"title":"Stratified & Transitional Epithelia","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s5","snippet":"Stratified & Transitional Epithelia Stratified epithelia have multiple cell layers, providing protection against mechanical abrasion, chemical insult, and desiccation. Classification is based on the shape of the surface (apical) cells, regardless of the shape of deeper layers. Stratified Squamous Ep...","sourceLabel":"Section in Histology"},"35":{"title":"Glandular Epithelium","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s6","snippet":"Glandular Epithelium Glands are epithelial structures specialized for secretion . They arise embryologically as epithelial invaginations into underlying connective tissue. Glands are classified as exocrine (secrete via ducts to a surface) or endocrine (secrete hormones directly into blood; ductless)...","sourceLabel":"Section in Histology"},"36":{"title":"Connective Tissue Proper","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s7","snippet":"Connective Tissue Proper Connective tissue is the most abundant and widely distributed tissue type. Unlike epithelium, its cells are separated by abundant extracellular matrix (ECM) consisting of ground substance and fibers. All connective tissue derives from embryonic mesenchyme (mesoderm), except ...","sourceLabel":"Section in Histology"},"37":{"title":"Cartilage","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s8","snippet":"Cartilage Cartilage is an avascular, aneural connective tissue with a firm but flexible ECM. Chondrocytes reside in lacunae and receive nutrition by diffusion through the matrix. Cartilage grows by interstitial growth (mitosis of existing chondrocytes) and appositional growth (new cartilage deposite...","sourceLabel":"Section in Histology"},"38":{"title":"Bone & Ossification","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s9","snippet":"Bone & Ossification Bone is a mineralized connective tissue providing structural support, mineral homeostasis (calcium/phosphate reservoir), and hematopoiesis. Its matrix is ~35% organic ( type I collagen + osteocalcin, osteopontin) and ~65% inorganic ( hydroxyapatite crystals, Ca 10 (PO 4 ) 6 (OH) ...","sourceLabel":"Section in Histology"},"39":{"title":"Blood & Hematopoiesis","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s10","snippet":"Blood & Hematopoiesis Blood is a specialized liquid connective tissue with a fluid ECM called plasma . Formed elements include erythrocytes (RBCs), leukocytes (WBCs), and thrombocytes (platelets). Blood smears stained with Wright-Giemsa (Romanowsky-type) stain are the standard for peripheral blood e...","sourceLabel":"Section in Histology"},"40":{"title":"Skeletal Muscle","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s11","snippet":"Skeletal Muscle Skeletal muscle constitutes ~40% of body mass and is responsible for voluntary movement. Fibers are multinucleated syncytia formed by myoblast fusion during development, with peripheral nuclei pushed against the sarcolemma. Fibers are arranged in fascicles, each surrounded by connect...","sourceLabel":"Section in Histology"},"41":{"title":"Cardiac Muscle","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s12","snippet":"Cardiac Muscle Cardiac muscle shares the striated pattern of skeletal muscle but has critical structural and functional differences. Cardiomyocytes are mononucleated (occasionally binucleated) with centrally located nuclei, branching fibers, and intercalated discs at cell junctions. Figure 13 - Card...","sourceLabel":"Section in Histology"},"42":{"title":"Smooth Muscle","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s13","snippet":"Smooth Muscle Smooth muscle is the involuntary, non-striated muscle of visceral organs, blood vessels, and the iris. Cells are fusiform (spindle-shaped) with a single central, cigar-shaped nucleus that may appear corkscrew-shaped in contracted cells on longitudinal section. Key Features Smooth muscl...","sourceLabel":"Section in Histology"},"43":{"title":"Neurons & Synapses","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s14","snippet":"Neurons & Synapses Neurons are electrically excitable cells that transmit information through electrical impulses and chemical synapses. They are post-mitotic in the adult (with limited exceptions in the hippocampus and olfactory bulb). Each neuron has a cell body (soma/perikaryon) , dendrites (rece...","sourceLabel":"Section in Histology"},"44":{"title":"Glial Cells & Myelination","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s15","snippet":"Glial Cells & Myelination Glial cells (neuroglia) outnumber neurons and provide structural support, metabolic maintenance, and insulation. Unlike neurons, most glial cells retain mitotic capacity, making them the most common source of primary CNS tumors. CNS Glial Cells Cell Type Function Key Featur...","sourceLabel":"Section in Histology"},"45":{"title":"Peripheral Nerve & Ganglia","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s16","snippet":"Peripheral Nerve & Ganglia Peripheral nerves have a connective tissue organization analogous to skeletal muscle: Layer Surrounds Special Features Epineurium Entire nerve Dense irregular CT; outermost layer Perineurium Fascicle Concentric layers of flat epithelioid cells; forms blood-nerve barrier; m...","sourceLabel":"Section in Histology"},"46":{"title":"Skin & Appendages","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s17","snippet":"Skin & Appendages The skin is the largest organ, composed of epidermis (keratinized stratified squamous epithelium) and dermis (connective tissue), overlying the hypodermis (subcutaneous fat, not technically part of the skin). Figure 19 - Skin Layers. H&E stained section of skin showing the keratini...","sourceLabel":"Section in Histology"},"47":{"title":"Gastrointestinal Tract","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s18","snippet":"Gastrointestinal Tract The GI tract follows a consistent four-layer plan from esophagus to anal canal: mucosa (epithelium + lamina propria + muscularis mucosae), submucosa , muscularis externa (inner circular + outer longitudinal smooth muscle), and serosa/adventitia . Regional Epithelial Variation ...","sourceLabel":"Section in Histology"},"48":{"title":"Liver, Gallbladder & Pancreas","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s19","snippet":"Liver, Gallbladder & Pancreas Liver The liver is organized into hepatic lobules : hexagonal units centered on a central vein with portal triads (hepatic artery, portal vein, bile duct) at the periphery. Hepatocytes are arranged in anastomosing plates separated by sinusoids (fenestrated capillaries l...","sourceLabel":"Section in Histology"},"49":{"title":"Kidney & Urinary Tract","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s20","snippet":"Kidney & Urinary Tract Each kidney contains ~1 million nephrons , the functional units responsible for filtration, reabsorption, secretion, and concentration. The nephron comprises the renal corpuscle (glomerulus + Bowman capsule) and a tubular system. Nephron Segments Segment Epithelium Key Feature...","sourceLabel":"Section in Histology"},"50":{"title":"Respiratory System","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s21","snippet":"Respiratory System The respiratory system transitions from the conducting zone (nasal cavity to terminal bronchioles) to the respiratory zone (respiratory bronchioles, alveolar ducts, alveolar sacs, alveoli) where gas exchange occurs. Figure 29 - Trachea. Cross-section of the trachea showing pseudos...","sourceLabel":"Section in Histology"},"51":{"title":"Lymphoid Organs","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s22","snippet":"Lymphoid Organs Lymphoid organs are classified as primary (where lymphocytes mature: bone marrow for B cells, thymus for T cells) or secondary (where immune responses are initiated: lymph nodes, spleen, MALT). Lymph Node Bean-shaped; surrounded by a capsule. Cortex : lymphoid follicles-primary (inac...","sourceLabel":"Section in Histology"},"52":{"title":"Endocrine Glands","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s23","snippet":"Endocrine Glands Pituitary Gland (Hypophysis) The anterior pituitary (adenohypophysis) is organized as cords and clusters of cells. Three histologic types based on H&E staining: acidophils (GH, prolactin), basophils (FSH, LH, TSH, ACTH), and chromophobes (degranulated or inactive cells). The posteri...","sourceLabel":"Section in Histology"},"53":{"title":"Reproductive Organs","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s24","snippet":"Reproductive Organs Male Reproductive System The seminiferous tubule is lined by Sertoli cells (supporting, forming the blood-testis barrier with tight junctions) and spermatogenic cells in various stages: spermatogonia (basal) &rarr; primary spermatocytes &rarr; secondary spermatocytes &rarr; sperm...","sourceLabel":"Section in Histology"},"54":{"title":"Eye & Ear","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s25","snippet":"Eye & Ear Eye The eye has three tunics: fibrous (sclera + cornea), vascular (uvea) (choroid, ciliary body, iris), and neural (retina). The cornea is avascular and has 5 layers: corneal epithelium (stratified squamous, non-keratinized), Bowman layer (acellular collagen), stroma (90% of thickness; typ...","sourceLabel":"Section in Histology"},"55":{"title":"Pathologic Histology","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s26","snippet":"Pathologic Histology Understanding normal tissue architecture enables recognition of pathologic patterns. Key categories include cellular adaptations, cell injury/death, inflammation, neoplasia, and deposition diseases. Cellular Adaptations Adaptation Definition Example Hypertrophy Increase in cell ...","sourceLabel":"Section in Histology"},"56":{"title":"Clinical Correlates & Diagnostic Stains","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s27","snippet":"Clinical Correlates & Diagnostic Stains Histologic findings directly guide clinical decision-making. This section summarizes high-yield diagnostic patterns and the stains used to identify them. Diagnostic Stain Applications by Organ System Clinical Scenario Stain Expected Finding Liver fibrosis stag...","sourceLabel":"Section in Histology"},"57":{"title":"High-Yield Review & Reference Tables","pageTitle":"Histology","pageUrl":"/foundational/histology","url":"/foundational/histology#s28","snippet":"High-Yield Review & Reference Tables Exam Focus: The following topics are heavily tested on USMLE Step 1, COMLEX, and shelf examinations. Focus on pattern recognition, stain identification, and clinicopathologic correlations. Pathognomonic Histologic Findings Finding Diagnosis Auer rods (pink, needl...","sourceLabel":"Section in Histology"},"58":{"title":"Embryology","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology","snippet":"Foundational Science Embryology Complete Subject Reference Gametogenesis, fertilization, gastrulation, organogenesis, germ layer derivatives, congenital anomalies, teratology, fetal development, and every developmental mechanism, signaling pathway, and clinical malformation across the full scope of ..."},"59":{"title":"Overview & Significance","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s1","snippet":"Overview & Significance Embryology is the study of human development from fertilization through birth. Understanding embryologic processes is essential for explaining congenital anomalies, anatomical relationships, and the rational basis for surgical repair. Approximately 3% of live-born infants hav...","sourceLabel":"Section in Embryology"},"60":{"title":"Core Principles & Signaling","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s2","snippet":"Core Principles & Signaling Embryologic development is orchestrated by a conserved set of signaling molecules, transcription factors, and morphogen gradients. Mutations in these pathways underlie many congenital syndromes. Major Signaling Pathways Pathway Role in Development Associated Defect Sonic ...","sourceLabel":"Section in Embryology"},"61":{"title":"Gametogenesis","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s3","snippet":"Gametogenesis Gametogenesis is the formation of haploid gametes (sperm and oocytes) from diploid germ cells through meiosis. Errors during meiosis are the leading cause of chromosomal aneuploidies such as trisomy 21 (Down syndrome). Figure 2 - Gametogenesis: Oogenesis and Spermatogenesis. Comparison...","sourceLabel":"Section in Embryology"},"62":{"title":"Fertilization & Cleavage","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s4","snippet":"Fertilization & Cleavage Fertilization normally occurs in the ampulla of the uterine tube within 24 hours of ovulation. The process restores the diploid chromosome number, determines genetic sex, and initiates cleavage. Steps of Fertilization Capacitation - sperm undergo functional maturation in the...","sourceLabel":"Section in Embryology"},"63":{"title":"Implantation & Bilaminar Disc","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s5","snippet":"Implantation & Bilaminar Disc Implantation begins around day 6 when the blastocyst attaches to the posterior wall of the uterus (most common site). The syncytiotrophoblast invades the endometrial stroma, and the embryo is fully embedded by day 9-10. Week 1 Events Day Event Day 0 Fertilization in amp...","sourceLabel":"Section in Embryology"},"64":{"title":"Gastrulation & Trilaminar Disc","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s6","snippet":"Gastrulation & Trilaminar Disc Gastrulation occurs during week 3 and is the most critical event in early development. It establishes the three primary germ layers (ectoderm, mesoderm, endoderm) and the body axes (cranial-caudal, dorsal-ventral, left-right). Figure 6 - Gastrulation: From Bilaminar to...","sourceLabel":"Section in Embryology"},"65":{"title":"Neurulation & Neural Tube","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s7","snippet":"Neurulation & Neural Tube Neurulation is the process by which the neural plate folds to form the neural tube, the precursor to the entire CNS. It begins during week 3 and the neural tube closes by the end of week 4. Figure 8 - Neurulation Process. The neural plate folds to form the neural groove, th...","sourceLabel":"Section in Embryology"},"66":{"title":"Ectoderm Derivatives","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s8","snippet":"Ectoderm Derivatives The ectoderm gives rise to the nervous system, epidermis, and associated structures. It subdivides into surface ectoderm , neuroectoderm (neural tube), and neural crest . Figure 11 - Germ Layer Derivatives in Detail. The three embryonic germ layers and their specific organ and t...","sourceLabel":"Section in Embryology"},"67":{"title":"Mesoderm Derivatives","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s9","snippet":"Mesoderm Derivatives The mesoderm is the middle germ layer and gives rise to the musculoskeletal, cardiovascular, urogenital, and hematopoietic systems. It subdivides into paraxial, intermediate, and lateral plate mesoderm. Comprehensive Mesoderm Derivative Table Mesoderm Type Structures Clinical Co...","sourceLabel":"Section in Embryology"},"68":{"title":"Endoderm Derivatives","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s10","snippet":"Endoderm Derivatives The endoderm lines the primitive gut tube and gives rise to the epithelial lining of the GI tract, respiratory tract, and associated glandular organs. Remember: endoderm forms the parenchyma (functional epithelium) while mesoderm forms the surrounding stroma, smooth muscle, and ...","sourceLabel":"Section in Embryology"},"69":{"title":"Neural Crest Derivatives","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s11","snippet":"Neural Crest Derivatives The neural crest is often called the \"fourth germ layer\" because of its extraordinary diversity of derivatives. Neural crest cells originate at the neural tube-ectoderm junction and migrate extensively throughout the embryo. Comprehensive Neural Crest Derivative Table Catego...","sourceLabel":"Section in Embryology"},"70":{"title":"Pharyngeal Arches","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s12","snippet":"Pharyngeal Arches The pharyngeal (branchial) apparatus consists of arches, pouches, clefts, and membranes. Six arches develop (the 5th regresses), each containing mesoderm-derived muscle, neural crest-derived cartilage/bone, an aortic arch artery, and a cranial nerve. Understanding arch derivatives ...","sourceLabel":"Section in Embryology"},"71":{"title":"Pharyngeal Pouches, Clefts & Membranes","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s13","snippet":"Pharyngeal Pouches, Clefts & Membranes Pharyngeal pouches are endoderm-lined outpocketings between arches on the internal (pharyngeal) side. Clefts are ectoderm-lined grooves on the external surface. Membranes are where pouch endoderm meets cleft ectoderm. Pharyngeal Pouch Derivatives Pouch Derivati...","sourceLabel":"Section in Embryology"},"72":{"title":"Heart Development & Septation","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s14","snippet":"Heart Development & Septation The heart is the first functional organ, with beating beginning around day 22 . It develops from splanchnic lateral plate mesoderm. Cardiac development involves tube formation, looping, septation, and valve formation, with defects in any step producing congenital heart ...","sourceLabel":"Section in Embryology"},"73":{"title":"Fetal Circulation & Shunts","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s15","snippet":"Fetal Circulation & Shunts Fetal circulation is adapted for gas exchange at the placenta rather than the lungs. Three critical shunts divert blood away from the non-functional fetal lungs and liver. Figure 18 - Fetal Circulation. The three fetal shunts bypass the non-functional lungs and liver: the ...","sourceLabel":"Section in Embryology"},"74":{"title":"Respiratory System Development","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s16","snippet":"Respiratory System Development The respiratory system develops from a ventral outgrowth of the foregut endoderm (the laryngotracheal diverticulum ) during week 4. The epithelium is endoderm-derived; cartilage, smooth muscle, and vasculature are mesoderm-derived. Figure 20 - Respiratory System Develo...","sourceLabel":"Section in Embryology"},"75":{"title":"GI Development: Foregut, Midgut & Hindgut","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s17","snippet":"GI Development: Foregut, Midgut & Hindgut The primitive gut tube forms by cranial-caudal and lateral folding of the embryonic disc, incorporating the yolk sac endoderm. The gut is divided into foregut, midgut, and hindgut based on blood supply from the three ventral branches of the aorta. Gut Tube D...","sourceLabel":"Section in Embryology"},"76":{"title":"Renal System Development","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s18","snippet":"Renal System Development The urinary system develops from intermediate mesoderm in a cranial-to-caudal sequence through three successive kidney systems. The definitive kidney (metanephros) is derived from two sources: the metanephric mesoderm (mesenchyme) and the ureteric bud. Figure 22 - Kidney Dev...","sourceLabel":"Section in Embryology"},"77":{"title":"Genital System & Sexual Differentiation","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s19","snippet":"Genital System & Sexual Differentiation The genital system develops from the same precursor structures in both sexes. Sex determination depends on the presence or absence of the SRY gene on the Y chromosome. Until week 6, male and female embryos are phenotypically indistinguishable (indifferent gona...","sourceLabel":"Section in Embryology"},"78":{"title":"CNS Development","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s20","snippet":"CNS Development The CNS develops from the neural tube, which forms three primary brain vesicles during week 4 that further subdivide into five secondary vesicles by week 5. Brain Vesicles & Derivatives Primary Vesicle Secondary Vesicle Adult Derivative Cavity Prosencephalon (forebrain) Telencephalon...","sourceLabel":"Section in Embryology"},"79":{"title":"Musculoskeletal & Limb Development","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s21","snippet":"Musculoskeletal & Limb Development Limb buds appear during weeks 4-5, with upper limbs developing slightly before lower limbs. Three signaling centers coordinate limb patterning along three axes. Figure 28 - Limb Bud and Apical Ectodermal Ridge (AER). The AER at the distal tip of the limb bud secret...","sourceLabel":"Section in Embryology"},"80":{"title":"Congenital Anomalies by System","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s22","snippet":"Congenital Anomalies by System Congenital anomalies affect ~3% of live births and are a leading cause of infant mortality. Understanding the embryologic basis of each defect guides diagnosis, counseling, and surgical management. Cardiovascular Anomalies Defect Embryologic Error Key Feature VSD Incom...","sourceLabel":"Section in Embryology"},"81":{"title":"Teratology & Critical Periods","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s23","snippet":"Teratology & Critical Periods A teratogen is any agent that can cause a structural or functional defect in the developing embryo or fetus. Teratogenicity depends on the timing of exposure, dose, genotype of the embryo, and the specific agent. The most vulnerable period is weeks 3-8 (organogenesis). ...","sourceLabel":"Section in Embryology"},"82":{"title":"Placenta, Membranes & Umbilical Cord","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s24","snippet":"Placenta, Membranes & Umbilical Cord The placenta is a fetomaternal organ that serves as the site of nutrient, gas, and waste exchange. It also functions as an endocrine organ, producing hormones essential for pregnancy maintenance. Figure 31 - Placental Anatomy. The placenta consists of a fetal por...","sourceLabel":"Section in Embryology"},"83":{"title":"Twinning & Multiple Gestations","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s25","snippet":"Twinning & Multiple Gestations Twins occur in approximately 1 in 80 pregnancies (higher with assisted reproduction). The type of twinning determines the arrangement of placental membranes and the associated risks. Dizygotic vs. Monozygotic Twins Feature Dizygotic (Fraternal) Monozygotic (Identical) ...","sourceLabel":"Section in Embryology"},"84":{"title":"Fetal Development & Milestones","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s26","snippet":"Fetal Development & Milestones The fetal period (weeks 9-38) is characterized by rapid growth and functional maturation of organ systems established during the embryonic period. Key Fetal Milestones Week Milestone Week 9 Fetal period begins; liver is major site of hematopoiesis; external genitalia b...","sourceLabel":"Section in Embryology"},"85":{"title":"Clinical Correlates","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s27","snippet":"Clinical Correlates Embryologic knowledge directly translates to clinical practice across multiple specialties. The following clinical scenarios demonstrate how developmental principles guide diagnosis and management. Prenatal Screening & Diagnosis Test Timing What It Detects First trimester screen ...","sourceLabel":"Section in Embryology"},"86":{"title":"High-Yield Review & Reference Tables","pageTitle":"Embryology","pageUrl":"/foundational/embryology","url":"/foundational/embryology#s28","snippet":"High-Yield Review & Reference Tables Board-relevant embryology concepts and the most frequently tested associations for USMLE Step 1, COMLEX, and shelf examinations. Quick-Reference: Germ Layer Origins Structure Germ Layer Tip Epidermis, lens, enamel, anterior pituitary Surface ectoderm \"Surface\" st...","sourceLabel":"Section in Embryology"},"87":{"title":"Physiology","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology","snippet":"Foundational Science Physiology Complete Subject Reference Cardiovascular, respiratory, renal, GI, neurophysiology, endocrine, acid-base, and every physiologic principle, equation, regulatory mechanism, and clinical correlation across the full scope of human physiology."},"88":{"title":"Overview & Scope of Physiology","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s1","snippet":"Overview & Scope of Physiology Physiology is the study of how living organisms function — from the molecular events within a single ion channel to the integrated responses of the whole body during exercise, hemorrhage, or disease. It bridges the gap between the structural knowledge of anatomy and hi...","sourceLabel":"Section in Physiology"},"89":{"title":"Cell Physiology & Membrane Transport","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s2","snippet":"Cell Physiology & Membrane Transport All physiologic processes begin at the cell membrane — a 7-8 nm phospholipid bilayer that separates the intracellular from the extracellular environment and controls the selective passage of ions, nutrients, and signaling molecules. Figure 1 - Membrane Transport ...","sourceLabel":"Section in Physiology"},"90":{"title":"Homeostasis & Feedback Systems","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s3","snippet":"Homeostasis & Feedback Systems Homeostasis — the maintenance of a stable internal environment — is the central organizing principle of physiology. The body continuously monitors variables (temperature, pH, osmolality, blood glucose, blood pressure) and activates corrective responses through feedback...","sourceLabel":"Section in Physiology"},"91":{"title":"Cardiac Electrophysiology","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s4","snippet":"Cardiac Electrophysiology The heart is a self-excitable organ. Specialized pacemaker cells generate spontaneous depolarizations that propagate through a precisely organized conduction system, ensuring coordinated atrial and ventricular contraction roughly 100,000 times per day. Understanding cardiac...","sourceLabel":"Section in Physiology"},"92":{"title":"The Cardiac Cycle & Pressure-Volume Loops","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s5","snippet":"The Cardiac Cycle & Pressure-Volume Loops Figure 9 - The Wiggers Diagram. This composite diagram integrates aortic, left ventricular, and left atrial pressures with ventricular volume changes, the ECG, and heart sounds across the cardiac cycle. S1 occurs at mitral/tricuspid valve closure (onset of s...","sourceLabel":"Section in Physiology"},"93":{"title":"Cardiac Output & Hemodynamics","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s6","snippet":"Cardiac Output & Hemodynamics Cardiac Output (CO) CO = HR x SV (normal ~5 L/min at rest). Stroke volume is determined by three factors: preload (EDV, governed by venous return — Frank-Starling law), afterload (wall stress during ejection, approximated by SVR or aortic pressure), and contractility (i...","sourceLabel":"Section in Physiology"},"94":{"title":"Vascular Physiology & Blood Pressure Regulation","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s7","snippet":"Vascular Physiology & Blood Pressure Regulation Vascular Structure & Function Arteries are high-pressure, elastic vessels that dampen pulsatile flow into steady flow (Windkessel effect). Arterioles are the principal resistance vessels and the major site of blood pressure regulation — small changes i...","sourceLabel":"Section in Physiology"},"95":{"title":"Pulmonary Mechanics & Ventilation","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s8","snippet":"Pulmonary Mechanics & Ventilation Figure 14 - Lung Volumes and Capacities. A spirometry tracing illustrating the four primary lung volumes (tidal volume, inspiratory reserve volume, expiratory reserve volume, and residual volume) and their combinations into capacities (vital capacity, total lung cap...","sourceLabel":"Section in Physiology"},"96":{"title":"Gas Exchange & V/Q Matching","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s9","snippet":"Gas Exchange & V/Q Matching The Alveolar Gas Equation Alveolar Gas Equation P A O 2 = FiO 2 (P atm - P H2O ) - (P a CO 2 / R) At sea level on room air: P A O 2 = 0.21 (760 - 47) - (40 / 0.8) = 150 - 50 = ~100 mmHg A-a gradient = P A O 2 - P a O 2 Normal A-a gradient = 2.5 + (0.21 x age in years) You...","sourceLabel":"Section in Physiology"},"97":{"title":"Oxygen & CO 2 Transport","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s10","snippet":"Oxygen & CO 2 Transport Oxygen Transport Total O 2 content of blood (CaO 2 ) = (1.34 x Hb x SaO 2 ) + (0.003 x PaO 2 ). At normal values: (1.34 x 15 x 0.98) + (0.003 x 100) = 19.7 + 0.3 = 20 mL O 2 /dL . Dissolved O 2 contributes only ~1.5% — virtually all O 2 is carried bound to hemoglobin. O 2 del...","sourceLabel":"Section in Physiology"},"98":{"title":"Glomerular Filtration & Renal Blood Flow","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s11","snippet":"Glomerular Filtration & Renal Blood Flow Figure 19 - Nephron Structure and Blood Flow. Blood enters the glomerulus via the afferent arteriole and exits via the efferent arteriole. The filtrate passes through the proximal convoluted tubule (PCT), descending and ascending limbs of the loop of Henle, d...","sourceLabel":"Section in Physiology"},"99":{"title":"Tubular Transport & Nephron Function","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s12","snippet":"Tubular Transport & Nephron Function Proximal Convoluted Tubule (PCT) The workhorse of the nephron — reabsorbs ~65% of filtered Na + , water, K + , HCO 3 - , glucose, amino acids, phosphate, and urea. All glucose and amino acid reabsorption occurs here via Na + -coupled secondary active transport (S...","sourceLabel":"Section in Physiology"},"100":{"title":"Water Balance, ADH & Concentration Mechanisms","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s13","snippet":"Water Balance, ADH & Concentration Mechanisms Antidiuretic Hormone (ADH / Vasopressin) ADH is synthesized in the supraoptic and paraventricular nuclei of the hypothalamus, stored in and released from the posterior pituitary. The primary stimulus for ADH release is increased plasma osmolality (detect...","sourceLabel":"Section in Physiology"},"101":{"title":"RAAS & Sodium/Potassium Homeostasis","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s14","snippet":"RAAS & Sodium/Potassium Homeostasis The Renin-Angiotensin-Aldosterone System Renin is released by juxtaglomerular (JG) cells of the afferent arteriole in response to: (1) decreased renal perfusion pressure, (2) decreased NaCl delivery to the macula densa, (3) increased sympathetic stimulation (beta-...","sourceLabel":"Section in Physiology"},"102":{"title":"Acid-Base Fundamentals & Buffer Systems","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s15","snippet":"Acid-Base Fundamentals & Buffer Systems The Henderson-Hasselbalch Equation Henderson-Hasselbalch Equation pH = pK a + log([HCO 3 - ] / [0.03 x PaCO 2 ]) pH = 6.1 + log(24 / [0.03 x 40]) = 6.1 + log(24/1.2) = 6.1 + log(20) = 6.1 + 1.3 = 7.40 The ratio of HCO 3 - to dissolved CO 2 must be ~20:1 for no...","sourceLabel":"Section in Physiology"},"103":{"title":"Acid-Base Disorders & Compensation","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s16","snippet":"Acid-Base Disorders & Compensation Primary Acid-Base Disorders Disorder pH Primary Change Compensation Expected Compensation Metabolic acidosis Low Low HCO 3 - Decrease PaCO 2 Winter's formula: PaCO 2 = 1.5(HCO 3 - ) + 8 +/- 2 Metabolic alkalosis High High HCO 3 - Increase PaCO 2 PaCO 2 = 0.7(HCO 3 ...","sourceLabel":"Section in Physiology"},"104":{"title":"GI Motility & Secretion","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s17","snippet":"GI Motility & Secretion GI Motility The GI tract has intrinsic motility generated by the interstitial cells of Cajal (ICC) — the pacemaker cells that generate slow waves (basic electrical rhythm). Slow wave frequency varies by location: stomach ~3/min, duodenum ~12/min, ileum ~8/min. Slow waves set ...","sourceLabel":"Section in Physiology"},"105":{"title":"Digestion, Absorption & Hepatobiliary Function","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s18","snippet":"Digestion, Absorption & Hepatobiliary Function Figure 22 - Carbohydrate Digestion and Absorption. Starch digestion begins with salivary amylase and continues with pancreatic amylase in the duodenum, yielding oligosaccharides. Brush border enzymes (maltase, sucrase, lactase, isomaltase) cleave these ...","sourceLabel":"Section in Physiology"},"106":{"title":"Neuronal Signaling & Synaptic Transmission","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s19","snippet":"Neuronal Signaling & Synaptic Transmission The Action Potential Neurons communicate via action potentials — all-or-none electrical events that propagate along axons. At rest, the membrane is at approximately -70 mV (K + leak channels dominate). When a stimulus depolarizes the membrane to threshold (...","sourceLabel":"Section in Physiology"},"107":{"title":"Autonomic Nervous System","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s20","snippet":"Autonomic Nervous System Figure 25 - Sympathetic Nervous System Connections. Preganglionic sympathetic neurons originate from the thoracolumbar cord (T1-L2), synapse in paravertebral chain ganglia or prevertebral ganglia (celiac, superior/inferior mesenteric), and send postganglionic fibers to targe...","sourceLabel":"Section in Physiology"},"108":{"title":"Sensory & Motor Systems","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s21","snippet":"Sensory & Motor Systems Spinal Cord Lesion Syndromes Syndrome Lesion Deficits Classic Cause Brown-Sequard Hemisection of spinal cord Ipsilateral: motor loss (corticospinal), vibration/proprioception loss (DCML). Contralateral: pain/temp loss (spinothalamic, 1-2 levels below) Penetrating trauma, late...","sourceLabel":"Section in Physiology"},"109":{"title":"Endocrine Physiology & Hormone Signaling","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s22","snippet":"Endocrine Physiology & Hormone Signaling Hormone Classification by Mechanism Class Examples Receptor Location Signal Transduction Speed of Action Peptide/Protein Insulin, glucagon, GH, PTH, ADH Cell surface (GPCR or RTK) cAMP, IP3/DAG, JAK-STAT, RTK Fast (minutes) Steroid Cortisol, aldosterone, test...","sourceLabel":"Section in Physiology"},"110":{"title":"Thyroid, Adrenal & Calcium Homeostasis","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s23","snippet":"Thyroid, Adrenal & Calcium Homeostasis Thyroid Physiology The thyroid gland synthesizes T4 (thyroxine, ~90% of output, relatively inactive) and T3 (triiodothyronine, ~10% of output, 3-5x more active). Peripheral conversion of T4 to T3 by 5'-deiodinase (type 1 and 2) produces most circulating T3. Typ...","sourceLabel":"Section in Physiology"},"111":{"title":"Muscle Physiology & Excitation-Contraction Coupling","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s24","snippet":"Muscle Physiology & Excitation-Contraction Coupling Figure 29 - Skeletal Muscle Fiber Architecture. Each muscle fiber contains hundreds of myofibrils composed of repeating sarcomere units. T-tubules transmit the action potential deep into the fiber, coupling to the sarcoplasmic reticulum (SR) which ...","sourceLabel":"Section in Physiology"},"112":{"title":"Reproductive Physiology","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s25","snippet":"Reproductive Physiology Growth Hormone & Prolactin Growth hormone (GH) is released from anterior pituitary somatotrophs in a pulsatile fashion (peak during deep sleep). It is stimulated by GHRH and ghrelin, inhibited by somatostatin and IGF-1. GH acts directly (lipolysis, insulin resistance, glucone...","sourceLabel":"Section in Physiology"},"113":{"title":"Clinical Correlates & Integrative Physiology","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s26","snippet":"Clinical Correlates & Integrative Physiology Fluid Compartments & Body Water Distribution Total body water (TBW) = ~60% of body weight in a 70 kg male (~42 L). Distribution: intracellular fluid (ICF) = 2/3 of TBW (~28 L); extracellular fluid (ECF) = 1/3 of TBW (~14 L). ECF is further divided into in...","sourceLabel":"Section in Physiology"},"114":{"title":"High-Yield Review & Key Equations","pageTitle":"Physiology","pageUrl":"/foundational/physiology","url":"/foundational/physiology#s27","snippet":"High-Yield Review & Key Equations Essential Equations Equation Formula Application Fick Principle CO = VO 2 / (CaO 2 - CvO 2 ) Gold standard for cardiac output measurement MAP CO x SVR; also DBP + 1/3(PP) Organ perfusion pressure Starling Equation Q = K f [(P c - P i ) - sigma(pi c - pi i )] Capilla...","sourceLabel":"Section in Physiology"},"115":{"title":"Biochemistry","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry","snippet":"Foundational Science Biochemistry Complete Subject Reference Amino acids, protein structure, enzyme kinetics, carbohydrate metabolism, lipid metabolism, nucleotide metabolism, vitamins, cofactors, and every metabolic pathway, enzyme deficiency, and clinical correlation across the full scope of medic..."},"116":{"title":"Overview & Scope of Medical Biochemistry","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s1","snippet":"Overview & Scope of Medical Biochemistry Biochemistry is the study of chemical processes within and relating to living organisms. In medical education, it serves as the molecular foundation for understanding physiology, pharmacology, pathology, and genetics. Virtually every clinical discipline relie...","sourceLabel":"Section in Biochemistry"},"117":{"title":"Water, pH & Buffer Systems","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s2","snippet":"Water, pH & Buffer Systems Water constitutes approximately 60% of body mass and serves as the universal solvent for biochemical reactions. Its unique properties-high heat capacity, high heat of vaporization, and ability to form hydrogen bonds-make it indispensable for life. The Henderson-Hasselbalch...","sourceLabel":"Section in Biochemistry"},"118":{"title":"Thermodynamics & Bioenergetics","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s3","snippet":"Thermodynamics & Bioenergetics Biochemical reactions obey the laws of thermodynamics. The Gibbs free energy change (&Delta;G) determines whether a reaction proceeds spontaneously. &Delta;G < 0 indicates an exergonic (spontaneous) reaction; &Delta;G > 0 indicates an endergonic (nonspontaneous) reacti...","sourceLabel":"Section in Biochemistry"},"119":{"title":"Amino Acid Classification & Properties","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s4","snippet":"Amino Acid Classification & Properties There are 20 standard amino acids encoded by the genetic code, each with a central &alpha;-carbon bonded to an amino group, a carboxyl group, a hydrogen atom, and a variable R-group (side chain). All standard amino acids except glycine are L-enantiomers . Amino...","sourceLabel":"Section in Biochemistry"},"120":{"title":"Protein Structure & Folding","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s5","snippet":"Protein Structure & Folding Protein function depends entirely on three-dimensional structure. There are four hierarchical levels of protein structure, each stabilized by distinct forces. Levels of Protein Structure Level Description Stabilizing Forces Clinical Example Primary (1&deg;) Linear amino a...","sourceLabel":"Section in Biochemistry"},"121":{"title":"Hemoglobin & Oxygen Transport","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s6","snippet":"Hemoglobin & Oxygen Transport Hemoglobin (Hb) is a tetrameric protein (&alpha; 2 &beta; 2 in HbA) that binds up to four O 2 molecules with cooperative binding , producing a sigmoidal oxygen-dissociation curve. This cooperativity arises from conformational changes between the tense (T, deoxy, low O 2...","sourceLabel":"Section in Biochemistry"},"122":{"title":"Collagen & Connective Tissue Disorders","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s7","snippet":"Collagen & Connective Tissue Disorders Collagen is the most abundant protein in the body (~25-35% of total protein). Its hallmark is the triple helix : three left-handed polypeptide chains (each a polyproline II helix) wind around each other in a right-handed super-helix. The repeating sequence is G...","sourceLabel":"Section in Biochemistry"},"123":{"title":"Enzyme Kinetics & Inhibition","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s8","snippet":"Enzyme Kinetics & Inhibition Enzymes are biological catalysts that increase reaction rates by lowering activation energy without being consumed. Most are proteins; some are RNA ( ribozymes ). The active site binds substrate with specificity described by the lock-and-key model (Fischer) or the induce...","sourceLabel":"Section in Biochemistry"},"124":{"title":"Enzyme Regulation & Clinical Enzymology","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s9","snippet":"Enzyme Regulation & Clinical Enzymology Enzyme activity is regulated at multiple levels to maintain metabolic homeostasis. Mechanisms of Enzyme Regulation Mechanism Description Example Allosteric regulation Effector binding at a site other than the active site changes enzyme conformation PFK-1: acti...","sourceLabel":"Section in Biochemistry"},"125":{"title":"Glycolysis & Pyruvate Metabolism","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s10","snippet":"Glycolysis & Pyruvate Metabolism Glycolysis is the 10-step cytoplasmic pathway that converts one molecule of glucose into two molecules of pyruvate, generating 2 net ATP (by substrate-level phosphorylation) and 2 NADH. It is the central metabolic pathway used by all cells and the only source of ATP ...","sourceLabel":"Section in Biochemistry"},"126":{"title":"TCA Cycle & Oxidative Phosphorylation","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s11","snippet":"TCA Cycle & Oxidative Phosphorylation The tricarboxylic acid (TCA/Krebs/citric acid) cycle occurs in the mitochondrial matrix. Acetyl-CoA condenses with oxaloacetate to form citrate, and through 8 enzymatic steps regenerates oxaloacetate while producing 3 NADH, 1 FADH 2 , and 1 GTP per turn. Two tur...","sourceLabel":"Section in Biochemistry"},"127":{"title":"Gluconeogenesis & Glycogen Metabolism","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s12","snippet":"Gluconeogenesis & Glycogen Metabolism Gluconeogenesis generates glucose from non-carbohydrate precursors (lactate, glycerol, glucogenic amino acids, propionyl-CoA) primarily in the liver and to a lesser extent the kidney cortex . It is essentially the reverse of glycolysis except at three irreversib...","sourceLabel":"Section in Biochemistry"},"128":{"title":"Glycogen Storage Diseases","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s13","snippet":"Glycogen Storage Diseases The glycogen storage diseases (GSDs) are inherited enzyme deficiencies that lead to abnormal glycogen accumulation or impaired glycogen mobilization. They classically present with hepatomegaly, hypoglycemia, or myopathy depending on the tissue affected. Type Name Deficient ...","sourceLabel":"Section in Biochemistry"},"129":{"title":"Pentose Phosphate Pathway & G6PD Deficiency","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s14","snippet":"Pentose Phosphate Pathway & G6PD Deficiency The pentose phosphate pathway (PPP/HMP shunt) occurs in the cytoplasm and has two phases. The oxidative phase is irreversible and generates NADPH (for reductive biosynthesis and glutathione reduction) and ribulose-5-phosphate . The non-oxidative phase is r...","sourceLabel":"Section in Biochemistry"},"130":{"title":"Fructose & Galactose Metabolism","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s15","snippet":"Fructose & Galactose Metabolism Fructose and galactose are dietary sugars that enter glycolysis after conversion to glycolytic intermediates. Defects in these pathways cause distinct clinical syndromes. Fructose Metabolism Disorders Condition Deficient Enzyme Accumulated Substrate Clinical Features ...","sourceLabel":"Section in Biochemistry"},"131":{"title":"Fatty Acid Synthesis & Beta-Oxidation","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s16","snippet":"Fatty Acid Synthesis & Beta-Oxidation Fatty acid synthesis and &beta;-oxidation are reciprocally regulated pathways that occur in different cellular compartments. Fatty Acid Synthesis vs. Beta-Oxidation Feature Synthesis &beta;-Oxidation Location Cytoplasm Mitochondrial matrix Carrier ACP (acyl carr...","sourceLabel":"Section in Biochemistry"},"132":{"title":"Ketogenesis & Ketolysis","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s17","snippet":"Ketogenesis & Ketolysis Ketogenesis occurs in liver mitochondria during prolonged fasting, starvation, or uncontrolled diabetes when acetyl-CoA production (from &beta;-oxidation) exceeds TCA cycle capacity. The three ketone bodies are acetoacetate , &beta;-hydroxybutyrate (the predominant circulatin...","sourceLabel":"Section in Biochemistry"},"133":{"title":"Lipoproteins & Cholesterol Metabolism","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s18","snippet":"Lipoproteins & Cholesterol Metabolism Lipids are transported in blood as lipoproteins-spherical particles with a hydrophobic core (triglycerides, cholesterol esters) and an amphipathic shell (phospholipids, free cholesterol, apolipoproteins). Lipoprotein Classes Lipoprotein Source Major Lipid Key Ap...","sourceLabel":"Section in Biochemistry"},"134":{"title":"Lysosomal Storage Diseases","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s19","snippet":"Lysosomal Storage Diseases Lysosomal storage diseases are inherited deficiencies of lysosomal enzymes, leading to accumulation of undigested substrates within lysosomes. Most are autosomal recessive (except Fabry and Hunter, which are X-linked). Disease Deficient Enzyme Accumulated Substrate Key Fea...","sourceLabel":"Section in Biochemistry"},"135":{"title":"Amino Acid Metabolism & Inborn Errors","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s20","snippet":"Amino Acid Metabolism & Inborn Errors Amino acid catabolism involves removal of the &alpha;-amino group (via transamination to &alpha;-ketoglutarate forming glutamate, then oxidative deamination by glutamate dehydrogenase releasing NH 4 + ) and disposal of the carbon skeleton. Ammonia is detoxified ...","sourceLabel":"Section in Biochemistry"},"136":{"title":"Purine & Pyrimidine Metabolism","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s21","snippet":"Purine & Pyrimidine Metabolism Purines (adenine, guanine) are synthesized de novo on a ribose-5-phosphate scaffold (from the PPP) using amino acids (Gly, Asp, Gln), CO 2 , and THF derivatives. IMP is the first purine nucleotide formed. Pyrimidines (cytosine, uracil, thymine) are built as a free base...","sourceLabel":"Section in Biochemistry"},"137":{"title":"Fat-Soluble Vitamins (A, D, E, K)","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s22","snippet":"Fat-Soluble Vitamins (A, D, E, K) Fat-soluble vitamins are absorbed with dietary fat via micelles, transported in chylomicrons, and stored in liver and adipose tissue. Deficiency may result from fat malabsorption (e.g., cystic fibrosis, celiac disease, cholestasis, short bowel syndrome, pancreatic i...","sourceLabel":"Section in Biochemistry"},"138":{"title":"Water-Soluble Vitamins (B Complex & C)","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s23","snippet":"Water-Soluble Vitamins (B Complex & C) Water-soluble vitamins generally serve as enzyme cofactors. They are not stored extensively (except B12 in liver, lasting 3-5 years), so deficiencies develop more rapidly than fat-soluble vitamin deficiencies. Vitamin Cofactor Form / Function Deficiency Syndrom...","sourceLabel":"Section in Biochemistry"},"139":{"title":"Minerals, Trace Elements & Nutrition","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s24","snippet":"Minerals, Trace Elements & Nutrition Minerals and trace elements serve as enzyme cofactors, structural components, and electrolytes essential for physiological function. Key Minerals & Trace Elements Element Function Deficiency Excess / Notes Iron (Fe) Heme (hemoglobin, myoglobin, cytochromes), FeS ...","sourceLabel":"Section in Biochemistry"},"140":{"title":"Molecular Biology & DNA Repair","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s25","snippet":"Molecular Biology & DNA Repair The central dogma of molecular biology describes the flow of genetic information: DNA &rarr; RNA (transcription) &rarr; Protein (translation). Understanding these processes is essential for interpreting molecular diagnostics and understanding antibiotic and chemotherap...","sourceLabel":"Section in Biochemistry"},"141":{"title":"Clinical Correlates & Metabolic Integration","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s26","snippet":"Clinical Correlates & Metabolic Integration Metabolic pathways do not operate in isolation; they are interconnected, hormonally regulated, and tissue-specific. Understanding the fed vs. fasted metabolic states and the integration of major pathways is essential for clinical reasoning. Fed vs. Fasted ...","sourceLabel":"Section in Biochemistry"},"142":{"title":"High-Yield Review & Reference Tables","pageTitle":"Biochemistry","pageUrl":"/foundational/biochemistry","url":"/foundational/biochemistry#s27","snippet":"High-Yield Review & Reference Tables This section consolidates the most frequently tested biochemistry concepts for rapid board review. Inborn Errors Quick-Reference Disease Enzyme Defect \"Buzzword\" Finding PKU Phenylalanine hydroxylase Musty body odor, mousey urine Maple syrup urine disease Branche...","sourceLabel":"Section in Biochemistry"},"143":{"title":"Genetics & Molecular Biology","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics","snippet":"Foundational Science Genetics Complete Subject Reference DNA structure, replication, transcription, translation, Mendelian inheritance, cytogenetics, molecular diagnostics, genetic testing, cancer genetics, and every genetic principle, mutation type, and clinical syndrome across the full scope of me..."},"144":{"title":"Overview & Scope of Medical Genetics","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s1","snippet":"Overview & Scope of Medical Genetics Medical genetics is the study of heredity, genes, and genetic variation as they relate to human health and disease. It integrates molecular biology, cytogenetics, biochemical genetics, and clinical medicine to explain how genetic factors cause, predispose to, or ...","sourceLabel":"Section in Genetics & Molecular Biology"},"145":{"title":"Key Terminology & Abbreviations","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s2","snippet":"Key Terminology & Abbreviations Term / Abbreviation Definition Allele One of two or more alternative forms of a gene at a given locus Locus Specific physical position of a gene on a chromosome Genotype The genetic constitution of an individual at one or more loci Phenotype The observable characteris...","sourceLabel":"Section in Genetics & Molecular Biology"},"146":{"title":"DNA Structure, Chromatin & Chromosomes","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s3","snippet":"DNA Structure, Chromatin & Chromosomes Deoxyribonucleic acid (DNA) is the hereditary material of all cellular organisms. Its structure determines how genetic information is stored, replicated, and expressed. Figure 1 - DNA Double Helix Structure. The DNA molecule consists of two antiparallel polynuc...","sourceLabel":"Section in Genetics & Molecular Biology"},"147":{"title":"DNA Replication","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s4","snippet":"DNA Replication DNA replication is semiconservative (each daughter strand retains one parental strand), as demonstrated by the Meselson-Stahl experiment. Replication proceeds bidirectionally from origins of replication and requires a complex machinery of enzymes. Figure 8 - Semiconservative Replicat...","sourceLabel":"Section in Genetics & Molecular Biology"},"148":{"title":"Transcription & RNA Processing","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s5","snippet":"Transcription & RNA Processing Transcription is the synthesis of RNA from a DNA template by RNA polymerase . In eukaryotes, three RNA polymerases exist, each responsible for different RNA species. Figure 10 - The Central Dogma of Molecular Biology. Genetic information flows from DNA to RNA (transcri...","sourceLabel":"Section in Genetics & Molecular Biology"},"149":{"title":"Translation & the Genetic Code","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s6","snippet":"Translation & the Genetic Code Translation is the process by which ribosomes decode mRNA into polypeptide chains. It occurs in the cytoplasm (free ribosomes) or on the rough endoplasmic reticulum (secreted and membrane proteins). Figure 15 - Ribosome Structure and Translation. The ribosome consists ...","sourceLabel":"Section in Genetics & Molecular Biology"},"150":{"title":"Regulation of Gene Expression","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s7","snippet":"Regulation of Gene Expression Gene expression is regulated at multiple levels - from chromatin remodeling to post-translational modification. Understanding these mechanisms is critical for comprehending disease pathogenesis and therapeutic targets. Figure 18 - Levels of Gene Expression Regulation. G...","sourceLabel":"Section in Genetics & Molecular Biology"},"151":{"title":"Types of Mutations","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s8","snippet":"Types of Mutations A mutation is any heritable change in the DNA sequence. Mutations range from single nucleotide changes to large chromosomal rearrangements and are the fundamental basis of genetic disease, evolution, and cancer. Figure 21 - Types of Point and Frameshift Mutations. Silent mutations...","sourceLabel":"Section in Genetics & Molecular Biology"},"152":{"title":"DNA Damage & Repair Mechanisms","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s9","snippet":"DNA Damage & Repair Mechanisms DNA is continuously damaged by endogenous (replication errors, oxidative stress) and exogenous (UV, radiation, chemicals) agents. Multiple repair pathways exist to maintain genomic integrity, and defects in these pathways are the basis of many cancer predisposition syn...","sourceLabel":"Section in Genetics & Molecular Biology"},"153":{"title":"Autosomal Dominant Inheritance","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s10","snippet":"Autosomal Dominant Inheritance Autosomal dominant (AD) disorders require only one mutant allele for phenotypic expression. Affected individuals are typically heterozygous (Aa). Each child of an affected parent has a 50% chance of inheriting the disorder. Characteristics of AD Inheritance Vertical tr...","sourceLabel":"Section in Genetics & Molecular Biology"},"154":{"title":"Autosomal Recessive Inheritance","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s11","snippet":"Autosomal Recessive Inheritance Autosomal recessive (AR) disorders require two mutant alleles (homozygous aa) for phenotypic expression. Heterozygous carriers (Aa) are typically unaffected. When two carriers mate, each child has a 25% chance of being affected, a 50% chance of being a carrier, and a ...","sourceLabel":"Section in Genetics & Molecular Biology"},"155":{"title":"X-Linked & Mitochondrial Inheritance","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s12","snippet":"X-Linked & Mitochondrial Inheritance X-Linked Recessive (XLR) XLR disorders predominantly affect males (hemizygous, XY) because they have only one X chromosome. Carrier females (heterozygous) are usually unaffected but may show mild manifestations due to skewed X-inactivation. No male-to-male transm...","sourceLabel":"Section in Genetics & Molecular Biology"},"156":{"title":"Pedigree Analysis & Genetic Counseling","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s13","snippet":"Pedigree Analysis & Genetic Counseling Pedigree analysis is the cornerstone of clinical genetics. Recognizing inheritance patterns from family histories allows proper diagnosis, risk calculation, and counseling. Figure 26 - Pedigree Symbols and Notation. Standard pedigree symbols: squares represent ...","sourceLabel":"Section in Genetics & Molecular Biology"},"157":{"title":"Trinucleotide Repeat Disorders & Anticipation","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s14","snippet":"Trinucleotide Repeat Disorders & Anticipation Trinucleotide repeat expansions are unstable mutations in which a three-nucleotide sequence is repeated an abnormal number of times. These repeats tend to expand during meiosis, leading to anticipation - earlier onset and/or more severe disease in succes...","sourceLabel":"Section in Genetics & Molecular Biology"},"158":{"title":"Genomic Imprinting & Uniparental Disomy","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s15","snippet":"Genomic Imprinting & Uniparental Disomy Genomic imprinting is the epigenetic silencing of one parental allele, so that only the allele from the other parent is expressed. This means loss or mutation of the active allele cannot be compensated by the silenced allele. Imprinting Disorders Disorder Chro...","sourceLabel":"Section in Genetics & Molecular Biology"},"159":{"title":"Mosaicism, Incomplete Penetrance & Variable Expressivity","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s16","snippet":"Mosaicism, Incomplete Penetrance & Variable Expressivity Mosaicism Mosaicism refers to the presence of two or more genetically distinct cell populations in a single individual, arising from a post-zygotic mutation. Somatic mosaicism - mutation in somatic cells; affects only tissues derived from the ...","sourceLabel":"Section in Genetics & Molecular Biology"},"160":{"title":"Chromosomal Structure & Aberrations","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s17","snippet":"Chromosomal Structure & Aberrations Chromosomal aberrations are changes in chromosome number or structure visible by cytogenetic techniques. They are a major cause of congenital anomalies, intellectual disability, and pregnancy loss. Figure 27 - Normal Human Karyotype (46,XX). A karyotype displays m...","sourceLabel":"Section in Genetics & Molecular Biology"},"161":{"title":"Autosomal Aneuploidies","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s18","snippet":"Autosomal Aneuploidies Aneuploidy is an abnormal chromosome number that is not a multiple of the haploid set (n = 23). It most commonly results from nondisjunction during meiosis I or meiosis II. Advanced maternal age is the primary risk factor. Major Autosomal Aneuploidies Disorder Karyotype Key Fe...","sourceLabel":"Section in Genetics & Molecular Biology"},"162":{"title":"Sex Chromosome Disorders","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s19","snippet":"Sex Chromosome Disorders Turner Syndrome (45,X) The only monosomy compatible with life. Affects females . Most 45,X conceptions end in spontaneous abortion (99%); live-born incidence is ~1/2,500 female births. Short stature, shield chest, widely spaced nipples, webbed neck (cystic hygroma remnant) P...","sourceLabel":"Section in Genetics & Molecular Biology"},"163":{"title":"Oncogenes & Tumor Suppressors","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s20","snippet":"Oncogenes & Tumor Suppressors Cancer is fundamentally a genetic disease arising from accumulated mutations in genes controlling cell growth, differentiation, and death. Two major categories of cancer genes exist: oncogenes (gain-of-function, dominant) and tumor suppressors (loss-of-function, recessi...","sourceLabel":"Section in Genetics & Molecular Biology"},"164":{"title":"Hereditary Cancer Syndromes","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s21","snippet":"Hereditary Cancer Syndromes Hereditary cancer syndromes account for 5-10% of all cancers. They result from germline mutations in tumor suppressor genes or DNA repair genes and follow an autosomal dominant inheritance pattern with incomplete penetrance. Major Hereditary Cancer Syndromes Syndrome Gene...","sourceLabel":"Section in Genetics & Molecular Biology"},"165":{"title":"Population Genetics & Hardy-Weinberg Equilibrium","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s22","snippet":"Population Genetics & Hardy-Weinberg Equilibrium Population genetics studies allele and genotype frequencies in populations and the forces that change them over time. Hardy-Weinberg Equilibrium In a large, randomly mating population with no selection, mutation, migration, or genetic drift, allele an...","sourceLabel":"Section in Genetics & Molecular Biology"},"166":{"title":"Genetic Testing & Molecular Diagnostics","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s23","snippet":"Genetic Testing & Molecular Diagnostics Advances in molecular technology have transformed genetic diagnosis. Understanding the capabilities and limitations of each technique is essential for clinical practice and is frequently tested. Major Genetic Testing Methods Technique What It Detects Clinical ...","sourceLabel":"Section in Genetics & Molecular Biology"},"167":{"title":"Pharmacogenomics","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s24","snippet":"Pharmacogenomics Pharmacogenomics studies how genetic variation affects drug metabolism, efficacy, and toxicity. Individualizing drug therapy based on genotype is a cornerstone of precision medicine. Cytochrome P450 Polymorphisms Enzyme Clinical Significance Substrate Examples CYP2D6 Poor metabolize...","sourceLabel":"Section in Genetics & Molecular Biology"},"168":{"title":"Gene Therapy & Emerging Technologies","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s25","snippet":"Gene Therapy & Emerging Technologies Gene Therapy Approaches Approach Mechanism Examples Gene replacement Deliver functional copy of defective gene (via viral vector) Luxturna (voretigene) for RPE65-associated retinal dystrophy; Zolgensma (onasemnogene) for SMA Gene editing (CRISPR-Cas9) Precise mod...","sourceLabel":"Section in Genetics & Molecular Biology"},"169":{"title":"Clinical Correlates Across Specialties","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s26","snippet":"Clinical Correlates Across Specialties Genetics intersects with virtually every clinical specialty. Understanding these connections is essential for integrated clinical reasoning. Specialty-Specific Genetic Considerations Specialty Key Genetic Topics Examples Cardiology Channelopathies, cardiomyopat...","sourceLabel":"Section in Genetics & Molecular Biology"},"170":{"title":"High-Yield Review & Board Pearls","pageTitle":"Genetics & Molecular Biology","pageUrl":"/foundational/genetics","url":"/foundational/genetics#s27","snippet":"High-Yield Review & Board Pearls RAPID REVIEW TABLE Concept Key Point DNA replication Semiconservative; leading strand continuous, lagging strand discontinuous (Okazaki fragments) Transcription RNA Pol II makes mRNA; &alpha;-amanitin inhibits Pol II; 5&prime; cap + poly-A tail + splicing Translation...","sourceLabel":"Section in Genetics & Molecular Biology"},"171":{"title":"Immunology","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology","snippet":"Foundational Science Immunology Complete Subject Reference Innate and adaptive immunity, complement, antibodies, T-cell and B-cell development, hypersensitivity, immunodeficiency, autoimmunity, transplant immunology, and every immune mechanism, receptor, and clinical application across the full scop..."},"172":{"title":"Overview & Significance","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s1","snippet":"Overview & Significance Immunology is the study of the immune system - the network of cells, tissues, organs, and soluble mediators that defend the body against infection and aberrant cells while maintaining tolerance to self. It integrates molecular biology, cell biology, genetics, and clinical med...","sourceLabel":"Section in Immunology"},"173":{"title":"Core Principles & Key Terminology","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s2","snippet":"Core Principles & Key Terminology Fundamental Organizing Concepts Concept Definition Innate immunity Rapid, non-specific, no memory; present at birth; uses germline-encoded receptors Adaptive immunity Slow onset (days), highly specific, generates memory; requires antigen exposure; uses somatically r...","sourceLabel":"Section in Immunology"},"174":{"title":"Cells of the Immune System","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s3","snippet":"Cells of the Immune System Myeloid Lineage Cell Key Markers Function Neutrophil CD66b; multilobed nucleus First responder; phagocytosis; NETs (neutrophil extracellular traps); most abundant WBC (60-70%) Monocyte / Macrophage CD14, CD16; kidney-shaped nucleus Phagocytosis, antigen presentation (MHC I...","sourceLabel":"Section in Immunology"},"175":{"title":"Barriers & Physical Defenses","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s4","snippet":"Barriers & Physical Defenses The first line of defense consists of physical, chemical, and biological barriers that prevent pathogen entry without requiring immune cell activation. Barrier Type Mechanism Examples Mechanical Physical exclusion of pathogens Skin (stratified squamous epithelium), mucoc...","sourceLabel":"Section in Immunology"},"176":{"title":"Pattern Recognition & Toll-Like Receptors","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s5","snippet":"Pattern Recognition & Toll-Like Receptors Innate immune cells detect pathogens through pattern recognition receptors (PRRs) that recognize conserved microbial structures called pathogen-associated molecular patterns (PAMPs) and host-derived danger signals called damage-associated molecular patterns ...","sourceLabel":"Section in Immunology"},"177":{"title":"Complement System","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s6","snippet":"Complement System The complement system is a cascade of >30 plasma proteins that enhance (\"complement\") the ability of antibodies and phagocytes to clear pathogens. Its three main functions are opsonization (C3b), inflammation (C3a, C5a - anaphylatoxins), and lysis (membrane attack complex, C5b-C9)....","sourceLabel":"Section in Immunology"},"178":{"title":"Phagocytosis & Inflammation","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s7","snippet":"Phagocytosis & Inflammation Figure 7 - Opsonization and Phagocytosis. Opsonins (IgG antibodies and C3b complement fragments) coat pathogen surfaces, enhancing recognition by phagocyte Fc receptors and complement receptors (CR1). This dramatically increases the efficiency of phagocytic engulfment com...","sourceLabel":"Section in Immunology"},"179":{"title":"T-Cell Development & Thymic Selection","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s8","snippet":"T-Cell Development & Thymic Selection Figure 10 - T-Cell Development and Thymic Selection. T-cell precursors migrate from bone marrow to the thymus, where they undergo maturation through double-negative (DN), double-positive (DP), and single-positive (SP) stages. Positive selection in the cortex ens...","sourceLabel":"Section in Immunology"},"180":{"title":"MHC & Antigen Presentation","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s9","snippet":"MHC & Antigen Presentation Figure 12 - MHC Class I and Class II Molecular Structure. MHC class I consists of an alpha chain with three domains plus beta-2-microglobulin, expressed on all nucleated cells. MHC class II consists of an alpha and a beta chain, each with two domains, expressed only on pro...","sourceLabel":"Section in Immunology"},"181":{"title":"CD4+ T Helper Subsets (Th1, Th2, Th17, Treg)","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s10","snippet":"CD4+ T Helper Subsets (Th1, Th2, Th17, Treg) Figure 14 - Clonal Selection and Expansion of T Cells. When a naive T cell encounters its cognate antigen presented by an APC, it undergoes clonal expansion, producing a large population of identical effector T cells. After pathogen clearance, most effect...","sourceLabel":"Section in Immunology"},"182":{"title":"CD8+ Cytotoxic T Cells & NK Cells","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s11","snippet":"CD8+ Cytotoxic T Cells & NK Cells Figure 16 - CD8+ Cytotoxic T Cell Killing Mechanism. Activated CTLs recognize endogenous peptides on MHC I of target cells. Upon binding, the CTL forms an immunological synapse and releases perforin (creates pores in the target membrane) and granzymes (serine protea...","sourceLabel":"Section in Immunology"},"183":{"title":"B-Cell Development & Activation","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s12","snippet":"B-Cell Development & Activation B cells develop in the bone marrow (hence \"B\") through a series of stages defined by immunoglobulin gene rearrangement status. Stages of B-Cell Development Stage Ig Status Key Event Pro-B cell Heavy chain VDJ rearrangement begins RAG-1/RAG-2 mediated; D-J first, then ...","sourceLabel":"Section in Immunology"},"184":{"title":"Antibody Structure & Function","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s13","snippet":"Antibody Structure & Function Figure 19 - Immunoglobulin (Antibody) Structure. Each antibody consists of two identical heavy chains and two identical light chains linked by disulfide bonds. The Fab region (variable domains) binds antigen with high specificity, while the Fc region (constant domains) ...","sourceLabel":"Section in Immunology"},"185":{"title":"Isotype Switching & Affinity Maturation","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s14","snippet":"Isotype Switching & Affinity Maturation Isotype (Class) Switching Isotype switching changes the antibody constant region (and thus the effector function) without altering antigen specificity. It requires: CD40L-CD40 interaction between Tfh cell and B cell (patients with CD40L deficiency &rarr; Hyper...","sourceLabel":"Section in Immunology"},"186":{"title":"Primary & Secondary Lymphoid Organs","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s15","snippet":"Primary & Secondary Lymphoid Organs Figure 23 - The Thymus: Primary Lymphoid Organ for T-Cell Maturation. The thymus is a bilobed organ located in the anterior mediastinum. Each lobule contains an outer cortex (site of positive selection by cortical epithelial cells) and inner medulla (site of negat...","sourceLabel":"Section in Immunology"},"187":{"title":"Immune Tolerance & Regulation","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s16","snippet":"Immune Tolerance & Regulation Central Tolerance Occurs in primary lymphoid organs during lymphocyte development: T cells (thymus) : Negative selection deletes strongly self-reactive T cells; some become Tregs (receptor editing is less common in T cells) B cells (bone marrow) : Self-reactive immature...","sourceLabel":"Section in Immunology"},"188":{"title":"Cytokines & Signaling Networks","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s17","snippet":"Cytokines & Signaling Networks Major Cytokines & Their Functions Cytokine Main Source Key Functions IL-1 Macrophages Fever, acute-phase proteins, endothelial activation; co-stimulates T cells IL-2 Th1 cells T-cell proliferation and survival; promotes Treg development; used therapeutically (high dose...","sourceLabel":"Section in Immunology"},"189":{"title":"Hypersensitivity Type I - Immediate (IgE-Mediated)","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s18","snippet":"Hypersensitivity Type I - Immediate (IgE-Mediated) Type I hypersensitivity is an immediate reaction (minutes) mediated by IgE antibodies bound to mast cells and basophils via Fc&epsilon;RI. On re-exposure, antigen cross-links surface IgE, triggering degranulation and release of preformed mediators (...","sourceLabel":"Section in Immunology"},"190":{"title":"Hypersensitivity Type II - Antibody-Mediated Cytotoxicity","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s19","snippet":"Hypersensitivity Type II - Antibody-Mediated Cytotoxicity Type II hypersensitivity involves IgG or IgM antibodies directed against antigens on cell surfaces or extracellular matrix. Damage occurs via complement activation (MAC lysis), opsonization and phagocytosis, or antibody-dependent cellular cyt...","sourceLabel":"Section in Immunology"},"191":{"title":"Hypersensitivity Type III - Immune Complex","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s20","snippet":"Hypersensitivity Type III - Immune Complex Type III hypersensitivity results from deposition of antigen-antibody (immune) complexes in tissues, particularly blood vessel walls, joints, and kidneys. Deposited complexes activate complement, generating C3a and C5a (recruit neutrophils) &rarr; neutrophi...","sourceLabel":"Section in Immunology"},"192":{"title":"Hypersensitivity Type IV - Delayed-Type","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s21","snippet":"Hypersensitivity Type IV - Delayed-Type Type IV hypersensitivity is the only type that is T-cell mediated (not antibody-mediated). It is \"delayed\" because it takes 24-72 hours to develop, requiring T-cell sensitization, migration, and cytokine-mediated tissue damage. Figure 31 - Type IV Hypersensiti...","sourceLabel":"Section in Immunology"},"193":{"title":"Autoimmune Diseases & Autoantibodies","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s22","snippet":"Autoimmune Diseases & Autoantibodies Autoimmune diseases arise from a loss of self-tolerance. They are classified as organ-specific (targeting a single organ) or systemic (affecting multiple organs). High-Yield Autoantibody Associations Autoantibody Disease Anti-dsDNA SLE (specific; correlates with ...","sourceLabel":"Section in Immunology"},"194":{"title":"Primary Immunodeficiency Syndromes","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s23","snippet":"Primary Immunodeficiency Syndromes Primary immunodeficiencies are inherited defects in immune system components. They are broadly classified by the arm of immunity affected. B-Cell (Humoral) Deficiencies Disorder Defect Presentation Diagnosis X-linked (Bruton) agammaglobulinemia BTK (Bruton tyrosine...","sourceLabel":"Section in Immunology"},"195":{"title":"Acquired Immunodeficiency (HIV/AIDS)","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s24","snippet":"Acquired Immunodeficiency (HIV/AIDS) Human Immunodeficiency Virus (HIV) is a lentivirus (retrovirus) that primarily infects CD4+ T cells, macrophages, and dendritic cells via the CD4 receptor and a co-receptor ( CCR5 in early infection, CXCR4 in late infection). It carries reverse transcriptase, int...","sourceLabel":"Section in Immunology"},"196":{"title":"Transplant Immunology & Rejection","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s25","snippet":"Transplant Immunology & Rejection Types of Grafts Graft Type Definition Example Autograft Self to self Skin graft from thigh to face; no rejection Isograft (syngeneic) Identical twin to twin No rejection (genetically identical) Allograft Same species, different individual Cadaveric kidney transplant...","sourceLabel":"Section in Immunology"},"197":{"title":"Tumor Immunology & Immunotherapy","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s26","snippet":"Tumor Immunology & Immunotherapy Immune Surveillance The immune system continuously monitors for and eliminates transformed cells via the cancer immunoediting model: (1) Elimination - immune cells (NK, CTLs) kill nascent tumor cells; (2) Equilibrium - immune pressure sculpts tumor variants; (3) Esca...","sourceLabel":"Section in Immunology"},"198":{"title":"Vaccination & Immunoprophylaxis","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s27","snippet":"Vaccination & Immunoprophylaxis Vaccine Types Type Mechanism Examples Key Points Live attenuated Weakened pathogen replicates, inducing strong humoral + cellular immunity MMR, varicella, rotavirus, BCG, oral polio (Sabin), yellow fever, intranasal influenza (FluMist) Strongest immune response; contr...","sourceLabel":"Section in Immunology"},"199":{"title":"High-Yield Review","pageTitle":"Immunology","pageUrl":"/foundational/immunology","url":"/foundational/immunology#s28","snippet":"High-Yield Review Top 30 Board-Testable Immunology Facts MHC I presents endogenous antigen to CD8+ T cells; MHC II presents exogenous antigen to CD4+ T cells (Rule of 8). All nucleated cells express MHC I; only professional APCs express MHC II. IgG is the only antibody that crosses the placenta; IgA...","sourceLabel":"Section in Immunology"},"200":{"title":"Microbiology","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology","snippet":"Foundational Science Microbiology Complete Subject Reference Bacteriology, virology, mycology, parasitology, antimicrobial mechanisms, resistance patterns, and every organism, virulence factor, diagnostic test, and treatment principle across the full scope of medical microbiology."},"201":{"title":"Overview & Scope of Medical Microbiology","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s1","snippet":"Overview & Scope of Medical Microbiology Medical microbiology is the study of organisms that cause human disease - bacteria, viruses, fungi, and parasites - and the host responses they provoke. It is the scientific foundation of infectious disease medicine and underpins rational antimicrobial prescr...","sourceLabel":"Section in Microbiology"},"202":{"title":"Core Principles & Classification","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s2","snippet":"Core Principles & Classification Microorganisms are classified using a hierarchical taxonomy (domain, phylum, class, order, family, genus, species). In clinical practice, bacteria are classified by Gram stain (positive vs. negative), morphology (cocci, rods, spirals), oxygen requirements (aerobic, a...","sourceLabel":"Section in Microbiology"},"203":{"title":"Bacterial Cell Structure & Physiology","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s3","snippet":"Bacterial Cell Structure & Physiology Understanding bacterial cell architecture is essential because virtually every antibiotic targets a specific structural or metabolic component. The cell wall, cell membrane, ribosomes, and nucleic acid machinery are the principal drug targets. Figure 4 - Gram-Po...","sourceLabel":"Section in Microbiology"},"204":{"title":"Staphylococci","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s4","snippet":"Staphylococci Staphylococci are Gram-positive cocci in clusters , catalase-positive, and facultative anaerobes. S. aureus is the most virulent species and is distinguished from coagulase-negative staphylococci (CoNS) by the coagulase test . Figure 5 - Staphylococcus aureus Gram Stain. Gram-positive ...","sourceLabel":"Section in Microbiology"},"205":{"title":"Streptococci & Enterococci","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s5","snippet":"Streptococci & Enterococci Streptococci are Gram-positive cocci in chains or pairs , catalase-negative. They are classified by hemolysis pattern (&alpha;, &beta;, &gamma;) and Lancefield grouping (carbohydrate antigens A-V). Figure 6 - Hemolysis Patterns on Blood Agar. Streptococci are classified by...","sourceLabel":"Section in Microbiology"},"206":{"title":"Gram-Positive Rods & Anaerobes","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s6","snippet":"Gram-Positive Rods & Anaerobes Gram-positive rods include aerobic and anaerobic species. The spore-forming genera ( Bacillus , Clostridium ) are especially important because spores confer environmental resistance. Figure 8 - Clostridium Species Morphology. Gram-positive, spore-forming anaerobic rods...","sourceLabel":"Section in Microbiology"},"207":{"title":"Enterobacterales","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s7","snippet":"Enterobacterales The Enterobacterales (formerly Enterobacteriaceae) are Gram-negative rods, facultative anaerobes, oxidase-negative, and glucose-fermenting. They are the most common cause of urinary tract infections, intra-abdominal infections, and Gram-negative bacteremia. Figure 10 - E. coli on EM...","sourceLabel":"Section in Microbiology"},"208":{"title":"Non-Fermenting Gram-Negative Rods","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s8","snippet":"Non-Fermenting Gram-Negative Rods Non-fermenters are Gram-negative rods that cannot ferment glucose. They are typically oxidase-positive and are important causes of nosocomial infections, particularly in the ICU. Intrinsic multidrug resistance is a hallmark. Figure 11 - Pseudomonas aeruginosa Cultur...","sourceLabel":"Section in Microbiology"},"209":{"title":"Gram-Negative Cocci & Fastidious Organisms","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s9","snippet":"Gram-Negative Cocci & Fastidious Organisms Figure 12 - Neisseria Gram Stain. Gram-negative diplococci (kidney-bean shaped), often seen intracellularly within polymorphonuclear leukocytes. N. gonorrhoeae ferments only glucose; N. meningitidis ferments both glucose and maltose. Neisseria Species Organ...","sourceLabel":"Section in Microbiology"},"210":{"title":"Anaerobic Gram-Negative Bacteria","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s10","snippet":"Anaerobic Gram-Negative Bacteria Anaerobic Gram-negative bacteria are normal flora of the GI tract, oral cavity, and female genital tract. They cause disease when they gain access to normally sterile sites, often in the setting of disrupted mucosal barriers. Organism Key Features Diseases Treatment ...","sourceLabel":"Section in Microbiology"},"211":{"title":"Mycobacterium tuberculosis","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s11","snippet":"Mycobacterium tuberculosis M. tuberculosis is an obligate aerobe with a mycolic acid -rich cell wall that makes it acid-fast (Ziehl-Neelsen stain: red bacilli). It grows slowly (doubling time 15-20 hours; culture takes 2-6 weeks on L&ouml;wenstein-Jensen media). One-quarter of the world's population...","sourceLabel":"Section in Microbiology"},"212":{"title":"Non-Tuberculous Mycobacteria","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s12","snippet":"Non-Tuberculous Mycobacteria Organism Key Features Disease Treatment M. avium complex (MAC) Most common NTM; disseminated in AIDS when CD4 <50 Disseminated MAC (fever, weight loss, hepatosplenomegaly, pancytopenia); pulmonary MAC (Lady Windermere syndrome) Azithromycin + ethambutol &plusmn; rifabuti...","sourceLabel":"Section in Microbiology"},"213":{"title":"Spirochetes, Rickettsiae & Atypicals","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s13","snippet":"Spirochetes, Rickettsiae & Atypicals Figure 14 - Primary Syphilis Chancre. Painless, clean-based ulcer at the site of Treponema pallidum inoculation. T. pallidum cannot be cultured; diagnosis relies on darkfield microscopy, serology (RPR/VDRL screening, FTA-ABS confirmation), and clinical findings. ...","sourceLabel":"Section in Microbiology"},"214":{"title":"DNA Viruses","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s14","snippet":"DNA Viruses DNA viruses generally replicate in the nucleus (exception: poxviruses replicate in cytoplasm - they carry their own DNA-dependent RNA polymerase). All DNA viruses are double-stranded except parvoviruses (ssDNA). All are icosahedral except poxviruses (complex). Mnemonic for enveloped DNA ...","sourceLabel":"Section in Microbiology"},"215":{"title":"RNA Viruses","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s15","snippet":"RNA Viruses RNA viruses are a diverse group. Most are single-stranded RNA; reoviruses are the exception (dsRNA). Negative-sense RNA viruses must carry their own RNA-dependent RNA polymerase (RdRp) to make mRNA. Positive-sense RNA viruses can serve directly as mRNA for translation. Figure 17 - Measle...","sourceLabel":"Section in Microbiology"},"216":{"title":"Retroviruses & HIV","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s16","snippet":"Retroviruses & HIV Retroviruses are enveloped, positive-sense ssRNA viruses that carry reverse transcriptase to convert RNA &rarr; DNA, which integrates into the host genome via integrase . Figure 19 - HIV Virion Structure. The HIV particle contains the gp120/gp41 envelope glycoproteins (binding CD4...","sourceLabel":"Section in Microbiology"},"217":{"title":"Hepatitis Viruses","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s17","snippet":"Hepatitis Viruses Virus Family Genome Transmission Chronicity Key Features HAV Picornavirus ssRNA (+) Fecal-oral No Self-limited; no chronic state; IgM anti-HAV = acute; vaccine available HBV Hepadnavirus Partially dsDNA Blood, sexual, vertical Yes (5% adults, 90% neonates) Reverse transcriptase; HB...","sourceLabel":"Section in Microbiology"},"218":{"title":"Systemic (Endemic) Mycoses","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s18","snippet":"Systemic (Endemic) Mycoses The systemic (dimorphic) fungi are mold at 25&deg;C (environmental) and yeast at 37&deg;C (body temperature) - \"mold in the cold, yeast in the heat.\" They cause disease in immunocompetent individuals and are geographically restricted. Organism Geography Exposure Disease Di...","sourceLabel":"Section in Microbiology"},"219":{"title":"Opportunistic Fungi","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s19","snippet":"Opportunistic Fungi Opportunistic fungi cause disease primarily in immunocompromised hosts (neutropenia, HIV/AIDS, transplant recipients, chronic corticosteroid use). Figure 22 - Aspergillus Septate Hyphae. Septate hyphae branching at acute (45-degree) angles, characteristic of Aspergillus species. ...","sourceLabel":"Section in Microbiology"},"220":{"title":"Superficial & Cutaneous Mycoses","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s20","snippet":"Superficial & Cutaneous Mycoses Organism/Condition Clinical Presentation Diagnosis Treatment Dermatophytes (Trichophyton, Microsporum, Epidermophyton) Tinea capitis (scalp), tinea corporis (body - ringworm), tinea cruris (groin), tinea pedis (feet), tinea unguium/onychomycosis (nails) KOH prep showi...","sourceLabel":"Section in Microbiology"},"221":{"title":"Protozoa","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s21","snippet":"Protozoa Protozoa are single-celled eukaryotic parasites. They are classified by mode of motility: amoebae (pseudopods), flagellates (flagella), ciliates (cilia), and sporozoans/apicomplexa (non-motile, intracellular). Figure 27 - Malaria - Peripheral Blood Smear. Giemsa-stained thin blood smear dem...","sourceLabel":"Section in Microbiology"},"222":{"title":"Helminths","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s22","snippet":"Helminths Helminths are multicellular parasitic worms classified as nematodes (roundworms), cestodes (tapeworms), and trematodes (flukes). A hallmark of helminthic infections is eosinophilia . Nematodes (Roundworms) Organism Transmission Disease Diagnosis Treatment Ascaris lumbricoides Fecal-oral (e...","sourceLabel":"Section in Microbiology"},"223":{"title":"Ectoparasites","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s23","snippet":"Ectoparasites Organism Clinical Presentation Associated Diseases Treatment Sarcoptes scabiei Scabies: intense pruritus (worse at night), burrows in web spaces, wrists, genitalia; crusted (Norwegian) scabies in immunocompromised Secondary bacterial infection (GAS/S. aureus impetigo) Permethrin 5% cre...","sourceLabel":"Section in Microbiology"},"224":{"title":"Antibacterial Mechanisms & Agents","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s24","snippet":"Antibacterial Mechanisms & Agents Antibiotics are classified by their mechanism of action , which determines their spectrum, side effects, and resistance patterns. The five major targets are: (1) cell wall synthesis, (2) cell membrane, (3) protein synthesis (30S and 50S ribosomal subunits), (4) nucl...","sourceLabel":"Section in Microbiology"},"225":{"title":"Antimicrobial Resistance","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s25","snippet":"Antimicrobial Resistance Antimicrobial resistance is one of the greatest threats to global health. Understanding resistance mechanisms is essential for rational antibiotic selection and antimicrobial stewardship. Major Resistance Mechanisms Mechanism Description Clinical Examples Enzymatic inactivat...","sourceLabel":"Section in Microbiology"},"226":{"title":"Antifungal, Antiviral & Antiparasitic Agents","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s26","snippet":"Antifungal, Antiviral & Antiparasitic Agents Antifungal Agents Drug Class Mechanism Examples Key Uses & Side Effects Polyenes Bind ergosterol &rarr; membrane pore formation Amphotericin B (liposomal preferred), nystatin (topical) Broadest antifungal spectrum; nephrotoxicity (acute tubular necrosis),...","sourceLabel":"Section in Microbiology"},"227":{"title":"Clinical Correlates & Empiric Therapy","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s27","snippet":"Clinical Correlates & Empiric Therapy Rational antimicrobial prescribing requires matching the most likely pathogen to the clinical syndrome, local resistance patterns, and patient factors (allergies, renal function, immunocompromise). Empiric Antibiotic Therapy by Syndrome Clinical Syndrome Most Li...","sourceLabel":"Section in Microbiology"},"228":{"title":"High-Yield Review","pageTitle":"Microbiology","pageUrl":"/foundational/microbiology","url":"/foundational/microbiology#s28","snippet":"High-Yield Review Board-relevant and frequently tested topics across medical microbiology, organized for rapid review. Encapsulated Organisms - \"SHiNE SKiS\" S almonella, H aemophilus influenzae, N eisseria meningitidis, E scherichia coli (K1), S treptococcus pneumoniae, K lebsiella, Group B S trep. ...","sourceLabel":"Section in Microbiology"},"229":{"title":"Pathophysiology","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology","snippet":"Foundational Science Pathophysiology Complete Subject Reference Cellular injury, inflammation, hemodynamic disorders, neoplasia, immunopathology, genetic disease mechanisms, and every pathophysiologic process, mediator, and disease mechanism across the full scope of general pathology."},"230":{"title":"Overview & Scope of Pathophysiology","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s1","snippet":"Overview & Scope of Pathophysiology Pathophysiology is the study of disordered physiological processes that underlie disease. It bridges the gap between basic science and clinical medicine by explaining how and why diseases develop, progress, and produce clinical manifestations. General pathology en...","sourceLabel":"Section in Pathophysiology"},"231":{"title":"Cellular Homeostasis & Adaptation","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s2","snippet":"Cellular Homeostasis & Adaptation Normal cells operate within a narrow range of structure and function defined by their genetic program, metabolic demands, and extracellular signals. When stressed, cells can adapt through reversible changes in size, number, or phenotype. Adaptation is a key concept ...","sourceLabel":"Section in Pathophysiology"},"232":{"title":"Key Terminology & Abbreviations","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s3","snippet":"Key Terminology & Abbreviations Abbreviation Full Term ROS Reactive oxygen species TNF Tumor necrosis factor IL Interleukin NF-&kappa;B Nuclear factor kappa-light-chain-enhancer of activated B cells COX Cyclooxygenase LOX Lipoxygenase PG Prostaglandin LT Leukotriene NO Nitric oxide VEGF Vascular end...","sourceLabel":"Section in Pathophysiology"},"233":{"title":"Mechanisms of Cell Injury","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s4","snippet":"Mechanisms of Cell Injury Cell injury occurs when stresses exceed the cell's ability to adapt. Injury is initially reversible - the cell can return to normal if the stimulus is removed - but persistent or severe stress crosses a \"point of no return\" leading to irreversible injury and cell death. Maj...","sourceLabel":"Section in Pathophysiology"},"234":{"title":"Free Radical & Oxidative Injury","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s5","snippet":"Free Radical & Oxidative Injury Free radicals are chemical species with a single unpaired electron in an outer orbital, making them highly reactive. Reactive oxygen species (ROS) are the most important free radicals in biological systems and play a central role in cell injury, aging, and cancer. Maj...","sourceLabel":"Section in Pathophysiology"},"235":{"title":"Necrosis: Types & Mechanisms","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s6","snippet":"Necrosis: Types & Mechanisms Necrosis is the morphologic pattern of cell death that occurs after irreversible injury in a living organism. It is characterized by enzymatic digestion of the cell (autolysis or heterolysis) and always elicits an inflammatory response due to leakage of cellular contents...","sourceLabel":"Section in Pathophysiology"},"236":{"title":"Apoptosis & Programmed Cell Death","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s7","snippet":"Apoptosis & Programmed Cell Death Apoptosis is a tightly regulated, energy-dependent mechanism of programmed cell death that eliminates unwanted, damaged, or aged cells without eliciting an inflammatory response. Unlike necrosis, apoptotic cells shrink, their chromatin condenses, and they fragment i...","sourceLabel":"Section in Pathophysiology"},"237":{"title":"Intracellular Accumulations & Calcification","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s8","snippet":"Intracellular Accumulations & Calcification Abnormal intracellular accumulations result from excessive intake, abnormal metabolism, defective transport/secretion, or inability to degrade a substance. These accumulations provide important diagnostic clues on histopathology. Types of Intracellular Acc...","sourceLabel":"Section in Pathophysiology"},"238":{"title":"Acute Inflammation","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s9","snippet":"Acute Inflammation Acute inflammation is the rapid, initial response to tissue injury or infection, characterized by vasodilation, increased vascular permeability, and recruitment of leukocytes (predominantly neutrophils). It occurs within minutes to hours and typically resolves within days. Cardina...","sourceLabel":"Section in Pathophysiology"},"239":{"title":"Chemical Mediators of Inflammation","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s10","snippet":"Chemical Mediators of Inflammation Inflammatory mediators are derived from plasma proteins or cells and orchestrate every step of the inflammatory response. They are produced in response to tissue injury, PAMPs, and DAMPs, and their actions are tightly regulated to limit collateral tissue damage. Ce...","sourceLabel":"Section in Pathophysiology"},"240":{"title":"Chronic Inflammation & Granulomatous Disease","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s11","snippet":"Chronic Inflammation & Granulomatous Disease Chronic inflammation is a prolonged inflammatory response (weeks to years) characterized by simultaneous tissue destruction and repair. The dominant cell types shift from neutrophils to macrophages , lymphocytes , and plasma cells . It may follow acute in...","sourceLabel":"Section in Pathophysiology"},"241":{"title":"Tissue Repair, Regeneration & Fibrosis","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s12","snippet":"Tissue Repair, Regeneration & Fibrosis After inflammation, tissue integrity is restored by regeneration (replacement of damaged cells with cells of the same type) or repair by connective tissue (scar formation/fibrosis). The outcome depends on the tissue's regenerative capacity and the extent of dam...","sourceLabel":"Section in Pathophysiology"},"242":{"title":"Edema & Fluid Dynamics","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s13","snippet":"Edema & Fluid Dynamics Edema is the accumulation of excess fluid in the interstitial space (or body cavities, where it is termed effusion ). Understanding the Starling forces is essential to comprehending the pathophysiology of edema formation. Starling Forces Force Normal Value (capillary end) Effe...","sourceLabel":"Section in Pathophysiology"},"243":{"title":"Thrombosis & Virchow's Triad","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s14","snippet":"Thrombosis & Virchow's Triad Thrombosis is the pathologic formation of a blood clot (thrombus) within an intact blood vessel. It is governed by Virchow's triad : (1) endothelial injury, (2) stasis or turbulence, and (3) hypercoagulability. Figure 21 - Virchow's Triad. The three factors predisposing ...","sourceLabel":"Section in Pathophysiology"},"244":{"title":"Embolism","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s15","snippet":"Embolism An embolus is a detached intravascular mass (solid, liquid, or gaseous) carried by the blood to a site distant from its point of origin, where it lodges and obstructs a vessel. Approximately 99% of emboli arise from thrombi ( thromboembolism ). Figure 23 - Thromboembolism Pathophysiology. C...","sourceLabel":"Section in Pathophysiology"},"245":{"title":"Infarction & Ischemia","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s16","snippet":"Infarction & Ischemia An infarct is an area of ischemic necrosis caused by occlusion of the arterial supply or (less commonly) venous drainage. Infarcts are classified as white (anemic/pale) or red (hemorrhagic) based on the amount of hemorrhage and the tissue architecture. White vs Red Infarcts Fea...","sourceLabel":"Section in Pathophysiology"},"246":{"title":"Shock & Hemodynamic Collapse","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s17","snippet":"Shock & Hemodynamic Collapse Shock is a state of systemic hypoperfusion due to reduced cardiac output or reduced effective circulating blood volume, resulting in inadequate tissue oxygenation and cellular hypoxia. If uncorrected, shock progresses to irreversible organ damage and death. Figure 25 - C...","sourceLabel":"Section in Pathophysiology"},"247":{"title":"Disseminated Intravascular Coagulation (DIC)","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s18","snippet":"Disseminated Intravascular Coagulation (DIC) DIC is a consumptive coagulopathy characterized by widespread activation of the coagulation cascade, leading to formation of microthrombi throughout the vasculature with simultaneous consumption of platelets and clotting factors, resulting paradoxically i...","sourceLabel":"Section in Pathophysiology"},"248":{"title":"Neoplasia Fundamentals & Nomenclature","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s19","snippet":"Neoplasia Fundamentals & Nomenclature Neoplasia (\"new growth\") refers to unregulated cell proliferation that is autonomous and persists after removal of the inciting stimulus. A neoplasm (tumor) consists of neoplastic cells and supportive stroma (connective tissue and blood vessels). Benign vs Malig...","sourceLabel":"Section in Pathophysiology"},"249":{"title":"Hallmarks of Cancer & Molecular Oncology","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s20","snippet":"Hallmarks of Cancer & Molecular Oncology The Hallmarks of Cancer (Hanahan & Weinberg, 2000; updated 2011) define the fundamental capabilities acquired during multistep tumorigenesis. The Hallmarks Hallmark Mechanism Key Examples Sustaining proliferative signaling Oncogene activation provides constit...","sourceLabel":"Section in Pathophysiology"},"250":{"title":"Tumor Markers & Paraneoplastic Syndromes","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s21","snippet":"Tumor Markers & Paraneoplastic Syndromes Clinically Important Tumor Markers Marker Associated Cancer(s) Clinical Use PSA Prostate cancer Screening (controversial); monitoring treatment response AFP Hepatocellular carcinoma; yolk sac tumor (endodermal sinus tumor); mixed germ cell tumors Screening in...","sourceLabel":"Section in Pathophysiology"},"251":{"title":"Hypersensitivity Reactions (Types I-IV)","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s22","snippet":"Hypersensitivity Reactions (Types I-IV) Hypersensitivity reactions are exaggerated or inappropriate immune responses to antigens that result in tissue damage. They are classified by the Gell and Coombs system into four types. Figure 31 - Types of Hypersensitivity Reactions. The Gell and Coombs class...","sourceLabel":"Section in Pathophysiology"},"252":{"title":"Autoimmune Disease & Transplant Rejection","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s23","snippet":"Autoimmune Disease & Transplant Rejection Mechanisms of Autoimmunity Autoimmune disease results from failure of self-tolerance - the immune system attacks the body's own tissues. Central tolerance (deletion of self-reactive T and B cells in thymus and bone marrow) and peripheral tolerance (anergy, r...","sourceLabel":"Section in Pathophysiology"},"253":{"title":"Amyloidosis","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s24","snippet":"Amyloidosis Amyloidosis is a group of disorders characterized by extracellular deposition of misfolded proteins in an abnormal fibrillar configuration ( cross-beta-pleated sheet ). These deposits are insoluble, resistant to proteolysis, and progressively damage organs by displacing normal parenchyma...","sourceLabel":"Section in Pathophysiology"},"254":{"title":"Genetic Disorders & Inheritance Patterns","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s25","snippet":"Genetic Disorders & Inheritance Patterns Autosomal Dominant Disorders One mutant allele is sufficient to cause disease. Affected individuals typically have one affected parent. Variable expressivity and incomplete penetrance are common. Key examples: Disorder Gene / Defect Key Features Marfan syndro...","sourceLabel":"Section in Pathophysiology"},"255":{"title":"Metabolic & Storage Diseases","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s26","snippet":"Metabolic & Storage Diseases Lysosomal storage diseases result from inherited deficiency of specific lysosomal enzymes, leading to accumulation of undigested substrates within lysosomes. Most are autosomal recessive. Lysosomal Storage Diseases Disease Enzyme Deficiency Accumulated Substrate Key Feat...","sourceLabel":"Section in Pathophysiology"},"256":{"title":"Organ System Pathology Overview","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s27","snippet":"Organ System Pathology Overview General pathology principles recur across organ systems. This section provides a rapid-reference map linking pathophysiologic mechanisms to their most important organ-specific manifestations. Cardiovascular Pathology Highlights Process Manifestation Atherosclerosis Co...","sourceLabel":"Section in Pathophysiology"},"257":{"title":"High-Yield Review & Board Pearls","pageTitle":"Pathophysiology","pageUrl":"/foundational/pathophysiology","url":"/foundational/pathophysiology#s28","snippet":"High-Yield Review & Board Pearls CELL INJURY & DEATH Most common cause of cell injury: hypoxia/ischemia First biochemical change in ischemia: decreased oxidative phosphorylation &rarr; ATP depletion First morphologic change in reversible injury: cellular swelling (hydropic change) Most reliable mark...","sourceLabel":"Section in Pathophysiology"},"258":{"title":"Pharmacology","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology","snippet":"Foundational Science Pharmacology Complete Subject Reference Drug mechanisms, pharmacokinetics, pharmacodynamics, autonomic pharmacology, antimicrobials, cardiovascular drugs, CNS agents, endocrine pharmacology, chemotherapy, and every drug class, receptor, and clinical application across the full s..."},"259":{"title":"Overview & Significance","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s1","snippet":"Overview & Significance Pharmacology is the study of how drugs interact with biological systems to produce therapeutic effects, adverse reactions, and toxicities. It is the bridge between basic science and clinical medicine - every prescription, every dose adjustment, every adverse drug reaction, an...","sourceLabel":"Section in Pharmacology"},"260":{"title":"Core Principles & Drug-Receptor Theory","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s2","snippet":"Core Principles & Drug-Receptor Theory Figure 1 - Drug-Receptor Binding. A drug (ligand) binds to a specific receptor protein on or within a cell, forming a drug-receptor complex that triggers a downstream cellular response. Only the complementary ligand activates the receptor, illustrating the lock...","sourceLabel":"Section in Pharmacology"},"261":{"title":"Key Terminology & Abbreviations","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s3","snippet":"Key Terminology & Abbreviations Term / Abbreviation Definition ADME Absorption, Distribution, Metabolism, Excretion V d Volume of distribution - theoretical volume needed to contain total drug at plasma concentration t 1/2 Half-life - time for plasma concentration to decrease by 50% C ss Steady-stat...","sourceLabel":"Section in Pharmacology"},"262":{"title":"Absorption & Bioavailability","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s4","snippet":"Absorption & Bioavailability Absorption is the movement of drug from the site of administration into the systemic circulation. The rate and extent of absorption determine the bioavailability (F) - defined as the fraction of administered drug that reaches the systemic circulation in unchanged form. I...","sourceLabel":"Section in Pharmacology"},"263":{"title":"Distribution & Protein Binding","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s5","snippet":"Distribution & Protein Binding Once absorbed, drugs distribute from plasma into tissues. The volume of distribution (V d ) = Amount of drug in body / Plasma drug concentration. V d is a theoretical volume: a large V d means the drug distributes extensively into tissues (is not primarily in plasma); ...","sourceLabel":"Section in Pharmacology"},"264":{"title":"Metabolism & CYP450 System","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s6","snippet":"Metabolism & CYP450 System Drug metabolism (biotransformation) converts lipophilic drugs into more hydrophilic metabolites for renal excretion. Metabolism occurs primarily in the liver and is classified into two phases: Phase I vs Phase II Reactions Feature Phase I Phase II Type Oxidation, reduction...","sourceLabel":"Section in Pharmacology"},"265":{"title":"Excretion & Renal Dosing","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s7","snippet":"Excretion & Renal Dosing Renal excretion is the primary route of drug elimination. It involves three processes: glomerular filtration (free, unbound drug filtered at the glomerulus), tubular secretion (active transport of drug from peritubular capillaries into the tubular lumen - the most efficient ...","sourceLabel":"Section in Pharmacology"},"266":{"title":"Pharmacodynamics & Dose-Response","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s8","snippet":"Pharmacodynamics & Dose-Response Dose-Response Relationships The graded dose-response curve plots drug concentration (x-axis, log scale) vs response magnitude (y-axis) for a single subject. Key parameters: EC 50 (concentration at 50% E max - measure of potency), E max (maximal achievable effect - me...","sourceLabel":"Section in Pharmacology"},"267":{"title":"Autonomic Nervous System Overview","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s9","snippet":"Autonomic Nervous System Overview The autonomic nervous system (ANS) has two major divisions: sympathetic (\"fight or flight\") and parasympathetic (\"rest and digest\"). Both use a two-neuron chain: preganglionic neuron &rarr; ganglionic synapse &rarr; postganglionic neuron &rarr; effector organ. Figur...","sourceLabel":"Section in Pharmacology"},"268":{"title":"Cholinergic Agonists & Antagonists","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s10","snippet":"Cholinergic Agonists & Antagonists Direct Cholinergic Agonists Drug Mechanism Indications Key Notes Bethanechol Muscarinic agonist (M 3 ) Postoperative urinary retention, neurogenic bladder Not hydrolyzed by AChE; avoid in obstruction Carbachol Muscarinic + nicotinic agonist Glaucoma (miosis), intra...","sourceLabel":"Section in Pharmacology"},"269":{"title":"Adrenergic Agonists & Antagonists","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s11","snippet":"Adrenergic Agonists & Antagonists Direct Sympathomimetics Drug Receptor Activity Indications Key Effects / Notes Epinephrine &alpha; 1 , &alpha; 2 , &beta; 1 , &beta; 2 Anaphylaxis, cardiac arrest, asthma (acute) Low dose: &beta; 2 vasodilation; high dose: &alpha; 1 vasoconstriction Norepinephrine &...","sourceLabel":"Section in Pharmacology"},"270":{"title":"Antihypertensives","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s12","snippet":"Antihypertensives Figure 20 - Renin-Angiotensin-Aldosterone System (RAAS). Renin (released from the juxtaglomerular cells in response to decreased renal perfusion) cleaves angiotensinogen to angiotensin I, which is converted to angiotensin II by ACE. Angiotensin II causes vasoconstriction, aldostero...","sourceLabel":"Section in Pharmacology"},"271":{"title":"Antiarrhythmics","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s13","snippet":"Antiarrhythmics Figure 22 - Ventricular Action Potential. The ventricular (non-nodal) action potential consists of five phases: Phase 0 (rapid depolarization via Na + influx), Phase 1 (early repolarization), Phase 2 (plateau via Ca 2+ influx balanced by K + efflux), Phase 3 (rapid repolarization via...","sourceLabel":"Section in Pharmacology"},"272":{"title":"Heart Failure & Antianginal Drugs","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s14","snippet":"Heart Failure & Antianginal Drugs Heart Failure Pharmacotherapy Drug Class Mechanism Mortality Benefit in HFrEF Key Drugs ACEi / ARB / ARNI RAAS blockade; ARNI (sacubitril/valsartan) also &uarr;natriuretic peptides Yes (all three) Enalapril, losartan, sacubitril/valsartan &beta;-Blockers (select) &d...","sourceLabel":"Section in Pharmacology"},"273":{"title":"Anticoagulants, Antiplatelets & Thrombolytics","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s15","snippet":"Anticoagulants, Antiplatelets & Thrombolytics Figure 24 - Coagulation Cascade. The extrinsic pathway (tissue factor + Factor VII) and intrinsic pathway (Factors XII, XI, IX, VIII) converge at the common pathway (Factor X &rarr; prothrombin &rarr; thrombin &rarr; fibrin). Heparin (via antithrombin II...","sourceLabel":"Section in Pharmacology"},"274":{"title":"Lipid-Lowering Agents","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s16","snippet":"Lipid-Lowering Agents Class Mechanism Primary Effect Examples Side Effects Statins (-statin) HMG-CoA reductase inhibitor &rarr; &darr;cholesterol synthesis &rarr; &uarr;LDL receptor expression &darr;&darr;LDL (25-55%) Atorvastatin, rosuvastatin, simvastatin, pravastatin Myopathy/rhabdomyolysis (chec...","sourceLabel":"Section in Pharmacology"},"275":{"title":"Sedative-Hypnotics & Anxiolytics","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s17","snippet":"Sedative-Hypnotics & Anxiolytics Figure 25 - GABA A Receptor Structure. The GABA A receptor is a ligand-gated chloride channel composed of five subunits (typically 2&alpha;, 2&beta;, 1&gamma;). GABA binds at the &beta;/&alpha; interface to open the Cl &minus; channel. Benzodiazepines bind at the &al...","sourceLabel":"Section in Pharmacology"},"276":{"title":"Antidepressants & Mood Stabilizers","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s18","snippet":"Antidepressants & Mood Stabilizers Figure 26 - SSRI Serotonin Pathway. At the serotonergic synapse, serotonin (5-HT) is synthesized from tryptophan, packaged into vesicles, and released into the synaptic cleft where it activates postsynaptic 5-HT receptors. SSRIs selectively block the serotonin reup...","sourceLabel":"Section in Pharmacology"},"277":{"title":"Antipsychotics","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s19","snippet":"Antipsychotics First-Generation (Typical) Antipsychotics Mechanism: Block D 2 receptors in the mesolimbic pathway (therapeutic effect on positive symptoms) but also block D 2 in other pathways (causing side effects). Potency Examples Characteristic Side Effects High potency Haloperidol, fluphenazine...","sourceLabel":"Section in Pharmacology"},"278":{"title":"Opioids & Analgesics","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s20","snippet":"Opioids & Analgesics Opioid Receptor Pharmacology Receptor G-Protein Effects of Activation Key Agonists &mu; (mu) G i Analgesia (supraspinal), euphoria, respiratory depression, miosis, constipation, physical dependence Morphine, fentanyl, methadone, heroin &kappa; (kappa) G i Analgesia (spinal), sed...","sourceLabel":"Section in Pharmacology"},"279":{"title":"Antiepileptics & Parkinson Drugs","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s21","snippet":"Antiepileptics & Parkinson Drugs Antiepileptic Drugs (AEDs) Drug Mechanism Primary Indications Key Side Effects Phenytoin Na + channel blockade (use-dependent) Focal seizures, generalized tonic-clonic, status epilepticus Zero-order kinetics, gingival hyperplasia, hirsutism, SJS, fetal hydantoin synd...","sourceLabel":"Section in Pharmacology"},"280":{"title":"Antibacterials","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s22","snippet":"Antibacterials Figure 28 - Antibiotic Targets on the Bacterial Cell. Antibiotics exploit five major targets unique to or sufficiently different in bacteria: (1) cell wall synthesis (penicillins, cephalosporins, carbapenems, vancomycin), (2) cell membrane integrity (daptomycin, polymyxins), (3) prote...","sourceLabel":"Section in Pharmacology"},"281":{"title":"Antifungals, Antivirals & Antiparasitics","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s23","snippet":"Antifungals, Antivirals & Antiparasitics Antifungals Drug Mechanism Spectrum Key Toxicity Amphotericin B Binds ergosterol &rarr; forms pores in fungal membrane Broad-spectrum (Aspergillus, Candida, Crypto, Mucor, Histo, Coccidio) Nephrotoxicity (dose-limiting), infusion-related fever/chills (\"shake ...","sourceLabel":"Section in Pharmacology"},"282":{"title":"Endocrine Pharmacology","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s24","snippet":"Endocrine Pharmacology Diabetes Medications Class Mechanism Examples Key Side Effects Metformin Activates AMPK &rarr; &darr;hepatic gluconeogenesis, &uarr;insulin sensitivity Metformin Lactic acidosis (rare, contraindicated in eGFR <30), GI upset, B12 deficiency; no hypoglycemia, weight neutral/loss...","sourceLabel":"Section in Pharmacology"},"283":{"title":"Chemotherapy & Immunosuppressants","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s25","snippet":"Chemotherapy & Immunosuppressants Figure 30 - Cell Cycle and Chemotherapy Drug Targets. The cell cycle consists of G 1 (growth), S (DNA synthesis), G 2 (preparation for mitosis), and M (mitosis) phases. Cell-cycle-specific (CCS) agents act during particular phases: antimetabolites (S phase), vinca a...","sourceLabel":"Section in Pharmacology"},"284":{"title":"Toxicology & Antidotes","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s26","snippet":"Toxicology & Antidotes Toxidromes Toxidrome Features Common Agents Anticholinergic Hyperthermia, dry skin, mydriasis, tachycardia, delirium, urinary retention, ileus Antihistamines, TCAs, atropine, jimsonweed Cholinergic DUMBBELSS : Diarrhea, Urination, Miosis, Bronchospasm/Bradycardia, Emesis, Lacr...","sourceLabel":"Section in Pharmacology"},"285":{"title":"Special Populations & Drug Interactions","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s27","snippet":"Special Populations & Drug Interactions Pregnancy Drug Safety The FDA replaced the old letter categories (A, B, C, D, X) with the Pregnancy and Lactation Labeling Rule (PLLR) in 2015, but letter categories remain commonly referenced. Key teratogenic drugs to know: Drug Teratogenic Effect Timing of R...","sourceLabel":"Section in Pharmacology"},"286":{"title":"High-Yield Review","pageTitle":"Pharmacology","pageUrl":"/foundational/pharmacology","url":"/foundational/pharmacology#s28","snippet":"High-Yield Review Board-Critical Concepts The following topics are the most heavily tested pharmacology concepts across USMLE Step 1, Step 2, and shelf exams. Master these and you will be well prepared. Top 30 High-Yield Facts # Fact 1 Competitive antagonists shift dose-response curve right (same E ...","sourceLabel":"Section in Pharmacology"},"287":{"title":"Medical Documentation","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation","snippet":"Clinical Skill Medical Documentation Complete Subject Reference SOAP notes, H&P, progress notes, discharge summaries, procedure notes, consult notes, telephone encounters, billing/coding fundamentals, ICD-10, CPT, E/M coding, electronic health records, and every documentation standard for accurate, ..."},"288":{"title":"Purposes & Significance of Documentation","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s1","snippet":"Purposes & Significance of Documentation Medical documentation is the permanent written record of a patient encounter - what was said, seen, thought, and done. It is simultaneously a clinical communication tool, a medicolegal record, a billing instrument, a quality measurement substrate, and a resea...","sourceLabel":"Section in Medical Documentation"},"289":{"title":"Core Principles: Accuracy, Timeliness & Legibility","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s2","snippet":"Core Principles: Accuracy, Timeliness & Legibility Five principles govern every clinical note regardless of setting, specialty, or format: accuracy, completeness, timeliness, legibility, and objectivity. Violations of any of these principles can render an otherwise thorough note clinically useless o...","sourceLabel":"Section in Medical Documentation"},"290":{"title":"Medicolegal Aspects & HIPAA Basics","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s3","snippet":"Medicolegal Aspects & HIPAA Basics The medical record is the single most important piece of evidence in a malpractice action. Plaintiff attorneys evaluate cases primarily by chart review, and the quality of documentation often determines whether a case is pursued, settled, or dismissed. Simultaneous...","sourceLabel":"Section in Medical Documentation"},"291":{"title":"Chief Complaint & HPI Structure","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s4","snippet":"Chief Complaint & HPI Structure The History and Physical (H&P) is the foundational narrative document of inpatient and outpatient medicine. It establishes the reason for the encounter, the relevant background, the clinician's physical findings, and the initial diagnostic and therapeutic plan. The H&...","sourceLabel":"Section in Medical Documentation"},"292":{"title":"Past Medical, Surgical, Family & Social History","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s5","snippet":"Past Medical, Surgical, Family & Social History Past Medical History (PMH) List active and relevant resolved medical conditions. For each, include the year of diagnosis, current control, and treating specialist when relevant. Avoid listing obsolete problems that no longer affect care (e.g., \"strep t...","sourceLabel":"Section in Medical Documentation"},"293":{"title":"Review of Systems","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s6","snippet":"Review of Systems The Review of Systems (ROS) is a structured inventory of symptoms organized by body system. It is distinct from the HPI: the HPI focuses on the chief complaint, while the ROS screens broadly for symptoms the patient may not have spontaneously reported. A complete ROS covers 10+ sys...","sourceLabel":"Section in Medical Documentation"},"294":{"title":"Physical Exam Documentation","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s7","snippet":"Physical Exam Documentation The physical examination is documented in a standard head-to-toe sequence. Only document exams you actually performed - fabricating or copy-forwarding exam findings is the fastest way to lose a malpractice case and potentially your license. Standard Physical Exam Sequence...","sourceLabel":"Section in Medical Documentation"},"295":{"title":"Subjective & Objective Sections","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s8","snippet":"Subjective & Objective Sections The SOAP note - Subjective, Objective, Assessment, Plan - is the workhorse format for progress notes, outpatient visits, and consults. Introduced by Lawrence Weed in the 1960s as part of the Problem-Oriented Medical Record, SOAP imposes a logical flow: gather data (S ...","sourceLabel":"Section in Medical Documentation"},"296":{"title":"Assessment & Plan","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s9","snippet":"Assessment & Plan The Assessment and Plan (A/P) is the intellectual core of the note - where the clinician synthesizes the data into a diagnosis and a management strategy. Auditors, consultants, and attorneys read the A/P first; the S and O sections exist to support it. Figure 9 - SOAP Note Section ...","sourceLabel":"Section in Medical Documentation"},"297":{"title":"Clinical Reasoning & Differential Diagnosis","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s10","snippet":"Clinical Reasoning & Differential Diagnosis The best A/Ps make clinical reasoning explicit. Rather than jumping to a single diagnosis, document the differential considered and why one diagnosis is favored over alternatives. This serves three purposes: it forces rigorous thinking, it communicates you...","sourceLabel":"Section in Medical Documentation"},"298":{"title":"Inpatient Daily Progress Notes","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s11","snippet":"Inpatient Daily Progress Notes The inpatient progress note documents the daily clinical status, events, decisions, and plan for a hospitalized patient. It is the primary communication tool between the day team, the night team, consultants, and the following day's team. Progress notes follow the SOAP...","sourceLabel":"Section in Medical Documentation"},"299":{"title":"Outpatient Follow-Up Notes","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s12","snippet":"Outpatient Follow-Up Notes The outpatient follow-up note is shorter and more focused than inpatient notes. It addresses the specific reason for the visit, updates active problems, and documents the plan until the next encounter. The 2021 E/M revision made these notes dramatically simpler by eliminat...","sourceLabel":"Section in Medical Documentation"},"300":{"title":"Problem List Management","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s13","snippet":"Problem List Management The problem list is the structured summary of a patient's active and resolved medical problems. In the EHR, the problem list drives clinical decision support, billing, risk adjustment, and care gap alerts. A well-curated problem list is one of the highest-impact documentation...","sourceLabel":"Section in Medical Documentation"},"301":{"title":"Admission H&P & Discharge Summary","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s14","snippet":"Admission H&P & Discharge Summary Admission H&P The admission H&P is the most comprehensive note in a hospitalization. It must be completed within 24 hours of admission per Joint Commission standards and contains the full history, physical exam, differential diagnosis, and initial plan. Section Cont...","sourceLabel":"Section in Medical Documentation"},"302":{"title":"Transfer, Code Blue & Death Notes","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s15","snippet":"Transfer, Code Blue & Death Notes Transfer Note When a patient transfers between services, units, or facilities, a transfer note summarizes the hospital course to date and transfers responsibility. At minimum, include: reason for transfer, current problems, active medications, pending tests, code st...","sourceLabel":"Section in Medical Documentation"},"303":{"title":"Procedure & Operative Notes","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s16","snippet":"Procedure & Operative Notes Procedure notes document any invasive intervention, from a paracentesis to a cardiac catheterization. They are required immediately after the procedure and must contain specific elements to support billing, quality, and medicolegal purposes. Standard Procedure Note Elemen...","sourceLabel":"Section in Medical Documentation"},"304":{"title":"Consult, Telephone & ED Notes","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s17","snippet":"Consult, Telephone & ED Notes Consultation Notes A consult note answers a specific question posed by a referring provider. A good consult note has three essential elements: the question asked , the answer , and the recommendations . Never write a consult note without explicitly naming the question. ...","sourceLabel":"Section in Medical Documentation"},"305":{"title":"Psychiatric & Pediatric Notes","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s18","snippet":"Psychiatric & Pediatric Notes Psychiatric Notes Psychiatric notes require additional elements beyond standard medical documentation: mental status exam, suicide/homicide risk assessment, capacity evaluation, and treatment rationale. Because of heightened confidentiality concerns, psychotherapy proce...","sourceLabel":"Section in Medical Documentation"},"306":{"title":"Outpatient E/M Revision","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s19","snippet":"2021 Outpatient E/M Revision Evaluation and Management (E/M) codes describe physician cognitive work and are the primary billing mechanism for office visits, hospital visits, and consultations. In January 2021, CMS and the AMA implemented the most significant E/M revision in 25 years, fundamentally ...","sourceLabel":"Section in Medical Documentation"},"307":{"title":"Medical Decision Making & Time-Based Coding","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s20","snippet":"Medical Decision Making & Time-Based Coding Under the 2021 revision, MDM complexity is determined by three elements; the level reached in two of the three elements sets the overall MDM level. The Three MDM Elements Element What It Measures Problems addressed Number and complexity of problems managed...","sourceLabel":"Section in Medical Documentation"},"308":{"title":"Inpatient E/M, Critical Care & Modifiers","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s21","snippet":"Inpatient E/M, Critical Care & Modifiers Inpatient E/M coding was revised in January 2023 to align with the 2021 outpatient principles. Hospital observation codes (99217-99220, 99224-99226) were eliminated and merged into the inpatient/observation code set. Hospital Inpatient / Observation E/M (2023...","sourceLabel":"Section in Medical Documentation"},"309":{"title":"ICD-10-CM Structure & Specificity","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s22","snippet":"ICD-10-CM Structure & Specificity ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) is the diagnosis code set used in the United States since October 2015. It contains approximately 70,000 codes (compared to 14,000 in ICD-9) organized into 22 chapters by body...","sourceLabel":"Section in Medical Documentation"},"310":{"title":"CPT Codes & Procedural Billing","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s23","snippet":"CPT Codes & Procedural Billing Current Procedural Terminology (CPT) codes, maintained by the AMA, describe the services physicians provide. They are organized into three categories. CPT Code Categories Category Purpose Examples I Primary procedure/service codes (5 digits) 99213, 36415, 12001 II Perf...","sourceLabel":"Section in Medical Documentation"},"311":{"title":"HCC, MEAT & Risk Adjustment","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s24","snippet":"HCC, MEAT & Risk Adjustment Hierarchical Condition Categories (HCCs) are the CMS risk adjustment system for Medicare Advantage and increasingly for ACOs and value-based contracts. Each HCC carries a relative weight that adjusts payment upward for sicker patients. Proper HCC capture depends on docume...","sourceLabel":"Section in Medical Documentation"},"312":{"title":"EHR Pitfalls: Copy-Forward, Note Bloat & AI Tools","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s25","snippet":"EHR Pitfalls: Copy-Forward, Note Bloat & AI Tools The EHR solved legibility and access but created a new set of documentation problems: copy-forward propagation of errors, note bloat, click fatigue, and template-driven homogeneity. These problems contribute to clinician burnout, patient safety event...","sourceLabel":"Section in Medical Documentation"},"313":{"title":"Attestations, Addenda & Late Entries","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s26","snippet":"Attestations, Addenda & Late Entries Attending Attestation of Resident/Student Notes When a resident or medical student writes a note, the supervising attending must write an attestation demonstrating personal involvement. Medicare requires the attending to have personally performed key elements (fo...","sourceLabel":"Section in Medical Documentation"},"314":{"title":"Reference: Do-Not-Use List, Sample Notes & Pearls","pageTitle":"Medical Documentation","pageUrl":"/clinical-skills/medical-documentation","url":"/clinical-skills/medical-documentation#s27","snippet":"Reference: Do-Not-Use List, Sample Notes & Pearls The Joint Commission Official \"Do Not Use\" List These abbreviations have been implicated in actual patient harm and are prohibited in medical documentation at Joint Commission-accredited facilities. Do Not Use Reason Use Instead U, u (unit) Mistaken ...","sourceLabel":"Section in Medical Documentation"},"315":{"title":"Lab Interpretation","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation","snippet":"Clinical Skill Laboratory Interpretation Complete Subject Reference Systematic interpretation of common laboratory tests across hematology, chemistry, coagulation, microbiology, endocrinology, and toxicology. Reference ranges, critical values, abnormal patterns, and the differential diagnoses needed..."},"316":{"title":"Reference Ranges & Critical Values","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s1","snippet":"Reference Ranges & Critical Values Figure 1 - The Clinical Laboratory. Modern clinical laboratories process thousands of specimens daily using automated analyzers. Accurate interpretation begins with understanding the pre-analytic, analytic, and post-analytic phases of testing. Laboratory interpreta...","sourceLabel":"Section in Lab Interpretation"},"317":{"title":"Test Characteristics & Bayesian Reasoning","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s2","snippet":"Test Characteristics & Bayesian Reasoning Every diagnostic test has four fundamental characteristics that govern its clinical utility: sensitivity , specificity , positive predictive value (PPV) , and negative predictive value (NPV) . Sensitivity and specificity are properties of the test itself; pr...","sourceLabel":"Section in Lab Interpretation"},"318":{"title":"Pre-Analytic Errors & Specimen Integrity","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s3","snippet":"Pre-Analytic Errors & Specimen Integrity The majority of laboratory errors occur not in the analyzer but in the pre-analytic phase - during specimen collection, handling, labeling, and transport. A hemolyzed sample, a mislabeled tube, or a delayed transport can invalidate a result entirely or produc...","sourceLabel":"Section in Lab Interpretation"},"319":{"title":"RBC Indices & the Anemia Workup","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s4","snippet":"RBC Indices & the Anemia Workup Figure 5 - Blood Composition and the Hematocrit. When anticoagulated blood is centrifuged, it separates into plasma (top), a buffy coat of white blood cells and platelets (thin middle layer), and packed red blood cells (bottom). The hematocrit represents the percentag...","sourceLabel":"Section in Lab Interpretation"},"320":{"title":"Iron Studies, B12 & Folate","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s5","snippet":"Iron Studies, B12 & Folate Iron studies are the most commonly misinterpreted panel in hematology. The five components are serum iron , total iron-binding capacity (TIBC) , transferrin saturation (iron/TIBC &times; 100), ferritin , and sometimes soluble transferrin receptor. Each has pitfalls. Figure...","sourceLabel":"Section in Lab Interpretation"},"321":{"title":"Reticulocytes & Hemolysis Labs","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s6","snippet":"Reticulocytes & Hemolysis Labs Figure 8 - Erythrocyte Lifecycle and Breakdown. Red blood cells circulate for approximately 120 days before being removed by macrophages in the spleen and liver. Hemoglobin is broken down into globin (recycled as amino acids), iron (recycled via transferrin), and heme ...","sourceLabel":"Section in Lab Interpretation"},"322":{"title":"WBC Differential & Leukocyte Disorders","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s7","snippet":"WBC Differential & Leukocyte Disorders Figure 9 - Leukocyte Types on Peripheral Blood Smear. The five leukocyte types are identifiable by their nuclear morphology and cytoplasmic granule staining. Neutrophils have multilobed nuclei with fine granules; eosinophils show bilobed nuclei with bright red-...","sourceLabel":"Section in Lab Interpretation"},"323":{"title":"Platelets & Pancytopenia","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s8","snippet":"Platelets & Pancytopenia Figure 10 - Leukocyte Emigration and the Inflammatory Response. In response to infection or tissue injury, neutrophils marginate along vessel walls, adhere to endothelium, and emigrate into tissues via diapedesis. This process explains why the circulating WBC count can chang...","sourceLabel":"Section in Lab Interpretation"},"324":{"title":"Peripheral Blood Smear Findings","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s9","snippet":"Peripheral Blood Smear Findings Figure 12 - Schistocytes on Peripheral Blood Smear. Fragmented red blood cells (schistocytes, helmet cells) are the hallmark of microangiopathic hemolytic anemia (MAHA). Their presence with thrombocytopenia immediately raises concern for TTP, HUS, DIC, HELLP syndrome,...","sourceLabel":"Section in Lab Interpretation"},"325":{"title":"PT/INR, aPTT, TT & Mixing Studies","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s10","snippet":"PT/INR, aPTT, TT & Mixing Studies Figure 14 - The Coagulation Cascade. The coagulation cascade consists of the intrinsic pathway (measured by aPTT), the extrinsic pathway (measured by PT/INR), and the common pathway (factors X, V, II, and fibrinogen). Understanding which pathway is prolonged narrows...","sourceLabel":"Section in Lab Interpretation"},"326":{"title":"Anticoagulant Monitoring & DIC","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s11","snippet":"Anticoagulant Monitoring & DIC Figure 15 - The Three Steps of Hemostasis. Hemostasis proceeds through vascular spasm (immediate vasoconstriction), primary hemostasis (platelet adhesion and aggregation forming the platelet plug), and secondary hemostasis (the coagulation cascade generating a fibrin m...","sourceLabel":"Section in Lab Interpretation"},"327":{"title":"Thrombophilia, vWD & HIT","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s12","snippet":"Thrombophilia, vWD & HIT Hereditary Thrombophilia Workup Test Disorder Caveat Factor V Leiden (APC resistance) Activated protein C resistance Most common inherited thrombophilia Prothrombin G20210A Prothrombin gene mutation Genetic test; unaffected by anticoagulation Protein C activity Protein C def...","sourceLabel":"Section in Lab Interpretation"},"328":{"title":"Sodium, Potassium & Chloride","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s13","snippet":"Sodium, Potassium & Chloride Figure 16 - Electrolyte Distribution Across Fluid Compartments. Sodium is the dominant extracellular cation while potassium predominates intracellularly. This gradient, maintained by the Na/K-ATPase, is essential for membrane potential. Laboratory electrolyte values refl...","sourceLabel":"Section in Lab Interpretation"},"329":{"title":"Calcium, Magnesium & Phosphate","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s14","snippet":"Calcium, Magnesium & Phosphate Figure 20 - Calcium Homeostasis. Serum calcium is tightly regulated by PTH (raises calcium via bone resorption, renal reabsorption, and indirect intestinal absorption through 1,25-vitamin D activation) and calcitonin (lowers calcium via bone deposition). The first step...","sourceLabel":"Section in Lab Interpretation"},"330":{"title":"Renal Function: BUN, Creatinine & eGFR","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s15","snippet":"Renal Function: BUN, Creatinine & eGFR Figure 21 - The Glomerulus and Juxtaglomerular Apparatus. The glomerulus is the filtration unit of the kidney. Creatinine is freely filtered at the glomerulus, making it a useful marker of glomerular filtration rate (GFR). The juxtaglomerular apparatus regulate...","sourceLabel":"Section in Lab Interpretation"},"331":{"title":"AKI vs CKD & Urine Indices","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s16","snippet":"AKI vs CKD & Urine Indices Figure 22 - Urine Formation Along the Nephron. Urine formation involves three processes: glomerular filtration (non-selective passage of plasma into Bowman's capsule), tubular reabsorption (recovery of water, glucose, electrolytes, and bicarbonate), and tubular secretion (...","sourceLabel":"Section in Lab Interpretation"},"332":{"title":"Systematic ABG Interpretation","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s17","snippet":"Systematic ABG Interpretation Figure 23 - The pH Scale and Physiologic Range. Blood pH is maintained in a narrow range of 7.35-7.45 by the bicarbonate buffer system, respiratory compensation (CO2 elimination), and renal compensation (bicarbonate regeneration and acid excretion). Deviations below 7.3...","sourceLabel":"Section in Lab Interpretation"},"333":{"title":"Anion Gap, Delta-Delta & Mixed Disorders","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s18","snippet":"Anion Gap, Delta-Delta & Mixed Disorders Anion Gap Anion gap = Na &minus; (Cl + HCO 3 ) . Normal 8-12 mmol/L. Correct for albumin: add 2.5 per 1 g/dL decrease below 4. A patient with albumin 2 has a \"corrected\" normal AG of 13. HAGMA - MUDPILES and GOLD MARK MUDPILES GOLD MARK Methanol Glycols (ethy...","sourceLabel":"Section in Lab Interpretation"},"334":{"title":"Liver Function Tests","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s19","snippet":"Liver Function Tests Figure 26 - Hepatic Lobule Microanatomy. The liver lobule is the functional unit of the liver. Hepatocytes radiate from the central vein, bordered by portal triads (portal vein, hepatic artery, bile duct). ALT and AST are released from damaged hepatocytes (hepatocellular pattern...","sourceLabel":"Section in Lab Interpretation"},"335":{"title":"Pancreatic & Cardiac Markers","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s20","snippet":"Pancreatic & Cardiac Markers Figure 27 - Pancreatic Anatomy. The pancreas has both exocrine (acinar cells producing digestive enzymes including lipase and amylase) and endocrine (islets of Langerhans producing insulin and glucagon) functions. In acute pancreatitis, acinar cell damage releases lipase...","sourceLabel":"Section in Lab Interpretation"},"336":{"title":"Lipids & Thyroid Studies","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s21","snippet":"Lipids & Thyroid Studies Lipid Panel Component Optimal Notes Total cholesterol <200 mg/dL Sum of LDL + HDL + VLDL LDL <100 (very high risk <55) Usually calculated by Friedewald; direct assay when TG >400 HDL >40 M, >50 F Inverse CV risk Triglycerides <150 >500 risks pancreatitis; >1000 emergent Non-...","sourceLabel":"Section in Lab Interpretation"},"337":{"title":"Diabetes & Glycemic Markers","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s22","snippet":"Diabetes & Glycemic Markers Figure 30 - Blood Glucose Homeostasis. Blood glucose is maintained between 70-110 mg/dL through the opposing actions of insulin (promoting glucose uptake and glycogen synthesis) and glucagon (stimulating glycogenolysis and gluconeogenesis). Diabetes mellitus represents fa...","sourceLabel":"Section in Lab Interpretation"},"338":{"title":"Adrenal, Pituitary & Bone Chemistry","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s23","snippet":"Adrenal, Pituitary & Bone Chemistry Figure 32 - Adrenal Gland Anatomy and Hormone Production. The adrenal cortex produces mineralocorticoids (aldosterone from the zona glomerulosa), glucocorticoids (cortisol from the zona fasciculata), and androgens (DHEA-S from the zona reticularis). The medulla pr...","sourceLabel":"Section in Lab Interpretation"},"339":{"title":"Urinalysis & Microscopy","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s24","snippet":"Urinalysis & Microscopy Figure 34 - Body Fluid Compartments. Total body water distributes between intracellular (two-thirds) and extracellular (one-third) compartments, with the extracellular further divided into interstitial and intravascular spaces. Urinalysis provides a window into kidney handlin...","sourceLabel":"Section in Lab Interpretation"},"340":{"title":"Gram Stain & Culture Interpretation","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s25","snippet":"Gram Stain & Culture Interpretation Figure 35 - The Gram Stain Procedure. The Gram stain is the single most important rapid diagnostic test in microbiology. Crystal violet stains all bacteria, iodine fixes the dye, alcohol decolorizes thin-walled gram-negatives, and safranin counterstains them pink/...","sourceLabel":"Section in Lab Interpretation"},"341":{"title":"CSF & Body Fluid Analysis","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s26","snippet":"CSF & Body Fluid Analysis Figure 37 - Acid-Fast (Ziehl-Neelsen) Stain. Acid-fast bacilli (AFB) such as Mycobacterium tuberculosis resist decolorization by acid-alcohol due to their waxy mycolic acid cell wall, appearing red against a blue counterstain. AFB smear and culture of CSF, sputum, or other ...","sourceLabel":"Section in Lab Interpretation"},"342":{"title":"Toxicology Screens & Drug Levels","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s27","snippet":"Toxicology Screens & Drug Levels Figure 38 - Formed Elements of Blood - Summary Reference. Blood contains three major formed elements: erythrocytes (oxygen transport), leukocytes (immune defense in five subtypes), and platelets (hemostasis). The complete blood count (CBC) with differential quantifie...","sourceLabel":"Section in Lab Interpretation"},"343":{"title":"Critical Values, Formulas & Reference","pageTitle":"Lab Interpretation","pageUrl":"/clinical-skills/lab-interpretation","url":"/clinical-skills/lab-interpretation#s28","snippet":"Critical Values, Formulas & Reference Master Formula Reference Formula Calculation Anion gap Na &minus; (Cl + HCO 3 ); normal 8-12 Corrected AG (albumin) AG + 2.5 &times; (4 &minus; albumin) Delta ratio (AG &minus; 12) / (24 &minus; HCO 3 ) Winter's formula PaCO 2 = 1.5(HCO 3 ) + 8 &plusmn; 2 Serum ...","sourceLabel":"Section in Lab Interpretation"},"344":{"title":"EKG Interpretation","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation","snippet":"Clinical Skill EKG Interpretation Complete Subject Reference Systematic 12-lead ECG analysis: rate, rhythm, axis, intervals, hypertrophy, ischemia, infarction localization, arrhythmias, conduction blocks, electrolyte changes, drug effects, and every diagnostic pattern with the criteria needed to rec..."},"345":{"title":"Cardiac Electrophysiology","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s1","snippet":"Cardiac Electrophysiology The electrocardiogram (ECG/EKG) is a surface recording of the summed electrical activity of millions of cardiac myocytes as they depolarize and repolarize in sequence. Every wave, interval, and segment on the 12-lead ECG reflects a specific electrical event in the heart. Ma...","sourceLabel":"Section in EKG Interpretation"},"346":{"title":"Conduction System & Lead Placement","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s2","snippet":"Conduction System & Lead Placement Figure 4 - Chest Landmarks for ECG Placement. External anatomic landmarks used to locate the intercostal spaces for correct precordial electrode placement. Accurate landmarking at the angle of Louis (sternal angle) is essential to avoid misdiagnosis. Normal Conduct...","sourceLabel":"Section in EKG Interpretation"},"347":{"title":"Paper Speed, Calibration & Normal Intervals","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s3","snippet":"Paper Speed, Calibration & Normal Intervals Figure 8 - Normal ECG Waveform Components. A labeled diagram of the normal ECG tracing showing the P wave, PR interval, QRS complex, J point, ST segment, T wave, QT interval, and U wave. Each wave and interval corresponds to a specific phase of cardiac ele...","sourceLabel":"Section in EKG Interpretation"},"348":{"title":"The 10-Step Approach","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s4","snippet":"The 10-Step Approach Every ECG should be interpreted in the same order, every time. A systematic approach prevents the most common error in ECG reading: seeing the obvious abnormality and missing the subtle one. The ten-step approach below forms the backbone of any formal ECG read. Step What to Chec...","sourceLabel":"Section in EKG Interpretation"},"349":{"title":"Rate Calculation Methods","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s5","snippet":"Rate Calculation Methods Figure 9a - Rate Calculation on a Rhythm Strip. A rhythm strip in normal sinus rhythm. Rate can be calculated by the 300 method (300 divided by the number of large boxes between consecutive R waves) or the 1500 method (1500 divided by small boxes between R waves). Three Stan...","sourceLabel":"Section in EKG Interpretation"},"350":{"title":"Sinus Rhythms & Variants","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s6","snippet":"Sinus Rhythms & Variants Figure 9 - Normal Sinus Rhythm (12-Lead). A 12-lead ECG demonstrating normal sinus rhythm. Note the regular rhythm, upright P waves in leads I, II, and aVF, consistent PR intervals, narrow QRS complexes, and normal ST segments. Criteria for Normal Sinus Rhythm Rate 60-100 bp...","sourceLabel":"Section in EKG Interpretation"},"351":{"title":"Electrical Axis Determination","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s7","snippet":"Electrical Axis Determination Figure 10 - Hexaxial Reference System. The six frontal plane leads arranged in the hexaxial reference system. Each lead has a defined angle, and the mean QRS vector can be plotted using these axes to determine the electrical axis of the heart. Normal Axis Range The norm...","sourceLabel":"Section in EKG Interpretation"},"352":{"title":"PR, QRS & QT Intervals","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s8","snippet":"PR, QRS & QT Intervals PR Interval PR Interval Interpretation Causes Short (< 0.12 s) Preexcitation or junctional WPW, LGL, low atrial/junctional rhythm Normal (0.12-0.20 s) Normal AV conduction - Long (> 0.20 s) 1&deg; AV block &uarr;Vagal tone, AV node disease, drugs (digoxin, &beta;-blocker, CCB)...","sourceLabel":"Section in EKG Interpretation"},"353":{"title":"P Wave Morphology & Atrial Enlargement","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s9","snippet":"P Wave Morphology & Atrial Enlargement Figure 12 - P Wave Morphology: Normal and Abnormal. Comparison of the normal P wave with P pulmonale (tall, peaked P wave in right atrial enlargement) and P mitrale (broad, notched P wave in left atrial enlargement). The terminal negative deflection in V1 is ke...","sourceLabel":"Section in EKG Interpretation"},"354":{"title":"Left Ventricular Hypertrophy","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s10","snippet":"Left Ventricular Hypertrophy LVH on ECG is diagnosed by voltage criteria (increased QRS amplitude) often accompanied by repolarization abnormalities (\"strain pattern\"). Multiple scoring systems exist - all are specific but insensitive. Figure 13 - Left Ventricular Hypertrophy. A 12-lead ECG demonstr...","sourceLabel":"Section in EKG Interpretation"},"355":{"title":"Right Ventricular Hypertrophy","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s11","snippet":"Right Ventricular Hypertrophy RVH Criteria The normal adult RV is too thin to dominate the ECG. RVH is diagnosed when the R wave in V 1 is abnormally large and the ECG shows right-sided dominance. Criterion Value R wave in V 1 > 7 mm R/S ratio in V 1 > 1 R/S ratio in V 6 < 1 Right axis deviation > +...","sourceLabel":"Section in EKG Interpretation"},"356":{"title":"ST-Segment Morphology","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s12","snippet":"ST-Segment Morphology The ST segment is the interval from the J point to the onset of the T wave and represents phase 2 of the action potential. Any deviation from the isoelectric baseline raises concern for ischemia - but ST shifts have many causes, and morphology matters. Figure 14 - ST Elevation ...","sourceLabel":"Section in EKG Interpretation"},"357":{"title":"STEMI Criteria & Localization","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s13","snippet":"STEMI Criteria & Localization Fourth Universal Definition of MI - STEMI Criteria New ST elevation at the J point in at least two contiguous leads: &ge; 1 mm in any lead other than V 2 -V 3 In V 2 -V 3 : &ge; 2 mm (men &ge; 40 y), &ge; 2.5 mm (men < 40 y), &ge; 1.5 mm (women) Posterior STEMI: ST depr...","sourceLabel":"Section in EKG Interpretation"},"358":{"title":"STEMI Mimics & Sgarbossa Criteria","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s14","snippet":"STEMI Mimics & Sgarbossa Criteria Differential for ST Elevation Mimic Distinguishing Features Early repolarization Concave ST, J-point notch/slur, young healthy patient, most prominent V 2 -V 5 Pericarditis Diffuse concave ST elevation, PR depression, PR elevation in aVR, no reciprocal changes LVH D...","sourceLabel":"Section in EKG Interpretation"},"359":{"title":"Q Waves, T Inversion & Wellens","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s15","snippet":"Q Waves, T Inversion & Wellens Pathologic Q Waves A Q wave is pathologic if it is &ge; 0.04 s wide or > 25% of the R-wave amplitude in the same lead. Pathologic Q waves in contiguous leads indicate completed transmural infarction (usually > 6 hours after onset). Small \"septal\" q waves in I, aVL, V 5...","sourceLabel":"Section in EKG Interpretation"},"360":{"title":"Narrow Complex Tachycardias","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s16","snippet":"Narrow Complex Tachycardias A narrow-complex tachycardia (QRS < 0.12 s) originates at or above the His bundle. The first question is whether the rhythm is regular or irregular. Figure 25 - Atrial Fibrillation. A rhythm strip demonstrating atrial fibrillation with its hallmark features: irregularly i...","sourceLabel":"Section in EKG Interpretation"},"361":{"title":"Wide Complex Tachycardias","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s17","snippet":"Wide Complex Tachycardias A wide-complex tachycardia (QRS &ge; 0.12 s, rate > 100) is VT until proven otherwise. In patients with coronary disease, > 90% of wide-complex tachycardias are VT. Treat hemodynamic instability with synchronized cardioversion. Figure 28 - Monomorphic Ventricular Tachycardi...","sourceLabel":"Section in EKG Interpretation"},"362":{"title":"SVT vs VT Differentiation","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s18","snippet":"SVT vs VT Differentiation Classic Clues Favoring VT AV dissociation (pathognomonic) - independent P waves marching through Capture beats (fusion of sinus conducted beat with VT) Fusion beats (hybrid morphology) QRS > 0.14 s (RBBB pattern) or > 0.16 s (LBBB pattern) Extreme axis (&minus;90 to &plusmn...","sourceLabel":"Section in EKG Interpretation"},"363":{"title":"SA & AV Blocks","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s19","snippet":"SA & AV Blocks SA Blocks Type Features 1&deg; SA block Cannot diagnose on surface ECG (SA node firing is not visible) 2&deg; SA block (Wenckebach) Progressive shortening of P-P intervals then dropped P wave 2&deg; SA block (Mobitz II) Constant P-P then sudden dropped P 3&deg; SA block / arrest No P ...","sourceLabel":"Section in EKG Interpretation"},"364":{"title":"Escape Rhythms & AV Dissociation","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s20","snippet":"Escape Rhythms & AV Dissociation Intrinsic Rates of Escape Pacemakers Site Intrinsic Rate QRS Width SA node 60-100 Narrow Atrial ectopic 60-80 Narrow (abnormal P) Junctional 40-60 Narrow (no P or retrograde) Ventricular 20-40 Wide Types of AV Dissociation Type Mechanism Complete (3&deg; AV block) At...","sourceLabel":"Section in EKG Interpretation"},"365":{"title":"RBBB & LBBB","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s21","snippet":"RBBB & LBBB Figure 33 - Right Bundle Branch Block (RBBB). A 12-lead ECG demonstrating RBBB with the classic rSR' (rabbit ears) pattern in V1, broad terminal S wave in leads I and V6, and discordant T-wave changes in V1-V3. QRS duration is &ge; 0.12 s. Right Bundle Branch Block (RBBB) Criterion Value...","sourceLabel":"Section in EKG Interpretation"},"366":{"title":"Fascicular, Bifascicular & Trifascicular Blocks","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s22","snippet":"Fascicular, Bifascicular & Trifascicular Blocks Left Anterior Fascicular Block (LAFB) Left axis deviation (&minus;45&deg; to &minus;90&deg;) qR in I, aVL; rS in II, III, aVF QRS duration normal or only slightly prolonged (< 0.12 s) No other cause of LAD Left Posterior Fascicular Block (LPFB) Right a...","sourceLabel":"Section in EKG Interpretation"},"367":{"title":"Preexcitation & Paced Rhythms","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s23","snippet":"Preexcitation & Paced Rhythms Figure 37 - Wolff-Parkinson-White (WPW) Pattern. A 12-lead ECG demonstrating the WPW triad in sinus rhythm: short PR interval (< 0.12 s), delta waves (slurred QRS upstroke), and widened QRS complex due to ventricular preexcitation via an accessory pathway. Wolff-Parkins...","sourceLabel":"Section in EKG Interpretation"},"368":{"title":"Channelopathies & Inherited Syndromes","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s24","snippet":"Channelopathies & Inherited Syndromes Figure 38 - Brugada Syndrome ECG Types. Comparison of the three Brugada patterns in leads V1-V2. Type 1 (coved) with &ge; 2 mm ST elevation and descending T-wave inversion is diagnostic. Types 2 and 3 (saddleback) are suggestive but require provocation testing f...","sourceLabel":"Section in EKG Interpretation"},"369":{"title":"Electrolyte & Drug Effects","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s25","snippet":"Electrolyte & Drug Effects Electrolyte Summary Table Electrolyte Key ECG Findings Progression &uarr;K + Peaked T &rarr; long PR &rarr; wide QRS &rarr; sine wave Progressive with level &darr;K + Flat T, U waves, ST depression, long QU Torsades risk &uarr;Ca 2+ Short QT (short ST); Osborn wave possibl...","sourceLabel":"Section in EKG Interpretation"},"370":{"title":"Miscellaneous Patterns","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s26","snippet":"Miscellaneous Patterns Figure 42 - Normal R-Wave Progression. The normal progression of R-wave amplitude across the precordial leads V1 through V6. The R wave grows progressively taller while the S wave becomes smaller, with the transition zone (R = S) normally between V3 and V4. R-Wave Progression ...","sourceLabel":"Section in EKG Interpretation"},"371":{"title":"ECG Criteria Summary & Pitfalls","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s27","snippet":"ECG Criteria Summary & Pitfalls Essential Criteria at a Glance Finding Criterion 1&deg; AV block PR > 0.20 s LAE P wave > 0.12 s in II, terminal negative V 1 &ge; 1 mm &times; 0.04 s RAE P wave > 2.5 mm in II LVH (Sokolow-Lyon) S V 1 + R V 5/6 > 35 mm RVH R V 1 > 7 mm, R/S V 1 > 1 LBBB QRS &ge; 0.12...","sourceLabel":"Section in EKG Interpretation"},"372":{"title":"High-Yield Review","pageTitle":"EKG Interpretation","pageUrl":"/clinical-skills/ekg-interpretation","url":"/clinical-skills/ekg-interpretation#s28","snippet":"High-Yield Review Indications for Permanent Pacemaker Indication Detail Symptomatic sinus node dysfunction Bradycardia or pauses with symptoms Symptomatic 2&deg; Mobitz I Only if symptomatic 2&deg; Mobitz II Symptomatic or not High-grade or complete AV block All patients Alternating BBB True trifasc...","sourceLabel":"Section in EKG Interpretation"},"373":{"title":"Imaging Interpretation","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation","snippet":"Clinical Skill Imaging Interpretation Complete Subject Reference Systematic interpretation of radiographs, CT, MRI, ultrasound, and nuclear medicine across body systems. Modality selection, contrast considerations, normal anatomy, and the recognition patterns needed for every common imaging finding."},"374":{"title":"Imaging Modalities Overview","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s1","snippet":"Imaging Modalities Overview Diagnostic imaging is the most powerful clinical tool for non-invasive diagnosis, surveillance, and procedural guidance. Every clinician - not just radiologists - must be able to select the right study, understand its limitations, and interpret the most common findings. I...","sourceLabel":"Section in Imaging Interpretation"},"375":{"title":"X-Ray & CT Physics","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s2","snippet":"X-Ray & CT Physics Radiograph Formation X-rays are generated when high-energy electrons strike a tungsten anode. The beam passes through the patient and is attenuated differentially by tissues of different atomic number and density. The unattenuated photons strike the detector, producing a 2D projec...","sourceLabel":"Section in Imaging Interpretation"},"376":{"title":"MRI Physics & Sequences","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s3","snippet":"MRI Physics & Sequences MRI exploits the magnetic properties of hydrogen protons in tissue. In the main magnetic field (B 0 , typically 1.5 or 3 Tesla), protons align and precess at the Larmor frequency. A radiofrequency pulse tips them out of alignment; as they relax back, they emit a signal detect...","sourceLabel":"Section in Imaging Interpretation"},"377":{"title":"Ultrasound & Doppler Physics","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s4","snippet":"Ultrasound & Doppler Physics Ultrasound uses high-frequency (2-18 MHz) sound waves emitted and received by a transducer. Sound reflects at acoustic impedance boundaries; the time delay is used to map depth, and echo amplitude determines pixel brightness. Higher frequencies give better resolution but...","sourceLabel":"Section in Imaging Interpretation"},"378":{"title":"Contrast Agents & Safety","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s5","snippet":"Contrast Agents & Safety Iodinated (CT) Contrast Intravenous iodinated contrast opacifies vessels and enhancing tissues based on iodine's high atomic number. Modern low- or iso-osmolar non-ionic agents have substantially lower adverse event rates than older high-osmolar ionic agents. Contraindicatio...","sourceLabel":"Section in Imaging Interpretation"},"379":{"title":"Radiation Safety & ALARA","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s6","snippet":"Radiation Safety & ALARA ALARA (As Low As Reasonably Achievable) is the foundational principle of radiation safety. Every study should be justified (will it change management?), optimized (appropriate technique and dose), and limited (no repeats without cause). Pediatric patients are disproportionat...","sourceLabel":"Section in Imaging Interpretation"},"380":{"title":"Systematic CXR Approach (A-E)","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s7","snippet":"Systematic CXR Approach (A-E) The chest radiograph is the most frequently ordered imaging study in medicine and the most diagnostically high-yield for the cost. Interpretation discipline is the difference between finding and missing pathology. Always use the same system every time. The classic mnemo...","sourceLabel":"Section in Imaging Interpretation"},"381":{"title":"Pulmonary Parenchymal Patterns","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s8","snippet":"Pulmonary Parenchymal Patterns Lung opacities are categorized by distribution (focal vs diffuse), anatomic pattern (airspace vs interstitial vs nodular), and location. Recognizing patterns narrows the differential efficiently. Airspace vs Interstitial Disease Pattern Findings Differential Airspace /...","sourceLabel":"Section in Imaging Interpretation"},"382":{"title":"Pleura, Mediastinum & Cardiac Silhouette","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s9","snippet":"Pleura, Mediastinum & Cardiac Silhouette Pleural Disease Finding Appearance Clinical Pleural effusion (small) Blunting of costophrenic angle, meniscus sign (>200 mL) CHF, pneumonia, malignancy Large effusion Opacification, mediastinal shift away, layered fluid on decubitus Parapneumonic, empyema, he...","sourceLabel":"Section in Imaging Interpretation"},"383":{"title":"Lines, Tubes & Common Disease Patterns","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s10","snippet":"Lines, Tubes & Common Disease Patterns Every post-procedural or ICU chest radiograph must confirm correct positioning of lines and tubes and screen for complications (pneumothorax, malposition, hemorrhage). Line and Tube Positioning Device Correct Position Complications to Assess Endotracheal tube T...","sourceLabel":"Section in Imaging Interpretation"},"384":{"title":"Lung Nodules & Fleischner Criteria","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s11","snippet":"Lung Nodules & Fleischner Criteria A pulmonary nodule is a rounded opacity &le;3 cm surrounded by lung; larger lesions are masses . Solitary pulmonary nodules are common incidental findings. Characterization relies on size, margin, density, growth, and patient risk factors. Benign vs Malignant Featu...","sourceLabel":"Section in Imaging Interpretation"},"385":{"title":"PE CTA & Interstitial Lung Disease","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s12","snippet":"PE CTA & Interstitial Lung Disease CT Pulmonary Angiography for PE CT pulmonary angiography (CTPA) is the gold standard for diagnosing acute pulmonary embolism. Intravenous iodinated contrast is timed to peak pulmonary artery opacification. A positive study shows a filling defect (low-attenuation ar...","sourceLabel":"Section in Imaging Interpretation"},"386":{"title":"Abdominal Radiograph & KUB","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s13","snippet":"Abdominal Radiograph & KUB The abdominal radiograph is a low-cost screening tool with limited sensitivity but high specificity for certain findings. The acute abdominal series includes supine abdomen, upright abdomen, and upright chest (for free air). A KUB (kidneys, ureters, bladder) is a supine fi...","sourceLabel":"Section in Imaging Interpretation"},"387":{"title":"Abdominal CT - Acute Abdomen","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s14","snippet":"Abdominal CT - Acute Abdomen CT with IV contrast is the workhorse for evaluating adult abdominal pain. Oral contrast is used selectively (less often now with modern multidetector scanners). Non-contrast CT is reserved for renal stones and patients who cannot receive iodinated contrast. Common Acute ...","sourceLabel":"Section in Imaging Interpretation"},"388":{"title":"Abdominal Ultrasound & FAST","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s15","snippet":"Abdominal Ultrasound & FAST Right Upper Quadrant Ultrasound The first-line test for suspected biliary disease, liver lesions, and unexplained RUQ pain. Patients fast 8 hours to distend the gallbladder. Finding Appearance Clinical Cholelithiasis Echogenic, shadowing, mobile intraluminal focus Gallsto...","sourceLabel":"Section in Imaging Interpretation"},"389":{"title":"Hepatobiliary MRI & MRCP","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s16","snippet":"Hepatobiliary MRI & MRCP MRI is superior to CT for lesion characterization in the liver and biliary tree. Liver MRI uses T1, T2, in-phase/out-of-phase, DWI, and dynamic post-contrast sequences. Hepatobiliary agents (gadoxetate) provide additional delayed hepatocyte uptake information for focal lesio...","sourceLabel":"Section in Imaging Interpretation"},"390":{"title":"Renal & Urinary Tract Imaging","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s17","snippet":"Renal & Urinary Tract Imaging Modality Selection Indication First-Line Modality Suspected renal stone Non-contrast CT (stone protocol) Hematuria workup CT urography (multiphase) Hydronephrosis screening Ultrasound Renal mass characterization Multiphase CT or MRI (Bosniak) Renal artery stenosis Doppl...","sourceLabel":"Section in Imaging Interpretation"},"391":{"title":"Pelvic, Obstetric & Prostate Imaging","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s18","snippet":"Pelvic, Obstetric & Prostate Imaging Pelvic Ultrasound Transabdominal provides a global view (requires full bladder as acoustic window); transvaginal gives superior resolution of uterus, endometrium, ovaries, and adnexa. First-line for suspected ovarian pathology, pelvic pain, abnormal bleeding, and...","sourceLabel":"Section in Imaging Interpretation"},"392":{"title":"Fracture Description & Principles","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s19","snippet":"Fracture Description & Principles Every fracture description must be systematic and precise to communicate with the orthopedic surgeon. The components are: bone, location, pattern, displacement, angulation, rotation, and associated findings. Fracture Description Checklist Element Options Bone & loca...","sourceLabel":"Section in Imaging Interpretation"},"393":{"title":"Regional Fractures & Dislocations","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s20","snippet":"Regional Fractures & Dislocations Common Fractures by Region Region Fracture / Injury Key Feature Wrist Colles (distal radius, dorsal angulation) \"Dinner fork\" deformity, FOOSH in elderly Wrist Smith fracture Distal radius with volar angulation (reverse Colles) Wrist Scaphoid fracture Snuffbox tende...","sourceLabel":"Section in Imaging Interpretation"},"394":{"title":"Arthritis, Bone Tumors & MSK MRI","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s21","snippet":"Arthritis, Bone Tumors & MSK MRI Arthritis Radiographic Features Feature Osteoarthritis Rheumatoid Arthritis Distribution DIP, PIP, 1st CMC, weight-bearing joints MCP, PIP, wrists, symmetric Joint space Asymmetric narrowing Symmetric narrowing Osteophytes Prominent Absent Erosions Absent Marginal er...","sourceLabel":"Section in Imaging Interpretation"},"395":{"title":"CT Head & Intracranial Hemorrhage","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s22","snippet":"CT Head & Intracranial Hemorrhage Non-contrast CT head is the first-line imaging in acute neurologic presentations: trauma, stroke, altered mental status, severe headache. It is fast, widely available, and exquisitely sensitive for acute blood (hyperdense on CT). Intracranial Hemorrhage Subtypes Typ...","sourceLabel":"Section in Imaging Interpretation"},"396":{"title":"Ischemic Stroke Imaging","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s23","snippet":"Ischemic Stroke Imaging Stroke imaging has three goals: (1) exclude hemorrhage (non-contrast CT), (2) identify large vessel occlusion amenable to thrombectomy (CTA), (3) quantify salvageable penumbra (CT perfusion or MRI). Early CT Signs of Ischemic Stroke Sign Finding Timing Hyperdense MCA sign Bri...","sourceLabel":"Section in Imaging Interpretation"},"397":{"title":"MRI Brain & Spine","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s24","snippet":"MRI Brain & Spine Common Brain MRI Findings Pathology Signal Characteristics Acute infarct DWI bright, ADC dark; FLAIR bright after hours; T2 bright MS plaques Periventricular T2/FLAIR hyperintensities perpendicular to ventricles (Dawson fingers); active plaques enhance Glioblastoma Heterogeneous, r...","sourceLabel":"Section in Imaging Interpretation"},"398":{"title":"Vascular Imaging & CTA","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s25","snippet":"Vascular Imaging & CTA Aortic Imaging Condition CTA Findings Aortic dissection Intimal flap separating true from false lumen; Stanford A (ascending) = surgical emergency; Stanford B (descending) = usually medical Intramural hematoma Crescentic high-attenuation aortic wall thickening on non-contrast,...","sourceLabel":"Section in Imaging Interpretation"},"399":{"title":"Nuclear Medicine & Fluoroscopy","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s26","snippet":"Nuclear Medicine & Fluoroscopy Common Nuclear Medicine Studies Study Radiotracer Use Bone scan 99m Tc-MDP Metastases, stress fractures, osteomyelitis, Paget disease V/Q scan 99m Tc-MAA (perfusion), Xe-133 (ventilation) PE when CT contraindicated; PIOPED criteria (high/intermediate/low probability) H...","sourceLabel":"Section in Imaging Interpretation"},"400":{"title":"Modality Selection & Appropriateness","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s27","snippet":"Modality Selection & Appropriateness The ACR Appropriateness Criteria are evidence-based guidelines matching clinical scenarios to the most appropriate imaging studies. The goal is to minimize radiation, contrast, cost, and wasted time while maximizing diagnostic yield. First-Line Modality by Presen...","sourceLabel":"Section in Imaging Interpretation"},"401":{"title":"High-Yield Pearls & Report Terminology","pageTitle":"Imaging Interpretation","pageUrl":"/clinical-skills/imaging-interpretation","url":"/clinical-skills/imaging-interpretation#s28","snippet":"High-Yield Pearls & Report Terminology Common Radiology Report Terms Term Meaning Consolidation Airspace filling with fluid/cells/material, air bronchograms visible Ground-glass opacity Hazy increased density without obscuring vessels (CT term) Reticular Linear network pattern, suggests interstitial...","sourceLabel":"Section in Imaging Interpretation"},"402":{"title":"Clinical Procedures","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures","snippet":"Clinical Skill Clinical Procedures Complete Subject Reference Bedside and outpatient procedures across internal medicine, emergency medicine, and primary care: indications, contraindications, anatomy, equipment, technique, post-procedure care, and complications for every common clinical procedure."},"403":{"title":"Sterile Technique & Universal Precautions","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s1","snippet":"Sterile Technique & Universal Precautions Sterile technique is the cornerstone of safe bedside procedures. Every invasive procedure - from a peripheral IV to a central line - depends on maintaining a sterile field to prevent healthcare-associated infections (HAIs). Central line-associated bloodstrea...","sourceLabel":"Section in Clinical Procedures"},"404":{"title":"Informed Consent & Pre-Procedure Time-Out","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s2","snippet":"Informed Consent & Pre-Procedure Time-Out Informed consent is both an ethical imperative and a legal requirement for non-emergent procedures. Patients must understand the nature of the procedure, its risks, benefits, and reasonable alternatives (including no procedure). Capacity is procedure-specifi...","sourceLabel":"Section in Clinical Procedures"},"405":{"title":"Local Anesthesia & Procedural Sedation","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s3","snippet":"Local Anesthesia & Procedural Sedation Adequate analgesia improves patient cooperation, reduces stress response, and lowers the risk of complications. Local anesthetics work by blocking voltage-gated sodium channels in nerve fibers, preventing depolarization. Amide anesthetics (lidocaine, bupivacain...","sourceLabel":"Section in Clinical Procedures"},"406":{"title":"Peripheral IV & Ultrasound-Guided PIV","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s4","snippet":"Peripheral IV & Ultrasound-Guided PIV Peripheral venous access is the most commonly performed invasive procedure in medicine. A functional, large-bore PIV is the foundation of resuscitation: two 16-gauge PIVs can deliver fluids faster than a triple-lumen central line because flow is proportional to ...","sourceLabel":"Section in Clinical Procedures"},"407":{"title":"Arterial Line Placement","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s5","snippet":"Arterial Line Placement Arterial catheterization provides continuous blood pressure monitoring and convenient access for repeated arterial blood gas sampling. It is a cornerstone of critical care for any hemodynamically unstable patient, those on vasoactive infusions, or patients requiring frequent ...","sourceLabel":"Section in Clinical Procedures"},"408":{"title":"Central Venous Catheter Placement","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s6","snippet":"Central Venous Catheter Placement Central venous catheters (CVCs) provide reliable access for vasoactive infusions, central venous pressure monitoring, rapid resuscitation, vesicant chemotherapy, total parenteral nutrition, and access when peripheral options are exhausted. Ultrasound guidance has be...","sourceLabel":"Section in Clinical Procedures"},"409":{"title":"Intraosseous, PICC & Port Access","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s7","snippet":"Intraosseous, PICC & Port Access Intraosseous (IO) Access IO access provides rapid vascular access when peripheral IV placement fails in emergencies. The non-collapsible marrow space allows infusion of any medication or fluid that can be given through a PIV, at similar rates. Modern devices (EZ-IO d...","sourceLabel":"Section in Clinical Procedures"},"410":{"title":"Basic Airway & Bag-Mask Ventilation","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s8","snippet":"Basic Airway & Bag-Mask Ventilation Basic airway management is the most important skill in resuscitation. The ability to deliver effective bag-mask ventilation is more valuable than intubation, because inadequate oxygenation during intubation attempts is what causes hypoxic injury and cardiac arrest...","sourceLabel":"Section in Clinical Procedures"},"411":{"title":"Endotracheal Intubation & RSI","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s9","snippet":"Endotracheal Intubation & RSI Endotracheal intubation secures the airway with a cuffed tube, providing definitive protection against aspiration and reliable positive-pressure ventilation. Rapid sequence intubation (RSI) is the preferred technique for emergency intubation in patients at risk of aspir...","sourceLabel":"Section in Clinical Procedures"},"412":{"title":"Surgical Airway & Tracheostomy Care","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s10","snippet":"Surgical Airway & Tracheostomy Care Cricothyroidotomy Surgical cricothyroidotomy is the definitive rescue airway for \"can't intubate, can't oxygenate\" scenarios. It is faster and safer than emergency tracheostomy because the cricothyroid membrane is superficial and avascular. Indicated when failed i...","sourceLabel":"Section in Clinical Procedures"},"413":{"title":"Thoracentesis","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s11","snippet":"Thoracentesis Thoracentesis is the aspiration of pleural fluid for diagnostic analysis or therapeutic drainage of symptomatic effusions. Ultrasound guidance has become standard of care - it reduces pneumothorax rates by > 50% and allows identification of optimal puncture site, diaphragm position, an...","sourceLabel":"Section in Clinical Procedures"},"414":{"title":"Chest Tube & Needle Decompression","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s12","snippet":"Chest Tube & Needle Decompression Needle Thoracostomy for Tension Pneumothorax Tension pneumothorax is a clinical diagnosis (hypotension, distended neck veins, unilateral absent breath sounds, tracheal deviation) - treat immediately without imaging. The traditional site was 2nd intercostal space, mi...","sourceLabel":"Section in Clinical Procedures"},"415":{"title":"Pericardiocentesis","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s13","snippet":"Pericardiocentesis Pericardiocentesis is the percutaneous drainage of pericardial fluid, typically performed emergently for cardiac tamponade. Echocardiographic guidance has replaced blind subxiphoid approaches and has dramatically reduced complications. It is a life-saving procedure but requires ca...","sourceLabel":"Section in Clinical Procedures"},"416":{"title":"Paracentesis","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s14","snippet":"Paracentesis Paracentesis is the needle aspiration of peritoneal fluid for diagnostic evaluation or therapeutic relief of tense ascites. It is one of the safest invasive procedures when performed with ultrasound guidance and is mandatory in any cirrhotic patient admitted with ascites or sepsis to ru...","sourceLabel":"Section in Clinical Procedures"},"417":{"title":"NG/OG Tube Placement","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s15","snippet":"NG/OG Tube Placement Nasogastric and orogastric tubes decompress the stomach, provide enteral access for feeding or medication, and allow sampling of gastric contents. While seemingly routine, NG tube placement is uncomfortable for patients and carries real risks including airway misplacement (with ...","sourceLabel":"Section in Clinical Procedures"},"418":{"title":"Urinary Catheterization","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s16","snippet":"Urinary Catheterization Urethral catheterization provides bladder drainage for urinary retention, monitoring of urine output in critical illness, management of incontinence with wounds, and urinary diversion after GU surgery. CAUTIs are the most common HAI - use catheters only when necessary and rem...","sourceLabel":"Section in Clinical Procedures"},"419":{"title":"Lumbar Puncture","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s17","snippet":"Lumbar Puncture Lumbar puncture is the sampling of cerebrospinal fluid from the subarachnoid space for diagnosis of meningitis, subarachnoid hemorrhage, demyelinating disease, CNS malignancy, and measurement of opening pressure. It is also therapeutic for idiopathic intracranial hypertension and for...","sourceLabel":"Section in Clinical Procedures"},"420":{"title":"Traumatic LP & CSF Interpretation","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s18","snippet":"Traumatic LP & CSF Interpretation Normal CSF Values Parameter Normal Opening pressure 6-25 cmH2O (adults, lateral decubitus) Appearance Clear, colorless WBC &le; 5 cells/mm&sup3; (< 30% PMN) RBC 0 Protein 15-45 mg/dL Glucose 45-80 mg/dL (2/3 of serum) Figure 32 - CSF Specimen Collection. CSF is coll...","sourceLabel":"Section in Clinical Procedures"},"421":{"title":"Joint Aspiration & Injection","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s19","snippet":"Joint Aspiration & Injection Arthrocentesis is the aspiration of synovial fluid from a joint, essential for diagnosing septic arthritis (a limb- and life-threatening emergency), crystalline arthropathies, and inflammatory arthritis. The same approach is used for therapeutic injection of corticostero...","sourceLabel":"Section in Clinical Procedures"},"422":{"title":"Incision & Drainage of Abscess","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s20","snippet":"Incision & Drainage of Abscess Cutaneous abscesses require incision and drainage as the definitive treatment - antibiotics alone are inadequate. I&D provides source control, pain relief, and diagnostic specimens. Indications Fluctuant abscess on exam or ultrasound Hidradenitis suppurativa flare Pilo...","sourceLabel":"Section in Clinical Procedures"},"423":{"title":"Suturing & Wound Closure","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s21","snippet":"Suturing & Wound Closure Appropriate wound closure promotes healing, reduces infection, and optimizes cosmesis. Choice of technique depends on wound depth, location, tension, and contamination. Primary closure is appropriate for clean wounds < 6-8 hours old (up to 24 hours on face due to rich blood ...","sourceLabel":"Section in Clinical Procedures"},"424":{"title":"Splinting, Casting & Reductions","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s22","snippet":"Splinting, Casting & Reductions Splinting Principles Splints are half-circumferential plaster or fiberglass used for acute immobilization, allowing for swelling. Circumferential casts are applied after swelling has subsided (often after 3-7 days). Always immobilize the joint above and below a fractu...","sourceLabel":"Section in Clinical Procedures"},"425":{"title":"Nail & Soft Tissue Procedures","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s23","snippet":"Nail & Soft Tissue Procedures Nail Trephination (Subungual Hematoma) Indicated for painful subungual hematoma involving > 25-50% of the nail bed. Contraindicated if associated with distal phalanx fracture (relative - many still drain to relieve pain). Technique: cautery device (Bovie, electric caute...","sourceLabel":"Section in Clinical Procedures"},"426":{"title":"Skin Biopsy & Cryotherapy","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s24","snippet":"Skin Biopsy & Cryotherapy Skin Biopsy Types Type Technique Indications Shave Scalpel or curved razor removes epidermis and superficial dermis Raised lesions (seborrheic keratosis, nevi, BCC screening) Punch 3-6 mm circular blade penetrates to subcutaneous fat Inflammatory dermatoses, rashes, deep le...","sourceLabel":"Section in Clinical Procedures"},"427":{"title":"ENT Procedures & Epistaxis Management","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s25","snippet":"ENT Procedures & Epistaxis Management Epistaxis Anatomy Anterior bleeds (90%) : Kiesselbach's plexus on anterior nasal septum - watershed of anterior/posterior ethmoidal, sphenopalatine, and superior labial arteries. Posterior bleeds (10%) : sphenopalatine artery - present with bleeding from both na...","sourceLabel":"Section in Clinical Procedures"},"428":{"title":"Cardioversion, Defibrillation & ECG","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s26","snippet":"Cardioversion, Defibrillation & ECG Defibrillation Unsynchronized high-energy shock for pulseless VT/VF. Delivers energy regardless of cardiac cycle. Part of BLS/ACLS algorithm for shockable rhythms. Technique Recognize pulseless VT/VF Apply pads: anterior (right upper chest) + lateral (left midaxil...","sourceLabel":"Section in Clinical Procedures"},"429":{"title":"Complications, Checklists & Templates","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s27","snippet":"Complications, Checklists & Templates Master Procedure Complications Matrix Procedure Most Common Complication Most Serious Complication Peripheral IV Infiltration Sepsis from extended dwell Arterial line Hematoma/vasospasm Distal ischemia CVC (IJ) Carotid puncture CLABSI, PTX CVC (subclavian) PTX H...","sourceLabel":"Section in Clinical Procedures"},"430":{"title":"High-Yield Review","pageTitle":"Clinical Procedures","pageUrl":"/clinical-skills/clinical-procedures","url":"/clinical-skills/clinical-procedures#s28","snippet":"High-Yield Review Procedure Pearls - One-Liner Reminders Always perform a full time-out before any invasive procedure: patient, procedure, site, consent, allergies, anticoagulation, equipment, antibiotics. The time-out has reduced wrong-site and wrong-patient procedures by > 60%. Ultrasound guidance...","sourceLabel":"Section in Clinical Procedures"},"431":{"title":"Biostatistics & Epidemiology","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics","snippet":"Foundational Science Biostatistics & Epidemiology Complete Subject Reference Study design, descriptive and inferential statistics, hypothesis testing, sensitivity/specificity, odds and relative risk, confidence intervals, bias, confounding, clinical trial methodology, evidence-based medicine princip..."},"432":{"title":"Overview & Role of Biostatistics","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s1","snippet":"Overview & Role of Biostatistics Biostatistics and epidemiology are the quantitative foundations of evidence-based medicine. Biostatistics applies statistical methods to biological, medical, and public health data, while epidemiology is the study of the distribution and determinants of health-relate...","sourceLabel":"Section in Biostatistics & Epidemiology"},"433":{"title":"Core Terminology & Definitions","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s2","snippet":"Core Terminology & Definitions A shared vocabulary is essential for reading the medical literature. Misinterpretation of statistical terms is one of the most common sources of error in clinical reasoning. Foundational Terms Term Definition Population The entire group of interest (e.g., all adults wi...","sourceLabel":"Section in Biostatistics & Epidemiology"},"434":{"title":"Types of Data & Variables","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s3","snippet":"Types of Data & Variables The type of variable dictates which descriptive statistics and which statistical tests are appropriate. Misclassification of variable type is a common error that leads to choosing the wrong statistical test. Variable Classification Type Subtype Description Examples Categori...","sourceLabel":"Section in Biostatistics & Epidemiology"},"435":{"title":"Measures of Central Tendency","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s4","snippet":"Measures of Central Tendency Measures of central tendency describe the \"typical\" or \"center\" value of a dataset. The three classical measures are the mean, median, and mode, each with different strengths depending on data distribution. Mean, Median, Mode Measure Definition Best Used For Sensitive to...","sourceLabel":"Section in Biostatistics & Epidemiology"},"436":{"title":"Measures of Dispersion","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s5","snippet":"Measures of Dispersion Measures of dispersion quantify how spread out data are around the center. Two datasets can share the same mean but differ dramatically in variability, which matters enormously for clinical interpretation. Common Measures of Spread Measure Formula / Definition Comment Range Ma...","sourceLabel":"Section in Biostatistics & Epidemiology"},"437":{"title":"Distributions & Normality","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s6","snippet":"Distributions & Normality The shape of a data distribution determines which statistical methods are valid. Most inferential statistical tests assume specific distributional properties, and violating these assumptions can produce misleading results. The Normal (Gaussian) Distribution The normal distr...","sourceLabel":"Section in Biostatistics & Epidemiology"},"438":{"title":"Probability & Sampling","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s7","snippet":"Probability & Sampling Probability is the mathematical language of uncertainty and the foundation of inferential statistics. Sampling methods determine whether study results can be generalized to the target population. Rules of Probability Rule Formula Application Range 0 &le; P(A) &le; 1 Probabilit...","sourceLabel":"Section in Biostatistics & Epidemiology"},"439":{"title":"Central Limit Theorem & Standard Error","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s8","snippet":"Central Limit Theorem & Standard Error The central limit theorem (CLT) is the single most important result in statistics. It provides the theoretical foundation that allows statisticians to make inferences about population parameters from sample data even when the underlying population is not normal...","sourceLabel":"Section in Biostatistics & Epidemiology"},"440":{"title":"Confidence Intervals","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s9","snippet":"Confidence Intervals A confidence interval (CI) provides a range of plausible values for a population parameter based on sample data. CIs convey both the point estimate and its precision, and are generally preferred over p-values alone for reporting results. Interpretation A 95% confidence interval ...","sourceLabel":"Section in Biostatistics & Epidemiology"},"441":{"title":"Hypothesis Testing & p-Values","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s10","snippet":"Hypothesis Testing & p-Values Hypothesis testing is the formal framework for deciding whether observed data provide enough evidence to reject a null hypothesis in favor of an alternative. It produces the ubiquitous but frequently misinterpreted p-value. Steps in Hypothesis Testing State the null (H ...","sourceLabel":"Section in Biostatistics & Epidemiology"},"442":{"title":"Type I, Type II Errors & Power","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s11","snippet":"Type I, Type II Errors & Power Statistical inference can go wrong in two ways: rejecting a true null hypothesis (Type I error) or failing to reject a false null hypothesis (Type II error). Understanding these errors is essential for designing studies and interpreting results. Error Matrix H 0 True (...","sourceLabel":"Section in Biostatistics & Epidemiology"},"443":{"title":"Parametric Tests (t-test, ANOVA, Regression)","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s12","snippet":"Parametric Tests (t-test, ANOVA, Regression) Parametric tests assume that data follow a known distribution (usually normal) and compare means or other parameters. They are more powerful than non-parametric alternatives when assumptions are met. t-Tests Test Use Example One-sample t-test Compare samp...","sourceLabel":"Section in Biostatistics & Epidemiology"},"444":{"title":"Non-Parametric Tests (Chi-Square, Mann-Whitney)","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s13","snippet":"Non-Parametric Tests (Chi-Square, Mann-Whitney) Non-parametric tests make fewer assumptions about the underlying distribution. They are appropriate for ordinal data, small samples, or continuous data that is clearly non-normal and cannot be transformed. Tests for Categorical Data Test Use Requiremen...","sourceLabel":"Section in Biostatistics & Epidemiology"},"445":{"title":"Survival Analysis & Cox Regression","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s14","snippet":"Survival Analysis & Cox Regression Survival analysis handles time-to-event data, including the challenge of censoring - subjects whose event has not occurred by study end or who are lost to follow-up. It is essential in oncology, cardiology, and transplant medicine. Kaplan-Meier Analysis The Kaplan-...","sourceLabel":"Section in Biostatistics & Epidemiology"},"446":{"title":"Correlation & Logistic Regression","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s15","snippet":"Correlation & Logistic Regression Correlation Coefficients Correlation measures the strength and direction of association between two variables. It does not imply causation. Pearson's r: Linear correlation between two continuous, normally distributed variables. Range: &minus;1 to +1. Spearman's &rho...","sourceLabel":"Section in Biostatistics & Epidemiology"},"447":{"title":"Sensitivity, Specificity, PPV & NPV","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s16","snippet":"Sensitivity, Specificity, PPV & NPV Evaluating diagnostic tests requires understanding their intrinsic properties (sensitivity, specificity) and how those properties translate into clinical predictive values given disease prevalence. The 2&times;2 Diagnostic Table Disease + Disease &minus; Total Tes...","sourceLabel":"Section in Biostatistics & Epidemiology"},"448":{"title":"Likelihood Ratios & ROC Curves","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s17","snippet":"Likelihood Ratios & ROC Curves Likelihood Ratios Likelihood ratios combine sensitivity and specificity into a single number that quantifies how much a test result changes the probability of disease. Unlike PPV/NPV, LRs are independent of prevalence. Positive LR (LR+) = SN / (1 &minus; SP) - how much...","sourceLabel":"Section in Biostatistics & Epidemiology"},"449":{"title":"Bayes Theorem & Pre/Post-Test Probability","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s18","snippet":"Bayes Theorem & Pre/Post-Test Probability Bayes theorem formalizes how prior knowledge (pre-test probability) combines with new evidence (test results) to update the probability of disease (post-test probability). It is the mathematical foundation of clinical diagnostic reasoning. The Theorem P(Dise...","sourceLabel":"Section in Biostatistics & Epidemiology"},"450":{"title":"Measures of Disease Frequency","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s19","snippet":"Measures of Disease Frequency Epidemiology quantifies how common diseases are in populations. The core measures are incidence (new cases) and prevalence (existing cases), each with distinct uses and interpretations. Core Frequency Measures Measure Formula Interpretation Incidence rate New cases / pe...","sourceLabel":"Section in Biostatistics & Epidemiology"},"451":{"title":"Measures of Association (RR, OR, NNT)","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s20","snippet":"Measures of Association (RR, OR, NNT) Measures of association quantify the strength of the relationship between exposure and outcome. Different measures are appropriate for different study designs. 2&times;2 Table for Exposure/Outcome Disease + Disease &minus; Exposed a b Unexposed c d Relative Meas...","sourceLabel":"Section in Biostatistics & Epidemiology"},"452":{"title":"Standardization & Adjusted Rates","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s21","snippet":"Standardization & Adjusted Rates Comparing crude rates between populations can be misleading because of differences in underlying structure (e.g., age distribution). Standardization adjusts for these differences. Direct vs Indirect Standardization Method Approach Use Direct standardization Apply obs...","sourceLabel":"Section in Biostatistics & Epidemiology"},"453":{"title":"Observational Study Designs","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s22","snippet":"Observational Study Designs Observational studies observe exposures and outcomes without intervention. They are essential when randomization is unethical or impractical but are more vulnerable to bias and confounding than experiments. Descriptive Designs Design Description Strengths Limitations Case...","sourceLabel":"Section in Biostatistics & Epidemiology"},"454":{"title":"Randomized Controlled Trials & Phases","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s23","snippet":"Randomized Controlled Trials & Phases The randomized controlled trial is the gold standard for establishing causation and evaluating interventions. Random allocation controls for both known and unknown confounders, allowing causal inference. Key Features of RCTs Randomization: Allocation by chance e...","sourceLabel":"Section in Biostatistics & Epidemiology"},"455":{"title":"Meta-Analysis, Systematic Review & GRADE","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s24","snippet":"Meta-Analysis, Systematic Review & GRADE Systematic reviews and meta-analyses synthesize evidence across multiple studies to produce more precise estimates and resolve conflicting findings. They sit at the top of the evidence hierarchy when well-conducted. Systematic Review vs Meta-Analysis Systemat...","sourceLabel":"Section in Biostatistics & Epidemiology"},"456":{"title":"Bias & Error Types","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s25","snippet":"Bias & Error Types Bias is systematic error that distorts study results in a particular direction. Unlike random error, bias cannot be fixed by increasing sample size - it must be prevented through careful study design. Selection Bias Type Description Prevention Sampling (ascertainment) Sample not r...","sourceLabel":"Section in Biostatistics & Epidemiology"},"457":{"title":"Confounding, Effect Modification & Causation","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s26","snippet":"Confounding, Effect Modification & Causation Confounding A confounder is a variable that is (1) associated with the exposure, (2) independently associated with the outcome, and (3) not on the causal pathway between exposure and outcome. Confounding distorts the apparent relationship between exposure...","sourceLabel":"Section in Biostatistics & Epidemiology"},"458":{"title":"Screening & USPSTF Principles","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s27","snippet":"Screening & USPSTF Principles Screening is the testing of asymptomatic individuals to detect disease at an earlier, more treatable stage. Effective screening requires meeting specific criteria to justify its cost, harms, and population impact. WHO / Wilson-Jungner Criteria for Screening Disease is a...","sourceLabel":"Section in Biostatistics & Epidemiology"},"459":{"title":"High-Yield Review","pageTitle":"Biostatistics & Epidemiology","pageUrl":"/biostats/biostatistics","url":"/biostats/biostatistics#s28","snippet":"High-Yield Review The following is a distilled review of the most commonly tested and clinically essential concepts in biostatistics and epidemiology. Statistical Test Selection Cheat Sheet Outcome Groups Parametric Non-Parametric Continuous 1 sample vs known One-sample t-test Wilcoxon signed-rank C...","sourceLabel":"Section in Biostatistics & Epidemiology"},"460":{"title":"Evidence-Based Medicine","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine","snippet":"Foundational Science Evidence-Based Medicine Complete Subject Reference Asking clinical questions, finding evidence, critically appraising studies, applying evidence to patients, hierarchy of evidence, GRADE methodology, clinical practice guidelines, shared decision-making, and every concept and too..."},"461":{"title":"Overview & History of EBM","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s1","snippet":"Overview & History of EBM Evidence-based medicine (EBM) is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Rather than relying solely on pathophysiologic reasoning, clinical anecdote, or authority, EBM demands that tr...","sourceLabel":"Section in Evidence-Based Medicine"},"462":{"title":"Defining EBM & the Three Pillars","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s2","snippet":"Defining EBM & the Three Pillars The Sackett Definition David Sackett's 1996 BMJ editorial provides the canonical definition: \"Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of...","sourceLabel":"Section in Evidence-Based Medicine"},"463":{"title":"EBM vs Traditional Medicine","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s3","snippet":"EBM vs Traditional Medicine Traditional (pre-EBM) medical practice was dominated by eminence-based decisions - senior authorities in a field determined standards of care, often based on pathophysiologic reasoning or uncontrolled clinical experience. While valuable, this approach produced and perpetu...","sourceLabel":"Section in Evidence-Based Medicine"},"464":{"title":"Step 1 - Ask (PICO/PICOT)","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s4","snippet":"Step 1 - Ask (PICO/PICOT) The 5-step EBM cycle begins with transforming a clinical information need into an answerable question . A well-constructed question is the foundation of an efficient literature search and a relevant appraisal. The most widely used framework is PICO (sometimes extended to PI...","sourceLabel":"Section in Evidence-Based Medicine"},"465":{"title":"Types of Clinical Questions","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s5","snippet":"Types of Clinical Questions Different types of clinical questions demand different study designs for their answer. Recognizing the question type determines where to look and how to appraise what you find. The Five Major Question Types Question Type What It Asks Best Study Design Example Therapy Does...","sourceLabel":"Section in Evidence-Based Medicine"},"466":{"title":"Steps 2-5 - Acquire, Appraise, Apply, Assess","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s6","snippet":"Steps 2-5 - Acquire, Appraise, Apply, Assess Once the question is framed, the remaining steps of the EBM cycle turn evidence into action and feed back into improved practice. The Full 5-Step EBM Cycle Step Activity Key Tools 1. Ask Convert information need into an answerable question PICO/PICOT fram...","sourceLabel":"Section in Evidence-Based Medicine"},"467":{"title":"Databases & Point-of-Care Resources","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s7","snippet":"Databases & Point-of-Care Resources Knowing which database to search is as important as knowing how to search it. Resources differ in scope, filtering, and the degree to which evidence has already been appraised. Major Biomedical Databases Database Scope Notes PubMed Free interface to MEDLINE + PubM...","sourceLabel":"Section in Evidence-Based Medicine"},"468":{"title":"Search Strategy, Boolean Logic & MeSH","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s8","snippet":"Search Strategy, Boolean Logic & MeSH Efficient searching combines controlled vocabulary (MeSH), free-text terms, Boolean operators, and filters. A good strategy balances sensitivity (capturing all relevant studies) with specificity (excluding irrelevant ones). Boolean Operators Operator Effect Exam...","sourceLabel":"Section in Evidence-Based Medicine"},"469":{"title":"The Evidence Pyramid","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s9","snippet":"The Evidence Pyramid Not all evidence is created equal. The evidence pyramid visualizes a rough hierarchy of study designs by their ability to reduce bias in estimating treatment effects. Higher-tier designs are more likely (on average) to provide valid estimates, but a well-done cohort can outperfo...","sourceLabel":"Section in Evidence-Based Medicine"},"470":{"title":"Study Designs Overview","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s10","snippet":"Study Designs Overview The choice of study design is driven by the question and by ethical and practical constraints. This section summarizes the major designs and when to use each. Experimental Designs Design Key Feature Strength Weakness Parallel-group RCT Random assignment to arms Minimizes confo...","sourceLabel":"Section in Evidence-Based Medicine"},"471":{"title":"Validity of RCTs","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s11","snippet":"Validity of RCTs Critical appraisal of a therapy study asks three core questions: (1) Are the results valid? (2) What are the results? (3) Will they help me care for my patient? This section focuses on validity - whether the study design protects against bias. Key Validity Criteria for RCTs Criterio...","sourceLabel":"Section in Evidence-Based Medicine"},"472":{"title":"Results - Effect Size, RR, ARR, NNT, CI","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s12","snippet":"Results - Effect Size, RR, ARR, NNT, CI Once validity is established, the next appraisal question is: how large is the effect, and how precise is the estimate? Effect size measures quantify the impact; confidence intervals quantify precision. Core Effect Measures (Dichotomous Outcomes) Measure Formu...","sourceLabel":"Section in Evidence-Based Medicine"},"473":{"title":"Applicability & CONSORT","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s13","snippet":"Applicability & CONSORT A valid, precise result is useless if it does not apply to your patient. Applicability (external validity, generalizability) asks whether you can extrapolate the study findings to the person in front of you. Applicability Questions Is my patient similar enough to the trial po...","sourceLabel":"Section in Evidence-Based Medicine"},"474":{"title":"Diagnostic Study Validity & Biases","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s14","snippet":"Diagnostic Study Validity & Biases Diagnostic studies evaluate how well a test distinguishes patients with the disease from those without it. Critical appraisal here has its own vocabulary and pitfalls. Validity Criteria for Diagnostic Studies Criterion Why It Matters Independent, blinded comparison...","sourceLabel":"Section in Evidence-Based Medicine"},"475":{"title":"Sensitivity, Specificity, LRs, ROC, STARD & QUADAS-2","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s15","snippet":"Sensitivity, Specificity, LRs, ROC, STARD & QUADAS-2 The 2&times;2 Diagnostic Table Disease + Disease &minus; Test + True Positive (TP) False Positive (FP) Test &minus; False Negative (FN) True Negative (TN) Core Diagnostic Metrics Metric Formula Interpretation Sensitivity (Sn) TP / (TP + FN) Probab...","sourceLabel":"Section in Evidence-Based Medicine"},"476":{"title":"Prognosis Studies & Cohort Design","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s16","snippet":"Prognosis Studies & Cohort Design Prognosis studies estimate the likely course of a disease - rate of recovery, progression, complications, death, or functional outcome. They answer questions patients ask most often: \"What will happen to me?\" The ideal design is a prospective inception cohort with c...","sourceLabel":"Section in Evidence-Based Medicine"},"477":{"title":"Harm Studies & Hill Criteria","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s17","snippet":"Harm Studies & Hill Criteria Harm studies ask whether an exposure (drug, environmental factor, device) causes an adverse outcome. Because harms often cannot be ethically randomized, most harm evidence comes from cohorts, case-control studies, and pharmacovigilance. Cohort vs Case-Control for Harm De...","sourceLabel":"Section in Evidence-Based Medicine"},"478":{"title":"SR Methodology & PRISMA","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s18","snippet":"SR Methodology & PRISMA A systematic review is the highest form of literature synthesis when done well. Its value depends entirely on the rigor of its methods - a poorly conducted SR is worse than a single well-done trial because its conclusions carry false authority. Steps of a Systematic Review Fr...","sourceLabel":"Section in Evidence-Based Medicine"},"479":{"title":"Meta-Analysis & Forest Plots","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s19","snippet":"Meta-Analysis & Forest Plots Meta-analysis statistically combines results from multiple studies into a pooled effect estimate. Done well, it increases precision and power; done poorly, it produces a misleadingly confident summary of heterogeneous or biased studies. Figure 33 - Forest Plot (Binary Ou...","sourceLabel":"Section in Evidence-Based Medicine"},"480":{"title":"Heterogeneity, Publication Bias & GRADE","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s20","snippet":"Heterogeneity, Publication Bias & GRADE Heterogeneity Heterogeneity is variation between studies beyond what would be expected by chance. Sources include clinical (different populations, interventions), methodological (different designs, risk of bias), and statistical heterogeneity. Statistic Interp...","sourceLabel":"Section in Evidence-Based Medicine"},"481":{"title":"Clinical Practice Guidelines & AGREE II","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s21","snippet":"Clinical Practice Guidelines & AGREE II Clinical practice guidelines (CPGs) are \"statements that include recommendations intended to optimize patient care, informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options\" (IOM, 2011). Well-made guid...","sourceLabel":"Section in Evidence-Based Medicine"},"482":{"title":"Shared Decision-Making","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s22","snippet":"Shared Decision-Making Shared decision-making (SDM) is the process in which clinicians and patients make decisions together using the best available evidence, accounting for the patient's values, preferences, and circumstances. It is the clinical operationalization of the third pillar of EBM. When S...","sourceLabel":"Section in Evidence-Based Medicine"},"483":{"title":"Special Topics - RWE, Big Data, ML, NMA","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s23","snippet":"Special Topics - RWE, Big Data, ML, NMA Real-World Evidence (RWE) Real-world evidence is clinical evidence derived from routine care data - EHRs, claims databases, registries, wearables. The FDA formally incorporates RWE in post-marketing drug and device decisions. RWE can answer questions RCTs cann...","sourceLabel":"Section in Evidence-Based Medicine"},"484":{"title":"Common Pitfalls in EBM","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s24","snippet":"Common Pitfalls in EBM Even carefully conducted studies can mislead. The following pitfalls are among the most common reasons that apparently strong evidence fails to replicate or translate. Statistical vs Clinical Significance (Revisited) A p-value tells you whether an effect is likely different fr...","sourceLabel":"Section in Evidence-Based Medicine"},"485":{"title":"Reference - Checklists & Tables","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s25","snippet":"Reference - Checklists & Tables This section consolidates high-yield reference material - critical appraisal checklists, study design comparisons, GRADE summaries, and common database features. Critical Appraisal Quick Checklist - Therapy Question Look For Randomized? Method of sequence generation A...","sourceLabel":"Section in Evidence-Based Medicine"},"486":{"title":"High-Yield Review","pageTitle":"Evidence-Based Medicine","pageUrl":"/biostats/evidence-based-medicine","url":"/biostats/evidence-based-medicine#s26","snippet":"High-Yield Review This final section distills the most commonly tested and clinically essential EBM concepts. The EBM Mindset in One Paragraph Practicing EBM means approaching every clinical decision with humility about uncertainty, discipline about evidence, and respect for patient values. It means...","sourceLabel":"Section in Evidence-Based Medicine"},"487":{"title":"Medical Ethics & Bioethics","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics","snippet":"Foundational Knowledge Medical Ethics Complete Subject Reference The four principles of biomedical ethics, informed consent, capacity and competence, surrogate decision-making, end-of-life care, confidentiality, professionalism, conflicts of interest, research ethics, and every ethical principle and..."},"488":{"title":"Overview & Significance","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s1","snippet":"Overview & Significance Medical ethics is the systematic analysis of moral obligations and values that govern the practice of medicine. It answers the question, \"What should a physician do?\" when technical capability is not enough - when the answer depends on what is right, fair, honest, or kind. Ev...","sourceLabel":"Section in Medical Ethics & Bioethics"},"489":{"title":"History of Medical Ethics","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s2","snippet":"History of Medical Ethics Medical ethics has evolved from ancient professional codes grounded in physician virtue to modern frameworks emphasizing patient rights, informed consent, and social justice. The arc of this evolution - from paternalism to shared decision-making - is itself a core lesson ab...","sourceLabel":"Section in Medical Ethics & Bioethics"},"490":{"title":"Ethical Theories & Frameworks","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s3","snippet":"Ethical Theories & Frameworks Normative ethical theories provide the philosophical foundations from which medical principles are derived. No single theory resolves every dilemma; experienced ethicists draw on multiple frameworks depending on context. Understanding each theory helps clarify why reaso...","sourceLabel":"Section in Medical Ethics & Bioethics"},"491":{"title":"Codes of Ethics & Principlism","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s4","snippet":"Codes of Ethics & Principlism Professional codes translate abstract principles into concrete rules that govern everyday practice. They serve four functions: articulating shared norms, guiding individual conduct, holding the profession accountable, and signaling commitments to patients and society. F...","sourceLabel":"Section in Medical Ethics & Bioethics"},"492":{"title":"Autonomy","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s5","snippet":"Autonomy Autonomy (from Greek autos \"self\" and nomos \"rule\") is the capacity of a person to govern themselves - to deliberate about personal goals and act on those deliberations. Respect for autonomy requires that clinicians acknowledge patients' right to hold views, make choices, and act based on t...","sourceLabel":"Section in Medical Ethics & Bioethics"},"493":{"title":"Beneficence","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s6","snippet":"Beneficence Beneficence is the obligation to act for the benefit of others - to prevent harm, remove harm, and promote good. In medicine it is the physician's affirmative duty to help the patient, the oldest explicit obligation of the profession, dating to the Hippocratic tradition. Unlike autonomy,...","sourceLabel":"Section in Medical Ethics & Bioethics"},"494":{"title":"Non-Maleficence","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s7","snippet":"Non-Maleficence Non-maleficence, the obligation to avoid causing harm, is captured in the phrase primum non nocere (\"first, do no harm\") - a paraphrase not actually in the Hippocratic Oath but deeply embedded in medical culture. Non-maleficence is often treated together with beneficence, but they ar...","sourceLabel":"Section in Medical Ethics & Bioethics"},"495":{"title":"Justice & Balancing Principles","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s8","snippet":"Justice & Balancing Principles Justice in medical ethics concerns the fair distribution of benefits, risks, and resources. It addresses questions of who gets what care, on what basis, and at whose expense. Unlike the other principles, justice operates at individual, institutional, and societal level...","sourceLabel":"Section in Medical Ethics & Bioethics"},"496":{"title":"Elements & Standards of Disclosure","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s9","snippet":"Elements & Standards of Disclosure Informed consent is the process by which a patient, having been adequately informed, voluntarily authorizes a medical intervention. It is the operational expression of respect for autonomy and is both an ethical and legal requirement. Consent is not a form - it is ...","sourceLabel":"Section in Medical Ethics & Bioethics"},"497":{"title":"Exceptions, Refusal & Special Populations","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s10","snippet":"Exceptions, Refusal & Special Populations Recognized Exceptions to Informed Consent Exception Explanation Emergency Immediate intervention to prevent death or serious harm; consent presumed when patient incapacitated and no surrogate available Incapacity Patient lacks capacity; surrogate consent obt...","sourceLabel":"Section in Medical Ethics & Bioethics"},"498":{"title":"Capacity vs Competence","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s11","snippet":"Capacity vs Competence Capacity and competence are often used interchangeably in conversation but have distinct technical meanings. Competence is a legal determination made by a court; an adult is presumed competent unless adjudicated otherwise. Capacity is a clinical determination made by a physici...","sourceLabel":"Section in Medical Ethics & Bioethics"},"499":{"title":"Capacity Assessment in Practice","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s12","snippet":"Capacity Assessment in Practice When to Assess Capacity Formal capacity assessment is warranted when: (1) the patient's decision is inconsistent with previously stated values, (2) an abrupt change in decision-making pattern occurs, (3) cognitive impairment is suspected, (4) the decision carries very...","sourceLabel":"Section in Medical Ethics & Bioethics"},"500":{"title":"Surrogate Hierarchy & Standards","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s13","snippet":"Surrogate Hierarchy & Standards When a patient lacks capacity and the decision cannot wait, decisions are made by a surrogate. Surrogates should respect the patient's previously expressed wishes, values, and interests - they are not authorized to impose their own preferences. Typical Surrogate Hiera...","sourceLabel":"Section in Medical Ethics & Bioethics"},"501":{"title":"Advance Directives & POLST","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s14","snippet":"Advance Directives & POLST Advance directives are legal documents in which capable individuals specify preferences or designate surrogates for future decisions. They exist to extend autonomy into periods of incapacity. Patient Self-Determination Act (1990) The federal Patient Self-Determination Act ...","sourceLabel":"Section in Medical Ethics & Bioethics"},"502":{"title":"Family Conflict & Resolution","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s15","snippet":"Family Conflict & Resolution Family conflict at the bedside is common and distressing. Conflicts may arise between the patient and family, between family members, between family and the care team, or within the care team itself. Most are rooted in grief, fear, guilt, inadequate information, or unres...","sourceLabel":"Section in Medical Ethics & Bioethics"},"503":{"title":"Withholding vs Withdrawing & Futility","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s16","snippet":"Withholding vs Withdrawing & Futility End-of-life ethics is the domain where principles are most often in tension and where clear reasoning matters most. The patient is vulnerable, the stakes are final, and clinicians often feel emotional burden that clouds judgment. Psychological and Moral Weight E...","sourceLabel":"Section in Medical Ethics & Bioethics"},"504":{"title":"Brain Death & Organ Donation","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s17","snippet":"Brain Death & Organ Donation History of Brain Death The concept of brain death emerged in the 1960s with the advent of mechanical ventilation, which allowed cardiopulmonary function to continue in patients whose brains had irreversibly ceased to function. The 1968 Harvard criteria were the first wid...","sourceLabel":"Section in Medical Ethics & Bioethics"},"505":{"title":"Palliative Sedation & Double Effect","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s18","snippet":"Palliative Sedation & Double Effect Principled Distinctions End-of-life ethics relies on a set of principled distinctions that are contested but widely accepted in US ethics: killing vs allowing to die, intending vs foreseeing, ordinary vs extraordinary means, and active vs passive intervention. The...","sourceLabel":"Section in Medical Ethics & Bioethics"},"506":{"title":"Aid-in-Dying, CPR/DNR & Goals of Care","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s19","snippet":"Aid-in-Dying, CPR/DNR & Goals of Care The Shift from \"Code Status\" to \"Goals of Care\" Historically, code status was often the first and only end-of-life conversation, posed in procedural terms (\"do you want chest compressions?\"). The contemporary standard is to embed code status within a broader goa...","sourceLabel":"Section in Medical Ethics & Bioethics"},"507":{"title":"Confidentiality, HIPAA & Exceptions","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s20","snippet":"Confidentiality, HIPAA & Exceptions Confidentiality - the duty not to disclose information shared within a professional relationship - is as old as the Hippocratic Oath. It serves both individual autonomy and the public good: if patients cannot trust confidentiality, they will not disclose informati...","sourceLabel":"Section in Medical Ethics & Bioethics"},"508":{"title":"Professionalism & Boundaries","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s21","snippet":"Professionalism & Boundaries Professionalism is the set of attitudes, behaviors, and obligations that define the physician as a member of a profession that has made public commitments to patient welfare, competence, and integrity. Boundary issues are the most common professionalism concerns raised t...","sourceLabel":"Section in Medical Ethics & Bioethics"},"509":{"title":"Conflicts of Interest & Industry","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s22","snippet":"Conflicts of Interest & Industry A conflict of interest (COI) arises when a secondary interest (financial gain, career advancement, family relationship) may unduly influence a professional judgment concerning a primary interest (patient welfare, scientific integrity). COIs are not inherently unethic...","sourceLabel":"Section in Medical Ethics & Bioethics"},"510":{"title":"Research Ethics & IRB","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s23","snippet":"Research Ethics & IRB Research ethics applies broader ethical principles to the generation of generalizable knowledge. Because research subjects often bear risks without direct benefit, stricter safeguards apply than in clinical care. Historical Context: Why Research Ethics Is Distinct Clinical medi...","sourceLabel":"Section in Medical Ethics & Bioethics"},"511":{"title":"Pediatric & Reproductive Ethics","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s24","snippet":"Pediatric & Reproductive Ethics Constitutional and Statutory Background Pediatric and reproductive ethics operate against a dynamic legal backdrop. Federal and state law, court decisions, and agency regulations all shape what is permitted, required, or prohibited. Clinicians must be familiar with th...","sourceLabel":"Section in Medical Ethics & Bioethics"},"512":{"title":"Genetic Testing & Resource Allocation","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s25","snippet":"Genetic Testing & Resource Allocation Informed Consent for Genomic Testing Consent for clinical genomic testing should cover: the condition being tested for, the test's sensitivity and specificity, possible results (positive, negative, uncertain), implications for family members, handling of inciden...","sourceLabel":"Section in Medical Ethics & Bioethics"},"513":{"title":"Cross-Cultural, Truth-Telling & Error Disclosure","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s26","snippet":"Cross-Cultural, Truth-Telling & Error Disclosure Overview Some of the most difficult ethical issues in practice do not involve dramatic dilemmas but everyday patterns of communication: when and how to deliver hard news, how to navigate cultural differences without imposing one's own values, and how ...","sourceLabel":"Section in Medical Ethics & Bioethics"},"514":{"title":"Ethics Consultation & Landmark Cases","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s27","snippet":"Ethics Consultation & Landmark Cases Integrating Ethics into Daily Practice Ethics is not a separate activity reserved for consultations; it is a dimension of every clinical encounter. Brief ethical attention - asking the patient's goals, confirming understanding, checking for hidden concerns, ackno...","sourceLabel":"Section in Medical Ethics & Bioethics"},"515":{"title":"High-Yield Review","pageTitle":"Medical Ethics & Bioethics","pageUrl":"/ethics-law/medical-ethics","url":"/ethics-law/medical-ethics#s28","snippet":"High-Yield Review This section consolidates the most frequently tested concepts and the heuristics that resolve the overwhelming majority of medical ethics exam questions. One-Page Glossary Term Definition Autonomy Self-governance; right to make informed choices about one's own body and care Benefic...","sourceLabel":"Section in Medical Ethics & Bioethics"},"516":{"title":"Medical Law","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law","snippet":"Foundational Knowledge Medical Law Complete Subject Reference Medical malpractice, negligence, informed consent law, HIPAA, reportable conditions, EMTALA, end-of-life law, scope of practice, licensing, and every legal principle and statutory framework that governs the practice of medicine."},"517":{"title":"Overview & Significance","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s1","snippet":"Overview & Significance Medical law is the body of statutes, regulations, common-law doctrines, and constitutional principles that govern the practice of medicine, the physician-patient relationship, and the operation of health care institutions. Unlike medical ethics - which asks what a physician o...","sourceLabel":"Section in Medical Law"},"518":{"title":"Sources of Law & Jurisdiction","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s2","snippet":"Sources of Law & Jurisdiction American law governing medicine is layered. It derives from multiple sources and operates at both federal and state levels. Understanding where a given rule comes from explains how it can be changed, challenged, or enforced. The Four Sources of Law Source Authority Medi...","sourceLabel":"Section in Medical Law"},"519":{"title":"Civil vs Criminal Law & Standards of Proof","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s3","snippet":"Civil vs Criminal Law & Standards of Proof Most legal exposure in medicine is civil - a private lawsuit brought by a patient seeking money damages. Criminal liability is rare but serious, reserved for conduct such as sexual assault, drug diversion, Medicare fraud, manslaughter, or homicide. Administ...","sourceLabel":"Section in Medical Law"},"520":{"title":"Tort Law & the Physician-Patient Relationship","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s4","snippet":"Tort Law & the Physician-Patient Relationship A tort is a civil wrong for which the law provides a remedy in damages. Medical practice generates three broad categories of tort exposure: negligence (the overwhelming majority of malpractice cases), intentional torts (battery, false imprisonment, inten...","sourceLabel":"Section in Medical Law"},"521":{"title":"The Four Elements of Negligence","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s5","snippet":"The Four Elements of Negligence Medical malpractice is a specialized form of the tort of negligence . To prevail, a plaintiff must prove all four elements by a preponderance of the evidence. Failure on any single element defeats the claim. The Four Elements - \"Duty, Breach, Causation, Damages\" Eleme...","sourceLabel":"Section in Medical Law"},"522":{"title":"Standard of Care & Expert Testimony","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s6","snippet":"Standard of Care & Expert Testimony The standard of care is the legal yardstick against which physician conduct is measured. It is defined as the care that a reasonably prudent physician of similar training and experience would provide under similar circumstances. It is not perfection, nor is it \"be...","sourceLabel":"Section in Medical Law"},"523":{"title":"Causation, Damages & Res Ipsa Loquitur","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s7","snippet":"Causation, Damages & Res Ipsa Loquitur But-For and Proximate Cause Plaintiffs must show both that the breach was a but-for cause of the injury (the injury would not have happened absent the breach) and that the injury was a foreseeable consequence (proximate cause). In complex cases with multiple co...","sourceLabel":"Section in Medical Law"},"524":{"title":"Defenses & Tort Reform","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s8","snippet":"Defenses & Tort Reform Common Defenses to Malpractice Defense Elements Effect No breach Care met the standard Complete defense No causation Injury would have occurred anyway Complete defense Contributory negligence Any fault by the patient bars recovery (minority rule) Complete defense in a few stat...","sourceLabel":"Section in Medical Law"},"525":{"title":"Legal Elements of Informed Consent","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s9","snippet":"Legal Elements of Informed Consent Informed consent is both an ethical cornerstone and a legal requirement. It is rooted in the doctrine of autonomy and enforced through two legal theories: battery (when no consent was obtained for a touching) and negligence (when consent was obtained but inadequate...","sourceLabel":"Section in Medical Law"},"526":{"title":"Disclosure Standards & Exceptions","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s10","snippet":"Disclosure Standards & Exceptions The Two Disclosure Standards Standard Measured By Used In Reasonable physician standard What a reasonably prudent physician would disclose Roughly half of states; older rule Reasonable patient (materiality) standard What a reasonable patient would want to know to ma...","sourceLabel":"Section in Medical Law"},"527":{"title":"Minors, Capacity & Surrogate Consent","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s11","snippet":"Minors, Capacity & Surrogate Consent Capacity vs Competency Competency is a legal determination made by a court. Capacity is a clinical determination made by a physician at the bedside. An adult is presumed to have capacity unless clinical assessment demonstrates otherwise. Capacity is decision-spec...","sourceLabel":"Section in Medical Law"},"528":{"title":"HIPAA Privacy Rule","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s12","snippet":"HIPAA Privacy Rule The Health Insurance Portability and Accountability Act of 1996 (HIPAA) , together with its implementing regulations, is the federal framework for protecting patient health information. HIPAA does not preempt stricter state laws - it sets a national floor . The HITECH Act (2009) s...","sourceLabel":"Section in Medical Law"},"529":{"title":"Security Rule & Breach Notification","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s13","snippet":"Security Rule & Breach Notification Security Rule The HIPAA Security Rule governs electronic PHI (ePHI) and requires covered entities and business associates to implement administrative, physical, and technical safeguards: Safeguard Category Examples Administrative Risk analysis, workforce training,...","sourceLabel":"Section in Medical Law"},"530":{"title":"Patient Rights & Disclosures","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s14","snippet":"Patient Rights & Disclosures Individual Rights Under HIPAA Right Description Access Right to inspect and obtain a copy of PHI in the designated record set Amendment Right to request correction of inaccurate or incomplete PHI Accounting of disclosures Right to a list of non-routine disclosures made i...","sourceLabel":"Section in Medical Law"},"531":{"title":"State Privacy Laws & Heightened Protections","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s15","snippet":"State Privacy Laws & Heightened Protections HIPAA sets a federal minimum, but many categories of information receive heightened protection under state or federal law and require specific authorization even for routine disclosures. Categories with Heightened Protection Category Source Key Rule Substa...","sourceLabel":"Section in Medical Law"},"532":{"title":"EMTALA: Screening, Stabilization, Transfer","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s16","snippet":"EMTALA: Screening, Stabilization, Transfer The Emergency Medical Treatment and Active Labor Act (EMTALA) , enacted in 1986 as part of COBRA, was Congress's response to \"patient dumping\" - hospitals transferring or refusing care to uninsured patients. EMTALA applies to hospitals with emergency depart...","sourceLabel":"Section in Medical Law"},"533":{"title":"Fraud & Abuse: Stark, Anti-Kickback, FCA","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s17","snippet":"Fraud & Abuse: Stark, Anti-Kickback, FCA Federal fraud and abuse laws police the financial relationships between physicians, hospitals, and payers. They are strictly enforced, carry severe penalties, and can apply even in the absence of patient harm. Stark Law (Physician Self-Referral) The Stark Law...","sourceLabel":"Section in Medical Law"},"534":{"title":"Communicable & Occupational Diseases","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s18","snippet":"Communicable & Occupational Diseases Mandatory reporting laws require physicians to report certain conditions and events to public health authorities, licensing boards, or law enforcement. The categories and specifics vary by state, but the general framework is consistent. Reporting obligations are ...","sourceLabel":"Section in Medical Law"},"535":{"title":"Abuse, Violence & Public Safety Reporting","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s19","snippet":"Abuse, Violence & Public Safety Reporting Child Abuse & Neglect All 50 states mandate that physicians and other health care providers report suspected child abuse or neglect to child protective services or law enforcement. The standard is reasonable suspicion , not proof. Reporters acting in good fa...","sourceLabel":"Section in Medical Law"},"536":{"title":"Advance Directives & Surrogate Decision-Making","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s20","snippet":"Advance Directives & Surrogate Decision-Making Advance directives are legal instruments that allow competent adults to document their wishes for future medical care in the event they lose capacity. They are governed primarily by state law, with a federal framework provided by the Patient Self-Determ...","sourceLabel":"Section in Medical Law"},"537":{"title":"Brain Death, Futility & Aid in Dying","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s21","snippet":"Brain Death, Futility & Aid in Dying Determination of Death Under the Uniform Determination of Death Act (UDDA) , adopted by every state, an individual is dead if either: (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire...","sourceLabel":"Section in Medical Law"},"538":{"title":"Organ Donation & Medical Examiner Cases","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s22","snippet":"Organ Donation & Medical Examiner Cases Uniform Anatomical Gift Act (UAGA) Organ donation in the United States is governed by the Uniform Anatomical Gift Act (UAGA) , adopted in some form by every state. Under the UAGA, a competent adult may donate any or all organs and tissues upon death through a ...","sourceLabel":"Section in Medical Law"},"539":{"title":"Licensing, Scope of Practice & Credentialing","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s23","snippet":"Licensing, Scope of Practice & Credentialing Medical Licensure Medical licensure is a state function . Each state medical board sets requirements for initial licensure and ongoing practice: graduation from an accredited medical school, completion of USMLE (or COMLEX for DOs), postgraduate training (...","sourceLabel":"Section in Medical Law"},"540":{"title":"Controlled Substances, PDMPs & DEA","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s24","snippet":"Controlled Substances, PDMPs & DEA Prescribing controlled substances is among the most heavily regulated activities in medicine. Enforcement is aggressive, and errors can result in criminal prosecution, loss of DEA registration, and loss of medical licensure. Controlled Substances Act Schedules Sche...","sourceLabel":"Section in Medical Law"},"541":{"title":"Medical Records, OSHA & ADA","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s25","snippet":"Medical Records, OSHA & ADA Medical Record Ownership & Retention The physical or electronic medical record is generally owned by the provider or institution that created it, while the information belongs to the patient, who has rights of access, amendment, and copying. Retention periods are set by s...","sourceLabel":"Section in Medical Law"},"542":{"title":"Key Supreme Court Cases","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s26","snippet":"Key Supreme Court Cases A handful of U.S. Supreme Court decisions have shaped the constitutional framework within which medical law operates. Understanding these cases is essential background for every physician and is routinely tested on professionalism and ethics examinations. Landmark Cases in Me...","sourceLabel":"Section in Medical Law"},"543":{"title":"Risk Management & Documentation","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s27","snippet":"Risk Management & Documentation Risk management is the art of practicing medicine in a way that minimizes legal exposure without compromising care. Effective risk management rarely requires dramatic changes to clinical practice; it requires consistent attention to communication, documentation, and f...","sourceLabel":"Section in Medical Law"},"544":{"title":"High-Yield Review","pageTitle":"Medical Law","pageUrl":"/ethics-law/medical-law","url":"/ethics-law/medical-law#s28","snippet":"High-Yield Review The Core Legal Frameworks in One Table Topic Key Rule Malpractice Duty, Breach, Causation, Damages - all four required Standard of care Reasonably prudent physician; now typically national; proved by expert testimony Res ipsa loquitur Retained sponge, wrong-site surgery - inference...","sourceLabel":"Section in Medical Law"},"545":{"title":"Patient Safety & Quality Improvement","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety","snippet":"Foundational Knowledge Patient Safety Complete Subject Reference Medical errors, root cause analysis, systems thinking, never events, hospital-acquired conditions, medication safety, transitions of care, surgical safety, infection control, fall prevention, and every framework and intervention used t..."},"546":{"title":"Historical Origins & the Safety Movement","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s1","snippet":"Historical Origins & the Safety Movement Patient safety - the prevention of harm to patients from the processes of healthcare itself - emerged as a distinct discipline in the late 1990s, although its intellectual roots extend to Florence Nightingale's 19th-century hospital sanitation reforms and Ern...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"547":{"title":"Epidemiology & Cost of Medical Error","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s2","snippet":"Epidemiology & Cost of Medical Error Quantifying medical error is difficult because harm is often hidden, attributed to underlying disease, or never reported. Nevertheless, epidemiologic studies using chart review, administrative data, and trigger tools (such as the IHI Global Trigger Tool) consiste...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"548":{"title":"Just Culture & Systems Thinking","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s3","snippet":"Just Culture & Systems Thinking A just culture is an organizational environment in which staff feel safe to report errors and near misses without fear of inappropriate punishment, while still holding individuals accountable for reckless behavior. The concept, popularized by David Marx, replaces both...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"549":{"title":"High-Reliability Organizations & Safety I/II","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s4","snippet":"High-Reliability Organizations & Safety I/II High-reliability organizations (HROs) operate for long periods in complex, hazardous environments with very few accidents. Examples include aircraft carriers, nuclear power plants, and commercial aviation. Weick and Sutcliffe identified five characteristi...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"550":{"title":"Types of Error: Slips, Lapses, Mistakes, Violations","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s5","snippet":"Types of Error: Slips, Lapses, Mistakes, Violations James Reason's taxonomy distinguishes errors by the cognitive stage at which they occur. Slips and lapses are execution failures during routine (skill-based) action; mistakes are planning failures during rule-based or knowledge-based problem-solvin...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"551":{"title":"Swiss Cheese Model & Active/Latent Errors","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s6","snippet":"Swiss Cheese Model & Active/Latent Errors James Reason's Swiss Cheese Model is the most widely used metaphor in patient safety. Each layer of defense against harm (policies, procedures, training, technology, supervision) is imagined as a slice of Swiss cheese. Every slice has holes - weaknesses or g...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"552":{"title":"Sentinel, Adverse, Near-Miss & Severity Classes","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s7","snippet":"Sentinel, Adverse, Near-Miss & Severity Classes Patient-safety events are classified by outcome (did harm reach the patient?) and by severity (how bad was the harm?). The Joint Commission's definitions are the most widely used in US hospitals. Event Type Definitions Term Definition Example Adverse e...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"553":{"title":"Root Cause Analysis & the Sentinel Event Protocol","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s8","snippet":"Root Cause Analysis & the Sentinel Event Protocol Root cause analysis (RCA) is a structured, retrospective investigation of an adverse event or near miss with the goal of identifying the underlying systems factors (not individuals) that contributed, and generating durable corrective actions. It is t...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"554":{"title":"Fishbone, 5 Whys & Fault Tree Analysis","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s9","snippet":"Fishbone, 5 Whys & Fault Tree Analysis Several structured tools help an RCA team move from \"what happened\" to \"why it happened\" and expose the underlying contributing factors. Figure 14 - Fishbone (Ishikawa) Diagram. A cause-and-effect diagram used in root cause analysis. The problem forms the head ...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"555":{"title":"FMEA - Failure Mode & Effects Analysis","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s10","snippet":"FMEA - Failure Mode & Effects Analysis Failure Mode and Effects Analysis (FMEA) is a prospective (proactive) risk-assessment tool. While RCA is retrospective (\"what went wrong?\"), FMEA asks \"what could go wrong?\" It is used before implementing a new process, drug, technology, or facility to identify...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"556":{"title":"PDSA, Lean, Six Sigma & DMAIC","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s11","snippet":"PDSA, Lean, Six Sigma & DMAIC Quality improvement (QI) draws from industrial engineering methods adapted to healthcare. The three dominant methodologies are the Model for Improvement (PDSA), Lean (from Toyota), and Six Sigma (from Motorola). They are complementary: PDSA is the engine of small tests ...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"557":{"title":"Run Charts, Control Charts & A3 Thinking","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s12","snippet":"Run Charts, Control Charts & A3 Thinking Quality improvement depends on the ability to distinguish signal from noise in data. Two charts - the run chart and the control chart - are the workhorses of process monitoring and are built on statistical process control (SPC) theory developed by Walter Shew...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"558":{"title":"Medication Error Pathway & ADE vs ADR","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s13","snippet":"Medication Error Pathway & ADE vs ADR Medication errors are the most common source of preventable harm in hospitals. Preventable adverse drug events (ADEs) affect roughly 1 in 20 hospitalized patients and contribute to 7,000-9,000 US deaths per year. Errors can occur at any of five stages of the med...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"559":{"title":"High-Alert Medications & the ISMP List","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s14","snippet":"High-Alert Medications & the ISMP List High-alert medications are drugs that bear a heightened risk of causing significant patient harm when used in error. The Institute for Safe Medication Practices (ISMP) maintains the authoritative list and recommends enhanced safeguards for each. Major High-Aler...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"560":{"title":"LASA, Reconciliation & Technology Safeguards","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s15","snippet":"LASA, Reconciliation & Technology Safeguards Look-Alike / Sound-Alike (LASA) Drugs Look-alike, sound-alike (LASA) pairs are drugs whose names or packaging are easily confused. ISMP maintains a published list of confused-drug name pairs. Common LASA errors include: Drug Pair Harm Hydralazine / hydrox...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"561":{"title":"HAC List, Never Events & NQF Framework","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s16","snippet":"HAC List, Never Events & NQF Framework Hospital-acquired conditions (HACs) are complications that develop during a hospital stay. CMS identifies a set of HACs for which it will not pay the additional cost when acquired after admission, creating a financial incentive for prevention. The National Qual...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"562":{"title":"HAI Prevention: CLABSI, CAUTI, SSI, VAP, CDI","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s17","snippet":"HAI Prevention: CLABSI, CAUTI, SSI, VAP, CDI Healthcare-associated infections (HAIs) affect roughly 1 in 25 hospitalized patients at any given time in the US, cause tens of thousands of deaths annually, and add billions of dollars in costs. Evidence-based bundles - small groups of interventions perf...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"563":{"title":"Falls, Pressure Injuries & VTE Prophylaxis","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s18","snippet":"Falls, Pressure Injuries & VTE Prophylaxis Inpatient Falls Falls are the most common inpatient adverse event and a frequent cause of preventable harm, especially in older adults. Prevention begins with identifying high-risk patients using validated tools such as the Morse Fall Scale or Hendrich II ....","sourceLabel":"Section in Patient Safety & Quality Improvement"},"564":{"title":"WHO Checklist, Time-Outs & SCIP Measures","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s19","snippet":"WHO Checklist, Time-Outs & SCIP Measures The operating room has historically been one of the highest-risk environments in healthcare. Standardized checklists, time-outs, and bundled measures have transformed surgical safety and reduced morbidity and mortality. Figure 34 - WHO Surgical Safety Checkli...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"565":{"title":"Wrong-Site Surgery & Retained Items","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s20","snippet":"Wrong-Site Surgery & Retained Items Wrong-Site, Wrong-Patient, Wrong-Procedure Events Wrong-site surgery is rare (approximately 1 per 112,000 procedures) but devastating when it occurs. Root causes typically include: incomplete pre-op verification, unclear or absent site marking, scheduling errors, ...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"566":{"title":"Anesthesia, Fire & Specimen Safety","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s21","snippet":"Anesthesia, Fire & Specimen Safety Anesthesia Safety Anesthesiology is the safety success story of modern medicine. Mortality directly attributable to anesthesia dropped from approximately 1 in 10,000 in the 1970s to fewer than 1 in 200,000 today, through a combination of engineered forcing function...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"567":{"title":"Handoff Failures, SBAR & I-PASS","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s22","snippet":"Handoff Failures, SBAR & I-PASS Communication failures contribute to the majority of sentinel events analyzed by the Joint Commission. Transitions of care - between shifts, services, units, and facilities - are particularly vulnerable: information is lost, responsibility is diffused, and the mental ...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"568":{"title":"Teach-Back, Health Literacy & Interpreters","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s23","snippet":"Teach-Back, Health Literacy & Interpreters Patients who do not understand their diagnosis, medications, or discharge instructions are at dramatically higher risk of readmission, medication error, and poor outcomes. Nearly half of US adults have limited health literacy, and non-English speakers are a...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"569":{"title":"CRM, Briefings & Speak-Up Culture","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s24","snippet":"CRM, Briefings & Speak-Up Culture Crew Resource Management Crew Resource Management (CRM) originated in commercial aviation after NASA research showed that most airline crashes involved team communication failures rather than pilot skill deficits. CRM principles - flat hierarchy, cross-checking, ass...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"570":{"title":"Patient & Family Engagement, Shared Decision-Making","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s25","snippet":"Patient & Family Engagement, Shared Decision-Making Engaged patients and families are a critical defense layer. They can recognize errors that clinicians miss (wrong medication, unfamiliar rash, a missed detail in the history), and they are more adherent, better informed, and more satisfied when inv...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"571":{"title":"Error Disclosure, Apology Laws & the Second Victim","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s26","snippet":"Error Disclosure, Apology Laws & the Second Victim Principles of Error Disclosure Patients have a right to know when a medical error has harmed them. The Joint Commission standard (RI.01.02.01) requires that patients be informed of unanticipated outcomes. Disclosure is ethically mandatory, preserves...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"572":{"title":"Reporting Systems & Organizational Learning","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s27","snippet":"Reporting Systems & Organizational Learning An organization cannot improve what it cannot see. Reporting systems - voluntary and mandatory - create visibility into adverse events, near misses, and hazardous conditions so that leadership can act. Voluntary vs Mandatory Reporting Type Description Exam...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"573":{"title":"Regulatory Bodies, References & High-Yield Review","pageTitle":"Patient Safety & Quality Improvement","pageUrl":"/ethics-law/patient-safety","url":"/ethics-law/patient-safety#s28","snippet":"Regulatory Bodies, References & High-Yield Review Major US & International Bodies Organization Role The Joint Commission (TJC) Accreditation; National Patient Safety Goals; sentinel event database; Universal Protocol CMS Conditions of participation; HAC non-payment; value-based purchasing; HCAHPS; p...","sourceLabel":"Section in Patient Safety & Quality Improvement"},"574":{"title":"Healthcare Systems & Policy","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems","snippet":"Foundational Knowledge Healthcare Systems Complete Subject Reference Healthcare delivery models, US healthcare financing, Medicare and Medicaid, insurance, payment models, value-based care, ACOs, quality measurement, health policy, and every framework needed to understand how healthcare is organized..."},"575":{"title":"Overview & History of US Healthcare","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s1","snippet":"Overview & History of US Healthcare The US healthcare system is the largest, most expensive, and most administratively complex health system in the world. It is not a single system but a patchwork of private insurers, public programs, employer-sponsored coverage, safety-net providers, and out-of-poc...","sourceLabel":"Section in Healthcare Systems & Policy"},"576":{"title":"Triple, Quadruple & Quintuple Aim","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s2","snippet":"Triple, Quadruple & Quintuple Aim The Triple Aim is the single most influential framework in modern US health policy. Articulated by Don Berwick and colleagues at the Institute for Healthcare Improvement (IHI) in 2008, it names the three simultaneous goals of a high-performing health system. Every v...","sourceLabel":"Section in Healthcare Systems & Policy"},"577":{"title":"IOM Six Aims & Donabedian Framework","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s3","snippet":"IOM Six Aims & Donabedian Framework Two frameworks dominate US quality thinking: the Institute of Medicine (IOM) Six Aims for Improvement from the 2001 report Crossing the Quality Chasm , and Avedis Donabedian's structure-process-outcome taxonomy for quality measurement from 1966. IOM Six Aims - STE...","sourceLabel":"Section in Healthcare Systems & Policy"},"578":{"title":"Comparative International Health Systems","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s4","snippet":"Comparative International Health Systems Health systems worldwide fall into four archetypes, described by Princeton health economist Uwe Reinhardt and political scientist T.R. Reid. Understanding these models makes the US system's idiosyncrasies visible: the US is the only high-income country that u...","sourceLabel":"Section in Healthcare Systems & Policy"},"579":{"title":"US Healthcare Expenditure Overview","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s5","snippet":"US Healthcare Expenditure Overview Total US health expenditure (NHE, National Health Expenditure) reached $4.5-4.9 trillion in the mid-2020s - approximately 17-18% of GDP and roughly $13,500-14,500 per capita . For scale: US healthcare spending alone exceeds the entire GDP of all but a handful of co...","sourceLabel":"Section in Healthcare Systems & Policy"},"580":{"title":"Spending Categories & Sources","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s6","snippet":"Spending Categories & Sources Where the Money Goes (Spending by Category) Category % of NHE Notes Hospital care ~31% Largest single category; inpatient + outpatient + ED Physician & clinical services ~20% Professional fees across settings Prescription drugs (retail) ~9% Understates true drug spendin...","sourceLabel":"Section in Healthcare Systems & Policy"},"581":{"title":"Cost Drivers & Growth","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s7","snippet":"Cost Drivers & Growth Decomposing Healthcare Spending Growth Academic decompositions of US healthcare spending growth generally allocate contributions across: demographic change (population growth and aging, ~15%), economy-wide inflation (~10%), excess medical inflation (~15%), utilization growth (~...","sourceLabel":"Section in Healthcare Systems & Policy"},"582":{"title":"Provider Payment Mechanisms","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s8","snippet":"Provider Payment Mechanisms How providers are paid fundamentally shapes how they behave. Every payment model creates incentives - some aligned with quality, some with volume, some with cost containment, none perfectly. The Core Payment Methods Method How It Works Incentive Risk Borne By Fee-for-serv...","sourceLabel":"Section in Healthcare Systems & Policy"},"583":{"title":"Private Health Insurance","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s9","snippet":"Private Health Insurance Private health insurance covers approximately two-thirds of non-elderly Americans. It comes in two main forms: employer-sponsored insurance (ESI) - the dominant model, covering ~155 million - and individual-market coverage , purchased directly by consumers through ACA market...","sourceLabel":"Section in Healthcare Systems & Policy"},"584":{"title":"Managed Care Plan Types","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s10","snippet":"Managed Care Plan Types \"Managed care\" refers to insurance products that use network restrictions, utilization review, prior authorization, and primary-care gatekeeping to control cost. The major plan types differ in how restrictive they are. Origin of Managed Care Managed care emerged in the 1970s ...","sourceLabel":"Section in Healthcare Systems & Policy"},"585":{"title":"Cost-Sharing & Plan Mechanics","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s11","snippet":"Cost-Sharing & Plan Mechanics The Five Cost-Sharing Terms Term Definition Example Premium Fixed monthly payment to maintain coverage $500/month for a silver plan Deductible Amount patient pays out-of-pocket before insurance starts paying $2,000 - patient pays first $2,000 of covered care Copay Fixed...","sourceLabel":"Section in Healthcare Systems & Policy"},"586":{"title":"Networks, Prior Auth & Formularies","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s12","snippet":"Networks, Prior Auth & Formularies Network Adequacy Network adequacy standards require insurers to maintain a sufficient number of providers within reasonable time/distance of enrollees. Federal standards apply to Medicare Advantage (based on county types, provider specialties, max time/distance) an...","sourceLabel":"Section in Healthcare Systems & Policy"},"587":{"title":"Medicare Overview & Eligibility","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s13","snippet":"Medicare Overview & Eligibility Medicare is the federal health insurance program created in 1965 (Title XVIII of the Social Security Act) for Americans aged 65 and older. It has since expanded to cover people with disabilities, end-stage renal disease (ESRD), and ALS. In the mid-2020s, Medicare cove...","sourceLabel":"Section in Healthcare Systems & Policy"},"588":{"title":"Parts A, B, C & D","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s14","snippet":"Parts A, B, C & D The Four Parts of Medicare Part Coverage Financing Cost to Beneficiary Part A (Hospital Insurance) Inpatient hospital, SNF (up to 100 days post-hospitalization), hospice, some home health HI Trust Fund (payroll tax, 2.9%) Premium-free for most; deductible per benefit period (~$1,63...","sourceLabel":"Section in Healthcare Systems & Policy"},"589":{"title":"MACRA, QPP, MIPS & APMs","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s15","snippet":"MACRA, QPP, MIPS & APMs The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) permanently repealed the Sustainable Growth Rate (SGR) formula - which had threatened annual physician pay cuts for 15 years - and replaced it with the Quality Payment Program (QPP) . MACRA is the most important...","sourceLabel":"Section in Healthcare Systems & Policy"},"590":{"title":"Medicaid Structure & Eligibility","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s16","snippet":"Medicaid Structure & Eligibility Medicaid is a joint federal-state program created in 1965 (Title XIX) to provide health coverage for low-income Americans. Unlike Medicare, Medicaid is administered by states within federal parameters: each state designs its own program, sets eligibility above federa...","sourceLabel":"Section in Healthcare Systems & Policy"},"591":{"title":"Medicaid Waivers, Managed Care & LTC","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s17","snippet":"Medicaid Waivers, Managed Care & LTC Medicaid Waivers Federal Medicaid statute allows waivers that let states modify standard rules. The two most important: Waiver Authority Typical Use Section 1115 HHS Secretary demonstration authority Broad experimentation: work requirements, premium assistance, d...","sourceLabel":"Section in Healthcare Systems & Policy"},"592":{"title":"CHIP & Dual Eligibles","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s18","snippet":"CHIP & Dual Eligibles Medicaid MCO Procurement States contract with Medicaid MCOs through competitive procurement, typically running 3-5 year contracts with extensions. MCOs bid on regions or populations and must meet network adequacy, quality reporting, and medical loss ratio minimums. The national...","sourceLabel":"Section in Healthcare Systems & Policy"},"593":{"title":"ACA Coverage Provisions","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s19","snippet":"ACA Coverage Provisions The Patient Protection and Affordable Care Act of 2010 (ACA) is the largest US healthcare reform since 1965. It restructured the individual insurance market, created marketplaces, expanded Medicaid, introduced coverage mandates, and imposed new insurance regulations. Some ACA...","sourceLabel":"Section in Healthcare Systems & Policy"},"594":{"title":"Marketplaces, Subsidies & Mandates","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s20","snippet":"Marketplaces, Subsidies & Mandates Health Insurance Marketplaces Marketplaces (exchanges) are regulated online markets where individuals can compare and purchase ACA-compliant individual coverage. States could elect to run their own (state-based marketplaces, e.g., Covered California) or default to ...","sourceLabel":"Section in Healthcare Systems & Policy"},"595":{"title":"Insurance Market Regulations","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s21","snippet":"Insurance Market Regulations Medical Loss Ratio (MLR) The MLR requires insurers to spend at least 80% (individual/small group) or 85% (large group) of premium revenue on medical claims and quality improvement - with rebates to consumers if they fall short. MLR has returned billions in rebates since ...","sourceLabel":"Section in Healthcare Systems & Policy"},"596":{"title":"Alternative Payment Models","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s22","snippet":"Alternative Payment Models Alternative Payment Models (APMs) are reimbursement approaches that move away from pure fee-for-service, linking provider payment to quality and cost performance. They form a spectrum from modest FFS adjustments to full population risk. Volume to Value - The Payment Reform...","sourceLabel":"Section in Healthcare Systems & Policy"},"597":{"title":"ACOs & CMMI Innovation Models","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s23","snippet":"ACOs & CMMI Innovation Models Accountable Care Organizations An Accountable Care Organization (ACO) is a group of providers who collectively accept responsibility for the cost and quality of care for a defined population - typically assigned based on plurality of primary care utilization. If the ACO...","sourceLabel":"Section in Healthcare Systems & Policy"},"598":{"title":"Quality Measures & Risk Adjustment","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s24","snippet":"Quality Measures & Risk Adjustment Major Quality Measurement Programs Program Organization Scope HEDIS (Healthcare Effectiveness Data and Information Set) NCQA Health plan performance measures (screening rates, chronic disease control) CAHPS (Consumer Assessment of Healthcare Providers & Systems) AH...","sourceLabel":"Section in Healthcare Systems & Policy"},"599":{"title":"Workforce, GME & Safety Net","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s25","snippet":"Workforce, GME & Safety Net Specialty Distribution and Pipeline US physician workforce composition is a legacy of both training capacity and payment incentives. Primary care (family medicine, general internal medicine, general pediatrics) comprises ~35% of active physicians and ~33% of residency tra...","sourceLabel":"Section in Healthcare Systems & Policy"},"600":{"title":"Price Transparency, Surprise Billing & Drug Pricing","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s26","snippet":"Price Transparency, Surprise Billing & Drug Pricing Price Transparency CMS rules effective 2021-2022 require hospitals to publish machine-readable files of all negotiated rates by payer, and payers to provide consumer cost-estimator tools. Compliance has been uneven, but the data have already transf...","sourceLabel":"Section in Healthcare Systems & Policy"},"601":{"title":"Consolidation, Telehealth & Digital Health","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s27","snippet":"Consolidation, Telehealth & Digital Health Healthcare Antitrust Healthcare consolidation enforcement is split between the FTC (physician practices, insurers, most providers) and DOJ (hospital mergers, certain vertical cases). FTC challenges to hospital mergers have had a mixed record; major wins inc...","sourceLabel":"Section in Healthcare Systems & Policy"},"602":{"title":"Key Agencies, Legislation & High-Yield Review","pageTitle":"Healthcare Systems & Policy","pageUrl":"/ethics-law/healthcare-systems","url":"/ethics-law/healthcare-systems#s28","snippet":"Key Agencies, Legislation & High-Yield Review Key Federal Agencies Agency Parent Role HHS (Health & Human Services) Cabinet department Umbrella department for federal health programs CMS (Centers for Medicare & Medicaid Services) HHS Administers Medicare, Medicaid, CHIP, marketplaces FDA (Food & Dru...","sourceLabel":"Section in Healthcare Systems & Policy"},"603":{"title":"Public Health & Preventive Medicine","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health","snippet":"Foundational Knowledge Public Health Complete Subject Reference Epidemiology, infectious disease control, immunizations, screening, health promotion, environmental health, occupational health, global health, social determinants, emergency preparedness, and every public health discipline and interven..."},"604":{"title":"Defining Public Health","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s1","snippet":"Defining Public Health Public health is the science and art of preventing disease, prolonging life, and promoting health through the organized efforts of society. Coined by C.-E. A. Winslow in 1920, this definition still anchors the field: unlike clinical medicine, which treats individuals one at a ...","sourceLabel":"Section in Public Health & Preventive Medicine"},"605":{"title":"Core Functions & Essential Services","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s2","snippet":"Core Functions & Essential Services In 1988, the Institute of Medicine's landmark report The Future of Public Health defined three core functions : assessment (monitor health, diagnose problems), policy development (inform, educate, mobilize partnerships, develop policies), and assurance (enforce la...","sourceLabel":"Section in Public Health & Preventive Medicine"},"606":{"title":"History of Public Health","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s3","snippet":"History of Public Health Public health began as sanitation. Ancient Rome built aqueducts and sewers; medieval quarantines (\"quaranta giorni\" - forty days) isolated ships arriving in Venice during the Black Death. The modern era began in 19th-century Europe, where industrialization crowded workers in...","sourceLabel":"Section in Public Health & Preventive Medicine"},"607":{"title":"Public Health Agencies & Infrastructure","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s4","snippet":"Public Health Agencies & Infrastructure US public health is fragmented across federal, state, and local levels. The federal role is primarily funding, standard-setting, and surveillance; states hold constitutional police power over health; local health departments deliver most frontline services. Ma...","sourceLabel":"Section in Public Health & Preventive Medicine"},"608":{"title":"Descriptive & Analytic Epidemiology","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s5","snippet":"Descriptive & Analytic Epidemiology Epidemiology is the basic science of public health: the study of the distribution (descriptive) and determinants (analytic) of health-related states in populations. While biostatistics provides the quantitative tools, epidemiology asks the questions. Descriptive E...","sourceLabel":"Section in Public Health & Preventive Medicine"},"609":{"title":"Surveillance Systems","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s6","snippet":"Surveillance Systems Surveillance is the ongoing, systematic collection, analysis, and interpretation of health data for action. \"Data for action\" is the operative phrase - surveillance that doesn't drive intervention is just statistics. Figure 6 - Public Health Surveillance Framework. Surveillance ...","sourceLabel":"Section in Public Health & Preventive Medicine"},"610":{"title":"Outbreak Investigation","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s7","snippet":"Outbreak Investigation The CDC outlines a standard 10-step outbreak investigation that field epidemiologists (EIS officers) follow. Steps may be performed iteratively or in parallel, not strictly sequentially. Epidemic vs Outbreak vs Cluster Terminology is imprecise but carries connotation. An outbr...","sourceLabel":"Section in Public Health & Preventive Medicine"},"611":{"title":"Reportable & Notifiable Diseases","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s8","snippet":"Reportable & Notifiable Diseases Each US state defines its own reportable disease list (clinicians and labs must report to the state); states then voluntarily report to CDC's nationally notifiable list. As of recent CDC updates, roughly 120 conditions are nationally notifiable. Figure 13 - Major Com...","sourceLabel":"Section in Public Health & Preventive Medicine"},"612":{"title":"Chain of Infection & Transmission","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s9","snippet":"Chain of Infection & Transmission The chain of infection describes the six links required to sustain transmission. Breaking any single link interrupts the chain - this is the conceptual basis for every infection control intervention. Figure 15 - The Chain of Infection. Six links form the chain requi...","sourceLabel":"Section in Public Health & Preventive Medicine"},"613":{"title":"Herd Immunity & R 0","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s10","snippet":"Herd Immunity & R 0 Herd immunity (community immunity) is the indirect protection of susceptible individuals that occurs when a sufficiently large proportion of the population is immune, so that transmission cannot sustain itself. It is the mathematical reason vaccines protect even those who cannot ...","sourceLabel":"Section in Public Health & Preventive Medicine"},"614":{"title":"Isolation, Quarantine & Contact Tracing","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s11","snippet":"Isolation, Quarantine & Contact Tracing Isolation separates people who are ill with a contagious disease. Quarantine restricts the movement of asymptomatic people who have been exposed . Both are coercive tools with a long history in US law ( Jacobson v. Massachusetts , 1905; federal authority at po...","sourceLabel":"Section in Public Health & Preventive Medicine"},"615":{"title":"HAI, AMR, TB, HIV/STI & Pandemic Preparedness","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s12","snippet":"HAI, AMR, TB, HIV/STI & Pandemic Preparedness Healthcare-Associated Infections (HAI) HAIs affect roughly 1 in 31 hospitalized patients. Major categories include central line-associated bloodstream infection ( CLABSI ), catheter-associated UTI ( CAUTI ), surgical site infection ( SSI ), ventilator-as...","sourceLabel":"Section in Public Health & Preventive Medicine"},"616":{"title":"Vaccine Types & Technology","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s13","snippet":"Vaccine Types & Technology Vaccines expose the immune system to antigens derived from a pathogen, producing immunologic memory without causing disease. Platform choice determines immunogenicity, safety profile, cold chain, and contraindications. Figure 24 - Vaccine Types and Platforms. Modern vaccin...","sourceLabel":"Section in Public Health & Preventive Medicine"},"617":{"title":"ACIP Schedules & Catch-Up","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s14","snippet":"ACIP Schedules & Catch-Up The Advisory Committee on Immunization Practices (ACIP) develops US civilian immunization recommendations. Once CDC Director approves, recommendations are published in the MMWR, incorporated into the Vaccines for Children (VFC) program, and required to be covered without co...","sourceLabel":"Section in Public Health & Preventive Medicine"},"618":{"title":"Contraindications, Hesitancy & Safety Monitoring","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s15","snippet":"Contraindications, Hesitancy & Safety Monitoring Contraindications & Precautions Situation Rule Severe allergic reaction to prior dose or component Absolute contraindication to that vaccine Pregnancy Avoid live vaccines (MMR, varicella, LAIV); give Tdap 27-36 wks, influenza any trimester, RSV 32-36 ...","sourceLabel":"Section in Public Health & Preventive Medicine"},"619":{"title":"USPSTF & Screening Principles","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s16","snippet":"USPSTF & Screening Principles The US Preventive Services Task Force (USPSTF) is an independent volunteer panel of national experts in prevention and evidence-based medicine that makes recommendations about clinical preventive services. ACA Section 2713 requires that A- and B-graded services be cover...","sourceLabel":"Section in Public Health & Preventive Medicine"},"620":{"title":"Adult Screening Recommendations","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s17","snippet":"Adult Screening Recommendations The USPSTF recommendations below reflect commonly tested adult preventive services. Always consult current recommendations before clinical use - ages and intervals are updated frequently. Cancer Screening Cancer Population Test & Interval Grade Breast Women 40-74 Mamm...","sourceLabel":"Section in Public Health & Preventive Medicine"},"621":{"title":"Chemoprevention & Behavioral Counseling","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s18","snippet":"Chemoprevention & Behavioral Counseling Adult immunization is a core preventive service with lower uptake than childhood immunization in nearly every category. Strategies to improve uptake include standing orders, presumptive recommendations, EHR prompts, pharmacist-delivered vaccines, and removing ...","sourceLabel":"Section in Public Health & Preventive Medicine"},"622":{"title":"Well-Child Care & Bright Futures","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s19","snippet":"Well-Child Care & Bright Futures Bright Futures is the AAP-authored national health promotion guideline for preventive pediatric care, adopted by HRSA and covered without cost-sharing under the ACA. It specifies the content of well-child visits from birth through age 21. Developmental Surveillance &...","sourceLabel":"Section in Public Health & Preventive Medicine"},"623":{"title":"Health Behavior Models","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s20","snippet":"Health Behavior Models Behavior change is the common final pathway of most clinical prevention. Theories of health behavior give clinicians and program designers frameworks for understanding why people do what they do - and how to intervene. Figure 31 - The Health Belief Model. This foundational beh...","sourceLabel":"Section in Public Health & Preventive Medicine"},"624":{"title":"Tobacco, Alcohol, Activity & Nutrition","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s21","snippet":"Tobacco, Alcohol, Activity & Nutrition Stages of Change - Matching the Intervention Stage Patient Characteristics Clinician Strategy Precontemplation Not considering change in next 6 months Raise awareness, offer information, explore ambivalence Contemplation Considering change within 6 months Decis...","sourceLabel":"Section in Public Health & Preventive Medicine"},"625":{"title":"Air, Water, Food & Toxicants","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s22","snippet":"Air, Water, Food & Toxicants Air Quality The EPA's Clean Air Act sets National Ambient Air Quality Standards (NAAQS) for six criteria pollutants : ozone (O 3 ), particulate matter (PM 2.5 , PM 10 ), carbon monoxide, nitrogen dioxide, sulfur dioxide, and lead. PM 2.5 drives most health impact, associ...","sourceLabel":"Section in Public Health & Preventive Medicine"},"626":{"title":"Climate, Radiation & Vector-Borne Disease","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s23","snippet":"Climate, Radiation & Vector-Borne Disease Figure 33 - Climate Change and Health Framework. Climate change affects health through multiple pathways: direct heat effects, air quality degradation, extreme weather events, changing infectious disease ecology, food and water insecurity, and mental health ...","sourceLabel":"Section in Public Health & Preventive Medicine"},"627":{"title":"Occupational Health & Injury Prevention","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s24","snippet":"Occupational Health & Injury Prevention Endocrine Disruptors & Emerging Contaminants PFAS (\"forever chemicals\"), bisphenol A (BPA), phthalates, pesticides, flame retardants, and certain metals act as endocrine disruptors with effects on thyroid, reproduction, development, and metabolism. Low-dose, l...","sourceLabel":"Section in Public Health & Preventive Medicine"},"628":{"title":"Social Determinants & Health Equity","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s25","snippet":"Social Determinants & Health Equity Social determinants of health (SDOH) are the conditions in which people are born, grow, live, work, and age - the non-medical factors that drive most health outcomes. The WHO estimates that medical care accounts for only 10-20% of modifiable determinants; social a...","sourceLabel":"Section in Public Health & Preventive Medicine"},"629":{"title":"Global Health & Emerging Threats","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s26","snippet":"Global Health & Emerging Threats Global health includes both international cooperation and attention to the health of all people regardless of borders. It differs from \"international health\" (traditionally focused on LMICs) in scope and ethos - global health considers health threats and solutions sh...","sourceLabel":"Section in Public Health & Preventive Medicine"},"630":{"title":"Emergency Preparedness & Bioterrorism","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s27","snippet":"Emergency Preparedness & Bioterrorism Emergency preparedness is a shared responsibility across federal, state, local, and tribal governments, healthcare systems, private sector, and individuals. The US system is anchored by the National Response Framework and the Pandemic and All-Hazards Preparednes...","sourceLabel":"Section in Public Health & Preventive Medicine"},"631":{"title":"High-Yield Review & Reference","pageTitle":"Public Health & Preventive Medicine","pageUrl":"/ethics-law/public-health","url":"/ethics-law/public-health#s28","snippet":"High-Yield Review & Reference Figure 39 - Infectious Disease Burden Pyramid. The burden pyramid illustrates how total infections far exceed detected cases at every level. Only a small fraction of infections result in hospitalization or death, but even a small percentage of a large denominator produc...","sourceLabel":"Section in Public Health & Preventive Medicine"},"632":{"title":"Internal Medicine","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine","snippet":"Specialty Reference Internal Medicine Complete Specialty Reference Every organ system, diagnosis, classification, medication, risk score, and management strategy — cardiovascular through rheumatology — in one place."},"633":{"title":"Systems-Based Approach","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s1","snippet":"Systems-Based Approach Internal medicine is the parent specialty of adult non-surgical care — its scope spans every organ system, and its intellectual core is the integration of multi-system pathology in a single patient. The internist's daily work is diagnosis under uncertainty, multi-drug optimiza...","sourceLabel":"Section in Internal Medicine"},"634":{"title":"The Internal Medicine Physical Exam","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s2","snippet":"The Internal Medicine Physical Exam The IM exam is the most comprehensive in medicine — a full head-to-toe assessment on admission, then focused daily exams targeting active problems. Key elements that change management daily: volume status, cardiopulmonary findings, abdominal exam, and mental statu...","sourceLabel":"Section in Internal Medicine"},"635":{"title":"Key Terminology","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s3","snippet":"Key Terminology Term Definition / Clinical Relevance Preload Volume/pressure stretching the ventricle at end-diastole (approximated by LVEDP, CVP). Elevated in volume overload; reduced in hemorrhage/dehydration. Afterload Resistance the ventricle must overcome to eject blood (approximated by SVR, MA...","sourceLabel":"Section in Internal Medicine"},"636":{"title":"Hypertension","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s4","snippet":"Hypertension Hypertension affects ~47% of US adults under the 2017 ACC/AHA guideline thresholds. It is the single largest modifiable risk factor for stroke, MI, HF, CKD, and aortic dissection. Most cases (90–95%) are primary (essential) — no identifiable cause. Secondary causes must be considered in...","sourceLabel":"Section in Internal Medicine"},"637":{"title":"Heart Failure","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s5","snippet":"Heart Failure Heart failure is a clinical syndrome of dyspnea, fatigue, and volume overload resulting from structural or functional cardiac impairment. Prevalence: ~6.7 million US adults. Five-year mortality: ~50%. HF is the #1 cause of hospitalization in adults > 65. Figure 5 - Heart Failure Pathop...","sourceLabel":"Section in Internal Medicine"},"638":{"title":"Coronary Artery Disease","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s6","snippet":"Coronary Artery Disease CAD is atherosclerotic narrowing of the coronary arteries — the #1 cause of death worldwide. Manifests as stable angina (supply-demand mismatch with exertion), unstable angina (rest pain, new-onset, crescendo), NSTEMI (troponin elevation without ST elevation), or STEMI (trans...","sourceLabel":"Section in Internal Medicine"},"639":{"title":"Atrial Fibrillation","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s7","snippet":"Atrial Fibrillation AFib is the most common sustained arrhythmia — irregular, chaotic atrial activity replacing organized P waves, producing an \"irregularly irregular\" ventricular response. Prevalence: ~5 million US adults, rising with age (10% of those > 80). Key risks: 5&times; stroke risk, 2&time...","sourceLabel":"Section in Internal Medicine"},"640":{"title":"Venous Thromboembolism (DVT/PE)","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s8","snippet":"Venous Thromboembolism (DVT/PE) VTE encompasses DVT and PE — a single disease continuum. DVT: most commonly in the deep veins of the lower extremities (iliac, femoral, popliteal). PE: thrombus embolizes to pulmonary vasculature — can be fatal. Virchow's triad : stasis, endothelial injury, hypercoagu...","sourceLabel":"Section in Internal Medicine"},"641":{"title":"COPD","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s9","snippet":"COPD COPD is a chronic, progressive airflow limitation that is not fully reversible — caused by significant exposure to noxious particles (cigarette smoke in > 80% of cases). It encompasses chronic bronchitis (productive cough &ge; 3 months/year for 2 consecutive years) and emphysema (destruction of...","sourceLabel":"Section in Internal Medicine"},"642":{"title":"Asthma","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s10","snippet":"Asthma Asthma is reversible airflow obstruction due to airway hyperresponsiveness, chronic inflammation, and mucus hypersecretion. Unlike COPD, spirometry shows improvement post-bronchodilator (&ge; 12% and &ge; 200 mL increase in FEV₁). Peak incidence in childhood but can present at any age. Type 2...","sourceLabel":"Section in Internal Medicine"},"643":{"title":"Pneumonia","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s11","snippet":"Pneumonia Pneumonia is infection of the lung parenchyma causing consolidation. Leading infectious cause of death globally. Classification determines empiric antibiotic choice: Figure 16 - Lobar Pneumonia on Chest Radiograph. Imaging appearance of bacterial pneumonia showing lobar consolidation with ...","sourceLabel":"Section in Internal Medicine"},"644":{"title":"Interstitial Lung Disease & Pleural Disease","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s12","snippet":"Interstitial Lung Disease & Pleural Disease ILD is a group of disorders causing progressive fibrosis or inflammation of the lung interstitium. PFTs show a restrictive pattern: reduced FVC and TLC with preserved or elevated FEV₁/FVC ratio. DLCO is characteristically reduced (impaired gas diffusion ac...","sourceLabel":"Section in Internal Medicine"},"645":{"title":"GERD & Peptic Ulcer Disease","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s13","snippet":"GERD & Peptic Ulcer Disease GERD: reflux of gastric acid into the esophagus causing heartburn, regurgitation, and risk of erosive esophagitis, stricture, Barrett's esophagus (intestinal metaplasia — premalignant, requires surveillance EGD). Diagnosis: clinical for typical symptoms; pH monitoring or ...","sourceLabel":"Section in Internal Medicine"},"646":{"title":"Inflammatory Bowel Disease","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s14","snippet":"Inflammatory Bowel Disease IBD comprises two chronic idiopathic inflammatory disorders of the GI tract. Bimodal age onset: 15–30 and 50–70. Figure 19 - Mucosal Barrier in IBD. Structure of the intestinal mucosal barrier and its disruption in inflammatory bowel disease, showing epithelial tight junct...","sourceLabel":"Section in Internal Medicine"},"647":{"title":"Liver Disease & Cirrhosis","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s15","snippet":"Liver Disease & Cirrhosis Cirrhosis is the end stage of chronic liver injury — replacement of functional hepatocytes with fibrosis and regenerative nodules. Common causes: alcohol (60–70%), NAFLD/NASH (rising rapidly, now called MASLD/MASH), hepatitis C, hepatitis B, autoimmune hepatitis, hemochroma...","sourceLabel":"Section in Internal Medicine"},"648":{"title":"Pancreatitis","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s16","snippet":"Pancreatitis Acute pancreatitis: inflammatory injury to the pancreas. Diagnosis requires 2 of 3: (1) characteristic abdominal pain (epigastric, radiating to back), (2) lipase &ge; 3&times; ULN, (3) characteristic imaging findings on CT. Causes: gallstones (~40%) and alcohol (~30%) account for ~70%. ...","sourceLabel":"Section in Internal Medicine"},"649":{"title":"Celiac Disease & Malabsorption","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s17","snippet":"Celiac Disease & Malabsorption Celiac disease: autoimmune enteropathy triggered by dietary gluten (wheat, barley, rye) in genetically susceptible individuals (HLA-DQ2 in ~95%, DQ8 in ~5%). Prevalence ~1%. Presents with chronic diarrhea, steatorrhea, weight loss, iron deficiency anemia (refractory to...","sourceLabel":"Section in Internal Medicine"},"650":{"title":"Acute Kidney Injury","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s18","snippet":"Acute Kidney Injury AKI is defined by KDIGO as any of: Cr rise &ge; 0.3 mg/dL within 48 hr, Cr rise &ge; 1.5&times; baseline within 7 days, or UOP < 0.5 mL/kg/hr for 6 hours. Incidence: 10–15% of hospitalized patients, up to 50% in ICU. KDIGO Staging Stage Serum Creatinine Urine Output 1 1.5–1.9&tim...","sourceLabel":"Section in Internal Medicine"},"651":{"title":"Chronic Kidney Disease","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s19","snippet":"Chronic Kidney Disease CKD is defined as kidney damage or GFR < 60 mL/min/1.73 m² for &ge; 3 months. Most common causes: diabetes (40%), hypertension (28%), glomerulonephritis (10%). CKD is a cardiovascular risk multiplier — patients are more likely to die of CV disease than progress to ESRD. CKD St...","sourceLabel":"Section in Internal Medicine"},"652":{"title":"Electrolyte Disorders","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s20","snippet":"Electrolyte Disorders Figure 23 - ECG Changes in Potassium Disorders. Progressive ECG manifestations of hyperkalemia (peaked T waves, flattened P waves, widened QRS, sine wave) and hypokalemia (U waves, flattened T waves, ST depression), critical for rapid bedside diagnosis. Sodium Disorders Disorde...","sourceLabel":"Section in Internal Medicine"},"653":{"title":"Acid-Base Disorders & Glomerulonephritis","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s21","snippet":"Acid-Base Disorders & Glomerulonephritis Figure 24 - Acid-Base Homeostasis. Acid-base balance maintained through effective renal and respiratory homeostatic mechanisms, illustrating the Henderson-Hasselbalch relationship and buffering systems. Acid-Base — Systematic Approach Step 1: pH < 7.35 = acid...","sourceLabel":"Section in Internal Medicine"},"654":{"title":"Diabetes Mellitus","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s22","snippet":"Diabetes Mellitus Diabetes affects ~37 million Americans (~11%). Type 2 accounts for 90–95% of cases. Diagnosis: fasting glucose &ge; 126 mg/dL, random glucose &ge; 200 with symptoms, OGTT 2-hr &ge; 200, or A1C &ge; 6.5% (confirmed on repeat testing unless unequivocal hyperglycemia). Prediabetes: A1...","sourceLabel":"Section in Internal Medicine"},"655":{"title":"Thyroid Disorders","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s23","snippet":"Thyroid Disorders Figure 28 - Thyroid Disorder Evaluation. Systematic diagnostic approach to thyroid disorders, emphasizing TSH as the initial screening test and the algorithmic workup for hypothyroidism and hyperthyroidism. Approach: TSH Is the Screening Test TSH Free T4 Interpretation Common Cause...","sourceLabel":"Section in Internal Medicine"},"656":{"title":"Adrenal Disorders","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s24","snippet":"Adrenal Disorders Figure 29 - Adrenal Cortex Functional Zones. Anatomy of the adrenal cortex showing the three zones (glomerulosa, fasciculata, reticularis) and their respective hormone products: aldosterone, cortisol, and androgens. Adrenal Insufficiency Primary (Addison's): destruction of the adre...","sourceLabel":"Section in Internal Medicine"},"657":{"title":"Calcium & Bone Disorders","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s25","snippet":"Calcium & Bone Disorders Figure 31 - Calcium & PTH Homeostasis. Integrated calcium homeostasis showing the interplay between PTH, vitamin D, and calcitonin across bone, kidney, and intestine, and the pathophysiology of hypercalcemia and hypocalcemia. Calcium Homeostasis Always correct for albumin: c...","sourceLabel":"Section in Internal Medicine"},"658":{"title":"Anemia","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s26","snippet":"Anemia Anemia is defined as Hgb < 13.5 g/dL (men) or < 12.0 g/dL (women). The MCV-based approach is the diagnostic backbone: Figure 32 - Microcytic Anemia Evaluation. Diagnostic flowchart for microcytic anemia (MCV < 80 fL), using iron studies and hemoglobin electrophoresis to differentiate iron def...","sourceLabel":"Section in Internal Medicine"},"659":{"title":"Coagulation Disorders","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s27","snippet":"Coagulation Disorders Figure 35 - Coagulation Cascade. The coagulation pathway showing the extrinsic (tissue factor), intrinsic (contact activation), and common pathways leading to fibrin clot formation, with corresponding laboratory test correlations (PT/INR, aPTT). Coagulation Cascade — Key Lab Co...","sourceLabel":"Section in Internal Medicine"},"660":{"title":"Transfusion Medicine","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s28","snippet":"Transfusion Medicine Product Contents Indication / Threshold Volume / Details Packed RBCs Red cells in additive solution Hgb < 7 (restrictive, most patients). Hgb < 8 (cardiac disease, symptomatic). Active hemorrhage ~300 mL/unit. Expected rise: 1 g/dL per unit. Type and screen before transfusion Pl...","sourceLabel":"Section in Internal Medicine"},"661":{"title":"Sepsis & SIRS","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s29","snippet":"Sepsis & SIRS Figure 37 - Sepsis Fluid Resuscitation Algorithm. Proposed algorithm for fluid management in early septic shock, including assessment of fluid responsiveness using passive leg raise and dynamic indices to guide crystalloid administration. Sepsis (Sepsis-3, 2016): life-threatening organ...","sourceLabel":"Section in Internal Medicine"},"662":{"title":"UTI & Pyelonephritis","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s30","snippet":"UTI & Pyelonephritis Entity Presentation Diagnosis Treatment Uncomplicated cystitis (women) Dysuria, frequency, urgency, suprapubic pain. No fever UA (pyuria, nitrites, LE positive). Culture optional in uncomplicated Nitrofurantoin 100 mg BID &times; 5 days (first-line), TMP-SMX DS BID &times; 3 day...","sourceLabel":"Section in Internal Medicine"},"663":{"title":"Infective Endocarditis","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s31","snippet":"Infective Endocarditis Infection of the endocardial surface, usually a heart valve. Most common organisms: S. aureus (#1 overall and in acute IE/IVDU), viridans group streptococci (subacute, native valve), Enterococcus (elderly, GU source), HACEK organisms (subacute, culture-negative for days), coag...","sourceLabel":"Section in Internal Medicine"},"664":{"title":"HIV & C. difficile","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s32","snippet":"HIV & C. difficile HIV Diagnosis: 4th-gen HIV Ag/Ab combo test (detects p24 antigen + HIV-1/2 antibodies). If positive, confirm with HIV-1/HIV-2 differentiation assay. Acute HIV: mononucleosis-like illness 2–4 weeks post-exposure (fever, pharyngitis, rash, lymphadenopathy) — high viral load, may be ...","sourceLabel":"Section in Internal Medicine"},"665":{"title":"Rheumatoid Arthritis & SLE","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s33","snippet":"Rheumatoid Arthritis & SLE Figure 38 - SLE Pathogenesis. Mechanism of autoantibody production and tissue injury in lupus, illustrating self-antigen-dependent activation of autoreactive B cells and CD4 T cells, dendritic cell involvement, and immune complex-mediated organ damage. Rheumatoid Arthritis...","sourceLabel":"Section in Internal Medicine"},"666":{"title":"Gout & Pseudogout","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s34","snippet":"Gout & Pseudogout Figure 39 - Gout Pathophysiology. Progression from hyperuricemia to clinical gout, illustrating monosodium urate crystal deposition, intermittent acute inflammatory flares, chronic tophaceous disease, and structural joint damage. Feature Gout Pseudogout (CPPD) Crystal Monosodium ur...","sourceLabel":"Section in Internal Medicine"},"667":{"title":"Vasculitis","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s35","snippet":"Vasculitis Vasculitis = inflammation of blood vessel walls. Classified by vessel size (Chapel Hill Consensus): Figure 41 - Vasculitis Classification by Vessel Size. The Chapel Hill Consensus nomenclature showing the distribution of vessel involvement by large, medium, and small vessel vasculitides a...","sourceLabel":"Section in Internal Medicine"},"668":{"title":"Sarcoidosis","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s36","snippet":"Sarcoidosis Systemic granulomatous disease of unknown etiology characterized by non-caseating granulomas in affected organs. Peak incidence: 25–35 years; 3&times; more common and more severe in Black Americans. Most common presentation: bilateral hilar lymphadenopathy (BHL) on CXR, often discovered ...","sourceLabel":"Section in Internal Medicine"},"669":{"title":"Amyloidosis","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s37","snippet":"Amyloidosis Amyloidosis is the deposition of misfolded protein fibrils (amyloid) in tissues, disrupting organ function. Congo red stain shows apple-green birefringence under polarized light — pathognomonic. Type Precursor Protein Associations Key Organ Involvement Treatment AL (primary) Immunoglobul...","sourceLabel":"Section in Internal Medicine"},"670":{"title":"Autoimmune Hepatitis","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s38","snippet":"Autoimmune Hepatitis Chronic liver inflammation caused by autoimmune attack on hepatocytes. Bimodal: young women (Type 1, most common) and children (Type 2). Presents with fatigue, jaundice, elevated transaminases (often ALT > AST, sometimes dramatically elevated — can mimic acute viral hepatitis), ...","sourceLabel":"Section in Internal Medicine"},"671":{"title":"Imaging & Diagnostics","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s39","snippet":"Imaging & Diagnostics Figure 44 - Congestion Assessment Timeline. The spectrum of hemodynamic and clinical congestion in heart failure with associated therapeutic recommendations, from subclinical congestion through clinical decompensation to decongestion targets. Modality Primary Use in IM Key Inte...","sourceLabel":"Section in Internal Medicine"},"672":{"title":"Classification Systems (All)","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s40","snippet":"Classification Systems (All) System Used For Key Features ACC/AHA HTN (2017) Blood pressure classification Normal/Elevated/Stage 1/Stage 2/Crisis. Stage 1 starts at 130/80 (lowered from 140/90) NYHA (I–IV) Heart failure functional status I = no limitation, IV = symptoms at rest. Guides device therap...","sourceLabel":"Section in Internal Medicine"},"673":{"title":"Medications Master Table","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s41","snippet":"Medications Master Table Cardiovascular Generic (Brand) Class Mechanism Typical Dose Indication Critical Pearl Lisinopril (Zestril) ACEI Blocks ACE &rarr; decreases angiotensin II &rarr; vasodilation + decreased aldosterone 10–40 mg daily HTN, HFrEF, DM nephropathy, post-MI Monitor K+/Cr. Cough 10%....","sourceLabel":"Section in Internal Medicine"},"674":{"title":"Abbreviations Master List","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s42","snippet":"Abbreviations Master List General & Cardiovascular Abbreviation Meaning ACEI / ARB Angiotensin-converting enzyme inhibitor / angiotensin receptor blocker AFib Atrial fibrillation ACS Acute coronary syndrome BNP / NT-proBNP B-type natriuretic peptide / N-terminal pro-BNP CAD Coronary artery disease C...","sourceLabel":"Section in Internal Medicine"},"675":{"title":"Risk Scores & Preventive Guidelines","pageTitle":"Internal Medicine","pageUrl":"/medical/internal-medicine","url":"/medical/internal-medicine#s43","snippet":"Risk Scores & Preventive Guidelines Key Risk Scores Score Purpose Components Action Threshold ASCVD Pooled Cohort Equation 10-year CV risk (primary prevention) Age, sex, race, total/HDL cholesterol, SBP, BP treatment, DM, smoking &ge; 7.5%: moderate-intensity statin. &ge; 20%: high-intensity statin ...","sourceLabel":"Section in Internal Medicine"},"676":{"title":"Family Medicine","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine","snippet":"Specialty Reference Family Medicine Complete Specialty Reference Every diagnosis, screening guideline, medication, procedure, classification system, immunization schedule, and management strategy across the full lifespan — in one place."},"677":{"title":"Scope of Family Medicine","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s1","snippet":"Scope of Family Medicine Family medicine is the only specialty defined by breadth rather than organ system, disease category, or patient age. A family physician manages undifferentiated illness across the entire lifespan — newborn through geriatric — in ambulatory, inpatient, and procedural settings...","sourceLabel":"Section in Family Medicine"},"678":{"title":"The Comprehensive Physical Exam","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s2","snippet":"The Comprehensive Physical Exam The family medicine physical exam adapts to context — a focused exam for an acute sore throat is fundamentally different from a comprehensive annual wellness exam. However, every family physician must be able to perform a complete head-to-toe examination and know the ...","sourceLabel":"Section in Family Medicine"},"679":{"title":"Preventive Medicine Framework","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s3","snippet":"Preventive Medicine Framework Preventive care is the defining activity of family medicine. The US Preventive Services Task Force (USPSTF) issues evidence-graded recommendations (A, B, C, D, I) that drive screening and counseling decisions. Grade A/B recommendations are standard of care — most insure...","sourceLabel":"Section in Family Medicine"},"680":{"title":"Hypertension","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s4","snippet":"Hypertension Hypertension affects 47% of US adults (~116 million) and is the leading modifiable risk factor for stroke, MI, heart failure, CKD, and aortic dissection. The 2017 ACC/AHA guidelines lowered the diagnostic threshold from 140/90 to 130/80 mmHg, instantly reclassifying ~31 million American...","sourceLabel":"Section in Family Medicine"},"681":{"title":"Diabetes Mellitus","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s5","snippet":"Diabetes Mellitus Type 2 diabetes mellitus (T2DM) affects 37 million Americans (~11% of the population). It is the leading cause of CKD, non-traumatic lower extremity amputation, and adult-onset blindness. Family physicians manage the majority of T2DM in the US. The ADA Standards of Care (2024) defi...","sourceLabel":"Section in Family Medicine"},"682":{"title":"Dyslipidemia","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s6","snippet":"Dyslipidemia Dyslipidemia — elevated LDL-C, low HDL-C, or elevated triglycerides — is a primary driver of atherosclerotic cardiovascular disease. LDL-C is the primary therapeutic target. The 2018 AHA/ACC cholesterol guidelines shifted management from treating to a numeric LDL target toward a risk-ba...","sourceLabel":"Section in Family Medicine"},"683":{"title":"Obesity & Metabolic Syndrome","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s7","snippet":"Obesity & Metabolic Syndrome Obesity (BMI &ge;30) affects 42% of US adults and is the strongest modifiable risk factor for T2DM, OSA, NAFLD, OA, and multiple cancers (endometrial, breast, colon). Metabolic syndrome — a cluster of insulin resistance-driven findings — is present in ~35% of adults. Fig...","sourceLabel":"Section in Family Medicine"},"684":{"title":"Chronic Pain Management","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s8","snippet":"Chronic Pain Management Chronic pain (lasting >3 months) affects ~50 million US adults. Family physicians prescribe the majority of chronic pain medications and must balance adequate analgesia with opioid risk. The CDC Clinical Practice Guideline for Prescribing Opioids (2022) updated the 2016 guide...","sourceLabel":"Section in Family Medicine"},"685":{"title":"Upper Respiratory Infections & Sinusitis","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s9","snippet":"Upper Respiratory Infections & Sinusitis URIs are the most common reason for ambulatory visits in the US (~500 million/year). The vast majority are viral (rhinovirus, coronavirus, RSV, influenza, parainfluenza, adenovirus). Inappropriate antibiotic prescribing for viral URIs is the single largest dr...","sourceLabel":"Section in Family Medicine"},"686":{"title":"Otitis & Pharyngitis","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s10","snippet":"Otitis & Pharyngitis Acute Otitis Media (AOM) Most common bacterial infection in children. Diagnosis requires: (1) acute onset of symptoms (ear pain, irritability, fever), (2) middle ear effusion (bulging TM, limited mobility on pneumatic otoscopy, air-fluid level), AND (3) signs of middle ear infla...","sourceLabel":"Section in Family Medicine"},"687":{"title":"Urinary Tract Infections","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s11","snippet":"Urinary Tract Infections UTIs are the second most common infection seen in primary care. Uncomplicated cystitis occurs almost exclusively in premenopausal, non-pregnant women. Complicated UTI includes: male patients, pregnant patients, catheterized patients, anatomic abnormalities, immunosuppression...","sourceLabel":"Section in Family Medicine"},"688":{"title":"Skin & Soft Tissue Infections","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s12","snippet":"Skin & Soft Tissue Infections Skin and soft tissue infections (SSTIs) range from simple cellulitis to necrotizing fasciitis. The primary clinical decision: purulent (abscess likely — I&D is the primary treatment) vs non-purulent (cellulitis/erysipelas — antibiotics are the primary treatment). SSTI C...","sourceLabel":"Section in Family Medicine"},"689":{"title":"Acute Low Back Pain","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s13","snippet":"Acute Low Back Pain Low back pain is the leading cause of disability worldwide and the second most common reason for primary care visits. ~90% of acute low back pain is nonspecific mechanical pain — no identifiable structural pathology, self-limited within 4-6 weeks. The critical task in primary car...","sourceLabel":"Section in Family Medicine"},"690":{"title":"Acute Abdomen Triage","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s14","snippet":"Acute Abdomen Triage The family physician's role in acute abdominal pain is pattern recognition and triage — determining who needs emergent surgical evaluation, who needs urgent workup, and who can be managed conservatively. Location of pain is the most useful initial discriminator. Abdominal Pain b...","sourceLabel":"Section in Family Medicine"},"691":{"title":"Osteoarthritis","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s15","snippet":"Osteoarthritis Osteoarthritis (OA) is the most common joint disease — affecting >32 million US adults. It is a disease of the entire joint, not just \"worn cartilage\": cartilage degradation, subchondral bone remodeling, osteophyte formation, synovial inflammation, and ligament/meniscal degeneration a...","sourceLabel":"Section in Family Medicine"},"692":{"title":"Tendinopathies & Overuse Injuries","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s16","snippet":"Tendinopathies & Overuse Injuries Tendinopathy (formerly \"tendinitis\") is the preferred term because histology shows collagen degeneration and failed healing, not acute inflammation. Common sites encountered in family medicine: Condition Location Exam Finding First-Line Treatment Lateral epicondylit...","sourceLabel":"Section in Family Medicine"},"693":{"title":"Chronic Low Back Pain","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s17","snippet":"Chronic Low Back Pain Chronic LBP persists beyond 12 weeks. Unlike acute LBP, chronic LBP is a biopsychosocial condition: psychosocial factors (depression, catastrophizing, job dissatisfaction, fear-avoidance behavior) are stronger predictors of chronicity than MRI findings. Up to 60% of asymptomati...","sourceLabel":"Section in Family Medicine"},"694":{"title":"Osteoporosis","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s18","snippet":"Osteoporosis Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration &rarr; increased fracture risk. Affects 10 million Americans (80% women). Hip fractures carry 20-30% one-year mortality in elderly patients. The USPSTF recommends DEXA screeni...","sourceLabel":"Section in Family Medicine"},"695":{"title":"Depression & Anxiety","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s19","snippet":"Depression & Anxiety Depression and anxiety are the two most common mental health conditions in primary care. Family physicians manage the majority of depression and anxiety in the US — only ~20% of patients are referred to psychiatry. The PHQ-9 (depression) and GAD-7 (anxiety) are validated screeni...","sourceLabel":"Section in Family Medicine"},"696":{"title":"ADHD","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s20","snippet":"ADHD Attention-deficit/hyperactivity disorder (ADHD) affects 5-7% of children and 2.5-4% of adults. Family physicians diagnose and manage the majority of pediatric ADHD. DSM-5 requires 6+ symptoms of inattention and/or hyperactivity-impulsivity persisting &ge;6 months, present before age 12, in &ge;...","sourceLabel":"Section in Family Medicine"},"697":{"title":"Substance Use Disorders","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s21","snippet":"Substance Use Disorders Substance use disorders (SUDs) are among the most under-recognized and undertreated conditions in primary care. Family physicians are uniquely positioned to screen (SBIRT: Screening, Brief Intervention, Referral to Treatment), initiate medication-assisted treatment (MAT), and...","sourceLabel":"Section in Family Medicine"},"698":{"title":"Insomnia","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s22","snippet":"Insomnia Chronic insomnia (difficulty initiating or maintaining sleep &ge;3 nights/week for &ge;3 months) affects 10-15% of adults. First-line treatment is NOT medication — it is cognitive behavioral therapy for insomnia (CBT-I) , which has better long-term efficacy than any pharmacotherapy and no s...","sourceLabel":"Section in Family Medicine"},"699":{"title":"Contraception","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s23","snippet":"Contraception Family physicians provide the majority of contraceptive care in the US. Contraceptive counseling should be patient-centered, using the tiered-effectiveness model (LARC &rarr; hormonal &rarr; barrier) while respecting patient autonomy. Contraceptive Methods by Effectiveness Method Typic...","sourceLabel":"Section in Family Medicine"},"700":{"title":"Prenatal Care","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s24","snippet":"Prenatal Care Family physicians deliver ~20% of babies in the US and provide the majority of prenatal care in rural settings. Standard prenatal visit schedule: monthly through 28 weeks, biweekly 28-36 weeks, weekly 36 weeks to delivery. First visit ideally at 8-10 weeks. Prenatal Visit Laboratory Sc...","sourceLabel":"Section in Family Medicine"},"701":{"title":"Menopause","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s25","snippet":"Menopause Menopause is defined as 12 consecutive months of amenorrhea without other cause, reflecting ovarian follicular depletion. Average age: 51 years. Perimenopause (the transition) begins 4-8 years before final menstrual period and is characterized by irregular cycles, vasomotor symptoms, and h...","sourceLabel":"Section in Family Medicine"},"702":{"title":"Cervical & Breast Cancer Screening","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s26","snippet":"Cervical & Breast Cancer Screening Cervical Cancer Screening Age Group Recommended Screening Frequency <21 No screening (regardless of sexual activity) — 21-29 Cytology (Pap) alone Every 3 years 30-65 Pap + hrHPV co-testing (preferred) OR hrHPV alone OR Pap alone Co-testing q5yr; hrHPV alone q5yr; P...","sourceLabel":"Section in Family Medicine"},"703":{"title":"Well-Child Visits & Milestones","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s27","snippet":"Well-Child Visits & Milestones The AAP Bright Futures schedule defines well-child visit timing: newborn, 1 month, 2, 4, 6, 9, 12, 15, 18, 24, 30 months, then annually 3-21 years. Each visit includes growth assessment (plotted on CDC growth charts — weight, length/height, head circumference through 2...","sourceLabel":"Section in Family Medicine"},"704":{"title":"Immunization Schedule","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s28","snippet":"Immunization Schedule The CDC/ACIP immunization schedule is the most frequently referenced guideline in family medicine. Keeping children on schedule prevents an estimated 42,000 deaths per year in the US. The schedule is updated annually; the core childhood series: Childhood Immunization Schedule (...","sourceLabel":"Section in Family Medicine"},"705":{"title":"Common Pediatric Conditions","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s29","snippet":"Common Pediatric Conditions Croup (Laryngotracheobronchitis) Peak age 6 months - 3 years. Cause: parainfluenza virus (75%). Classic presentation: barky/seal-like cough, inspiratory stridor, hoarse voice, preceded by URI prodrome. Steeple sign on AP neck X-ray (subglottic narrowing — but X-ray rarely...","sourceLabel":"Section in Family Medicine"},"706":{"title":"Adolescent Health","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s30","snippet":"Adolescent Health Adolescent visits (11-21 years) require a unique approach: confidential screening for high-risk behaviors, STI screening, contraception counseling, and mental health assessment. The HEEADSSS psychosocial assessment framework: Home, Education/Employment, Eating, Activities, Drugs, S...","sourceLabel":"Section in Family Medicine"},"707":{"title":"Polypharmacy & Deprescribing","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s31","snippet":"Polypharmacy & Deprescribing Polypharmacy (typically defined as &ge;5 concurrent medications) affects >40% of adults &ge;65. It is a direct cause of adverse drug events (ADEs), falls, cognitive impairment, hospitalization, and mortality. The family physician manages the medication list longitudinall...","sourceLabel":"Section in Family Medicine"},"708":{"title":"Dementia & Cognitive Decline","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s32","snippet":"Dementia & Cognitive Decline Dementia affects ~6.7 million Americans &ge;65. Alzheimer's disease accounts for 60-80% of cases, followed by vascular dementia (10-20%), Lewy body dementia (5-15%), and frontotemporal dementia (5-10%). Family physicians are typically the first to identify cognitive decl...","sourceLabel":"Section in Family Medicine"},"709":{"title":"Falls Prevention","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s33","snippet":"Falls Prevention Falls are the leading cause of injury-related death in adults &ge;65 (36,000 deaths/year in the US). One in four older adults falls each year, and falls are the most common cause of traumatic brain injury and hip fracture in this population. The USPSTF recommends exercise interventi...","sourceLabel":"Section in Family Medicine"},"710":{"title":"Advanced Care Planning","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s34","snippet":"Advanced Care Planning Advanced care planning (ACP) is the process of discussing and documenting a patient's values, goals, and preferences for future medical care in the event they cannot speak for themselves. Every adult — especially those &ge;65 or with serious illness — should have ACP documente...","sourceLabel":"Section in Family Medicine"},"711":{"title":"Common Rashes — Eczema, Psoriasis, Fungal","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s35","snippet":"Common Rashes — Eczema, Psoriasis, Fungal Atopic Dermatitis (Eczema) Chronic, relapsing, intensely pruritic dermatitis. Affects 10-20% of children and 1-3% of adults. Distribution varies by age: infants (face, extensor surfaces), children/adults (flexural areas — antecubital fossa, popliteal fossa, ...","sourceLabel":"Section in Family Medicine"},"712":{"title":"Skin Cancer Screening (ABCDE)","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s36","snippet":"Skin Cancer Screening (ABCDE) Melanoma accounts for only 1% of skin cancers but causes the majority of skin cancer deaths (~8,000/year in the US). Family physicians perform opportunistic skin cancer screening during physical exams — the USPSTF has an I (insufficient evidence) rating for routine whol...","sourceLabel":"Section in Family Medicine"},"713":{"title":"Acne","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s37","snippet":"Acne Acne vulgaris affects 85% of adolescents and can persist into adulthood. Pathophysiology involves four mechanisms: (1) follicular hyperkeratinization (plugging), (2) excess sebum production (androgen-driven), (3) Cutibacterium acnes (formerly Propionibacterium acnes) proliferation, (4) inflamma...","sourceLabel":"Section in Family Medicine"},"714":{"title":"Joint Injections","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s38","snippet":"Joint Injections Corticosteroid injections are among the most commonly performed office procedures in family medicine. Indications: inflammatory or degenerative joint pain refractory to oral management, bursitis, trigger finger, de Quervain's tenosynovitis, plantar fasciitis. Figure 28 - Knee Joint ...","sourceLabel":"Section in Family Medicine"},"715":{"title":"Skin Biopsy & Excision","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s39","snippet":"Skin Biopsy & Excision Family physicians perform the majority of skin biopsies in the US. The three main biopsy types serve different diagnostic purposes: Technique Method Best For Pearl Shave biopsy Tangential excision with blade or DermaBlade parallel to skin surface Raised lesions, superficial le...","sourceLabel":"Section in Family Medicine"},"716":{"title":"Spirometry","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s40","snippet":"Spirometry Spirometry is the office-based pulmonary function test used to diagnose and monitor obstructive lung diseases (asthma, COPD). Every family medicine office should have the capability to perform spirometry. Figure 30 - Normal Spirometry Flow-Volume Loop. A normal spirometry tracing showing ...","sourceLabel":"Section in Family Medicine"},"717":{"title":"Wound Care","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s41","snippet":"Wound Care Laceration repair and wound management are core family medicine procedures. The two critical decisions: (1) Does this wound need closure? (2) Primary (sutures/staples now), delayed primary (close in 3-5 days if contaminated), or secondary intention (leave open to heal by granulation)? Wou...","sourceLabel":"Section in Family Medicine"},"718":{"title":"Splinting & Fracture Management","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s42","snippet":"Splinting & Fracture Management Family physicians diagnose and initially manage the majority of non-displaced fractures. Proper splinting immobilizes the injured area, reduces pain, and prevents further injury during the healing process. Splinting Principles Immobilize one joint above and one joint ...","sourceLabel":"Section in Family Medicine"},"719":{"title":"USPSTF Screening Guidelines — Consolidated","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s43","snippet":"USPSTF Screening Guidelines — Consolidated Condition Population Screening Method Interval Grade Hypertension Adults &ge;18 Office BP Annual; q3-5yr if normal <40 A Type 2 Diabetes Adults 35-70 with overweight/obesity FPG, A1C, or OGTT Every 3 years B Dyslipidemia Men &ge;35; women &ge;45 Lipid panel...","sourceLabel":"Section in Family Medicine"},"720":{"title":"Classification Systems","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s44","snippet":"Classification Systems System Application Key Features JNC 8 / 2017 ACC/AHA BP Classification Hypertension staging Normal, Elevated, Stage 1 (130-139/80-89), Stage 2 (&ge;140/90), Crisis (>180/120) ADA Diabetes Criteria Diabetes diagnosis FPG &ge;126, 2-hr OGTT &ge;200, A1C &ge;6.5%, random glucose ...","sourceLabel":"Section in Family Medicine"},"721":{"title":"Medications Master Table","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s45","snippet":"Medications Master Table Antihypertensives Generic (Brand) Class Typical Dose Mechanism Key Pearl Lisinopril (Zestril) ACEi 10-40 mg daily &darr; Angiotensin II Cough 10-20%; angioedema; monitor K+/Cr; CI in pregnancy Losartan (Cozaar) ARB 50-100 mg daily AT1 receptor blockade No cough; uricosuric e...","sourceLabel":"Section in Family Medicine"},"722":{"title":"Abbreviations Master List","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s46","snippet":"Abbreviations Master List Diagnoses HTN Hypertension DM / T2DM Diabetes mellitus / Type 2 diabetes mellitus DM1 Type 1 diabetes mellitus CAD Coronary artery disease CHF / HF Congestive heart failure HFrEF Heart failure with reduced ejection fraction HFpEF Heart failure with preserved ejection fracti...","sourceLabel":"Section in Family Medicine"},"723":{"title":"Immunization Schedules (Adult & Pediatric)","pageTitle":"Family Medicine","pageUrl":"/medical/family-medicine","url":"/medical/family-medicine#s47","snippet":"Immunization Schedules (Adult & Pediatric) Adult Immunization Schedule (CDC/ACIP) Vaccine Indication Schedule Pearl Influenza All adults annually 1 dose annually (fall) Egg allergy no longer a contraindication (even with anaphylaxis); high-dose (Fluzone HD) or adjuvanted (Fluad) for &ge;65 Td/Tdap A...","sourceLabel":"Section in Family Medicine"},"724":{"title":"Pediatrics","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics","snippet":"Specialty Reference Pediatrics Complete Specialty Reference Every age-specific diagnosis, milestone, vaccination, weight-based dosing, neonatal condition, and management strategy from birth through adolescence in one place."},"725":{"title":"Pediatric Anatomy & Physiology","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s1","snippet":"Pediatric Anatomy & Physiology Children are not small adults. Virtually every organ system differs from adult physiology in ways that have direct clinical consequences - from airway anatomy that predisposes to obstruction, to immature renal function that alters drug clearance, to a higher metabolic ...","sourceLabel":"Section in Pediatrics"},"726":{"title":"The Pediatric Assessment","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s2","snippet":"The Pediatric Assessment The pediatric assessment begins the moment you enter the room. The Pediatric Assessment Triangle (PAT) provides a rapid (<30 second) visual assessment of severity before any hands-on examination. It evaluates three components: Appearance (TICLS: Tone, Interactiveness, Consol...","sourceLabel":"Section in Pediatrics"},"727":{"title":"Key Terminology & Abbreviations","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s3","snippet":"Key Terminology & Abbreviations Pediatrics uses age-specific terminology and abbreviations that differ from adult medicine in important ways. Mastering this vocabulary is essential for interpreting growth data, immunization records, neonatal documentation, and pediatric emergency protocols. Abbrevia...","sourceLabel":"Section in Pediatrics"},"728":{"title":"Developmental Milestones","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s4","snippet":"Developmental Milestones Developmental milestones represent the expected acquisition of skills across four domains: gross motor, fine motor, language, and social-emotional. While there is normal variation, consistent delay in reaching milestones may indicate developmental disability, neurologic dise...","sourceLabel":"Section in Pediatrics"},"729":{"title":"Immunization Schedule","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s5","snippet":"Immunization Schedule Vaccination is the single most effective preventive intervention in pediatrics. The CDC immunization schedule is updated annually and published by the Advisory Committee on Immunization Practices (ACIP). Understanding the schedule, minimum intervals, contraindications, and the ...","sourceLabel":"Section in Pediatrics"},"730":{"title":"Growth & Nutrition","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s6","snippet":"Growth & Nutrition Expected Growth Patterns Age Weight Gain Length/Height Gain Head Circumference 0-3 months 30 g/day (1 oz/day) 3.5 cm/month 2 cm/month 3-6 months 20 g/day 2 cm/month 1 cm/month 6-12 months 10 g/day 1.5 cm/month 0.5 cm/month 1-2 years ~2.5 kg/year 12 cm/year - 2-puberty ~2 kg/year 5...","sourceLabel":"Section in Pediatrics"},"731":{"title":"Anticipatory Guidance & Screening","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s7","snippet":"Anticipatory Guidance & Screening Preventive care in pediatrics involves both surveillance for disease and anticipatory guidance for safety, nutrition, and development at each well-child visit. AAP Recommended Screening Schedule Screening Ages Method Newborn metabolic screen 24-48 hours of life Heel...","sourceLabel":"Section in Pediatrics"},"732":{"title":"Newborn Assessment","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s8","snippet":"Newborn Assessment APGAR Score Assessed at 1 and 5 minutes after birth (and every 5 minutes thereafter if score <7). It is a rapid assessment of the newborn's transition to extrauterine life, not a predictor of long-term neurologic outcome. Sign 0 Points 1 Point 2 Points A ppearance (color) Blue/pal...","sourceLabel":"Section in Pediatrics"},"733":{"title":"Neonatal Jaundice","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s9","snippet":"Neonatal Jaundice Jaundice (hyperbilirubinemia) affects ~60% of term and ~80% of preterm newborns. Most is benign physiologic jaundice, but severe unconjugated hyperbilirubinemia can cause kernicterus (bilirubin encephalopathy) - irreversible brain damage to the basal ganglia, hippocampus, and crani...","sourceLabel":"Section in Pediatrics"},"734":{"title":"Neonatal Respiratory Distress","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s10","snippet":"Neonatal Respiratory Distress Respiratory distress is the most common reason for NICU admission. The differential is guided by gestational age, mode of delivery, and timing of symptom onset. Figure 5 - Respiratory Distress Syndrome (RDS) Progression on Chest Radiograph. Sequential chest radiographs ...","sourceLabel":"Section in Pediatrics"},"735":{"title":"Neonatal Sepsis","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s11","snippet":"Neonatal Sepsis Neonatal sepsis is a clinical syndrome of systemic infection in the first 28 days of life. It is the leading infectious cause of neonatal mortality. The immature neonatal immune system (poor opsonization, low complement, deficient neutrophil function) makes neonates uniquely suscepti...","sourceLabel":"Section in Pediatrics"},"736":{"title":"Congenital Anomalies","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s12","snippet":"Congenital Anomalies Figure 9 - Congenital Diaphragmatic Hernia (CDH). Chest radiograph demonstrating cystic lucencies in the left hemithorax with mediastinal shift to the right. The bowel loops have herniated through the diaphragmatic defect, compressing the ipsilateral lung and causing respiratory...","sourceLabel":"Section in Pediatrics"},"737":{"title":"Asthma in Children","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s13","snippet":"Asthma in Children Asthma is the most common chronic disease of childhood, affecting ~8% of U.S. children. It is characterized by reversible airway obstruction, bronchial hyperresponsiveness, and chronic airway inflammation. The NAEPP EPR-4 (2020) guidelines provide stepwise therapy recommendations....","sourceLabel":"Section in Pediatrics"},"738":{"title":"Croup & Epiglottitis","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s14","snippet":"Croup & Epiglottitis Croup (Laryngotracheobronchitis) Croup is the most common cause of acute upper airway obstruction in children ages 6 months to 3 years (peak 1-2 years). It is caused by parainfluenza virus (types 1 and 3 most common) and produces subglottic edema with a characteristic \"barking\" ...","sourceLabel":"Section in Pediatrics"},"739":{"title":"Bronchiolitis","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s15","snippet":"Bronchiolitis Bronchiolitis is the most common lower respiratory tract infection in infants <12 months (peak 2-6 months). RSV causes ~70% of cases (other causes: rhinovirus, human metapneumovirus, parainfluenza, adenovirus). It produces inflammation, edema, and mucus plugging of the small airways (b...","sourceLabel":"Section in Pediatrics"},"740":{"title":"Pneumonia in Children","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s16","snippet":"Pneumonia in Children The most likely causative organisms vary significantly by age group, which determines empiric therapy. Etiology by Age Age Most Common Organisms Empiric Therapy Neonates (<28 days) GBS, E. coli, Listeria, HSV Ampicillin + gentamicin (&plusmn; acyclovir if HSV suspected) 1-3 mon...","sourceLabel":"Section in Pediatrics"},"741":{"title":"Fever in Children","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s17","snippet":"Fever in Children Fever is the most common presenting complaint in pediatric emergency departments. The approach to fever varies dramatically by age because the risk of serious bacterial infection (SBI) - UTI, bacteremia, meningitis - is highest in the youngest infants who may appear well despite se...","sourceLabel":"Section in Pediatrics"},"742":{"title":"Otitis Media & Pharyngitis","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s18","snippet":"Otitis Media & Pharyngitis Acute Otitis Media (AOM) AOM is the most common reason for antibiotic prescriptions in children. Peak incidence is 6-24 months. Diagnosis requires: (1) acute onset of symptoms, (2) middle ear effusion (bulging TM, impaired mobility on pneumatic otoscopy, air-fluid level), ...","sourceLabel":"Section in Pediatrics"},"743":{"title":"Common Childhood Exanthems","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s19","snippet":"Common Childhood Exanthems Disease Agent Rash Description Key Features Measles (Rubeola) Paramyxovirus Erythematous maculopapular rash starting at face/hairline &rarr; spreads cephalocaudal; confluent 3 C's: Cough, Coryza, Conjunctivitis; Koplik spots (white spots on buccal mucosa) before rash; high...","sourceLabel":"Section in Pediatrics"},"744":{"title":"Meningitis in Children","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s20","snippet":"Meningitis in Children Bacterial meningitis is a medical emergency in pediatrics. Prompt recognition and treatment reduce mortality and long-term neurologic sequelae (hearing loss, intellectual disability, seizures). Age-Based Empiric Therapy Age Common Organisms Empiric Antibiotics <1 month GBS, E....","sourceLabel":"Section in Pediatrics"},"745":{"title":"UTI in Children","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s21","snippet":"UTI in Children UTI is the most common serious bacterial infection in febrile infants. Presentation varies dramatically with age: neonates present with nonspecific signs (fever, irritability, poor feeding, jaundice), while older children present with classic dysuria, frequency, and suprapubic/flank ...","sourceLabel":"Section in Pediatrics"},"746":{"title":"Vomiting & Dehydration","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s22","snippet":"Vomiting & Dehydration Assessment of Dehydration Severity Feature Mild (3-5%) Moderate (6-9%) Severe (&ge;10%) Mental status Normal, thirsty Irritable, restless Lethargic, obtunded Eyes Normal Slightly sunken Deeply sunken Tears Present Decreased Absent Mucous membranes Slightly dry Dry Parched Skin...","sourceLabel":"Section in Pediatrics"},"747":{"title":"Abdominal Pain in Children","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s23","snippet":"Abdominal Pain in Children Appendicitis Most common surgical emergency in children. Classic presentation: periumbilical pain migrating to right lower quadrant (McBurney point) , anorexia, nausea/vomiting, low-grade fever. The Pediatric Appendicitis Score (PAS) and Alvarado score help risk-stratify. ...","sourceLabel":"Section in Pediatrics"},"748":{"title":"Pediatric GI Emergencies","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s24","snippet":"Pediatric GI Emergencies Necrotizing Enterocolitis (NEC) NEC is the most common GI emergency in premature neonates (primarily <32 weeks GA and <1,500 g). Pathogenesis involves mucosal injury from ischemia, formula feeding, and bacterial invasion. Presentation: feeding intolerance, abdominal distensi...","sourceLabel":"Section in Pediatrics"},"749":{"title":"Celiac Disease & Food Allergies","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s25","snippet":"Celiac Disease & Food Allergies Celiac Disease An immune-mediated enteropathy triggered by gluten (wheat, barley, rye) in genetically predisposed individuals (HLA-DQ2 or DQ8). Prevalence ~1% in Western populations. Classic presentation in children: chronic diarrhea, abdominal distension, failure to ...","sourceLabel":"Section in Pediatrics"},"750":{"title":"Congenital Heart Disease - Acyanotic","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s26","snippet":"Congenital Heart Disease - Acyanotic Acyanotic (left-to-right shunt) lesions present with signs of pulmonary overcirculation: tachypnea, poor feeding, diaphoresis with feeds, recurrent respiratory infections, and failure to thrive. They do not cause cyanosis initially, but long-standing shunts can c...","sourceLabel":"Section in Pediatrics"},"751":{"title":"Congenital Heart Disease - Cyanotic","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s27","snippet":"Congenital Heart Disease - Cyanotic Cyanotic CHD presents with hypoxemia that does not significantly improve with supplemental oxygen (the \"hyperoxia test\" : PaO2 remains <150 mmHg after 10 minutes of 100% FiO2, suggesting intracardiac right-to-left shunt rather than lung disease). The \"5 T's\" of cy...","sourceLabel":"Section in Pediatrics"},"752":{"title":"Kawasaki Disease","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s28","snippet":"Kawasaki Disease Kawasaki disease (KD) is an acute, self-limited vasculitis of medium-sized arteries with a predilection for the coronary arteries . It is the leading cause of acquired heart disease in children in developed countries. Peak incidence: 6 months to 5 years; male predominance (1.5:1); h...","sourceLabel":"Section in Pediatrics"},"753":{"title":"Short Stature & Growth Disorders","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s29","snippet":"Short Stature & Growth Disorders Short stature is defined as height <3rd percentile or >2 SD below the mean for age and sex. The differential is broad, but most children have either constitutional delay of growth and puberty or familial (genetic) short stature, both of which are normal variants. Dif...","sourceLabel":"Section in Pediatrics"},"754":{"title":"Precocious & Delayed Puberty","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s30","snippet":"Precocious & Delayed Puberty Tanner Staging Stage Girls (Breast) Girls (Pubic Hair) Boys (Genitalia) Boys (Pubic Hair) I Prepubertal None Prepubertal None II Breast buds (thelarche) Sparse, straight, medial labia Testicular enlargement (>4 mL / >2.5 cm) Sparse, base of penis III Breast elevation Dar...","sourceLabel":"Section in Pediatrics"},"755":{"title":"Pediatric Diabetes","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s31","snippet":"Pediatric Diabetes Type 1 Diabetes Autoimmune destruction of pancreatic beta cells; accounts for ~95% of diabetes in children <10 years. Presentation: polyuria, polydipsia, polyphagia, weight loss over days to weeks. ~30-40% present in DKA at diagnosis. Autoantibodies: GAD65, IA-2, insulin autoantib...","sourceLabel":"Section in Pediatrics"},"756":{"title":"Febrile Seizures","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s32","snippet":"Febrile Seizures Febrile seizures are the most common seizure type in children, affecting 2-5% of children ages 6 months to 5 years. They occur in the setting of fever (&ge;38&deg;C / 100.4&deg;F) without evidence of CNS infection or other defined cause. Simple vs. Complex Feature Simple Febrile Sei...","sourceLabel":"Section in Pediatrics"},"757":{"title":"ADHD","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s33","snippet":"ADHD Attention-deficit/hyperactivity disorder is the most common neurodevelopmental disorder in children, affecting ~8-10% of school-age children. Boys are diagnosed 2-3&times; more often than girls (partly due to more externalizing behavior; girls more often present with inattentive type). DSM-5 Di...","sourceLabel":"Section in Pediatrics"},"758":{"title":"Autism Spectrum Disorder","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s34","snippet":"Autism Spectrum Disorder ASD is a neurodevelopmental disorder characterized by persistent deficits in social communication/interaction and restricted, repetitive behaviors/interests. Prevalence: ~1 in 36 children (CDC 2023), with 4:1 male-to-female ratio. DSM-5 Criteria (Both Required) Domain Exampl...","sourceLabel":"Section in Pediatrics"},"759":{"title":"Pediatric Resuscitation","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s35","snippet":"Pediatric Resuscitation Pediatric cardiac arrest is most often due to respiratory failure or shock (asphyxia), unlike adult arrest which is usually primary cardiac (VF/VT). The most common preterminal rhythm in children is bradycardia progressing to PEA/asystole . Early recognition of respiratory di...","sourceLabel":"Section in Pediatrics"},"760":{"title":"Non-Accidental Trauma","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s36","snippet":"Non-Accidental Trauma Child abuse is tragically common: ~700,000 confirmed cases annually in the U.S., with ~1,750 fatalities per year. Children <3 years are at highest risk. All healthcare providers are mandatory reporters in all 50 states - suspected abuse must be reported even without proof. Repo...","sourceLabel":"Section in Pediatrics"},"761":{"title":"Foreign Body Ingestion & Poisoning","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s37","snippet":"Foreign Body Ingestion & Poisoning Foreign Body Ingestion Object Urgency Management Button battery (disk/coin battery) EMERGENT If in esophagus: endoscopic removal within 2 hours (generates hydroxide at negative pole &rarr; liquefactive necrosis &rarr; esophageal perforation, aortoesophageal fistula...","sourceLabel":"Section in Pediatrics"},"762":{"title":"Pediatric Vital Signs by Age","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s38","snippet":"Pediatric Vital Signs by Age Age Heart Rate (bpm) Respiratory Rate Systolic BP (mmHg) Diastolic BP (mmHg) Weight (kg, est.) Premature 120-170 40-70 55-75 35-45 1-2.5 Newborn (0-28 days) 120-160 30-60 60-76 30-45 2.5-4 1-6 months 100-150 25-50 72-104 37-56 4-7 6-12 months 90-140 25-40 72-104 37-56 7-...","sourceLabel":"Section in Pediatrics"},"763":{"title":"Classification Systems","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s39","snippet":"Classification Systems APGAR Score See Section 08 for full APGAR scoring table. Assessed at 1 and 5 minutes. Score 7-10 = reassuring; 4-6 = moderately depressed; 0-3 = severely depressed. Tanner Staging See Section 30 for full Tanner staging table. Stages I (prepubertal) through V (adult) for breast...","sourceLabel":"Section in Pediatrics"},"764":{"title":"Medications Master Table","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s40","snippet":"Medications Master Table Common Pediatric Antibiotics (Weight-Based Dosing) Drug Dose Route Common Indication Amoxicillin 40-90 mg/kg/day &divide; BID-TID PO AOM (80-90 mg/kg/day), pharyngitis (50 mg/kg/day), pneumonia, UTI Amoxicillin-clavulanate 90 mg/kg/day of amoxicillin component &divide; BID P...","sourceLabel":"Section in Pediatrics"},"765":{"title":"Abbreviations Master List","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s41","snippet":"Abbreviations Master List AAP American Academy of Pediatrics ABR Auditory brainstem response ACIP Advisory Committee on Immunization Practices ADHD Attention-deficit/hyperactivity disorder AGA Appropriate for gestational age AOM Acute otitis media APGAR Appearance, Pulse, Grimace, Activity, Respirat...","sourceLabel":"Section in Pediatrics"},"766":{"title":"Growth Charts & Screening Schedules","pageTitle":"Pediatrics","pageUrl":"/medical/pediatrics","url":"/medical/pediatrics#s42","snippet":"Growth Charts & Screening Schedules Well-Child Visit Schedule (AAP / Bright Futures) Visit Age Key Activities Newborn 3-5 days Weight check, jaundice assessment, feeding evaluation, newborn screen results 1 month 1 month Growth, HepB #2, feeding, development 2 months 2 months DTaP #1, IPV #1, Hib #1...","sourceLabel":"Section in Pediatrics"},"767":{"title":"Emergency Medicine","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine","snippet":"Specialty Reference Emergency Medicine Complete Specialty Reference Every critical presentation, resuscitation protocol, acute diagnosis, procedure, disposition decision, and management strategy in one place."},"768":{"title":"The Emergency Medicine Approach","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s1","snippet":"The Emergency Medicine Approach Emergency medicine is the only specialty defined not by an organ system or patient demographic but by acuity and undifferentiated presentation . The ED physician sees every chief complaint, from cardiac arrest to laceration repair, and must risk-stratify within minute...","sourceLabel":"Section in Emergency Medicine"},"769":{"title":"Resuscitation Fundamentals","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s2","snippet":"Resuscitation Fundamentals ACLS - Cardiac Arrest Algorithms The 2020 AHA Guidelines define two pathways based on initial rhythm: Shockable (VF/pVT) Non-Shockable (Asystole/PEA) Defibrillate immediately (biphasic 120-200 J, mono 360 J) CPR &times; 2 min, then rhythm check Resume CPR &times; 2 min, rh...","sourceLabel":"Section in Emergency Medicine"},"770":{"title":"Key Terminology & Abbreviations","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s3","snippet":"Key Terminology & Abbreviations Emergency medicine uses a dense layer of abbreviations across triage, resuscitation, trauma, and disposition. A comprehensive list is provided in Section 50 . Below are the foundational terms every EM reference requires: ABCDE Airway, Breathing, Circulation, Disabilit...","sourceLabel":"Section in Emergency Medicine"},"771":{"title":"Acute Coronary Syndromes","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s4","snippet":"Acute Coronary Syndromes ACS is a spectrum of acute myocardial ischemia ranging from unstable angina (UA) to non-ST-elevation MI (NSTEMI) to ST-elevation MI (STEMI). ACS is the leading cause of death worldwide and the most common high-acuity cardiac presentation in the ED. The critical ED task is ra...","sourceLabel":"Section in Emergency Medicine"},"772":{"title":"Acute Heart Failure & Pulmonary Edema","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s5","snippet":"Acute Heart Failure & Pulmonary Edema Acute decompensated heart failure (ADHF) presents as sudden or worsening dyspnea, orthopnea, and hypoxia from pulmonary venous congestion. The ED must rapidly distinguish cardiogenic pulmonary edema from pneumonia, COPD, and PE. BNP > 400 pg/mL (or NT-proBNP > 9...","sourceLabel":"Section in Emergency Medicine"},"773":{"title":"Aortic Dissection & Aortic Emergencies","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s6","snippet":"Aortic Dissection & Aortic Emergencies Aortic dissection is a tear in the aortic intima allowing blood to enter the media, creating a false lumen. Mortality increases 1-2% per hour if untreated. Classic presentation: sudden-onset \"tearing\" or \"ripping\" chest/back pain that is maximal at onset, radia...","sourceLabel":"Section in Emergency Medicine"},"774":{"title":"Cardiac Arrest & Post-Arrest Care","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s7","snippet":"Cardiac Arrest & Post-Arrest Care Cardiac arrest survival depends on the chain of survival: early recognition, early CPR, early defibrillation, and advanced resuscitation. Out-of-hospital cardiac arrest (OHCA) survival to discharge averages 10-12% nationally; in-hospital cardiac arrest (IHCA) surviv...","sourceLabel":"Section in Emergency Medicine"},"775":{"title":"Arrhythmia Management","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s8","snippet":"Arrhythmia Management Tachyarrhythmias Rhythm ECG Features Stable Management Unstable Management SVT (AVNRT/AVRT) Narrow complex, regular, rate 150-250, no visible P waves Vagal maneuvers (modified Valsalva) &rarr; Adenosine 6 mg rapid IV push (may repeat 12 mg &times; 2) Synchronized cardioversion ...","sourceLabel":"Section in Emergency Medicine"},"776":{"title":"Hypertensive Emergencies","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s9","snippet":"Hypertensive Emergencies A hypertensive emergency is severely elevated BP (often > 180/120) with acute end-organ damage : encephalopathy, acute stroke, aortic dissection, acute MI, pulmonary edema, eclampsia, acute renal failure, or retinal hemorrhage. Hypertensive urgency is severely elevated BP wi...","sourceLabel":"Section in Emergency Medicine"},"777":{"title":"Pulmonary Embolism","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s10","snippet":"Pulmonary Embolism PE is the third leading cause of cardiovascular death. The ED challenge is identifying PE among the high volume of patients with chest pain and dyspnea while avoiding unnecessary CT angiography. Risk stratification begins with clinical probability assessment. Figure 11 - CT Pulmon...","sourceLabel":"Section in Emergency Medicine"},"778":{"title":"Cardiac Tamponade","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s11","snippet":"Cardiac Tamponade Pericardial fluid accumulation compressing the heart, impairing diastolic filling. The physiologic consequence is obstructive shock - reduced cardiac output despite adequate volume. Causes: malignancy (most common cause of large effusions), uremia, post-MI (Dressler syndrome), trau...","sourceLabel":"Section in Emergency Medicine"},"779":{"title":"Acute Asthma & Status Asthmaticus","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s12","snippet":"Acute Asthma & Status Asthmaticus Asthma exacerbation severity drives treatment intensity. Mild-moderate: speaks in sentences, RR < 30, SpO2 &ge; 90%, PEF > 50% predicted. Severe: speaks in words, RR > 30, accessory muscle use, SpO2 < 90%, PEF < 50%. Status asthmaticus : severe exacerbation refracto...","sourceLabel":"Section in Emergency Medicine"},"780":{"title":"COPD Exacerbation","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s13","snippet":"COPD Exacerbation Acute worsening of respiratory symptoms (dyspnea, cough, sputum volume/purulence) beyond normal day-to-day variation requiring a change in medication. Most common triggers: viral/bacterial infection (60-80%), air pollution, PE, and pneumothorax. COPD patients live with chronic CO2 ...","sourceLabel":"Section in Emergency Medicine"},"781":{"title":"Pneumonia (CAP, HAP, Aspiration)","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s14","snippet":"Pneumonia (CAP, HAP, Aspiration) Community-acquired pneumonia (CAP) is the most common infectious cause of death in the US. Typical pathogens: S. pneumoniae (most common), H. influenzae , M. catarrhalis . Atypical: Mycoplasma , Chlamydophila , Legionella . Viral: influenza, RSV, SARS-CoV-2. Severity...","sourceLabel":"Section in Emergency Medicine"},"782":{"title":"Pneumothorax","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s15","snippet":"Pneumothorax Figure 14 - Pneumothorax on Chest Radiograph. Erect chest X-ray demonstrating a visible visceral pleural line with absent lung markings beyond the line, the classic radiographic finding of pneumothorax. Types Type Mechanism Presentation Management Simple spontaneous (primary) Rupture of...","sourceLabel":"Section in Emergency Medicine"},"783":{"title":"Acute Respiratory Failure & Mechanical Ventilation","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s16","snippet":"Acute Respiratory Failure & Mechanical Ventilation Type I (hypoxemic) : PaO2 < 60 mmHg on room air. Caused by V/Q mismatch, shunt, diffusion impairment (pneumonia, ARDS, PE, pulmonary edema). Type II (hypercapnic) : PaCO2 > 50 mmHg with respiratory acidosis. Caused by alveolar hypoventilation (COPD,...","sourceLabel":"Section in Emergency Medicine"},"784":{"title":"Acute Ischemic Stroke","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s17","snippet":"Acute Ischemic Stroke Stroke is a time-critical emergency - \"time is brain.\" Approximately 1.9 million neurons are lost per minute during a large-vessel occlusion. The ED role is rapid recognition (NIHSS assessment), immediate CT to exclude hemorrhage, and initiation of reperfusion therapy within th...","sourceLabel":"Section in Emergency Medicine"},"785":{"title":"Hemorrhagic Stroke (ICH & SAH)","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s18","snippet":"Hemorrhagic Stroke (ICH & SAH) Figure 18 - Hemorrhagic Stroke on CT Head. Non-contrast CT demonstrating hyperdense (bright white) intraparenchymal blood. CT is the first-line study in stroke to differentiate ischemic from hemorrhagic stroke, as the management differs fundamentally. Intracerebral Hem...","sourceLabel":"Section in Emergency Medicine"},"786":{"title":"Status Epilepticus","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s19","snippet":"Status Epilepticus Defined as continuous seizure activity lasting &ge; 5 minutes or &ge; 2 seizures without return to baseline. A true time-critical neurological emergency - prolonged seizure activity causes excitotoxic neuronal injury, rhabdomyolysis, hyperthermia, and systemic acidosis. Mortality ...","sourceLabel":"Section in Emergency Medicine"},"787":{"title":"Meningitis & Encephalitis","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s20","snippet":"Meningitis & Encephalitis Bacterial meningitis carries 20-25% mortality even with treatment and requires emergent antibiotics - do not delay for LP or imaging . Classic triad: fever, nuchal rigidity, altered mental status (present in only ~44% of bacterial meningitis). Kernig's sign (pain with knee ...","sourceLabel":"Section in Emergency Medicine"},"788":{"title":"Spinal Cord Compression","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s21","snippet":"Spinal Cord Compression Acute spinal cord compression is a neurosurgical/oncologic emergency . Most common cause: metastatic disease (breast, lung, prostate account for >50%). Other causes: epidural abscess, disk herniation, epidural hematoma. Presentation: progressive back pain (often the first sym...","sourceLabel":"Section in Emergency Medicine"},"789":{"title":"Traumatic Brain Injury","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s22","snippet":"Traumatic Brain Injury Glasgow Coma Scale (GCS) Component Response Score Eye Opening (E) Spontaneous 4 To voice 3 To pain 2 None 1 Verbal (V) Oriented 5 Confused 4 Inappropriate words 3 Incomprehensible sounds 2 None 1 Motor (M) Obeys commands 6 Localizes pain 5 Withdrawal (flexion) 4 Abnormal flexi...","sourceLabel":"Section in Emergency Medicine"},"790":{"title":"Cervical Spine Injury","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s23","snippet":"Cervical Spine Injury The ED must identify or confidently exclude c-spine injury in every trauma patient. Clinical decision rules allow safe clearance without imaging in low-risk patients. Figure 26 - Cervical Spine Fractures on CT. Multiplanar CT images demonstrating cervical spine fractures. CT wi...","sourceLabel":"Section in Emergency Medicine"},"791":{"title":"Chest Trauma","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s24","snippet":"Chest Trauma Figure 28 - Pulmonary Embolism: Spectrum of CT Findings. CTA images showing different presentations of PE from central (saddle) emboli to segmental and subsegmental filling defects. The clot burden and presence of right heart strain determine clinical severity and treatment approach. Ch...","sourceLabel":"Section in Emergency Medicine"},"792":{"title":"Abdominal Trauma & FAST Exam","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s25","snippet":"Abdominal Trauma & FAST Exam Figure 29 - FAST Exam Probe Positions and Views. The four standard FAST exam windows: right upper quadrant (Morison's pouch), left upper quadrant (splenorenal recess), suprapubic (pelvis), and subxiphoid (pericardium). The FAST exam rapidly detects free intraperitoneal f...","sourceLabel":"Section in Emergency Medicine"},"793":{"title":"Pelvic Fracture & Hemorrhage","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s26","snippet":"Pelvic Fracture & Hemorrhage Figure 31 - Cervical Facet Dislocation on CT. CT demonstrating facet joint dislocation with vertebral subluxation. Bilateral facet dislocations cause approximately 50% subluxation with high risk of spinal cord injury requiring emergent reduction. Unstable pelvic fracture...","sourceLabel":"Section in Emergency Medicine"},"794":{"title":"Orthopedic Emergencies","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s27","snippet":"Orthopedic Emergencies Open Fractures - Gustilo-Anderson Classification Type Wound Size Soft Tissue Injury Contamination Antibiotic I < 1 cm Minimal Clean Cefazolin 2 g IV II 1-10 cm Moderate Moderate Cefazolin 2 g IV IIIA > 10 cm Extensive, adequate coverage High Cefazolin + gentamicin IIIB > 10 cm...","sourceLabel":"Section in Emergency Medicine"},"795":{"title":"Acute Abdomen & Imaging Approach","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s28","snippet":"Acute Abdomen & Imaging Approach The \"acute abdomen\" is not a diagnosis but a clinical presentation: acute abdominal pain requiring urgent evaluation and often intervention. The ED approach centers on identifying surgical emergencies (appendicitis, perforated viscus, bowel obstruction, mesenteric is...","sourceLabel":"Section in Emergency Medicine"},"796":{"title":"Appendicitis & Cholecystitis","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s29","snippet":"Appendicitis & Cholecystitis Appendicitis Lifetime incidence 7-8%. Classic presentation: periumbilical pain migrating to RLQ (visceral &rarr; somatic pain as inflammation reaches the parietal peritoneum), anorexia, nausea/vomiting, low-grade fever. McBurney's point tenderness (1/3 of the distance fr...","sourceLabel":"Section in Emergency Medicine"},"797":{"title":"Bowel Obstruction & Mesenteric Ischemia","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s30","snippet":"Bowel Obstruction & Mesenteric Ischemia Small Bowel Obstruction (SBO) Causes: adhesions from prior surgery (75%), hernias (15%), malignancy, Crohn's disease, volvulus. Presentation: crampy abdominal pain, nausea/vomiting (earlier and more profuse in proximal obstruction), obstipation/constipation, d...","sourceLabel":"Section in Emergency Medicine"},"798":{"title":"GI Hemorrhage","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s31","snippet":"GI Hemorrhage Upper GI Bleeding (UGIB) Source proximal to the ligament of Treitz. Presentation: hematemesis (bright red or coffee-ground emesis), melena (black tarry stool), or hematochezia (if massive). Most common causes: peptic ulcer disease (35-50%), esophageal/gastric varices (10-20%), Mallory-...","sourceLabel":"Section in Emergency Medicine"},"799":{"title":"Pancreatitis","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s32","snippet":"Pancreatitis Diagnosis requires 2 of 3: (1) characteristic abdominal pain (epigastric, radiating to back, worse after eating), (2) serum lipase &ge; 3&times; upper limit of normal, (3) imaging findings (CT showing pancreatic edema/necrosis/peripancreatic stranding). Lipase is preferred over amylase ...","sourceLabel":"Section in Emergency Medicine"},"800":{"title":"Sepsis & Septic Shock","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s33","snippet":"Sepsis & Septic Shock Figure 33 - Sepsis-3 Clinical Criteria and Definitions. Diagnostic framework for sepsis and septic shock per the 2016 Sepsis-3 definitions. Sepsis requires suspected infection plus acute organ dysfunction (SOFA increase of 2 or more points). Septic shock adds vasopressor requir...","sourceLabel":"Section in Emergency Medicine"},"801":{"title":"Skin & Soft Tissue Infections","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s34","snippet":"Skin & Soft Tissue Infections Figure 34 - Necrotizing Fasciitis: CT Imaging. CT demonstrating gas within the soft tissues tracking along fascial planes, a specific but not sensitive finding in necrotizing fasciitis. CT sensitivity is approximately 93% for necrotizing soft tissue infections. Spectrum...","sourceLabel":"Section in Emergency Medicine"},"802":{"title":"Toxidrome Recognition & General Approach","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s35","snippet":"Toxidrome Recognition & General Approach A toxidrome is a constellation of signs and symptoms that suggests a particular class of poisoning. Recognizing the toxidrome narrows the differential immediately and guides empiric treatment before confirmatory labs return. Toxidrome Vital Signs Pupils Key F...","sourceLabel":"Section in Emergency Medicine"},"803":{"title":"Acetaminophen & Salicylate Toxicity","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s36","snippet":"Acetaminophen & Salicylate Toxicity Acetaminophen (APAP) Overdose The most common cause of acute liver failure in the US. Toxic dose: > 150 mg/kg or > 7.5 g in adults. Metabolism: at therapeutic doses, APAP is metabolized via glucuronidation/sulfation. In overdose, these pathways saturate, and CYP2E...","sourceLabel":"Section in Emergency Medicine"},"804":{"title":"Alcohol Withdrawal & Sedative-Hypnotic Toxicity","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s37","snippet":"Alcohol Withdrawal & Sedative-Hypnotic Toxicity Alcohol withdrawal is a spectrum from mild (tremor, anxiety, insomnia, 6-24 hrs after last drink) to moderate (hallucinations, 12-48 hrs) to seizures (12-48 hrs) to delirium tremens (48-96 hrs: confusion, agitation, autonomic instability, hyperthermia,...","sourceLabel":"Section in Emergency Medicine"},"805":{"title":"Anaphylaxis","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s38","snippet":"Anaphylaxis Figure 36 - Anaphylaxis: Clinical Features and Severity Grading. Clinical manifestations of anaphylaxis across organ systems. Skin findings (urticaria, angioedema) occur in 90% of cases but may be absent in rapidly progressive anaphylaxis. Cardiovascular collapse can occur without skin f...","sourceLabel":"Section in Emergency Medicine"},"806":{"title":"Environmental Emergencies","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s39","snippet":"Environmental Emergencies Heat Emergencies Entity Core Temp Key Features Treatment Heat exhaustion < 40&deg;C (104&deg;F) Heavy sweating, weakness, headache, nausea, normal mentation Rest, cool environment, oral/IV rehydration Heat stroke &ge; 40&deg;C (104&deg;F) Altered mental status (confusion, s...","sourceLabel":"Section in Emergency Medicine"},"807":{"title":"Pediatric Emergencies","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s40","snippet":"Pediatric Emergencies Febrile Seizures Most common seizure type in children (2-5% of children aged 6 months to 5 years). Simple febrile seizure: generalized, < 15 minutes, does not recur within 24 hours. Complex: focal, > 15 minutes, or recurrent within 24 hours. Simple febrile seizures are benign -...","sourceLabel":"Section in Emergency Medicine"},"808":{"title":"Obstetric Emergencies","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s41","snippet":"Obstetric Emergencies Ectopic Pregnancy Implantation outside the uterine cavity (95% in fallopian tube). Risk factors: prior ectopic, PID, tubal surgery, IUD. Presentation: abdominal/pelvic pain + vaginal bleeding + positive pregnancy test. Ruptured ectopic causes acute abdomen with hemoperitoneal s...","sourceLabel":"Section in Emergency Medicine"},"809":{"title":"Psychiatric Emergencies","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s42","snippet":"Psychiatric Emergencies Suicidal Patient Risk assessment: SAD PERSONS (Sex, Age, Depression, Previous attempt, Ethanol abuse, Rational thinking loss, Social supports lacking, Organized plan, No spouse, Sickness). High-risk features: specific plan, access to means (especially firearms), active psycho...","sourceLabel":"Section in Emergency Medicine"},"810":{"title":"Geriatric Emergencies","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s43","snippet":"Geriatric Emergencies Elderly patients (&ge; 65 years) present atypically: MI without chest pain (dyspnea, confusion), sepsis without fever (hypothermia is a worse prognostic sign), UTI presenting as altered mental status, appendicitis without peritoneal signs. Falls are the leading cause of injury-...","sourceLabel":"Section in Emergency Medicine"},"811":{"title":"Airway Management & RSI","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s44","snippet":"Airway Management & RSI Rapid Sequence Intubation (RSI) RSI is the standard of care for emergency intubation in the ED. It involves simultaneous administration of a sedative and neuromuscular blocking agent to facilitate endotracheal intubation while minimizing aspiration risk. Phase Action Details ...","sourceLabel":"Section in Emergency Medicine"},"812":{"title":"Vascular Access & Chest Procedures","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s45","snippet":"Vascular Access & Chest Procedures Vascular Access Hierarchy Access Type Gauge/Size Flow Rate When to Use Peripheral IV (PIV) 18G (green) or 16G (gray) ~200-350 mL/min (16G with pressure bag) First-line; 2 large-bore IVs for trauma/resuscitation Intraosseous (IO) 15G (EZ-IO drill) ~80-125 mL/min (pr...","sourceLabel":"Section in Emergency Medicine"},"813":{"title":"Wound Management & Procedural Sedation","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s46","snippet":"Wound Management & Procedural Sedation Laceration Repair Assessment: mechanism, contamination, depth (tendon/nerve/vessel/joint involvement?), foreign body, neurovascular status distal to wound, time since injury. Anesthesia: local infiltration with lidocaine 1% (max 4.5 mg/kg without epi, 7 mg/kg w...","sourceLabel":"Section in Emergency Medicine"},"814":{"title":"Reduction Techniques & Bedside Ultrasound","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s47","snippet":"Reduction Techniques & Bedside Ultrasound Shoulder Dislocation Reduction Multiple techniques exist; selection depends on patient body habitus, cooperation, and provider experience. External rotation method : patient supine, elbow at 90&deg;, slowly externally rotate the arm (adducted) until relocate...","sourceLabel":"Section in Emergency Medicine"},"815":{"title":"Clinical Decision Rules & Scoring Systems","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s48","snippet":"Clinical Decision Rules & Scoring Systems Rule/Score Application Key Thresholds HEART Score Chest pain risk stratification 0-3: low risk (safe for discharge); 4-6: moderate; 7-10: high (early invasive) Wells PE PE probability &le;4: unlikely (D-dimer to rule out); >4: likely (CTA) Wells DVT DVT prob...","sourceLabel":"Section in Emergency Medicine"},"816":{"title":"Medications Master Table","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s49","snippet":"Medications Master Table RSI & Airway Medications Drug (Brand) Mechanism Dose Indication Critical Pearl Etomidate (Amidate) GABA-A agonist 0.3 mg/kg IV RSI induction Hemodynamically neutral; single-dose adrenal suppression clinically insignificant Ketamine (Ketalar) NMDA antagonist 1.5-2 mg/kg IV RS...","sourceLabel":"Section in Emergency Medicine"},"817":{"title":"Abbreviations Master List","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s50","snippet":"Abbreviations Master List General & Resuscitation ABCDE Airway, Breathing, Circulation, Disability, Exposure ACLS Advanced Cardiovascular Life Support ACS Acute coronary syndrome AED Automated external defibrillator AMS Altered mental status ATLS Advanced Trauma Life Support BLS Basic life support B...","sourceLabel":"Section in Emergency Medicine"},"818":{"title":"Disposition Decision Framework & References","pageTitle":"Emergency Medicine","pageUrl":"/medical/emergency-medicine","url":"/medical/emergency-medicine#s51","snippet":"Disposition Decision Framework & References Disposition Decision Framework Every ED patient requires a disposition decision: discharge home, observe (observation unit), admit to the floor, or admit to the ICU. This decision integrates acuity, diagnosis, clinical trajectory, and patient factors. Disp...","sourceLabel":"Section in Emergency Medicine"},"819":{"title":"Cardiology","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology","snippet":"Specialty Reference Cardiology Complete Specialty Reference Every diagnosis, condition, procedure, device, medication, classification system, EKG finding, hemodynamic parameter, and management strategy in one place."},"820":{"title":"Cardiac Anatomy & Physiology","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s1","snippet":"Cardiac Anatomy & Physiology The heart is a four-chambered muscular pump weighing approximately 250-350 g in adults, located in the mediastinum behind the sternum and between the lungs. It receives deoxygenated blood from the systemic venous circulation, sends it through the pulmonary circuit for ga...","sourceLabel":"Section in Cardiology"},"821":{"title":"The Cardiac Physical Exam","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s2","snippet":"The Cardiac Physical Exam Inspection & Palpation Assess for jugular venous distension (JVD) - the internal jugular vein is used; with the patient at 45&deg;, the top of the venous pulsation measured vertically above the sternal angle + 5 cm (the estimated distance from the sternal angle to the RA) g...","sourceLabel":"Section in Cardiology"},"822":{"title":"Key Terminology & Abbreviations","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s3","snippet":"Key Terminology & Abbreviations Cardiology has one of the densest abbreviation vocabularies in medicine. Mastering these terms is essential for reading EKG reports, catheterization data, echocardiograms, and clinical notes. Abbreviation Meaning EF Ejection fraction CO / CI Cardiac output / cardiac i...","sourceLabel":"Section in Cardiology"},"823":{"title":"Stable Angina / Chronic Coronary Syndrome","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s4","snippet":"Stable Angina / Chronic Coronary Syndrome Chronic coronary syndrome (CCS), formerly \"stable angina,\" is fixed atherosclerotic narrowing of coronary arteries causing a supply-demand mismatch during exertion. Coronary artery disease remains the leading cause of death worldwide, responsible for ~18 mil...","sourceLabel":"Section in Cardiology"},"824":{"title":"Acute Coronary Syndromes (STEMI, NSTEMI, UA)","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s5","snippet":"Acute Coronary Syndromes (STEMI, NSTEMI, UA) ACS encompasses the spectrum of acute myocardial ischemia from unstable angina (UA) to NSTEMI to STEMI - all caused by acute disruption of an atherosclerotic plaque with superimposed thrombus formation. ACS accounts for >1.5 million hospital admissions pe...","sourceLabel":"Section in Cardiology"},"825":{"title":"Post-MI Complications","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s6","snippet":"Post-MI Complications Post-MI complications are time-dependent and must be anticipated. They are a frequent cause of in-hospital deterioration and a board exam staple. Timing Complication Mechanism / Presentation Management Hours Arrhythmias (VT/VF, AFib, bradycardia) VT/VF most common cause of earl...","sourceLabel":"Section in Cardiology"},"826":{"title":"Heart Failure with Reduced EF (HFrEF)","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s7","snippet":"Heart Failure with Reduced EF (HFrEF) HFrEF is defined as clinical heart failure with LVEF &le;40%. It affects ~6.7 million Americans, with 1 million new diagnoses per year. Five-year mortality remains ~50%. Ischemic cardiomyopathy (post-MI LV dysfunction) is the most common cause, followed by non-i...","sourceLabel":"Section in Cardiology"},"827":{"title":"Heart Failure with Preserved EF (HFpEF)","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s8","snippet":"Heart Failure with Preserved EF (HFpEF) HFpEF is defined as clinical heart failure with LVEF &ge;50% (HFmrEF = EF 41-49%). It accounts for ~50% of all HF and is increasing in prevalence, driven by the aging population, obesity, hypertension, and diabetes. Unlike HFrEF, most traditional HF therapies ...","sourceLabel":"Section in Cardiology"},"828":{"title":"Acute Decompensated Heart Failure","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s9","snippet":"Acute Decompensated Heart Failure ADHF is the most common cause of hospital admission in patients >65 years. Presentation: worsening dyspnea (exertional &rarr; orthopnea &rarr; PND &rarr; dyspnea at rest), weight gain, peripheral edema, JVD, pulmonary crackles/rales, S3 gallop. Precipitants: medicat...","sourceLabel":"Section in Cardiology"},"829":{"title":"Cardiogenic Shock","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s10","snippet":"Cardiogenic Shock Cardiogenic shock is the most severe form of heart failure - inadequate cardiac output resulting in end-organ hypoperfusion despite adequate intravascular volume. Mortality remains 40-50% even with aggressive treatment. Most commonly caused by acute MI (especially large anterior ST...","sourceLabel":"Section in Cardiology"},"830":{"title":"Atrial Fibrillation & Flutter","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s11","snippet":"Atrial Fibrillation & Flutter Atrial fibrillation (AF) is the most common sustained arrhythmia, affecting ~6 million Americans and ~33 million people globally. AF is characterized by disorganized atrial electrical activity (no discrete P waves, irregularly irregular ventricular response) originating...","sourceLabel":"Section in Cardiology"},"831":{"title":"Supraventricular Tachycardias (SVT)","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s12","snippet":"Supraventricular Tachycardias (SVT) SVT is a generic term for tachyarrhythmias (HR >100) originating above the ventricles. The most common mechanism is AVNRT (AV nodal reentrant tachycardia, ~60% of SVTs) - a reentrant circuit within or near the AV node using slow and fast pathways. Second most comm...","sourceLabel":"Section in Cardiology"},"832":{"title":"Ventricular Tachycardia & Fibrillation","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s13","snippet":"Ventricular Tachycardia & Fibrillation Ventricular tachycardia (VT) = &ge;3 consecutive ventricular beats at >100 bpm. Non-sustained VT (NSVT) = lasts <30 seconds and self-terminates. Sustained VT = lasts &ge;30 seconds or requires intervention. Monomorphic VT (uniform QRS) usually arises from scar-...","sourceLabel":"Section in Cardiology"},"833":{"title":"Bradyarrhythmias & Heart Block","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s14","snippet":"Bradyarrhythmias & Heart Block Bradycardia is HR <60 bpm. Symptomatic bradycardia (syncope, pre-syncope, HF, fatigue, exercise intolerance) requires treatment. Causes: intrinsic conduction system disease (fibrosis/degeneration - most common cause for permanent pacemaker), medications (beta-blockers,...","sourceLabel":"Section in Cardiology"},"834":{"title":"Sudden Cardiac Death & Channelopathies","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s15","snippet":"Sudden Cardiac Death & Channelopathies Sudden cardiac death (SCD) claims ~350,000 lives per year in the US. The most common cause in adults >35 is CAD/ischemic cardiomyopathy . In adults <35, the leading causes are HCM , arrhythmogenic right ventricular cardiomyopathy (ARVC) , coronary artery anomal...","sourceLabel":"Section in Cardiology"},"835":{"title":"Aortic Stenosis","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s16","snippet":"Aortic Stenosis Aortic stenosis (AS) is the most common valvular disease requiring intervention in developed countries. The most common etiology in adults >70 is calcific/degenerative disease of a trileaflet valve. In patients 50-70, bicuspid aortic valve (BAV, prevalence ~1-2%) is the most common c...","sourceLabel":"Section in Cardiology"},"836":{"title":"Aortic Regurgitation","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s17","snippet":"Aortic Regurgitation Aortic regurgitation (AR) is backflow from the aorta into the LV during diastole. Chronic AR causes volume overload with progressive LV dilation (eccentric hypertrophy) - the LV compensates for years before decompensating. Common causes: bicuspid aortic valve, aortic root dilati...","sourceLabel":"Section in Cardiology"},"837":{"title":"Mitral Regurgitation","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s18","snippet":"Mitral Regurgitation Mitral regurgitation (MR) is the most common valvular lesion in the US. Two pathologic types: Primary (organic) MR - intrinsic valve pathology (MVP with flail leaflet, rheumatic disease, endocarditis, annular calcification). Secondary (functional) MR - normal valve leaflets with...","sourceLabel":"Section in Cardiology"},"838":{"title":"Mitral Stenosis","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s19","snippet":"Mitral Stenosis Mitral stenosis (MS) is overwhelmingly caused by rheumatic heart disease (chronic inflammatory scarring fuses the commissures, thickens leaflets, and shortens chordae). Normal mitral valve area is 4-6 cm&sup2;. Symptoms typically develop when MVA <2.0 cm&sup2;. Severe MS = MVA <1.0 c...","sourceLabel":"Section in Cardiology"},"839":{"title":"Tricuspid & Pulmonic Valve Disease","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s20","snippet":"Tricuspid & Pulmonic Valve Disease Tricuspid regurgitation (TR) is the most common right-sided valve lesion. Primary causes: endocarditis (especially IV drug users), carcinoid syndrome, Ebstein's anomaly, rheumatic disease. Secondary (functional) TR is far more common - caused by RV/annular dilation...","sourceLabel":"Section in Cardiology"},"840":{"title":"Prosthetic Valve Management","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s21","snippet":"Prosthetic Valve Management Valve Types Type Examples Durability Anticoagulation Key Issue Mechanical St. Jude (bileaflet), Medtronic Hall (tilting disc), ball-and-cage (Starr-Edwards, historical) Lifelong (>20-30 years) Lifelong warfarin required (DOACs contraindicated) Thrombosis risk if subtherap...","sourceLabel":"Section in Cardiology"},"841":{"title":"Infective Endocarditis","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s22","snippet":"Infective Endocarditis Infective endocarditis (IE) is infection of the endocardial surface, typically involving heart valves. In-hospital mortality is 15-25%. Risk factors: prosthetic valves, structural heart disease, IV drug use (IVDU), poor dentition, central venous catheters, immunosuppression. I...","sourceLabel":"Section in Cardiology"},"842":{"title":"Pericarditis (Acute & Constrictive)","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s23","snippet":"Pericarditis (Acute & Constrictive) Acute Pericarditis Inflammation of the pericardium, most commonly idiopathic/viral (Coxsackievirus, echovirus, CMV, EBV) in developed countries. Other causes: post-MI (early or Dressler syndrome), uremia, autoimmune (SLE, RA), malignancy, tuberculosis (most common...","sourceLabel":"Section in Cardiology"},"843":{"title":"Cardiac Tamponade","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s24","snippet":"Cardiac Tamponade Tamponade occurs when pericardial fluid accumulates fast enough to compress cardiac chambers, impairing diastolic filling and reducing cardiac output. Even small effusions (100-200 mL) can cause tamponade if they accumulate rapidly (e.g., hemorrhagic post-PCI or post-cardiac surger...","sourceLabel":"Section in Cardiology"},"844":{"title":"Myocarditis","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s25","snippet":"Myocarditis Inflammation of the myocardium, most commonly caused by viral infection (Coxsackievirus B, adenovirus, parvovirus B19, SARS-CoV-2, HHV-6). Also: autoimmune (giant cell myocarditis, eosinophilic myocarditis), drug-induced (immune checkpoint inhibitors - nivolumab, pembrolizumab - can caus...","sourceLabel":"Section in Cardiology"},"845":{"title":"Hypertrophic Cardiomyopathy (HCM)","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s26","snippet":"Hypertrophic Cardiomyopathy (HCM) HCM is the most common inherited cardiac disorder (prevalence ~1:500), caused by mutations in sarcomere protein genes (most commonly beta-myosin heavy chain and myosin-binding protein C). Characterized by asymmetric septal hypertrophy (&ge;15 mm or &ge;13 mm with fa...","sourceLabel":"Section in Cardiology"},"846":{"title":"Dilated Cardiomyopathy","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s27","snippet":"Dilated Cardiomyopathy Dilated cardiomyopathy (DCM) is characterized by LV (or biventricular) dilation with systolic dysfunction (EF <40%) not explained by coronary artery disease, valvular disease, or hypertension. It is the most common indication for heart transplantation. Causes: idiopathic (~50%...","sourceLabel":"Section in Cardiology"},"847":{"title":"Restrictive Cardiomyopathy","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s28","snippet":"Restrictive Cardiomyopathy Restrictive cardiomyopathy (RCM) is characterized by impaired ventricular filling due to stiff, non-compliant myocardium with preserved (or only mildly reduced) systolic function and normal or near-normal ventricular dimensions. The atria are typically severely dilated. Ca...","sourceLabel":"Section in Cardiology"},"848":{"title":"Takotsubo (Stress) Cardiomyopathy","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s29","snippet":"Takotsubo (Stress) Cardiomyopathy Transient LV dysfunction triggered by intense emotional or physical stress (\"broken heart syndrome\"). Classically occurs in postmenopausal women after a stressful event. Pathophysiology: catecholamine surge causes direct myocardial stunning. Classic pattern: apical ...","sourceLabel":"Section in Cardiology"},"849":{"title":"Hypertension Management","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s30","snippet":"Hypertension Management Hypertension affects ~1.3 billion adults globally and is the leading modifiable risk factor for cardiovascular death. The 2017 ACC/AHA Guideline redefined HTN categories: Category SBP DBP Normal <120 <80 Elevated 120-129 <80 Stage 1 HTN 130-139 80-89 Stage 2 HTN &ge;140 &ge;9...","sourceLabel":"Section in Cardiology"},"850":{"title":"Pulmonary Hypertension","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s31","snippet":"Pulmonary Hypertension Pulmonary hypertension (PH) is defined hemodynamically as mean pulmonary artery pressure (mPAP) >20 mmHg at rest by right heart catheterization. The WHO classifies PH into 5 groups: Group Category Common Causes Treatment Approach 1 Pulmonary arterial hypertension (PAH) Idiopat...","sourceLabel":"Section in Cardiology"},"851":{"title":"Aortic Disease (Cardiology Perspective)","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s32","snippet":"Aortic Disease (Cardiology Perspective) Aortic Dissection Tear in the aortic intima allowing blood to enter the media, creating a false lumen. Stanford Type A = involves the ascending aorta (regardless of extent) - surgical emergency (mortality increases ~1-2% per hour without surgery). Stanford Typ...","sourceLabel":"Section in Cardiology"},"852":{"title":"Adult Congenital Heart Disease","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s33","snippet":"Adult Congenital Heart Disease The ACHD population is growing rapidly as surgical advances allow >90% of children with CHD to survive into adulthood. Common lesions encountered in adult cardiology practice: Lesion Pathophysiology Presentation in Adults Management Atrial Septal Defect (ASD) Left-to-r...","sourceLabel":"Section in Cardiology"},"853":{"title":"Cardiac Tumors","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s34","snippet":"Cardiac Tumors Primary cardiac tumors are rare (~0.02% of autopsies). ~75% are benign, ~25% malignant. Metastatic tumors to the heart are 20-40&times; more common than primary tumors (lung, breast, melanoma, lymphoma). Myxoma is the most common primary cardiac tumor (~50%). Typically originates from...","sourceLabel":"Section in Cardiology"},"854":{"title":"Cardiac Amyloidosis","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s35","snippet":"Cardiac Amyloidosis Amyloid deposition in the myocardium causes progressive restrictive cardiomyopathy with diastolic (and eventually systolic) heart failure. Two main types: AL amyloidosis (light-chain - from plasma cell dyscrasia/myeloma; rapidly progressive, median survival ~6 months without trea...","sourceLabel":"Section in Cardiology"},"855":{"title":"Cardiac Sarcoidosis","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s36","snippet":"Cardiac Sarcoidosis Sarcoidosis involves the heart in ~25% of patients with systemic disease (often subclinical). Granulomatous infiltration of the myocardium causes conduction disease (AV block is the most common cardiac manifestation), ventricular arrhythmias (VT, SCD risk), and cardiomyopathy (re...","sourceLabel":"Section in Cardiology"},"856":{"title":"Peripartum Cardiomyopathy","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s37","snippet":"Peripartum Cardiomyopathy New-onset systolic HF (EF <45%) developing in the last month of pregnancy through 5 months postpartum, with no other identifiable cause. Incidence ~1:1,000 to 1:4,000 deliveries; higher in Black women, multiparity, preeclampsia, multiple gestations. Pathophysiology involves...","sourceLabel":"Section in Cardiology"},"857":{"title":"Athlete's Heart vs Pathologic Hypertrophy","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s38","snippet":"Athlete's Heart vs Pathologic Hypertrophy Chronic exercise produces physiologic cardiac remodeling - \"athlete's heart\" - that can mimic pathologic hypertrophy (HCM, DCM). Key distinctions: Feature Athlete's Heart HCM Wall thickness Usually &le;12 mm (gray zone 13-15 mm) Usually &ge;15 mm, asymmetric...","sourceLabel":"Section in Cardiology"},"858":{"title":"Cardiac Catheterization & PCI","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s39","snippet":"Cardiac Catheterization & PCI Diagnostic Catheterization Invasive coronary angiography remains the gold standard for defining coronary anatomy. Access: radial artery (preferred - lower bleeding, lower access-site complications, earlier ambulation) or femoral artery (larger sheath capacity, used for ...","sourceLabel":"Section in Cardiology"},"859":{"title":"Electrophysiology Studies & Ablation","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s40","snippet":"Electrophysiology Studies & Ablation EP study: Diagnostic procedure using multipolar catheters placed in the heart (via femoral/jugular vein access) to map electrical activity, measure conduction intervals (AH and HV intervals), and induce arrhythmias with programmed stimulation to characterize thei...","sourceLabel":"Section in Cardiology"},"860":{"title":"Device Therapy (Pacemakers, ICDs, CRT)","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s41","snippet":"Device Therapy (Pacemakers, ICDs, CRT) Figure 36 - ICD vs Pacemaker Capabilities. Visual comparison of standard pacemaker versus implantable cardioverter-defibrillator (ICD) functionality. ICDs provide all pacemaker functions plus the ability to detect and terminate life-threatening ventricular tach...","sourceLabel":"Section in Cardiology"},"861":{"title":"Structural Interventions (TAVR, MitraClip, WATCHMAN)","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s42","snippet":"Structural Interventions (TAVR, MitraClip, WATCHMAN) TAVR (Transcatheter Aortic Valve Replacement) Catheter-delivered bioprosthetic valve deployed within the diseased native aortic valve. Access: transfemoral (preferred, >90% of cases), transapical, transaortic, subclavian, or transcaval. Valve type...","sourceLabel":"Section in Cardiology"},"862":{"title":"Cardioversion & Defibrillation","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s43","snippet":"Cardioversion & Defibrillation Synchronized cardioversion delivers a shock timed to the R wave (avoids the vulnerable T-wave period, which could trigger VF). Used for: AFib/flutter, SVT, and hemodynamically stable monomorphic VT. Energy: AFib typically 120-200J biphasic; AFL 50-100J; SVT 50-100J; st...","sourceLabel":"Section in Cardiology"},"863":{"title":"Imaging & Diagnostics","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s44","snippet":"Imaging & Diagnostics Modality What It Shows Clinical Interpretation Notes 12-Lead EKG Cardiac rhythm, rate, intervals, axis, ST/T changes, hypertrophy, conduction PR interval (normal 120-200 ms), QRS (normal <120 ms), QTc (normal <470 ms male, <480 ms female). ST elevation: STEMI, pericarditis, ear...","sourceLabel":"Section in Cardiology"},"864":{"title":"Classification Systems - All in One Place","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s45","snippet":"Classification Systems - All in One Place System Classifies Key Features NYHA (I-IV) HF functional class I (no limitation) &rarr; IV (symptoms at rest); guides therapy and device decisions ACC/AHA HF Stages (A-D) HF disease progression A (at risk) &rarr; D (advanced/refractory); stages only progress...","sourceLabel":"Section in Cardiology"},"865":{"title":"Medications Master Table","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s46","snippet":"Medications Master Table Antiplatelet Agents Drug (Brand) Mechanism Dose Indication Critical Pearl Aspirin Irreversible COX-1 inhibitor 81 mg daily (chronic); 325 mg loading All ACS, post-PCI, chronic CAD, stroke prevention Continue perioperatively in most cardiac patients Clopidogrel (Plavix) Irrev...","sourceLabel":"Section in Cardiology"},"866":{"title":"Abbreviations Master List","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s47","snippet":"Abbreviations Master List Anatomy & Physiology RA Right atrium LA Left atrium RV Right ventricle LV Left ventricle LAD Left anterior descending artery LCx Left circumflex artery RCA Right coronary artery LMCA Left main coronary artery PDA Posterior descending artery OM Obtuse marginal branch SA Sino...","sourceLabel":"Section in Cardiology"},"867":{"title":"Risk Factors & Comorbidities","pageTitle":"Cardiology","pageUrl":"/medical/cardiology","url":"/medical/cardiology#s48","snippet":"Risk Factors & Comorbidities Core Risk Factors in Every Cardiology Patient Hypertension: Current meds, BP control, adherence. Target <130/80 for most cardiac patients. Uncontrolled HTN is the leading risk factor for HF, stroke, AF, and aortic disease. Diabetes mellitus: Type, A1C, current regimen, m...","sourceLabel":"Section in Cardiology"},"868":{"title":"Pulmonology / Critical Care","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology","snippet":"Specialty Reference Pulmonology Complete Specialty Reference Every diagnosis, classification, procedure, ventilator mode, medication, scoring system, and management strategy in pulmonary and critical care medicine in one place."},"869":{"title":"Pulmonary Anatomy","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s1","snippet":"Pulmonary Anatomy The respiratory system extends from the nose and mouth to the alveolar surface area of approximately 70 m 2 — roughly the size of a tennis court. Understanding its branching architecture, lobar anatomy, vascular supply, and lymphatic drainage is prerequisite to interpreting imaging...","sourceLabel":"Section in Pulmonology / Critical Care"},"870":{"title":"Pulmonary Physiology","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s2","snippet":"Pulmonary Physiology Gas Exchange — The Alveolar-Capillary Interface The alveolar-capillary membrane consists of surfactant → alveolar epithelium (type I pneumocyte) → basement membrane → capillary endothelium. Total thickness: 0.2-0.5 micrometers. Oxygen and CO 2 exchange by passive diffusion along...","sourceLabel":"Section in Pulmonology / Critical Care"},"871":{"title":"The Pulmonary Exam","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s3","snippet":"The Pulmonary Exam Inspection Respiratory rate (normal 12-20/min); pattern of breathing (Cheyne-Stokes, Kussmaul, Biot's); use of accessory muscles (sternocleidomastoid, intercostals, abdominal muscles); pursed-lip breathing (COPD — creates auto-PEEP to stent open airways); paradoxical abdominal mov...","sourceLabel":"Section in Pulmonology / Critical Care"},"872":{"title":"Pulmonary Function Tests","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s4","snippet":"Pulmonary Function Tests Spirometry The cornerstone of pulmonary diagnostics. Measures FEV 1 (forced expiratory volume in 1 second), FVC (forced vital capacity), and their ratio ( FEV 1 /FVC ). The patient takes a maximal inspiration then exhales as forcefully and completely as possible. Pattern FEV...","sourceLabel":"Section in Pulmonology / Critical Care"},"873":{"title":"COPD","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s5","snippet":"COPD Chronic obstructive pulmonary disease is defined by persistent airflow limitation (post-bronchodilator FEV 1 /FVC < 0.70) that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and lungs to noxious particles or gases. COPD is the third leading c...","sourceLabel":"Section in Pulmonology / Critical Care"},"874":{"title":"Asthma","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s6","snippet":"Asthma Asthma is a chronic inflammatory disorder of the airways characterized by variable airflow obstruction, airway hyperresponsiveness, and airway remodeling. Unlike COPD, airflow limitation in asthma is typically reversible (spontaneously or with treatment). Affects ~300 million people worldwide...","sourceLabel":"Section in Pulmonology / Critical Care"},"875":{"title":"Bronchiectasis","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s7","snippet":"Bronchiectasis Permanent, abnormal dilation of bronchi caused by a cycle of infection, inflammation, and airway wall destruction. Presents with chronic productive cough with large volumes of purulent sputum (often \"cupfuls\"), recurrent respiratory infections, and hemoptysis (sometimes massive — bron...","sourceLabel":"Section in Pulmonology / Critical Care"},"876":{"title":"Alpha-1 Antitrypsin Deficiency","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s8","snippet":"Alpha-1 Antitrypsin Deficiency The most common genetic cause of COPD. Alpha-1 antitrypsin (AAT) is a serine protease inhibitor (SERPINA1 gene, chromosome 14) produced by the liver that protects lung tissue from neutrophil elastase. Deficiency allows unopposed elastase activity, leading to early-onse...","sourceLabel":"Section in Pulmonology / Critical Care"},"877":{"title":"Idiopathic Pulmonary Fibrosis (IPF)","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s9","snippet":"Idiopathic Pulmonary Fibrosis (IPF) The most common and most lethal idiopathic interstitial pneumonia. Median survival 3-5 years from diagnosis — worse than many cancers. Affects predominantly older males (> 60 years), often with a history of smoking. Presents with progressive exertional dyspnea, dr...","sourceLabel":"Section in Pulmonology / Critical Care"},"878":{"title":"Nonspecific Interstitial Pneumonia (NSIP)","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s10","snippet":"Nonspecific Interstitial Pneumonia (NSIP) The second most common idiopathic interstitial pneumonia, with significantly better prognosis than IPF (5-year survival ~80% for cellular NSIP, ~60% for fibrotic NSIP). Affects younger patients (40-50s), more women, and is often associated with connective ti...","sourceLabel":"Section in Pulmonology / Critical Care"},"879":{"title":"Hypersensitivity Pneumonitis","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s11","snippet":"Hypersensitivity Pneumonitis An immune-mediated lung disease caused by repeated inhalation of organic antigens in sensitized individuals. Common culprits: bird proteins (pigeon/parrot fancier's lung), Thermophilic actinomycetes in moldy hay (farmer's lung), hot tub mist (Mycobacterium avium complex)...","sourceLabel":"Section in Pulmonology / Critical Care"},"880":{"title":"Sarcoidosis","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s12","snippet":"Sarcoidosis A systemic granulomatous disease of unknown etiology characterized by noncaseating granulomas in affected organs — lungs (90%+), lymph nodes, skin, eyes, liver, nervous system, heart. Most common in African Americans (3:1) and Northern Europeans, peak onset 25-40 years. The pulmonary pre...","sourceLabel":"Section in Pulmonology / Critical Care"},"881":{"title":"Occupational Lung Disease","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s13","snippet":"Occupational Lung Disease Asbestosis Diffuse interstitial fibrosis from asbestos fiber inhalation (shipyard workers, insulation, construction, automotive brakes). Latency period 15-20 years after exposure. HRCT shows bilateral lower-lobe predominant reticular opacities and honeycombing (UIP-like pat...","sourceLabel":"Section in Pulmonology / Critical Care"},"882":{"title":"Community-Acquired Pneumonia (CAP)","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s14","snippet":"Community-Acquired Pneumonia (CAP) The most common infectious cause of death in the developed world. Common pathogens: Streptococcus pneumoniae (most common identifiable cause), Mycoplasma pneumoniae (atypical; younger patients, walking pneumonia), Haemophilus influenzae (COPD patients), Legionella ...","sourceLabel":"Section in Pulmonology / Critical Care"},"883":{"title":"Hospital- & Ventilator-Associated Pneumonia","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s15","snippet":"Hospital- & Ventilator-Associated Pneumonia Hospital-acquired pneumonia (HAP) : develops &ge; 48 hours after hospital admission, not intubated. Ventilator-associated pneumonia (VAP) : develops &ge; 48 hours after endotracheal intubation. Both are caused by a different pathogen spectrum than CAP: MRS...","sourceLabel":"Section in Pulmonology / Critical Care"},"884":{"title":"Lung Abscess","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s16","snippet":"Lung Abscess A circumscribed collection of pus within the lung parenchyma, usually resulting from aspiration of oropharyngeal contents. Classic patient: poor dentition, alcoholism, impaired consciousness (seizures, overdose, anesthesia), dysphagia. Location: dependent lung segments — posterior segme...","sourceLabel":"Section in Pulmonology / Critical Care"},"885":{"title":"Tuberculosis","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s17","snippet":"Tuberculosis Caused by Mycobacterium tuberculosis, an acid-fast bacillus transmitted by airborne droplet nuclei. One-quarter of the world's population has latent TB infection. In the US, TB disproportionately affects immigrants from endemic areas, homeless populations, incarcerated individuals, and ...","sourceLabel":"Section in Pulmonology / Critical Care"},"886":{"title":"Fungal Pulmonary Infections","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s18","snippet":"Fungal Pulmonary Infections Histoplasmosis Endemic to the Ohio and Mississippi River valleys; Histoplasma capsulatum lives in soil contaminated with bat/bird droppings (caves, chicken coops). Most infections asymptomatic or mild flu-like illness. Severe acute pneumonia with diffuse reticulonodular i...","sourceLabel":"Section in Pulmonology / Critical Care"},"887":{"title":"Pneumocystis Pneumonia (PJP)","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s19","snippet":"Pneumocystis Pneumonia (PJP) Caused by Pneumocystis jirovecii (formerly P. carinii — hence the persistent abbreviation PCP/PJP). Occurs in severely immunocompromised patients: HIV with CD4 < 200, solid organ transplant, prolonged high-dose corticosteroids (&ge; 20 mg prednisone daily for &ge; 3 week...","sourceLabel":"Section in Pulmonology / Critical Care"},"888":{"title":"Pleural Effusion","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s20","snippet":"Pleural Effusion Abnormal accumulation of fluid in the pleural space. Detected on CXR when &ge; 200-300 mL (blunting of the costophrenic angle on upright PA film); lateral decubitus can detect as little as 50 mL. Ultrasound is the best bedside tool for detecting, characterizing, and guiding drainage...","sourceLabel":"Section in Pulmonology / Critical Care"},"889":{"title":"Empyema","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s21","snippet":"Empyema Infected pleural effusion — the result of uncontrolled parapneumonic effusion progression. Stages: simple parapneumonic (exudative; free-flowing, sterile, pH > 7.2, glucose > 60, LDH < 1000; treat underlying pneumonia), complicated parapneumonic (fibrinopurulent; pH < 7.2, glucose < 60, LDH ...","sourceLabel":"Section in Pulmonology / Critical Care"},"890":{"title":"Pneumothorax","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s22","snippet":"Pneumothorax Figure 23 - Pneumothorax on Chest Radiograph. Upright PA chest radiograph showing a pneumothorax with the visceral pleural line visible and absence of lung markings peripherally. The degree of lung collapse and clinical stability determine management. Types Type Mechanism Risk Factors M...","sourceLabel":"Section in Pulmonology / Critical Care"},"891":{"title":"Mesothelioma","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s23","snippet":"Mesothelioma Figure 25 - Malignant Pleural Mesothelioma on CT. CT of the chest demonstrating circumferential nodular pleural thickening with ipsilateral pleural effusion, characteristic of malignant mesothelioma. Contrast-enhancing pleural thickening greater than 1 cm involving the mediastinal pleur...","sourceLabel":"Section in Pulmonology / Critical Care"},"892":{"title":"Pulmonary Embolism (PE)","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s24","snippet":"Pulmonary Embolism (PE) Obstruction of the pulmonary arterial vasculature by thrombus (usually from lower extremity DVT), resulting in V/Q mismatch, increased dead space, and in massive PE, right ventricular failure. PE is the third most common cause of cardiovascular death after MI and stroke. Mort...","sourceLabel":"Section in Pulmonology / Critical Care"},"893":{"title":"Pulmonary Hypertension","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s25","snippet":"Pulmonary Hypertension Defined hemodynamically as mean pulmonary artery pressure (mPAP) > 20 mmHg at rest on right heart catheterization (updated from > 25 at the 6th World Symposium on PH, 2018). Pulmonary vascular resistance (PVR) > 2 Wood units further confirms pre-capillary PH. Symptoms are nons...","sourceLabel":"Section in Pulmonology / Critical Care"},"894":{"title":"Pulmonary Arteriovenous Malformations","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s26","snippet":"Pulmonary Arteriovenous Malformations Abnormal direct connections between pulmonary arteries and veins bypassing the capillary bed, creating a right-to-left shunt. 80-90% are associated with hereditary hemorrhagic telangiectasia (HHT/Osler-Weber-Rendu syndrome) — autosomal dominant; mutations in ENG...","sourceLabel":"Section in Pulmonology / Critical Care"},"895":{"title":"Non-Small Cell Lung Cancer (NSCLC)","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s27","snippet":"Non-Small Cell Lung Cancer (NSCLC) NSCLC accounts for ~85% of all lung cancers. Three major subtypes: adenocarcinoma (40-50% — most common; peripheral location; associated with non-smokers and women; driver mutations common), squamous cell carcinoma (25-30% — central/endobronchial; strongly linked t...","sourceLabel":"Section in Pulmonology / Critical Care"},"896":{"title":"Small Cell Lung Cancer (SCLC)","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s28","snippet":"Small Cell Lung Cancer (SCLC) Figure 32 - Small Cell Lung Cancer on CT. CT imaging of SCLC showing a centrally located mass with bulky mediastinal lymphadenopathy, characteristic of this aggressive neuroendocrine tumor that almost exclusively occurs in smokers. Aggressive neuroendocrine tumor accoun...","sourceLabel":"Section in Pulmonology / Critical Care"},"897":{"title":"Solitary Pulmonary Nodule","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s29","snippet":"Solitary Pulmonary Nodule A round opacity &le; 3 cm in the lung parenchyma (lesions > 3 cm are masses, assumed malignant until proven otherwise). Most are incidental findings. Assessment of malignancy risk: patient factors (age, smoking history, cancer history, COPD) and nodule factors (size, morpho...","sourceLabel":"Section in Pulmonology / Critical Care"},"898":{"title":"ARDS","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s30","snippet":"ARDS Acute respiratory distress syndrome is diffuse, non-cardiogenic pulmonary edema caused by inflammatory damage to the alveolar-capillary membrane. In-hospital mortality remains 35-45%. The most common causes are pneumonia and non-pulmonary sepsis (together accounting for ~60% of cases); other ca...","sourceLabel":"Section in Pulmonology / Critical Care"},"899":{"title":"Mechanical Ventilation","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s31","snippet":"Mechanical Ventilation Modes of Ventilation Mode How It Works Patient Trigger When Used Volume Control (VC-CMV / AC) Delivers a set tidal volume at a set rate. Pressure varies with compliance/resistance. Patient can trigger additional breaths at set Vt Most common initial mode; reliable minute venti...","sourceLabel":"Section in Pulmonology / Critical Care"},"900":{"title":"Shock","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s32","snippet":"Shock Circulatory failure resulting in inadequate tissue oxygen delivery. The four hemodynamic profiles: Type CO SVR PCWP/CVP Common Causes Key Treatment Distributive (septic, anaphylactic, neurogenic) &uarr; &darr;&darr; &darr; or normal Sepsis (most common), anaphylaxis, spinal cord injury Fluids ...","sourceLabel":"Section in Pulmonology / Critical Care"},"901":{"title":"Sepsis & Septic Shock","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s33","snippet":"Sepsis & Septic Shock Sepsis (Sepsis-3 definition): life-threatening organ dysfunction caused by a dysregulated host response to infection. Operationally: suspected/confirmed infection + acute change in SOFA score &ge; 2 . Septic shock : sepsis with persistent hypotension requiring vasopressors to m...","sourceLabel":"Section in Pulmonology / Critical Care"},"902":{"title":"Sedation, Analgesia & Delirium","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s34","snippet":"Sedation, Analgesia & Delirium The PADIS Guidelines (Pain, Agitation/Sedation, Delirium, Immobility, Sleep) The mantra: analgesia first, then sedation . Pain is the primary driver of agitation in the ICU; treating pain reduces sedative requirements. Target the lightest level of sedation that keeps t...","sourceLabel":"Section in Pulmonology / Critical Care"},"903":{"title":"Obstructive Sleep Apnea","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s35","snippet":"Obstructive Sleep Apnea Recurrent partial (hypopnea) or complete (apnea) upper airway collapse during sleep, causing intermittent hypoxemia, sleep fragmentation, and sympathetic activation. Prevalence: 10-20% of adults; severely underdiagnosed. Risk factors: obesity (BMI > 30 — strongest risk factor...","sourceLabel":"Section in Pulmonology / Critical Care"},"904":{"title":"Central Sleep Apnea","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s36","snippet":"Central Sleep Apnea Cessation of airflow due to absent respiratory effort (no signal from the brainstem respiratory center), unlike OSA where effort continues against a collapsed airway. Most commonly associated with heart failure (Cheyne-Stokes respiration — crescendo-decrescendo breathing pattern ...","sourceLabel":"Section in Pulmonology / Critical Care"},"905":{"title":"Obesity Hypoventilation Syndrome","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s37","snippet":"Obesity Hypoventilation Syndrome The triad of: (1) obesity (BMI &ge; 30, typically &ge; 40), (2) chronic daytime hypercapnia (PaCO 2 > 45 mmHg while awake), and (3) exclusion of other causes of hypoventilation (neuromuscular, chest wall, COPD, hypothyroidism). Coexists with OSA in ~90% of cases. Pat...","sourceLabel":"Section in Pulmonology / Critical Care"},"906":{"title":"Neuromuscular Respiratory Failure","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s38","snippet":"Neuromuscular Respiratory Failure Respiratory failure from weakness of the respiratory muscles (diaphragm, intercostals, accessory muscles, bulbar muscles) in neuromuscular disease. Conditions: amyotrophic lateral sclerosis (ALS), myasthenia gravis, Guillain-Barre syndrome (GBS), muscular dystrophie...","sourceLabel":"Section in Pulmonology / Critical Care"},"907":{"title":"Pulmonary Eosinophilia","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s39","snippet":"Pulmonary Eosinophilia A group of disorders characterized by eosinophilic infiltration of the lung parenchyma ± peripheral blood eosinophilia. Acute eosinophilic pneumonia (AEP) : acute febrile illness (days) with bilateral infiltrates, hypoxemic respiratory failure, BAL eosinophils > 25%, periphera...","sourceLabel":"Section in Pulmonology / Critical Care"},"908":{"title":"Pulmonary Alveolar Proteinosis","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s40","snippet":"Pulmonary Alveolar Proteinosis Accumulation of surfactant-like lipoproteinaceous material in alveoli due to impaired macrophage clearance. Most common form (90%) is autoimmune PAP caused by antibodies against granulocyte-macrophage colony-stimulating factor (GM-CSF) — GM-CSF is essential for alveola...","sourceLabel":"Section in Pulmonology / Critical Care"},"909":{"title":"Lymphangioleiomyomatosis (LAM)","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s41","snippet":"Lymphangioleiomyomatosis (LAM) A rare, progressive cystic lung disease occurring almost exclusively in women of childbearing age . Characterized by proliferation of abnormal smooth muscle-like cells (LAM cells) that infiltrate airways, lymphatics, and blood vessels. Associated with tuberous sclerosi...","sourceLabel":"Section in Pulmonology / Critical Care"},"910":{"title":"Cystic Fibrosis — Adult","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s42","snippet":"Cystic Fibrosis — Adult Autosomal recessive; CFTR gene (chromosome 7) mutations cause dysfunctional chloride/bicarbonate channels → thick, dehydrated secretions in lungs, pancreas, GI tract, reproductive system, and sweat glands. The most common mutation is F508del (~70% of alleles). Median survival...","sourceLabel":"Section in Pulmonology / Critical Care"},"911":{"title":"Bronchoscopy","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s43","snippet":"Bronchoscopy Flexible Bronchoscopy The workhorse diagnostic and therapeutic procedure of pulmonology. Performed via the nose or mouth (or via ETT in intubated patients) under moderate sedation or general anesthesia. The bronchoscopist sequentially examines the vocal cords, trachea, carina, and each ...","sourceLabel":"Section in Pulmonology / Critical Care"},"912":{"title":"Thoracentesis","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s44","snippet":"Thoracentesis Percutaneous drainage of pleural fluid for diagnostic and/or therapeutic purposes. Performed under ultrasound guidance (standard of care — reduces pneumothorax rate from ~10% to < 1%). Patient seated upright, leaning forward. Entry site: 1-2 intercostal spaces below the upper border of...","sourceLabel":"Section in Pulmonology / Critical Care"},"913":{"title":"Chest Tube & PleurX Catheter","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s45","snippet":"Chest Tube & PleurX Catheter Chest Tube (Tube Thoracostomy) Indications: pneumothorax (large, symptomatic, tension, or on mechanical ventilation), large or complicated pleural effusion, empyema, hemothorax, post-thoracic surgery. Insertion: 4th-5th intercostal space, anterior to mid-axillary line (t...","sourceLabel":"Section in Pulmonology / Critical Care"},"914":{"title":"Medical Thoracoscopy & Tracheostomy","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s46","snippet":"Medical Thoracoscopy & Tracheostomy Medical Thoracoscopy (Pleuroscopy) Performed by pulmonologists under moderate sedation and local anesthesia (contrast with surgical VATS which requires general anesthesia and lung isolation). A single port is used to introduce a rigid or semi-rigid pleuroscope int...","sourceLabel":"Section in Pulmonology / Critical Care"},"915":{"title":"Imaging & Diagnostics","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s47","snippet":"Imaging & Diagnostics Modality What It Shows Interpretation Notes Chest X-ray (CXR) Lung parenchyma, pleura, mediastinum, bones, cardiac silhouette First-line for most pulmonary complaints; AP vs PA affects cardiac size; decubitus for layering effusion CT Chest (HRCT) High-resolution parenchymal det...","sourceLabel":"Section in Pulmonology / Critical Care"},"916":{"title":"Classification Systems — All in One Place","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s48","snippet":"Classification Systems — All in One Place System Classifies Key Features GOLD (spirometric) COPD airflow severity 1 (&ge; 80%), 2 (50-79%), 3 (30-49%), 4 (< 30%) based on FEV 1 % predicted GOLD ABE COPD treatment groups A (low symptoms, low exacerbations), B (high symptoms, low exacerbations), E (fr...","sourceLabel":"Section in Pulmonology / Critical Care"},"917":{"title":"Medications Master Table","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s49","snippet":"Medications Master Table Inhaled Bronchodilators Drug (Brand) Class Mechanism Dose/Device Pearl Albuterol (ProAir, Ventolin) SABA &beta;2 agonist 2 puffs PRN q4-6h; neb 2.5mg PRN Tachycardia, tremor, hypokalemia at high doses Ipratropium (Atrovent) SAMA Muscarinic antagonist (M1, M3) 2 puffs QID; ne...","sourceLabel":"Section in Pulmonology / Critical Care"},"918":{"title":"ABG Interpretation","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s50","snippet":"ABG Interpretation Systematic Approach Step 1: Assess oxygenation (PaO 2 — normal 80-100 mmHg on room air). Step 2: Assess pH (normal 7.35-7.45; < 7.35 = acidemia, > 7.45 = alkalemia). Step 3: Identify the primary disorder (respiratory: PaCO 2 abnormal; metabolic: HCO 3 abnormal). Step 4: Check for ...","sourceLabel":"Section in Pulmonology / Critical Care"},"919":{"title":"Abbreviations Master List","pageTitle":"Pulmonology / Critical Care","pageUrl":"/medical/pulmonology","url":"/medical/pulmonology#s51","snippet":"Abbreviations Master List Anatomy & Physiology RUL Right upper lobe RML Right middle lobe RLL Right lower lobe LUL Left upper lobe LLL Left lower lobe PA Pulmonary artery PV Pulmonary vein IVC Inferior vena cava RV Right ventricle (or residual volume) LV Left ventricle FRC Functional residual capaci...","sourceLabel":"Section in Pulmonology / Critical Care"},"920":{"title":"Gastroenterology","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology","snippet":"Specialty Reference Gastroenterology Complete Specialty Reference Every diagnosis, procedure, classification system, medication, endoscopic technique, hepatology detail, and management strategy in one place."},"921":{"title":"GI Anatomy — Esophagus Through Rectum","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s1","snippet":"GI Anatomy — Esophagus Through Rectum Esophagus The esophagus is a 25 cm muscular tube extending from the pharynx (C6) to the gastroesophageal junction (GEJ, ~T11). Divided into thirds: upper third (skeletal muscle, innervated by recurrent laryngeal nerve), middle third (mixed), lower third (smooth ...","sourceLabel":"Section in Gastroenterology"},"922":{"title":"Hepatobiliary & Pancreatic Anatomy","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s2","snippet":"Hepatobiliary & Pancreatic Anatomy Liver The liver (~1.5 kg) occupies the right upper quadrant. Functionally divided into right and left lobes by Cantlie's line (from the gallbladder fossa to the IVC), not the falciform ligament. The Couinaud classification divides the liver into 8 functionally inde...","sourceLabel":"Section in Gastroenterology"},"923":{"title":"The GI Physical Exam","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s3","snippet":"The GI Physical Exam Abdominal Exam — Systematic Approach Inspection: Distension (ascites, obstruction, ileus), visible peristalsis (in thin patients with obstruction), scars (prior surgeries), caput medusae (periumbilical venous distension — portal hypertension), Grey Turner sign (flank ecchymosis ...","sourceLabel":"Section in Gastroenterology"},"924":{"title":"Key Terminology","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s4","snippet":"Key Terminology Core GI Terms Dysphagia: Difficulty swallowing. Oropharyngeal = difficulty initiating swallow (neurologic/muscular). Esophageal = food sticks after initiation; solids only = mechanical obstruction (stricture, ring, tumor); solids + liquids = motility disorder (achalasia, scleroderma)...","sourceLabel":"Section in Gastroenterology"},"925":{"title":"GERD","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s5","snippet":"GERD Gastroesophageal reflux disease is the most common outpatient GI diagnosis — affecting ~20% of the US adult population weekly. GERD occurs when reflux of gastric contents causes troublesome symptoms (heartburn, regurgitation) or mucosal complications (erosive esophagitis, stricture, Barrett's e...","sourceLabel":"Section in Gastroenterology"},"926":{"title":"Barrett's Esophagus","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s6","snippet":"Barrett's Esophagus Figure 6 - Endoscopic Detection of Barrett Esophagus. Multiple endoscopic imaging modalities used to identify intestinal metaplasia in Barrett esophagus, including white-light imaging, narrow-band imaging (NBI), and chromoendoscopy with indigo carmine staining showing characteris...","sourceLabel":"Section in Gastroenterology"},"927":{"title":"Esophageal Cancer","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s7","snippet":"Esophageal Cancer Two main histologic types with distinct epidemiology, risk factors, and location: Feature Squamous Cell Carcinoma (SCC) Adenocarcinoma Location Upper and middle esophagus Distal esophagus / GEJ Epidemiology Predominant worldwide; \"Asian esophageal belt\" Rising rapidly in Western co...","sourceLabel":"Section in Gastroenterology"},"928":{"title":"Achalasia","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s8","snippet":"Achalasia Achalasia is a primary esophageal motility disorder characterized by failure of LES relaxation and absent peristalsis of the esophageal body, caused by loss of inhibitory neurons (nitric oxide/VIP-secreting) in the myenteric (Auerbach's) plexus. Incidence: ~1/100,000 per year. Presentation...","sourceLabel":"Section in Gastroenterology"},"929":{"title":"Eosinophilic Esophagitis (EoE)","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s9","snippet":"Eosinophilic Esophagitis (EoE) Figure 9 - Endoscopic Findings in Eosinophilic Esophagitis. Characteristic EoE features: concentric rings (trachealization), linear furrows, white exudates/plaques (eosinophilic microabscesses), edema, and strictures. These findings are graded using the EREFS scoring s...","sourceLabel":"Section in Gastroenterology"},"930":{"title":"Esophageal Varices","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s10","snippet":"Esophageal Varices Dilated submucosal veins in the distal esophagus resulting from portal hypertension (hepatic venous pressure gradient [HVPG] &ge; 10 mmHg). Present in ~50% of cirrhotics; ~30% will bleed within 2 years if untreated. Variceal hemorrhage carries 15-20% mortality per episode. Varices...","sourceLabel":"Section in Gastroenterology"},"931":{"title":"Peptic Ulcer Disease","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s11","snippet":"Peptic Ulcer Disease Peptic ulcers are mucosal defects extending through the muscularis mucosae in the stomach or duodenum. Two dominant etiologies account for > 90% of cases: Helicobacter pylori infection (~60-70% of duodenal ulcers, ~30-40% of gastric ulcers) and NSAID use (~20-25%). Other causes:...","sourceLabel":"Section in Gastroenterology"},"932":{"title":"Gastric Cancer","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s12","snippet":"Gastric Cancer Gastric adenocarcinoma accounts for ~95% of gastric malignancies. Two histologic types (Lauren classification): intestinal type (well-differentiated, gland-forming, associated with H. pylori → chronic atrophic gastritis → intestinal metaplasia → dysplasia → cancer sequence; declining ...","sourceLabel":"Section in Gastroenterology"},"933":{"title":"Gastroparesis","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s13","snippet":"Gastroparesis Delayed gastric emptying in the absence of mechanical obstruction. Three main etiologies: diabetic (~30%, from vagal neuropathy), idiopathic (~35%, often post-viral), and post-surgical (~15%, vagotomy, fundoplication, bariatric surgery). Symptoms: nausea/vomiting (often of partially di...","sourceLabel":"Section in Gastroenterology"},"934":{"title":"Zollinger-Ellison Syndrome (ZES)","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s14","snippet":"Zollinger-Ellison Syndrome (ZES) Gastrin-secreting neuroendocrine tumor (gastrinoma) causing severe acid hypersecretion → refractory/multiple peptic ulcers, secretory diarrhea, and esophagitis. 80% sporadic, 20% associated with MEN1 (parathyroid hyperplasia + pituitary adenoma + pancreatic/duodenal ...","sourceLabel":"Section in Gastroenterology"},"935":{"title":"Celiac Disease","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s15","snippet":"Celiac Disease Immune-mediated enteropathy triggered by gluten (gliadin fraction of wheat, barley, rye) in genetically susceptible individuals (HLA-DQ2 in ~95%, HLA-DQ8 in ~5%). Prevalence: ~1% of the general population (the majority undiagnosed). Pathophysiology: tissue transglutaminase (tTG) deami...","sourceLabel":"Section in Gastroenterology"},"936":{"title":"Small Bowel Obstruction (SBO)","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s16","snippet":"Small Bowel Obstruction (SBO) Mechanical obstruction of the small intestine. Most common cause: postoperative adhesions (~65-75%), followed by hernias (~15%), malignancy (~10%), and Crohn's disease (~5%). Presentation: colicky abdominal pain, nausea/vomiting (bilious, earlier with more proximal obst...","sourceLabel":"Section in Gastroenterology"},"937":{"title":"Carcinoid Tumors (Neuroendocrine Tumors)","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s17","snippet":"Carcinoid Tumors (Neuroendocrine Tumors) Small bowel NETs (carcinoid tumors) are the most common small bowel malignancy and the most common neuroendocrine tumor of the GI tract. Arise from enterochromaffin cells, predominantly in the ileum. Often multifocal (30%). Secrete serotonin (5-HT), which is ...","sourceLabel":"Section in Gastroenterology"},"938":{"title":"Small Bowel Crohn's Disease","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s18","snippet":"Small Bowel Crohn's Disease Figure 19 - Crohn's Ileitis on MR Enterography. MR enterography demonstrating mural hyperenhancement, wall thickening, stricture formation, and upstream small bowel dilation characteristic of active small bowel Crohn's disease. MRE is the preferred cross-sectional imaging...","sourceLabel":"Section in Gastroenterology"},"939":{"title":"Small Intestinal Bacterial Overgrowth (SIBO)","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s19","snippet":"Small Intestinal Bacterial Overgrowth (SIBO) Excessive colonization of the small intestine by bacteria normally found in the colon, leading to malabsorption and GI symptoms. Normal small bowel bacterial count is < 10 3 CFU/mL; SIBO is defined as &ge; 10 5 CFU/mL (though this threshold is debated). R...","sourceLabel":"Section in Gastroenterology"},"940":{"title":"Crohn's Disease","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s20","snippet":"Crohn's Disease Crohn's disease (CD) is a chronic, relapsing, transmural inflammatory condition that can affect any segment of the GI tract. Bimodal age distribution: peaks at 15-35 and 55-70. Pathogenesis involves dysregulated immune response to commensal gut microbiota in genetically susceptible i...","sourceLabel":"Section in Gastroenterology"},"941":{"title":"Ulcerative Colitis","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s21","snippet":"Ulcerative Colitis Ulcerative colitis (UC) is a chronic inflammatory disease confined to the mucosa and submucosa of the colon and rectum, extending proximally in a continuous pattern from the rectum (always involved). Unlike CD, there are no skip lesions, no transmural disease, no granulomas, and n...","sourceLabel":"Section in Gastroenterology"},"942":{"title":"Biologic & Advanced Therapies for IBD","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s22","snippet":"Biologic & Advanced Therapies for IBD Drug (Brand) Class / Target Dosing Indications Key Pearls Infliximab (Remicade) Anti-TNF (chimeric mAb) 5 mg/kg IV at 0, 2, 6 wks then q8wk CD and UC (moderate-severe); fistulizing CD Most studied biologic in IBD; combination with thiopurine (combo therapy) redu...","sourceLabel":"Section in Gastroenterology"},"943":{"title":"Colorectal Cancer Screening","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s23","snippet":"Colorectal Cancer Screening Colorectal cancer (CRC) is the 3rd most common cancer and 2nd leading cause of cancer death in the US. Lifetime risk: ~4.5%. The adenoma-carcinoma sequence (normal mucosa → adenomatous polyp → carcinoma) takes ~10-15 years, making CRC highly amenable to screening and prev...","sourceLabel":"Section in Gastroenterology"},"944":{"title":"Polyp Classification & Management","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s24","snippet":"Polyp Classification & Management Paris Endoscopic Classification Type Morphology Description 0-Ip Polypoid, pedunculated Attached by a stalk 0-Isp Polypoid, subpedunculated Short or broad stalk 0-Is Polypoid, sessile Broad-based, no stalk 0-IIa Non-polypoid, slightly elevated Flat, elevated < 2.5 m...","sourceLabel":"Section in Gastroenterology"},"945":{"title":"Diverticular Disease","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s25","snippet":"Diverticular Disease Diverticulosis — outpouchings of the colonic mucosa and submucosa through the muscularis propria at points of vascular penetration (vasa recta). Present in > 60% of adults over age 60. Predominantly left-sided (sigmoid) in Western populations; right-sided in Asian populations. R...","sourceLabel":"Section in Gastroenterology"},"946":{"title":"Clostridioides difficile Infection (CDI)","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s26","snippet":"Clostridioides difficile Infection (CDI) C. difficile is the most common healthcare-associated infection and the most common cause of antibiotic-associated diarrhea. Toxin A (enterotoxin) and toxin B (cytotoxin) cause mucosal damage, inflammation, and pseudomembrane formation. Risk factors: antibiot...","sourceLabel":"Section in Gastroenterology"},"947":{"title":"Microscopic Colitis","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s27","snippet":"Microscopic Colitis Chronic, watery, non-bloody diarrhea with a grossly normal colonoscopy — diagnosis requires random colonic biopsies (especially right colon). Two subtypes: collagenous colitis (thickened subepithelial collagen band &ge; 10 mcm) and lymphocytic colitis (increased intraepithelial l...","sourceLabel":"Section in Gastroenterology"},"948":{"title":"Irritable Bowel Syndrome (IBS)","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s28","snippet":"Irritable Bowel Syndrome (IBS) Functional GI disorder defined by recurrent abdominal pain associated with defecation or a change in bowel habits, in the absence of structural or biochemical abnormalities. Prevalence: 10-15% of the population. Rome IV criteria : recurrent abdominal pain on average &g...","sourceLabel":"Section in Gastroenterology"},"949":{"title":"Viral Hepatitis (A, B, C)","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s29","snippet":"Viral Hepatitis (A, B, C) Hepatitis A (HAV) RNA picornavirus, fecal-oral transmission. Self-limited, does NOT cause chronic hepatitis. Incubation: 15-50 days. Diagnosis: anti-HAV IgM (acute infection), anti-HAV IgG (prior infection or vaccination/immunity). Treatment: supportive. Prevention: HAV vac...","sourceLabel":"Section in Gastroenterology"},"950":{"title":"Cirrhosis & Portal Hypertension","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s30","snippet":"Cirrhosis & Portal Hypertension Cirrhosis is the end stage of progressive hepatic fibrosis — irreversible distortion of hepatic architecture with regenerative nodules replacing normal parenchyma. In the US, leading causes: alcohol-associated liver disease (~30%), NAFLD/NASH (~25%), chronic hepatitis...","sourceLabel":"Section in Gastroenterology"},"951":{"title":"Ascites & Spontaneous Bacterial Peritonitis","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s31","snippet":"Ascites & Spontaneous Bacterial Peritonitis Ascites is the most common decompensating event in cirrhosis, developing in ~60% of compensated cirrhotics within 10 years. Pathogenesis: portal hypertension + splanchnic vasodilation → activation of RAAS and sympathetic nervous system → renal sodium and w...","sourceLabel":"Section in Gastroenterology"},"952":{"title":"Hepatic Encephalopathy","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s32","snippet":"Hepatic Encephalopathy Reversible neuropsychiatric dysfunction in patients with liver disease, caused primarily by failure to clear gut-derived neurotoxins — especially ammonia — from the portal circulation. Ammonia crosses the blood-brain barrier, is metabolized by astrocytes to glutamine (osmotica...","sourceLabel":"Section in Gastroenterology"},"953":{"title":"Hepatocellular Carcinoma (HCC)","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s33","snippet":"Hepatocellular Carcinoma (HCC) The most common primary liver malignancy and the 3rd leading cause of cancer death worldwide. Arises almost exclusively in the setting of chronic liver disease/cirrhosis. Risk factors: cirrhosis (any etiology), chronic HBV (can cause HCC without cirrhosis), chronic HCV...","sourceLabel":"Section in Gastroenterology"},"954":{"title":"Autoimmune Hepatitis","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s34","snippet":"Autoimmune Hepatitis Chronic inflammatory liver disease caused by loss of immune tolerance to hepatocytes. Predominantly affects women (4:1). Bimodal age distribution: 10-20 and 45-70 years. Two types: Type 1 (80% — ANA and/or anti-smooth muscle antibody [ASMA] positive; any age) and Type 2 (anti-li...","sourceLabel":"Section in Gastroenterology"},"955":{"title":"NAFLD & NASH (MASLD / MASH)","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s35","snippet":"NAFLD & NASH (MASLD / MASH) Non-alcoholic fatty liver disease is the most common chronic liver disease worldwide, affecting ~25% of the global population. Recently renamed: NAFLD → metabolic dysfunction-associated steatotic liver disease (MASLD) ; NASH → metabolic dysfunction-associated steatohepati...","sourceLabel":"Section in Gastroenterology"},"956":{"title":"Wilson's Disease & Hemochromatosis","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s36","snippet":"Wilson's Disease & Hemochromatosis Wilson's Disease Figure 30 - Copper Homeostasis Pathway. Outline of normal copper homeostasis: copper absorbed by the proximal small intestine is taken up by the liver, incorporated into ceruloplasmin, and excreted via bile. In Wilson's disease, defective ATP7B imp...","sourceLabel":"Section in Gastroenterology"},"957":{"title":"Cholelithiasis & Choledocholithiasis","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s37","snippet":"Cholelithiasis & Choledocholithiasis Cholelithiasis (gallstones): present in 10-15% of the US population. Types: cholesterol stones (~80%, from bile supersaturated with cholesterol, gallbladder hypomotility, and crystal nucleation) and pigment stones (black pigment — hemolysis, cirrhosis; brown pigm...","sourceLabel":"Section in Gastroenterology"},"958":{"title":"Cholangitis (Tokyo Guidelines)","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s38","snippet":"Cholangitis (Tokyo Guidelines) Acute cholangitis is a bacterial infection of the biliary system caused by biliary obstruction (most commonly choledocholithiasis, but also strictures, tumors, stents). Classic Charcot's triad : fever/chills + jaundice + RUQ pain (present in ~50-70%). Reynolds' pentad ...","sourceLabel":"Section in Gastroenterology"},"959":{"title":"Primary Sclerosing Cholangitis & Primary Biliary Cholangitis","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s39","snippet":"Primary Sclerosing Cholangitis & Primary Biliary Cholangitis Primary Sclerosing Cholangitis (PSC) Chronic, progressive disease characterized by inflammation and fibrosis of intrahepatic and extrahepatic bile ducts leading to multifocal strictures, cholestasis, and eventual biliary cirrhosis. Strong ...","sourceLabel":"Section in Gastroenterology"},"960":{"title":"Acute Pancreatitis","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s40","snippet":"Acute Pancreatitis Inflammation of the pancreas caused by premature intracellular activation of digestive enzymes. Diagnosis requires 2 of 3 criteria: (1) characteristic abdominal pain (acute onset, severe, epigastric, radiating to the back, worse supine, better leaning forward), (2) serum lipase or...","sourceLabel":"Section in Gastroenterology"},"961":{"title":"Chronic Pancreatitis","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s41","snippet":"Chronic Pancreatitis Progressive inflammatory destruction of the pancreas leading to irreversible structural damage and loss of exocrine (maldigestion) and endocrine (diabetes) function. Causes: alcohol (~45% in Western countries, requires > 5 years of heavy use), idiopathic (~30%), genetic (PRSS1, ...","sourceLabel":"Section in Gastroenterology"},"962":{"title":"Pancreatic Cancer","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s42","snippet":"Pancreatic Cancer Pancreatic ductal adenocarcinoma (PDAC) is the 4th leading cause of cancer death in the US with a 5-year survival of ~12%. Risk factors: smoking (2× risk), chronic pancreatitis, new-onset diabetes after age 50, obesity, family history (5-10% have familial predisposition — BRCA2, PA...","sourceLabel":"Section in Gastroenterology"},"963":{"title":"Pancreatic Cysts & IPMN","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s43","snippet":"Pancreatic Cysts & IPMN Pancreatic cysts are incidentally detected in 2-20% of abdominal imaging studies. Most are benign, but some harbor malignant potential. Key types: Cyst Type Demographic Location Fluid Analysis Malignant Potential Management Serous cystadenoma (SCA) Women > 60 Any Low CEA, low...","sourceLabel":"Section in Gastroenterology"},"964":{"title":"Upper GI Bleeding","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s44","snippet":"Upper GI Bleeding Upper GI bleeding (UGIB) originates proximal to the ligament of Treitz. Annual incidence: ~100/100,000. Causes: peptic ulcer disease (~35-50%), variceal bleeding (~10-20%), Mallory-Weiss tear (~5-10%), erosive esophagitis/gastritis, Dieulafoy lesion (aberrant submucosal artery that...","sourceLabel":"Section in Gastroenterology"},"965":{"title":"Lower GI Bleeding","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s45","snippet":"Lower GI Bleeding Lower GI bleeding (LGIB) originates distal to the ligament of Treitz. Causes by age: Young adults — hemorrhoids, anal fissures, IBD, Meckel's diverticulum. Middle-aged/elderly — diverticular bleeding (#1 cause of massive LGIB in > 60), angiodysplasia (#2), ischemic colitis, colorec...","sourceLabel":"Section in Gastroenterology"},"966":{"title":"Obscure & Occult GI Bleeding","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s46","snippet":"Obscure & Occult GI Bleeding Occult GI bleeding: positive fecal occult blood test (FOBT/FIT) or iron deficiency anemia without visible blood loss. Obscure GI bleeding: bleeding of unknown origin that persists or recurs after negative EGD and colonoscopy (now termed \"suspected small bowel bleeding\")....","sourceLabel":"Section in Gastroenterology"},"967":{"title":"Variceal Bleeding Management","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s47","snippet":"Variceal Bleeding Management Acute variceal hemorrhage is a life-threatening emergency with 15-20% mortality per episode. The approach combines resuscitation, pharmacologic therapy, and endoscopic intervention. Acute Management Protocol: 1. Resuscitation: Restrictive transfusion (target Hb 7-8 g/dL ...","sourceLabel":"Section in Gastroenterology"},"968":{"title":"Ischemic Colitis","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s48","snippet":"Ischemic Colitis The most common form of intestinal ischemia. Caused by transient, non-occlusive hypoperfusion of the colon (unlike acute mesenteric ischemia, which involves arterial occlusion of the SMA). The splenic flexure (watershed between SMA and IMA) and the rectosigmoid junction (watershed b...","sourceLabel":"Section in Gastroenterology"},"969":{"title":"Hereditary GI Cancer Syndromes","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s49","snippet":"Hereditary GI Cancer Syndromes Lynch Syndrome (Hereditary Nonpolyposis Colorectal Cancer / HNPCC) Autosomal dominant, caused by germline mutations in DNA mismatch repair (MMR) genes: MLH1, MSH2, MSH6, PMS2, or EPCAM (EPCAM deletions silence MSH2). Most common hereditary CRC syndrome (~3% of all CRC)...","sourceLabel":"Section in Gastroenterology"},"970":{"title":"GI Manifestations of Systemic Disease","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s50","snippet":"GI Manifestations of Systemic Disease Systemic Disease GI Manifestations Key Details Scleroderma (systemic sclerosis) Esophageal dysmotility (aperistalsis of distal 2/3, patulous LES → severe GERD), watermelon stomach (GAVE), colonic pseudo-obstruction Esophagus is the most commonly involved GI orga...","sourceLabel":"Section in Gastroenterology"},"971":{"title":"EGD & Colonoscopy","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s51","snippet":"EGD & Colonoscopy Esophagogastroduodenoscopy (EGD) Forward-viewing flexible endoscope passed through the mouth to examine the esophagus, stomach, and duodenum (to D2). Indications: dysphagia, odynophagia, refractory GERD, UGIB, unexplained anemia/weight loss, Barrett's surveillance, gastric ulcer fo...","sourceLabel":"Section in Gastroenterology"},"972":{"title":"ERCP & EUS","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s52","snippet":"ERCP & EUS Endoscopic Retrograde Cholangiopancreatography (ERCP) Figure 39 - Normal ERCP Cholangiogram. Fluoroscopic image during ERCP showing a normal biliary tree with the common bile duct, right and left hepatic ducts, and intrahepatic branches. ERCP provides direct visualization and therapeutic ...","sourceLabel":"Section in Gastroenterology"},"973":{"title":"Capsule Endoscopy, Liver Biopsy, Paracentesis","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s53","snippet":"Capsule Endoscopy, Liver Biopsy, Paracentesis Video Capsule Endoscopy (VCE) Swallowed wireless capsule (PillCam SB3 is most common) with camera capturing 2-6 frames/second transmitted to a recorder belt. Battery life: ~12 hours. Primarily for small bowel evaluation: obscure GI bleeding (first-line),...","sourceLabel":"Section in Gastroenterology"},"974":{"title":"Endoscopic Hemostasis Techniques","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s54","snippet":"Endoscopic Hemostasis Techniques Technique Mechanism Indications Details Injection therapy (epinephrine) Tamponade + vasoconstriction Initial control, always combine with second modality 1:10,000 epinephrine, inject in 0.5-2 mL aliquots around the bleeding site; monotherapy has high rebleed rate The...","sourceLabel":"Section in Gastroenterology"},"975":{"title":"Imaging in Gastroenterology","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s55","snippet":"Imaging in Gastroenterology Modality Common Indications Key Interpretation Points Abdominal X-ray (KUB) Obstruction, perforation, foreign body, constipation Free air under diaphragm (upright) = perforation; dilated loops with air-fluid levels = obstruction; \"3/6/9 rule\" (small bowel > 3 cm, colon > ...","sourceLabel":"Section in Gastroenterology"},"976":{"title":"Classification Systems (All)","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s56","snippet":"Classification Systems (All) System Used For Key Features Los Angeles Classification Erosive esophagitis Grade A (< 5 mm mucosal breaks); B (> 5 mm, not bridging folds); C (bridging, < 75%); D (&ge; 75% circumference) Prague C&M Barrett's esophagus extent C = circumferential extent; M = maximum tong...","sourceLabel":"Section in Gastroenterology"},"977":{"title":"Medications Master Table","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s57","snippet":"Medications Master Table Acid Suppression Drug (Brand) Class / Mechanism Dose Indication Pearl Omeprazole (Prilosec) PPI — irreversible H+/K+ ATPase inhibitor 20-40 mg daily GERD, PUD, ZES, H. pylori Take 30-60 min before first meal; CYP2C19 substrate Esomeprazole (Nexium) PPI 20-40 mg daily GERD, e...","sourceLabel":"Section in Gastroenterology"},"978":{"title":"Abbreviations Master List","pageTitle":"Gastroenterology","pageUrl":"/medical/gastroenterology","url":"/medical/gastroenterology#s58","snippet":"Abbreviations Master List Anatomy GEJ Gastroesophageal junction LES Lower esophageal sphincter UES Upper esophageal sphincter CBD Common bile duct CHD Common hepatic duct SMA Superior mesenteric artery IMA Inferior mesenteric artery SMV Superior mesenteric vein IVC Inferior vena cava GDA Gastroduode...","sourceLabel":"Section in Gastroenterology"},"979":{"title":"Nephrology","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology","snippet":"Specialty Reference Nephrology Complete Specialty Reference Every renal diagnosis, electrolyte disorder, acid-base disturbance, dialysis modality, transplant protocol, glomerular disease, classification system, and management strategy in one place."},"980":{"title":"Renal Anatomy & Physiology","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s1","snippet":"Renal Anatomy & Physiology The kidneys are paired retroperitoneal organs located at the T12-L3 vertebral levels, each weighing approximately 120-170 g in adults and measuring 10-12 cm in length. They receive ~20-25% of cardiac output (~1,000-1,200 mL/min) despite constituting only 0.5% of body weigh...","sourceLabel":"Section in Nephrology"},"981":{"title":"The Renal Physical Exam & Assessment","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s2","snippet":"The Renal Physical Exam & Assessment Volume Status Assessment Finding Hypovolemia Euvolemia Hypervolemia JVP Flat (<5 cm H₂O) 5-8 cm H₂O Elevated (>8 cm H₂O) Mucous membranes Dry Moist Moist Skin turgor Decreased (tenting) Normal Normal or taut Orthostatics Positive (SBP drop &ge;20 or HR rise &ge;2...","sourceLabel":"Section in Nephrology"},"982":{"title":"Key Terminology & Abbreviations","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s3","snippet":"Key Terminology & Abbreviations Nephrology employs a dense vocabulary of abbreviations spanning renal physiology, dialysis, transplant, and electrolyte disorders. Mastery of these terms is essential for interpreting renal panels, urinalyses, biopsy reports, and dialysis prescriptions. Abbreviation M...","sourceLabel":"Section in Nephrology"},"983":{"title":"AKI: Classification & Etiologies","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s4","snippet":"AKI: Classification & Etiologies Acute kidney injury (AKI) is defined as an abrupt decline in kidney function over hours to days. It is classified by the KDIGO criteria based on serum creatinine rise and/or urine output decline. AKI occurs in ~10-15% of hospitalized patients and up to 50% of ICU pat...","sourceLabel":"Section in Nephrology"},"984":{"title":"Acute Tubular Necrosis","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s5","snippet":"Acute Tubular Necrosis ATN is the most common cause of intrinsic AKI, accounting for ~85% of intrinsic renal failure. It results from ischemic or nephrotoxic injury to tubular epithelial cells, particularly in the S3 segment of the proximal tubule and the medullary thick ascending limb - areas with ...","sourceLabel":"Section in Nephrology"},"985":{"title":"Acute Interstitial Nephritis","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s6","snippet":"Acute Interstitial Nephritis AIN is a hypersensitivity-mediated inflammation of the renal interstitium, most commonly drug-induced (~70-75% of cases). It accounts for 15-20% of all AKI. The classic triad of fever, rash, and eosinophilia is present in only ~10-15% of cases (more common with methicill...","sourceLabel":"Section in Nephrology"},"986":{"title":"Contrast-Induced & Pigment Nephropathy","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s7","snippet":"Contrast-Induced & Pigment Nephropathy Contrast-Induced Nephropathy (CIN) CIN is defined as a rise in serum creatinine &ge;0.5 mg/dL or &ge;25% above baseline within 48-72 hours of contrast administration. Mechanism: renal vasoconstriction + direct tubular toxicity + oxidative stress. Risk factors: ...","sourceLabel":"Section in Nephrology"},"987":{"title":"CKD Staging & Progression","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s8","snippet":"CKD Staging & Progression CKD is defined as abnormalities of kidney structure or function present for >3 months , with implications for health. The most common causes in the US are diabetes mellitus (~45%) and hypertension (~28%). KDIGO classifies CKD by both GFR category and albuminuria category to...","sourceLabel":"Section in Nephrology"},"988":{"title":"CKD Complications Management","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s9","snippet":"CKD Complications Management Anemia of CKD Normocytic normochromic anemia develops primarily from decreased erythropoietin (EPO) production, typically when eGFR <30-45. Iron deficiency is common (reduced absorption, chronic blood loss from uremia-related platelet dysfunction, dialysis losses). Worku...","sourceLabel":"Section in Nephrology"},"989":{"title":"Diabetic Kidney Disease","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s10","snippet":"Diabetic Kidney Disease Diabetic kidney disease (DKD) is the leading cause of ESRD in the US (~45% of new dialysis initiations). It develops in ~30-40% of patients with type 1 or type 2 diabetes. Natural history: glomerular hyperfiltration &rarr; microalbuminuria (UACR 30-300) &rarr; overt proteinur...","sourceLabel":"Section in Nephrology"},"990":{"title":"Hypertensive Nephrosclerosis","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s11","snippet":"Hypertensive Nephrosclerosis Hypertensive nephrosclerosis is the second leading cause of ESRD in the US. Two forms exist: benign nephrosclerosis (chronic, slowly progressive) and malignant nephrosclerosis (accelerated hypertension with rapid GFR decline). Benign Nephrosclerosis Chronic hypertension ...","sourceLabel":"Section in Nephrology"},"991":{"title":"Nephrotic Syndrome","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s12","snippet":"Nephrotic Syndrome Nephrotic syndrome is defined by: proteinuria >3.5 g/day (or UPCR >3,500 mg/g), hypoalbuminemia (<3.0 g/dL), peripheral edema, hyperlipidemia, and lipiduria (fatty casts, oval fat bodies, Maltese crosses). Complications include venous thromboembolism (loss of antithrombin III, pro...","sourceLabel":"Section in Nephrology"},"992":{"title":"Nephritic Syndrome","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s13","snippet":"Nephritic Syndrome Nephritic syndrome is characterized by: hematuria (often with RBC casts and dysmorphic RBCs), hypertension, edema, oliguria, and a mild-to-moderate rise in creatinine. Proteinuria is usually subnephrotic (<3.5 g/day) but can overlap. The hallmark on biopsy is inflammatory injury t...","sourceLabel":"Section in Nephrology"},"993":{"title":"Lupus Nephritis","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s14","snippet":"Lupus Nephritis Lupus nephritis (LN) occurs in ~50-60% of SLE patients and is a major determinant of morbidity and mortality. Renal biopsy is essential for classification and treatment decisions. The ISN/RPS classification guides therapy. Figure 11 - Lupus Nephritis Biopsy. Renal biopsy specimens fr...","sourceLabel":"Section in Nephrology"},"994":{"title":"ANCA-Associated Vasculitis","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s15","snippet":"ANCA-Associated Vasculitis The ANCA-associated vasculitides (AAV) are small-vessel vasculitides that frequently involve the kidney as pauci-immune crescentic glomerulonephritis (type III RPGN). They include GPA (granulomatosis with polyangiitis), MPA (microscopic polyangiitis), and EGPA (eosinophili...","sourceLabel":"Section in Nephrology"},"995":{"title":"Thrombotic Microangiopathies","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s16","snippet":"Thrombotic Microangiopathies The thrombotic microangiopathies (TMAs) are characterized by microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and organ injury (especially kidney and brain). The hallmark pathology is endothelial injury with fibrin-platelet thrombi in arterioles and capillarie...","sourceLabel":"Section in Nephrology"},"996":{"title":"Polycystic Kidney Disease","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s17","snippet":"Polycystic Kidney Disease Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease (1:400-1,000), caused by mutations in PKD1 (85%, chromosome 16, worse prognosis) or PKD2 (15%, chromosome 4, milder). It accounts for ~5% of ESRD. Bilateral renal cysts develop ...","sourceLabel":"Section in Nephrology"},"997":{"title":"Renal Artery Stenosis","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s18","snippet":"Renal Artery Stenosis Renal artery stenosis (RAS) causes renovascular hypertension and ischemic nephropathy. Two main etiologies exist with distinct demographics and management approaches. Feature Atherosclerotic RAS Fibromuscular Dysplasia Epidemiology Older adults (>50); men; atherosclerosis risk ...","sourceLabel":"Section in Nephrology"},"998":{"title":"Renal Tubular Acidosis","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s19","snippet":"Renal Tubular Acidosis Renal tubular acidosis (RTA) refers to a group of disorders characterized by non-anion-gap metabolic acidosis due to impaired renal acid excretion or bicarbonate reabsorption, with a disproportionately preserved GFR. RTA Classification Feature Type 1 (Distal) Type 2 (Proximal)...","sourceLabel":"Section in Nephrology"},"999":{"title":"Sodium Disorders","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s20","snippet":"Sodium Disorders Hyponatremia (Na+ <135 mEq/L) The most common electrolyte disorder in hospitalized patients (~15-30%). Always assess serum osmolality first to exclude pseudohyponatremia (isotonic: hyperlipidemia/hyperproteinemia) and hypertonic hyponatremia (hyperglycemia: corrected Na+ = measured ...","sourceLabel":"Section in Nephrology"},"1000":{"title":"Potassium Disorders","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s21","snippet":"Potassium Disorders Hyperkalemia (K+ >5.0 mEq/L) Figure 21 - ECG in Severe Hyperkalemia. Twelve-lead ECG from a patient with serum potassium of 8.6 mEq/L demonstrating characteristic peaked T waves (most prominent in precordial leads), widened QRS complexes, and loss of P waves-classic progressive E...","sourceLabel":"Section in Nephrology"},"1001":{"title":"Calcium & Phosphorus Disorders","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s22","snippet":"Calcium & Phosphorus Disorders Hypercalcemia The two most common causes account for ~90%: primary hyperparathyroidism (outpatient) and malignancy (inpatient - via PTHrP, osteolytic metastases, or 1,25(OH)₂D production by lymphoma). Symptoms: \"stones, bones, groans, thrones, and psychiatric overtones...","sourceLabel":"Section in Nephrology"},"1002":{"title":"Magnesium Disorders","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s23","snippet":"Magnesium Disorders Hypomagnesemia (Mg2+ <1.8 mg/dL) Common in hospitalized patients (~12%). Causes: GI losses (diarrhea, malabsorption, PPI use), renal losses (loop/thiazide diuretics, alcohol, aminoglycosides, cisplatin, amphotericin B, calcineurin inhibitors), hungry bone syndrome. Effects: refra...","sourceLabel":"Section in Nephrology"},"1003":{"title":"Metabolic Acidosis","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s24","snippet":"Metabolic Acidosis Metabolic acidosis is defined by low pH (<7.35) with low HCO3&minus; (<22 mEq/L). The first step is to calculate the anion gap (AG) = Na+ &minus; (Cl&minus; + HCO3&minus;) ; normal = 12 &plusmn; 4. Adjust for albumin: corrected AG = AG + 2.5 &times; (4.0 &minus; albumin). Figure 2...","sourceLabel":"Section in Nephrology"},"1004":{"title":"Metabolic Alkalosis","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s25","snippet":"Metabolic Alkalosis Metabolic alkalosis (pH >7.45, HCO3&minus; >28 mEq/L) requires both a generation phase (HCO3&minus; gain or H+ loss) and a maintenance phase (impaired renal HCO3&minus; excretion, usually from volume depletion, chloride depletion, or hypokalemia). Check urine chloride to classify...","sourceLabel":"Section in Nephrology"},"1005":{"title":"Hemodialysis","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s26","snippet":"Hemodialysis Indications for Dialysis (AEIOU) Letter Indication Details A Acidosis Severe metabolic acidosis (pH <7.1) refractory to bicarbonate therapy E Electrolytes Refractory hyperkalemia (K+ >6.5 with EKG changes, or resistant to medical therapy) I Intoxication Dialyzable toxins: methanol, ethy...","sourceLabel":"Section in Nephrology"},"1006":{"title":"Peritoneal Dialysis","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s27","snippet":"Peritoneal Dialysis Peritoneal dialysis (PD) uses the peritoneal membrane as the dialysis membrane. Dialysate is instilled into the peritoneal cavity via a Tenckhoff catheter ; solutes diffuse from blood to dialysate, and water is removed by osmotic ultrafiltration (using dextrose or icodextrin in d...","sourceLabel":"Section in Nephrology"},"1007":{"title":"Continuous Renal Replacement Therapy","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s28","snippet":"Continuous Renal Replacement Therapy CRRT provides slow, continuous solute clearance and fluid removal over 24 hours, making it ideal for hemodynamically unstable ICU patients who cannot tolerate intermittent HD. It requires ICU-level monitoring and continuous anticoagulation of the circuit. CRRT Mo...","sourceLabel":"Section in Nephrology"},"1008":{"title":"Dialysis Emergencies","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s29","snippet":"Dialysis Emergencies Dialysis Disequilibrium Syndrome Occurs during or shortly after first HD sessions in severely uremic patients (BUN >150 mg/dL). Mechanism: rapid urea removal from blood creates an osmotic gradient between plasma and brain &rarr; cerebral edema. Symptoms: headache, nausea, confus...","sourceLabel":"Section in Nephrology"},"1009":{"title":"Pre-Transplant Evaluation & Listing","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s30","snippet":"Pre-Transplant Evaluation & Listing Kidney transplantation is the optimal renal replacement therapy for eligible ESRD patients, offering superior survival, quality of life, and cost-effectiveness compared to dialysis. Pre-emptive transplantation (before dialysis initiation) has the best outcomes. Ev...","sourceLabel":"Section in Nephrology"},"1010":{"title":"Immunosuppression Protocols","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s31","snippet":"Immunosuppression Protocols Induction Therapy (perioperative) Agent Mechanism Indication Key Side Effects Basiliximab Anti-IL-2R (CD25) monoclonal antibody; blocks T-cell proliferation Low immunologic risk patients Generally well-tolerated; low infection risk Anti-thymocyte globulin (ATG) Polyclonal...","sourceLabel":"Section in Nephrology"},"1011":{"title":"Transplant Complications","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s32","snippet":"Transplant Complications Figure 27 - Transplant Glomerulitis. Renal transplant biopsy demonstrating glomerulitis with endothelial cell swelling and inflammatory cell infiltration of glomerular capillaries, a key histologic finding in antibody-mediated rejection. Source: PMC/NIH. Rejection Types Type...","sourceLabel":"Section in Nephrology"},"1012":{"title":"Kidney Biopsy","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s33","snippet":"Kidney Biopsy Indications Unexplained AKI, nephrotic syndrome in adults, nephritic syndrome, rapidly progressive GN, persistent proteinuria >1 g/day, unexplained hematuria with proteinuria, systemic disease with renal involvement (SLE, vasculitis, amyloid), transplant dysfunction (to differentiate r...","sourceLabel":"Section in Nephrology"},"1013":{"title":"Urinalysis & Urine Studies","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s34","snippet":"Urinalysis & Urine Studies Complete UA Interpretation The urinalysis is the \"poor man's kidney biopsy\" and remains the most important initial test in nephrology. A complete UA includes: dipstick analysis (chemical), microscopy (cellular elements, casts, crystals), and quantitative studies (protein, ...","sourceLabel":"Section in Nephrology"},"1014":{"title":"Pregnancy & the Kidney","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s35","snippet":"Pregnancy & the Kidney Normal Renal Changes in Pregnancy GFR increases ~50% by second trimester (hyperfiltration) &rarr; serum creatinine normally decreases to 0.4-0.6 mg/dL. A \"normal\" Cr of 0.9 mg/dL may indicate renal impairment in pregnancy. Physiologic hydronephrosis (R > L, due to dextrorotate...","sourceLabel":"Section in Nephrology"},"1015":{"title":"Imaging in Nephrology","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s36","snippet":"Imaging in Nephrology Modality Indication Advantages Limitations Renal Ultrasound First-line for all renal pathology; AKI (rule out obstruction); CKD (kidney size); cysts; transplant evaluation No radiation, no contrast; bedside availability; Doppler for RAS screening Operator-dependent; limited by ...","sourceLabel":"Section in Nephrology"},"1016":{"title":"Classification Systems (All)","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s37","snippet":"Classification Systems (All) KDIGO AKI Staging Stage Creatinine Criteria Urine Output Criteria 1 &ge;0.3 mg/dL rise in 48 h OR 1.5-1.9&times; baseline <0.5 mL/kg/h &times; 6-12 h 2 2.0-2.9&times; baseline <0.5 mL/kg/h &times; &ge;12 h 3 &ge;3.0&times; baseline OR Cr &ge;4.0 OR RRT initiation <0.3 mL...","sourceLabel":"Section in Nephrology"},"1017":{"title":"Medications Master Table","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s38","snippet":"Medications Master Table Immunosuppressants Drug Mechanism Dose Key Toxicity Monitoring Cyclophosphamide Alkylating agent; crosslinks DNA IV: 0.5-1 g/m&sup2; monthly; Euro-Lupus: 500 mg q2wk &times; 6 Hemorrhagic cystitis (give MESNA), leukopenia, infections, gonadal toxicity, bladder cancer CBC q1-...","sourceLabel":"Section in Nephrology"},"1018":{"title":"Abbreviations Master List","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s39","snippet":"Abbreviations Master List General Nephrology GFR Glomerular filtration rate eGFR Estimated GFR CrCl Creatinine clearance BUN Blood urea nitrogen SCr Serum creatinine AKI Acute kidney injury CKD Chronic kidney disease ESRD End-stage renal disease KDIGO Kidney Disease: Improving Global Outcomes KDOQI ...","sourceLabel":"Section in Nephrology"},"1019":{"title":"Risk Scores & Guidelines","pageTitle":"Nephrology","pageUrl":"/medical/nephrology","url":"/medical/nephrology#s40","snippet":"Risk Scores & Guidelines Kidney Failure Risk Equation (KFRE) Predicts 2- and 5-year probability of kidney failure requiring dialysis or transplant, using four variables: age, sex, eGFR, and UACR . Validated in >30 countries and >700,000 patients. Used to guide referral timing and dialysis planning. ...","sourceLabel":"Section in Nephrology"},"1020":{"title":"Endocrinology","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology","snippet":"Specialty Reference Endocrinology Complete Specialty Reference Every hormone axis, diabetes protocol, thyroid disorder, adrenal condition, pituitary tumor, calcium pathway, and metabolic emergency - with diagnostic algorithms, dosing tables, and dynamic testing protocols in one place."},"1021":{"title":"Endocrine Anatomy & Physiology","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s1","snippet":"Endocrine Anatomy & Physiology The endocrine system comprises glands and specialized cells that produce hormones - chemical messengers released into the bloodstream to act on distant target organs. Unlike the nervous system's rapid, point-to-point signaling, endocrine signaling is slower but sustain...","sourceLabel":"Section in Endocrinology"},"1022":{"title":"The Endocrine Physical Exam","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s2","snippet":"The Endocrine Physical Exam Thyroid Examination The thyroid gland sits in the anterior neck, overlying the 2nd-4th tracheal rings. Normal weight is 15-20 g. Examine from behind the patient: palpate both lobes and the isthmus while the patient swallows (the thyroid moves with swallowing because it is...","sourceLabel":"Section in Endocrinology"},"1023":{"title":"Key Terminology & Abbreviations","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s3","snippet":"Key Terminology & Abbreviations Endocrinology uses dense abbreviations across diabetes management, thyroid diagnostics, adrenal testing, and pituitary evaluation. Mastery of these terms is essential for interpreting labs, imaging reports, and clinical notes. Abbreviation Meaning A1C (HbA1c) Glycosyl...","sourceLabel":"Section in Endocrinology"},"1024":{"title":"Type 1 Diabetes","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s4","snippet":"Type 1 Diabetes Type 1 diabetes mellitus (T1DM) results from autoimmune destruction of pancreatic beta cells, leading to absolute insulin deficiency. It accounts for ~5-10% of all diabetes cases. Peak incidence is bimodal: ages 4-6 and 10-14, but can occur at any age (including adults - latent autoi...","sourceLabel":"Section in Endocrinology"},"1025":{"title":"Type 2 Diabetes","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s5","snippet":"Type 2 Diabetes Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance and progressive beta cell dysfunction . It accounts for ~90-95% of all diabetes. Strong risk factors include obesity (especially visceral adiposity), family history, sedentary lifestyle, and ethnicity (higher prev...","sourceLabel":"Section in Endocrinology"},"1026":{"title":"Oral & Non-Insulin Agents","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s6","snippet":"Oral & Non-Insulin Agents Pharmacotherapy for T2DM has evolved dramatically. Agent selection now considers not only glycemic efficacy but also cardiovascular benefit, renal protection, weight effects, and hypoglycemia risk. Metformin remains first-line for most patients, but GLP-1 RAs and SGLT2 inhi...","sourceLabel":"Section in Endocrinology"},"1027":{"title":"Insulin Therapy","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s7","snippet":"Insulin Therapy Insulin is required for all patients with T1DM and many with T2DM when oral agents are insufficient or contraindicated. The goal of insulin therapy is to replicate the physiologic insulin profile: a continuous low-level basal secretion plus meal-time bolus surges. Insulin Types Categ...","sourceLabel":"Section in Endocrinology"},"1028":{"title":"Diabetic Ketoacidosis (DKA)","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s8","snippet":"Diabetic Ketoacidosis (DKA) Endocrine Emergency - DKA DKA is a life-threatening complication of absolute or relative insulin deficiency. Mortality is 1-5% in adults but higher with delayed treatment, cerebral edema (especially in children), or severe comorbidities. The most dangerous electrolyte abn...","sourceLabel":"Section in Endocrinology"},"1029":{"title":"Hyperosmolar Hyperglycemic State (HHS)","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s9","snippet":"Hyperosmolar Hyperglycemic State (HHS) HHS is a life-threatening diabetic emergency characterized by severe hyperglycemia (>600 mg/dL), hyperosmolality (>320 mOsm/kg), and profound dehydration without significant ketoacidosis. It occurs almost exclusively in T2DM, typically in elderly patients with ...","sourceLabel":"Section in Endocrinology"},"1030":{"title":"Thyroid Function Testing & Interpretation","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s10","snippet":"Thyroid Function Testing & Interpretation The TSH is the single best screening test for thyroid dysfunction. It is exquisitely sensitive to small changes in free thyroid hormone levels due to the log-linear relationship between free T4 and TSH. A 2-fold change in FT4 produces a 100-fold change in TS...","sourceLabel":"Section in Endocrinology"},"1031":{"title":"Hypothyroidism","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s11","snippet":"Hypothyroidism Primary hypothyroidism accounts for >95% of cases. The most common cause in iodine-sufficient regions is Hashimoto thyroiditis (chronic lymphocytic thyroiditis), an autoimmune condition with anti-TPO antibodies (positive in ~95%) and anti-thyroglobulin antibodies. Other causes include...","sourceLabel":"Section in Endocrinology"},"1032":{"title":"Hyperthyroidism","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s12","snippet":"Hyperthyroidism Hyperthyroidism refers to excess thyroid hormone production by the thyroid gland. Thyrotoxicosis is the broader term for any cause of excess thyroid hormone (including exogenous intake or destructive thyroiditis without glandular overproduction). Figure 9 - Immunopathogenesis of Grav...","sourceLabel":"Section in Endocrinology"},"1033":{"title":"Thyroid Nodules & Cancer","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s13","snippet":"Thyroid Nodules & Cancer Thyroid nodules are extremely common (palpable in 5% of the population, incidental on imaging in 20-70%). The clinical challenge is identifying the ~5-15% of nodules that harbor malignancy. All patients with a thyroid nodule should have a TSH measured. If TSH is low, obtain ...","sourceLabel":"Section in Endocrinology"},"1034":{"title":"Thyroid Storm","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s14","snippet":"Thyroid Storm Endocrine Emergency - Thyroid Storm Thyroid storm is a rare, life-threatening exacerbation of thyrotoxicosis with multisystem decompensation. Mortality is 10-30% even with treatment. Triggers include surgery, infection, trauma, iodine load, DKA, and abrupt ATD discontinuation. Clinical...","sourceLabel":"Section in Endocrinology"},"1035":{"title":"Adrenal Anatomy & Hormone Synthesis","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s15","snippet":"Adrenal Anatomy & Hormone Synthesis The adrenal glands are paired retroperitoneal organs sitting atop each kidney, weighing ~4 g each. Each gland has two functionally distinct regions: the outer cortex (mesoderm-derived, produces steroid hormones) and the inner medulla (neural crest-derived, produce...","sourceLabel":"Section in Endocrinology"},"1036":{"title":"Cushing Syndrome","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s16","snippet":"Cushing Syndrome Cushing syndrome refers to the clinical manifestations of chronic glucocorticoid excess from any cause. Cushing disease specifically refers to ACTH-secreting pituitary adenoma (the most common endogenous cause, ~70%). The most common overall cause is exogenous glucocorticoid use (ia...","sourceLabel":"Section in Endocrinology"},"1037":{"title":"Adrenal Insufficiency","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s17","snippet":"Adrenal Insufficiency Endocrine Emergency - Adrenal Crisis Adrenal crisis is a life-threatening emergency caused by acute cortisol deficiency. Triggers: abrupt steroid withdrawal, physiologic stress (illness, surgery, trauma) in patients with undiagnosed or undertreated adrenal insufficiency, pituit...","sourceLabel":"Section in Endocrinology"},"1038":{"title":"Primary Aldosteronism","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s18","snippet":"Primary Aldosteronism Primary aldosteronism (PA) is autonomous aldosterone production independent of renin. It is now recognized as the most common cause of secondary hypertension, present in 5-10% of all hypertensives and ~20% of those with resistant hypertension. It causes hypertension plus hypoka...","sourceLabel":"Section in Endocrinology"},"1039":{"title":"Pheochromocytoma & Paraganglioma","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s19","snippet":"Pheochromocytoma & Paraganglioma Pheochromocytomas (pheos) are catecholamine-secreting tumors arising from chromaffin cells of the adrenal medulla. Paragangliomas arise from extra-adrenal sympathetic or parasympathetic paraganglia. Together they are called PPGLs. Classic presentation: episodic heada...","sourceLabel":"Section in Endocrinology"},"1040":{"title":"Pituitary Anatomy & Hormones","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s20","snippet":"Pituitary Anatomy & Hormones The pituitary gland (hypophysis) sits in the sella turcica of the sphenoid bone, connected to the hypothalamus by the pituitary stalk (infundibulum). It weighs ~0.6 g and has two lobes with distinct embryologic origins and functions. Figure 20 - Hypothalamic and Pituitar...","sourceLabel":"Section in Endocrinology"},"1041":{"title":"Pituitary Adenomas","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s21","snippet":"Pituitary Adenomas Pituitary adenomas account for ~15% of intracranial neoplasms. They are classified by size ( microadenoma <10 mm, macroadenoma &ge;10 mm) and by functional status (secreting vs non-functioning). The most common incidental finding on brain MRI is a pituitary microadenoma (~10% prev...","sourceLabel":"Section in Endocrinology"},"1042":{"title":"Hypopituitarism","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s22","snippet":"Hypopituitarism Hypopituitarism is partial or complete loss of anterior pituitary hormone secretion. It can result from pituitary tumors (most common), surgery, radiation, infiltrative diseases (sarcoidosis, hemochromatosis, Langerhans cell histiocytosis), Sheehan syndrome (postpartum pituitary necr...","sourceLabel":"Section in Endocrinology"},"1043":{"title":"Diabetes Insipidus & SIADH","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s23","snippet":"Diabetes Insipidus & SIADH Diabetes Insipidus (DI) DI is characterized by the excretion of large volumes of dilute urine (polyuria >3 L/day, urine osmolality <300 mOsm/kg) due to ADH deficiency or resistance. Patients present with polyuria, polydipsia, nocturia, and if water intake is inadequate, hy...","sourceLabel":"Section in Endocrinology"},"1044":{"title":"Calcium Homeostasis","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s24","snippet":"Calcium Homeostasis Calcium is tightly regulated between 8.5-10.5 mg/dL (total) or 4.5-5.5 mg/dL (ionized). Approximately 40% of total calcium is protein-bound (mainly albumin), 10% is complexed with anions, and 50% is free/ionized (biologically active). The corrected calcium adjusts for hypoalbumin...","sourceLabel":"Section in Endocrinology"},"1045":{"title":"Hyperparathyroidism","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s25","snippet":"Hyperparathyroidism Primary Hyperparathyroidism (PHPT) The most common cause of hypercalcemia in the outpatient setting. Etiology: single parathyroid adenoma (~85%), four-gland hyperplasia (~10-15%, often MEN1 or MEN2A), parathyroid carcinoma (<1%). Lab pattern: elevated calcium + elevated or inappr...","sourceLabel":"Section in Endocrinology"},"1046":{"title":"Hypoparathyroidism & Hypocalcemia","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s26","snippet":"Hypoparathyroidism & Hypocalcemia Causes of Hypocalcemia Category Causes PTH Notes Hypoparathyroidism Post-surgical (most common - after thyroidectomy/parathyroidectomy), autoimmune (APS type 1), DiGeorge syndrome, infiltrative Low Also causes hyperphosphatemia Vitamin D deficiency Malabsorption, CK...","sourceLabel":"Section in Endocrinology"},"1047":{"title":"Osteoporosis & Metabolic Bone Disease","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s27","snippet":"Osteoporosis & Metabolic Bone Disease Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration, leading to increased fracture risk. It is defined by DEXA T-score or by the occurrence of a fragility fracture. Figure 27 - The Bone Remodeling Cycle...","sourceLabel":"Section in Endocrinology"},"1048":{"title":"Male Hypogonadism","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s28","snippet":"Male Hypogonadism Male hypogonadism is defined by low testosterone with associated symptoms. Symptoms include decreased libido, erectile dysfunction, fatigue, loss of muscle mass, increased body fat, decreased bone density, depressed mood, and reduced facial/body hair. Classification Type Level Test...","sourceLabel":"Section in Endocrinology"},"1049":{"title":"PCOS","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s29","snippet":"PCOS Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, affecting 6-12%. It is a leading cause of anovulatory infertility and is strongly associated with insulin resistance, metabolic syndrome, and type 2 diabetes. Figure 29 - PCOS Pathophysiology. S...","sourceLabel":"Section in Endocrinology"},"1050":{"title":"Menopause & HRT","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s30","snippet":"Menopause & HRT Menopause is defined as 12 consecutive months of amenorrhea without other cause, reflecting permanent cessation of ovarian function. Mean age: 51 years. The perimenopause transition begins 4-8 years before the final menstrual period. Diagnosis is clinical in women &ge;45; FSH (>30-40...","sourceLabel":"Section in Endocrinology"},"1051":{"title":"MEN Syndromes","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s31","snippet":"MEN Syndromes The multiple endocrine neoplasia (MEN) syndromes are autosomal dominant inherited disorders predisposing to tumors of multiple endocrine glands. Early genetic testing and surveillance are critical for affected families. Syndrome Gene Components Key Clinical Features MEN1 (Wermer syndro...","sourceLabel":"Section in Endocrinology"},"1052":{"title":"Carcinoid Tumors & NETs","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s32","snippet":"Carcinoid Tumors & NETs Neuroendocrine tumors (NETs) arise from enterochromaffin and other neuroendocrine cells throughout the body. The most common sites are the GI tract (small intestine > rectum > appendix) and lungs. They are graded by Ki-67 proliferation index: G1 (<3%), G2 (3-20%), G3 (>20%). ...","sourceLabel":"Section in Endocrinology"},"1053":{"title":"Hypoglycemia in Non-Diabetic Adults","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s33","snippet":"Hypoglycemia in Non-Diabetic Adults Hypoglycemia in a non-diabetic adult requires the Whipple triad : (1) symptoms consistent with hypoglycemia, (2) documented low plasma glucose (<55 mg/dL), and (3) resolution of symptoms with glucose correction. Differential Diagnosis Category Conditions Key Lab F...","sourceLabel":"Section in Endocrinology"},"1054":{"title":"Dynamic Endocrine Testing","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s34","snippet":"Dynamic Endocrine Testing Dynamic testing is the cornerstone of endocrine diagnosis. Stimulation tests assess gland reserve (can it respond?); suppression tests assess autonomy (can it be turned off?). Test Indication Protocol Interpretation Cosyntropin (ACTH) stimulation Adrenal insufficiency Cosyn...","sourceLabel":"Section in Endocrinology"},"1055":{"title":"Thyroid FNA & Endocrine Imaging","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s35","snippet":"Thyroid FNA & Endocrine Imaging Thyroid Ultrasound First-line imaging for thyroid nodules. Key features to report: nodule size, composition (solid, cystic, mixed), echogenicity (hypoechoic vs isoechoic vs hyperechoic), margins, calcifications (microcalcifications are suspicious), shape (taller-than-...","sourceLabel":"Section in Endocrinology"},"1056":{"title":"Imaging in Endocrinology","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s36","snippet":"Imaging in Endocrinology Clinical Scenario First-Line Imaging Second-Line / Advanced Key Findings Thyroid nodule Thyroid ultrasound FNA (US-guided), RAIU scan (if TSH low) Microcalcifications, hypoechoic, irregular margins = suspicious Hyperthyroidism etiology RAIU scan (I-123) TRAb/TSI, thyroid US ...","sourceLabel":"Section in Endocrinology"},"1057":{"title":"Classification Systems","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s37","snippet":"Classification Systems WHO Diabetes Classification (2019) Type Key Features Type 1 Autoimmune beta-cell destruction, absolute insulin deficiency Type 2 Insulin resistance + progressive beta-cell failure Gestational (GDM) First recognized during pregnancy (not preexisting) Specific types MODY (monoge...","sourceLabel":"Section in Endocrinology"},"1058":{"title":"Medications Master Table","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s38","snippet":"Medications Master Table Insulins Name Type Onset Peak Duration Notes Lispro (Humalog) Rapid 15 min 1-2 hr 3-5 hr Bolus/pump use Aspart (NovoLog) Rapid 15 min 1-2 hr 3-5 hr Bolus/pump use Regular (Humulin R) Short 30 min 2-4 hr 6-8 hr IV insulin drip; meals NPH (Humulin N) Intermediate 1-2 hr 4-8 hr...","sourceLabel":"Section in Endocrinology"},"1059":{"title":"Abbreviations Master List","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s39","snippet":"Abbreviations Master List A1C Glycosylated hemoglobin ACTH Adrenocorticotropic hormone ADH Antidiuretic hormone (vasopressin) AI Adrenal insufficiency AID Automated insulin delivery ALP Alkaline phosphatase ARR Aldosterone-to-renin ratio ATD Antithyroid drug AVS Adrenal vein sampling BIPSS Bilateral...","sourceLabel":"Section in Endocrinology"},"1060":{"title":"Risk Scores & Guidelines","pageTitle":"Endocrinology","pageUrl":"/medical/endocrinology","url":"/medical/endocrinology#s40","snippet":"Risk Scores & Guidelines Key Guidelines Organization Guideline Year Key Recommendations ADA Standards of Care in Diabetes 2024 A1C <7% for most adults; SGLT2i/GLP-1 RA for ASCVD/HF/CKD regardless of A1C; CGM for all T1DM and insulin-using T2DM; comprehensive foot exam annually ATA Thyroid Nodules & ...","sourceLabel":"Section in Endocrinology"},"1061":{"title":"Infectious Disease","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease","snippet":"Specialty Reference Infectious Disease Complete Specialty Reference Every pathogen, syndrome, antimicrobial agent, resistance pattern, empiric regimen, prophylaxis strategy, and management algorithm in one place."},"1062":{"title":"Microbiology Fundamentals","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s1","snippet":"Microbiology Fundamentals Infectious disease medicine rests on a foundation of microbiology - understanding how organisms are classified, how they cause disease, and how they evade host defenses and antimicrobial therapy. The Gram stain remains the single most important rapid diagnostic test in clin...","sourceLabel":"Section in Infectious Disease"},"1063":{"title":"The Infectious Disease Assessment","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s2","snippet":"The Infectious Disease Assessment The systematic evaluation of a patient with suspected infection involves identifying the source, the likely pathogen, and the severity of illness. The fever workup , blood culture interpretation, and sepsis screening tools are the cornerstones of ID assessment. Figu...","sourceLabel":"Section in Infectious Disease"},"1064":{"title":"Key Terminology & Abbreviations","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s3","snippet":"Key Terminology & Abbreviations Term Definition Bacteremia Presence of viable bacteria in the bloodstream, confirmed by positive blood culture Sepsis (Sepsis-3) Life-threatening organ dysfunction caused by dysregulated host response to infection; SOFA score &ge;2 Septic shock Subset of sepsis with v...","sourceLabel":"Section in Infectious Disease"},"1065":{"title":"Sepsis & Septic Shock","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s4","snippet":"Sepsis & Septic Shock Sepsis is a medical emergency defined by the Sepsis-3 consensus (2016) as life-threatening organ dysfunction caused by a dysregulated host response to infection. It affects over 1.7 million adults annually in the United States, with a mortality rate of 15-30% for sepsis and 40-...","sourceLabel":"Section in Infectious Disease"},"1066":{"title":"Bloodstream Infections & Bacteremia","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s5","snippet":"Bloodstream Infections & Bacteremia Catheter-Related Bloodstream Infections (CRBSI) Central venous catheters account for ~250,000 BSIs annually in the U.S. Diagnosis requires differential time to positivity (DTP) - blood cultures drawn through the catheter turn positive &ge;2 hours before peripheral...","sourceLabel":"Section in Infectious Disease"},"1067":{"title":"Fever of Unknown Origin","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s6","snippet":"Fever of Unknown Origin Fever of unknown origin (FUO) was classically defined by Petersdorf and Beeson (1961) as fever >38.3&deg;C on multiple occasions, lasting >3 weeks, with no diagnosis after 1 week of inpatient evaluation. Modern definitions allow outpatient workup. The etiology falls into four...","sourceLabel":"Section in Infectious Disease"},"1068":{"title":"Community-Acquired Pneumonia","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s7","snippet":"Community-Acquired Pneumonia Community-acquired pneumonia (CAP) is the leading infectious cause of death worldwide. The 2019 ATS/IDSA guidelines emphasize severity-based empiric therapy, covering typical and atypical pathogens, with risk stratification using validated scoring systems. Figure 7 - Che...","sourceLabel":"Section in Infectious Disease"},"1069":{"title":"Hospital-Acquired & Ventilator-Associated Pneumonia","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s8","snippet":"Hospital-Acquired & Ventilator-Associated Pneumonia Hospital-acquired pneumonia (HAP) develops &ge;48 hours after hospital admission and was not incubating at the time of admission. Ventilator-associated pneumonia (VAP) develops &ge;48 hours after endotracheal intubation. Both carry mortality rates ...","sourceLabel":"Section in Infectious Disease"},"1070":{"title":"Tuberculosis","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s9","snippet":"Tuberculosis Tuberculosis (TB), caused by Mycobacterium tuberculosis , remains a leading infectious killer globally, with ~10 million new cases and 1.5 million deaths annually. One-quarter of the world's population is latently infected. In the United States, TB disproportionately affects foreign-bor...","sourceLabel":"Section in Infectious Disease"},"1071":{"title":"Fungal Pneumonia & Opportunistic Infections","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s10","snippet":"Fungal Pneumonia & Opportunistic Infections Pneumocystis jirovecii Pneumonia (PJP) PJP occurs in severely immunocompromised patients, classically HIV with CD4 <200 cells/&micro;L . Presentation: gradual-onset dyspnea, dry cough, fever, bilateral ground-glass opacities on CT. Elevated LDH and (1,3)-b...","sourceLabel":"Section in Infectious Disease"},"1072":{"title":"Bacterial Meningitis","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s11","snippet":"Bacterial Meningitis Emergency - Bacterial Meningitis Bacterial meningitis is a medical emergency with mortality of 15-25% and neurologic sequelae in 30-50% of survivors. If suspected: blood cultures &rarr; empiric antibiotics + dexamethasone &rarr; lumbar puncture (in that order). Do NOT delay anti...","sourceLabel":"Section in Infectious Disease"},"1073":{"title":"Viral Encephalitis","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s12","snippet":"Viral Encephalitis HSV Encephalitis HSV-1 encephalitis is the most common cause of sporadic fatal encephalitis in the United States. It classically involves the temporal lobes (bilateral but asymmetric). Presentation: acute onset fever, headache, altered mental status, seizures, focal neurologic def...","sourceLabel":"Section in Infectious Disease"},"1074":{"title":"Brain Abscess & Epidural Abscess","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s13","snippet":"Brain Abscess & Epidural Abscess Brain Abscess Brain abscess arises from contiguous spread (sinusitis, otitis, dental infection), hematogenous dissemination (endocarditis, lung abscess, IVDU), or post-neurosurgical/trauma. Classic triad (present in <50%): headache, fever, focal neurologic deficit. O...","sourceLabel":"Section in Infectious Disease"},"1075":{"title":"Infective Endocarditis","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s14","snippet":"Infective Endocarditis Infective endocarditis (IE) is an infection of the endocardial surface of the heart, usually involving one or more heart valves. The diagnosis relies on the modified Duke criteria (2023 update), integrating clinical, microbiologic, imaging, and pathologic data. Figure 15 - Aor...","sourceLabel":"Section in Infectious Disease"},"1076":{"title":"Osteomyelitis","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s15","snippet":"Osteomyelitis Osteomyelitis is infection of bone, classified by mechanism: hematogenous (bacteremia seeding bone, common in children and vertebral bodies in adults), contiguous (direct spread from adjacent soft tissue, trauma, or surgery), and vascular insufficiency (diabetic foot). The most common ...","sourceLabel":"Section in Infectious Disease"},"1077":{"title":"Septic Arthritis","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s16","snippet":"Septic Arthritis Septic arthritis is a joint space infection that constitutes an orthopedic emergency - delayed treatment leads to irreversible cartilage destruction. The most common organism is S. aureus in adults and N. gonorrhoeae in sexually active young adults. Synovial Fluid Analysis Parameter...","sourceLabel":"Section in Infectious Disease"},"1078":{"title":"C. difficile Infection","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s17","snippet":"C. difficile Infection Clostridioides difficile infection (CDI) is the most common cause of healthcare-associated diarrhea. Risk factors: antibiotic exposure (especially fluoroquinolones, clindamycin, broad-spectrum cephalosporins), age >65, hospitalization, PPI use, immunosuppression. Figure 20 - C...","sourceLabel":"Section in Infectious Disease"},"1079":{"title":"Intra-Abdominal Infections","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s18","snippet":"Intra-Abdominal Infections Classification Type Examples Microbiology Primary peritonitis (SBP) Spontaneous bacterial peritonitis in cirrhotic ascites E. coli, Klebsiella, S. pneumoniae (monomicrobial) Secondary peritonitis Perforated viscus (appendicitis, diverticulitis, peptic ulcer) Polymicrobial:...","sourceLabel":"Section in Infectious Disease"},"1080":{"title":"Infectious Diarrhea","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s19","snippet":"Infectious Diarrhea Etiology by Mechanism Type Organisms Key Features Inflammatory (bloody/dysentery) Shigella, Salmonella, Campylobacter, EHEC (O157:H7), C. difficile, Entamoeba Fever, bloody diarrhea, fecal leukocytes, tenesmus; invade/damage mucosa Secretory (watery) Cholera, ETEC (traveler's dia...","sourceLabel":"Section in Infectious Disease"},"1081":{"title":"UTI & Pyelonephritis","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s20","snippet":"UTI & Pyelonephritis Classification Type Definition Common Pathogens Uncomplicated cystitis Lower UTI in non-pregnant, premenopausal woman with normal urinary tract E. coli (~80%), S. saprophyticus, Klebsiella, Proteus Complicated UTI UTI with structural/functional abnormality, pregnancy, male sex, ...","sourceLabel":"Section in Infectious Disease"},"1082":{"title":"Sexually Transmitted Infections","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s21","snippet":"Sexually Transmitted Infections Gonorrhea & Chlamydia Feature Gonorrhea (N. gonorrhoeae) Chlamydia (C. trachomatis) Presentation (male) Purulent urethral discharge, dysuria (2-5 day incubation) Mucoid/watery discharge, dysuria (7-21 day incubation); often asymptomatic Presentation (female) Cerviciti...","sourceLabel":"Section in Infectious Disease"},"1083":{"title":"PID & Tubo-ovarian Abscess","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s22","snippet":"PID & Tubo-ovarian Abscess Pelvic inflammatory disease (PID) is an ascending infection of the upper female genital tract (endometritis, salpingitis, peritonitis, tubo-ovarian abscess). It is primarily caused by N. gonorrhoeae and C. trachomatis , but is often polymicrobial (anaerobes, GNR, Mycoplasm...","sourceLabel":"Section in Infectious Disease"},"1084":{"title":"HIV Pathophysiology & Natural History","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s23","snippet":"HIV Pathophysiology & Natural History Human immunodeficiency virus (HIV) is a retrovirus that targets CD4+ T lymphocytes, leading to progressive immune deficiency. Without treatment, HIV progresses through well-defined stages over 8-10 years from acute infection to AIDS (CD4 <200 cells/&micro;L or A...","sourceLabel":"Section in Infectious Disease"},"1085":{"title":"HIV Testing & Diagnosis","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s24","snippet":"HIV Testing & Diagnosis Recommended Testing Algorithm (CDC 2014) Step Test Window Period Notes 1. Initial screen 4th-generation HIV-1/2 Ag/Ab combo assay ~2 weeks (detects p24 Ag) Detects both HIV-1/2 antibodies and p24 antigen; replaces older Ab-only tests 2. Confirmatory HIV-1/HIV-2 antibody diffe...","sourceLabel":"Section in Infectious Disease"},"1086":{"title":"Antiretroviral Therapy","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s25","snippet":"Antiretroviral Therapy ART is recommended for all persons with HIV regardless of CD4 count (treat early). The goal is durable viral suppression (HIV RNA <50 copies/mL), immune reconstitution, reduced transmission, and improved survival. Modern regimens are once-daily, well-tolerated, and highly effe...","sourceLabel":"Section in Infectious Disease"},"1087":{"title":"Opportunistic Infections in HIV","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s26","snippet":"Opportunistic Infections in HIV CD4-Based Risk & Prophylaxis CD4 Threshold Opportunistic Infection Prophylaxis When to Stop Prophylaxis <200 Pneumocystis jirovecii (PJP) TMP-SMX DS daily (also covers Toxoplasma) CD4 >200 for &ge;3 months on ART <100 Toxoplasma gondii (if IgG positive) TMP-SMX DS dai...","sourceLabel":"Section in Infectious Disease"},"1088":{"title":"Cellulitis, Abscess & Necrotizing Fasciitis","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s27","snippet":"Cellulitis, Abscess & Necrotizing Fasciitis Purulent vs Non-Purulent SSTI Type Organisms Treatment Non-purulent cellulitis (no abscess/drainage) Beta-hemolytic Streptococcus (GAS) most common; MSSA Cephalexin 500 mg QID, dicloxacillin 500 mg QID, or clindamycin 300-450 mg TID &times; 5-7 days. Add M...","sourceLabel":"Section in Infectious Disease"},"1089":{"title":"Diabetic Foot Infections","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s28","snippet":"Diabetic Foot Infections Diabetic foot infections (DFI) occur in ~25% of diabetics over their lifetime, and are the leading cause of non-traumatic lower extremity amputation. Classification guides management. Figure 37 - Radiographic Findings of Diabetic Foot Osteomyelitis. Plain radiograph demonstr...","sourceLabel":"Section in Infectious Disease"},"1090":{"title":"Antibiotic Spectrum & Selection","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s29","snippet":"Antibiotic Spectrum & Selection Beta-Lactam Antibiotics Class Examples Spectrum Key Notes Natural penicillins Penicillin G, Penicillin V Streptococcus, Treponema pallidum, Actinomyces Drug of choice for syphilis; narrow spectrum Anti-staphylococcal penicillins Nafcillin, oxacillin, dicloxacillin MSS...","sourceLabel":"Section in Infectious Disease"},"1091":{"title":"Antifungal Agents","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s30","snippet":"Antifungal Agents Class Agents Mechanism Spectrum Key Toxicities Azoles Fluconazole, voriconazole, itraconazole, posaconazole, isavuconazole Inhibit 14-&alpha;-demethylase (ergosterol synthesis) Fluconazole: Candida (not C. krusei, variable C. glabrata), Cryptococcus. Voriconazole: Aspergillus (DOC)...","sourceLabel":"Section in Infectious Disease"},"1092":{"title":"Antiviral Agents","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s31","snippet":"Antiviral Agents Agent Mechanism Indications Key Notes Acyclovir / Valacyclovir Guanosine analog; requires viral thymidine kinase for activation &rarr; inhibits viral DNA polymerase HSV (genital, encephalitis, keratitis), VZV (shingles, varicella) Dose-adjust for renal impairment; crystalline nephro...","sourceLabel":"Section in Infectious Disease"},"1093":{"title":"Antimicrobial Stewardship Principles","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s32","snippet":"Antimicrobial Stewardship Principles Antimicrobial stewardship programs (ASPs) aim to optimize antibiotic use, improve patient outcomes, reduce adverse events (C. difficile, resistance emergence), and decrease healthcare costs. Core strategies include: Key Stewardship Interventions Strategy Descript...","sourceLabel":"Section in Infectious Disease"},"1094":{"title":"Imaging in Infectious Disease","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s33","snippet":"Imaging in Infectious Disease Clinical Scenario Imaging Modality Key Findings Community-acquired pneumonia CXR (PA and lateral) Lobar consolidation, air bronchograms, pleural effusion; CT if CXR negative but high suspicion Lung abscess CT chest with contrast Thick-walled cavitary lesion with air-flu...","sourceLabel":"Section in Infectious Disease"},"1095":{"title":"Classification Systems","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s34","snippet":"Classification Systems Sepsis-3 (2016 Third International Consensus Definitions) Term Definition Sepsis Life-threatening organ dysfunction caused by a dysregulated host response to infection. Operationalized as suspected infection + acute SOFA score increase &ge;2 Septic shock Sepsis requiring vasop...","sourceLabel":"Section in Infectious Disease"},"1096":{"title":"Medications Master Table","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s35","snippet":"Medications Master Table Drug Class Route Standard Dose Renal Adjustment Key Toxicity / Monitoring Amoxicillin Aminopenicillin PO 500-1000 mg TID Reduce if CrCl <30 Rash, diarrhea, C. diff Amoxicillin-clavulanate BL/BLI PO 875/125 mg BID Avoid ER formulation if CrCl <30 Diarrhea, hepatotoxicity (cla...","sourceLabel":"Section in Infectious Disease"},"1097":{"title":"Abbreviations Master List","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s36","snippet":"Abbreviations Master List ABx Antibiotics AFB Acid-fast bacilli AMS Altered mental status ANC Absolute neutrophil count ART Antiretroviral therapy ASP Antimicrobial stewardship program AUC Area under the curve BAL Bronchoalveolar lavage BCG Bacillus Calmette-Gu&eacute;rin (TB vaccine) BCx Blood cult...","sourceLabel":"Section in Infectious Disease"},"1098":{"title":"Empiric Antibiotic Guide","pageTitle":"Infectious Disease","pageUrl":"/medical/infectious-disease","url":"/medical/infectious-disease#s37","snippet":"Empiric Antibiotic Guide Syndrome / Site Empiric Regimen Key Pathogens Duration Sepsis / septic shock (unknown source) Vancomycin + piperacillin-tazobactam (or meropenem if ESBL risk) S. aureus, GNR, Enterococcus, anaerobes Narrow based on source and cultures CAP (inpatient, non-ICU) Ceftriaxone + a...","sourceLabel":"Section in Infectious Disease"},"1099":{"title":"Hematology / Oncology","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology","snippet":"Specialty Reference Hematology / Oncology Complete Specialty Reference Every blood disorder, malignancy, coagulation pathway, chemotherapy regimen, transfusion protocol, and oncologic emergency in one place."},"1100":{"title":"Hematopoiesis & Blood Cell Biology","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s1","snippet":"Hematopoiesis & Blood Cell Biology All blood cells originate from a common pluripotent hematopoietic stem cell (HSC) residing in the bone marrow. HSCs are capable of self-renewal and differentiation into every mature blood lineage. Understanding normal hematopoiesis is essential for interpreting cyt...","sourceLabel":"Section in Hematology / Oncology"},"1101":{"title":"The Hematologic Assessment","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s2","snippet":"The Hematologic Assessment Complete Blood Count (CBC) Interpretation Parameter Normal Range Clinical Significance When Abnormal Hemoglobin (Hb) M: 13.5-17.5 g/dL; F: 12-16 g/dL Low = anemia; High = polycythemia Hematocrit (Hct) M: 41-53%; F: 36-46% Approximately 3&times; Hb value MCV 80-100 fL <80 =...","sourceLabel":"Section in Hematology / Oncology"},"1102":{"title":"Key Terminology & Abbreviations","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s3","snippet":"Key Terminology & Abbreviations HSC Hematopoietic Stem Cell CBC Complete Blood Count MCV Mean Corpuscular Volume RDW Red cell Distribution Width DAT Direct Antiglobulin Test (Direct Coombs) LDH Lactate Dehydrogenase EPO Erythropoietin TPO Thrombopoietin G-CSF Granulocyte Colony-Stimulating Factor ID...","sourceLabel":"Section in Hematology / Oncology"},"1103":{"title":"Iron Deficiency Anemia","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s4","snippet":"Iron Deficiency Anemia Iron deficiency anemia (IDA) is the most common cause of anemia worldwide, affecting an estimated 1-2 billion people. Iron is essential for hemoglobin synthesis, and depletion progresses through stages: iron depletion (low ferritin) &rarr; iron-deficient erythropoiesis (low tr...","sourceLabel":"Section in Hematology / Oncology"},"1104":{"title":"Megaloblastic Anemia","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s5","snippet":"Megaloblastic Anemia Megaloblastic anemias are characterized by impaired DNA synthesis leading to nuclear-cytoplasmic dyssynchrony and macrocytosis (MCV >100 fL). The two principal causes are vitamin B12 (cobalamin) and folate deficiency. Figure 6 - Hematopoietic Nutrient Metabolism. Therapeutic str...","sourceLabel":"Section in Hematology / Oncology"},"1105":{"title":"Hemolytic Anemias","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s6","snippet":"Hemolytic Anemias Hemolytic anemias result from premature RBC destruction (lifespan <120 days). They are classified as intrinsic (defect within the RBC - membrane, enzyme, or hemoglobin) or extrinsic (external factors acting on normal RBCs - immune, mechanical, infectious). Hemolysis may be intravas...","sourceLabel":"Section in Hematology / Oncology"},"1106":{"title":"Sickle Cell Disease","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s7","snippet":"Sickle Cell Disease Sickle cell disease (SCD) is an autosomal recessive hemoglobinopathy caused by a point mutation in the beta-globin gene (Glu &rarr; Val at position 6), producing hemoglobin S (HbS) . Under deoxygenated conditions, HbS polymerizes, causing RBCs to sickle. These rigid cells occlude...","sourceLabel":"Section in Hematology / Oncology"},"1107":{"title":"Thalassemias","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s8","snippet":"Thalassemias The thalassemias are inherited hemoglobinopathies characterized by decreased or absent production of one or more globin chains . This leads to ineffective erythropoiesis, hemolysis, and microcytic anemia. They are classified as alpha-thalassemia (reduced alpha-globin) or beta-thalassemi...","sourceLabel":"Section in Hematology / Oncology"},"1108":{"title":"Acute Myeloid Leukemia (AML)","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s9","snippet":"Acute Myeloid Leukemia (AML) AML is a clonal hematopoietic neoplasm characterized by proliferation of immature myeloid precursors ( blasts &ge;20% in bone marrow or peripheral blood). It is the most common acute leukemia in adults, with a median age at diagnosis of ~68 years. Prognosis is determined...","sourceLabel":"Section in Hematology / Oncology"},"1109":{"title":"Acute Lymphoblastic Leukemia (ALL)","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s10","snippet":"Acute Lymphoblastic Leukemia (ALL) ALL is a neoplasm of lymphoid progenitors (B-cell or T-cell lineage) with &ge;20% lymphoblasts in bone marrow. It is the most common malignancy in children (peak age 2-5 years) with cure rates of ~90% in pediatric patients. Adult ALL has a worse prognosis, with 5-y...","sourceLabel":"Section in Hematology / Oncology"},"1110":{"title":"Chronic Myeloid Leukemia (CML)","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s11","snippet":"Chronic Myeloid Leukemia (CML) CML is a myeloproliferative neoplasm defined by the Philadelphia chromosome t(9;22) producing the BCR-ABL1 fusion oncoprotein, a constitutively active tyrosine kinase. It accounts for ~15% of adult leukemias with a median age of diagnosis of ~64 years. Figure 18 - The ...","sourceLabel":"Section in Hematology / Oncology"},"1111":{"title":"Chronic Lymphocytic Leukemia (CLL)","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s12","snippet":"Chronic Lymphocytic Leukemia (CLL) CLL is the most common leukemia in Western adults, characterized by clonal proliferation of mature-appearing CD5+ B lymphocytes. Median age at diagnosis is ~70 years. Many patients are asymptomatic and discovered incidentally on CBC showing lymphocytosis. Diagnosis...","sourceLabel":"Section in Hematology / Oncology"},"1112":{"title":"Myelodysplastic Syndromes (MDS)","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s13","snippet":"Myelodysplastic Syndromes (MDS) MDS are clonal hematopoietic stem cell disorders characterized by dysplastic morphology , ineffective hematopoiesis , and peripheral cytopenias with a risk of transformation to AML (approximately 30% over time). Median age at diagnosis is ~70 years. Most cases are de ...","sourceLabel":"Section in Hematology / Oncology"},"1113":{"title":"Hodgkin Lymphoma","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s14","snippet":"Hodgkin Lymphoma Figure 21 - Reed-Sternberg Cells in Hodgkin Lymphoma. Histopathologic images showing classic Reed-Sternberg cells with characteristic binucleated or multinucleated morphology and prominent eosinophilic nucleoli (\"owl-eye\" appearance) in a mixed inflammatory background. These cells a...","sourceLabel":"Section in Hematology / Oncology"},"1114":{"title":"Non-Hodgkin Lymphoma - Aggressive","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s15","snippet":"Non-Hodgkin Lymphoma - Aggressive Diffuse Large B-Cell Lymphoma (DLBCL) DLBCL is the most common NHL subtype (~30-40% of all NHL). It presents as a rapidly growing mass (nodal or extranodal). Subtypes by gene expression profiling: germinal center B-cell (GCB, better prognosis) and activated B-cell (...","sourceLabel":"Section in Hematology / Oncology"},"1115":{"title":"Non-Hodgkin Lymphoma - Indolent","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s16","snippet":"Non-Hodgkin Lymphoma - Indolent Follicular Lymphoma (FL) Second most common NHL (~20%). Characterized by t(14;18) BCL2/IGH translocation causing BCL-2 overexpression (anti-apoptotic). Presents with painless generalized lymphadenopathy; bone marrow involvement is common. Grade 1-2 is indolent; grade ...","sourceLabel":"Section in Hematology / Oncology"},"1116":{"title":"Multiple Myeloma","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s17","snippet":"Multiple Myeloma Multiple myeloma (MM) is a malignant plasma cell neoplasm characterized by monoclonal immunoglobulin production, bone destruction, and end-organ damage. Median age at diagnosis is ~69 years. It accounts for ~10% of hematologic malignancies. Figure 22 - Multiple Myeloma Pathogenesis....","sourceLabel":"Section in Hematology / Oncology"},"1117":{"title":"MGUS & Smoldering Myeloma","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s18","snippet":"MGUS & Smoldering Myeloma Monoclonal Gammopathy of Undetermined Significance (MGUS) Feature Criteria Definition M-protein <3 g/dL, bone marrow plasma cells <10%, no end-organ damage (no CRAB or SLiM criteria) Prevalence ~3-4% of population >50 years; increases with age Progression risk ~1% per year ...","sourceLabel":"Section in Hematology / Oncology"},"1118":{"title":"AL Amyloidosis","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s19","snippet":"AL Amyloidosis AL (immunoglobulin light chain) amyloidosis results from deposition of misfolded monoclonal light chain fragments (usually lambda) as insoluble amyloid fibrils in tissues. It is a systemic disease that can affect virtually any organ. It is related to plasma cell neoplasms but requires...","sourceLabel":"Section in Hematology / Oncology"},"1119":{"title":"Hemostasis Overview","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s20","snippet":"Hemostasis Overview Hemostasis is the physiologic process that stops bleeding while maintaining blood fluidity. It involves three phases: primary hemostasis (platelet plug formation), secondary hemostasis (coagulation cascade forming fibrin clot), and fibrinolysis (clot breakdown by plasmin). Primar...","sourceLabel":"Section in Hematology / Oncology"},"1120":{"title":"Thrombocytopenia","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s21","snippet":"Thrombocytopenia Thrombocytopenia is defined as a platelet count <150 &times; 10 9 /L. The approach is to categorize by mechanism: decreased production , increased destruction , or sequestration . Always rule out pseudothrombocytopenia (EDTA-dependent platelet clumping) by examining the smear or rep...","sourceLabel":"Section in Hematology / Oncology"},"1121":{"title":"Inherited Bleeding Disorders","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s22","snippet":"Inherited Bleeding Disorders Hemophilia A & B Feature Hemophilia A Hemophilia B Deficient factor Factor VIII Factor IX Inheritance X-linked recessive X-linked recessive Frequency 1 in 5,000 males 1 in 30,000 males Lab findings Prolonged aPTT, normal PT, low factor VIII level Prolonged aPTT, normal P...","sourceLabel":"Section in Hematology / Oncology"},"1122":{"title":"Acquired Coagulopathies","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s23","snippet":"Acquired Coagulopathies Disseminated Intravascular Coagulation (DIC) DIC is a consumptive coagulopathy triggered by systemic activation of the coagulation cascade. It results in simultaneous widespread microvascular thrombosis and hemorrhagic diathesis from consumption of platelets and clotting fact...","sourceLabel":"Section in Hematology / Oncology"},"1123":{"title":"Anticoagulation Management","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s24","snippet":"Anticoagulation Management Figure 30 - Iron Overload and Hematologic Complications. Systemic complications of chronic transfusion therapy and iron overload affecting the heart (cardiomyopathy), liver (fibrosis/cirrhosis), and endocrine organs, emphasizing the critical role of iron chelation and moni...","sourceLabel":"Section in Hematology / Oncology"},"1124":{"title":"Venous Thromboembolism","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s25","snippet":"Venous Thromboembolism Venous thromboembolism (VTE) encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE). It is the third most common cardiovascular disease after MI and stroke, with annual incidence of ~1-2 per 1,000 adults. Figure 31 - DVT Diagnosis: Compression Ultrasound. Venous co...","sourceLabel":"Section in Hematology / Oncology"},"1125":{"title":"Hypercoagulable States","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s26","snippet":"Hypercoagulable States Inherited Thrombophilias Condition Defect Prevalence VTE Risk Factor V Leiden Resistance to activated protein C (factor V R506Q mutation) 5% of Caucasians (heterozygous) 3-8&times; (heterozygous); 50-80&times; (homozygous) Prothrombin G20210A Elevated prothrombin levels 2-3% o...","sourceLabel":"Section in Hematology / Oncology"},"1126":{"title":"Heparin-Induced Thrombocytopenia","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s27","snippet":"Heparin-Induced Thrombocytopenia HIT is a prothrombotic immune-mediated drug reaction caused by IgG antibodies against the platelet factor 4 (PF4)-heparin complex . These antibodies activate platelets, generating a massive prothrombotic state. HIT occurs in ~0.5-5% of patients on UFH (less common wi...","sourceLabel":"Section in Hematology / Oncology"},"1127":{"title":"Polycythemia Vera","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s28","snippet":"Polycythemia Vera Polycythemia vera (PV) is a clonal myeloproliferative neoplasm characterized by erythrocytosis (elevated red cell mass) driven by the JAK2 V617F mutation (present in >95% of PV cases; JAK2 exon 12 mutations in remaining). The major risks are thrombosis (stroke, MI, DVT, splanchnic ...","sourceLabel":"Section in Hematology / Oncology"},"1128":{"title":"Essential Thrombocythemia","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s29","snippet":"Essential Thrombocythemia Essential thrombocythemia (ET) is an MPN characterized by sustained thrombocytosis (&ge;450 &times; 10 9 /L) with megakaryocyte proliferation. Driver mutations: JAK2 V617F (~60%), CALR (~25%), MPL (~5%), and triple-negative (~10%). Risks include thrombosis and, less commonl...","sourceLabel":"Section in Hematology / Oncology"},"1129":{"title":"Primary Myelofibrosis","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s30","snippet":"Primary Myelofibrosis Primary myelofibrosis (PMF) is an MPN characterized by progressive bone marrow fibrosis , extramedullary hematopoiesis (especially in the spleen, causing massive splenomegaly), and a leukoerythroblastic blood picture (teardrop cells, nucleated RBCs, immature granulocytes). Driv...","sourceLabel":"Section in Hematology / Oncology"},"1130":{"title":"Cancer Staging & Performance Status","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s31","snippet":"Cancer Staging & Performance Status TNM Staging System Component Description Categories T (Tumor) Size and extent of primary tumor T0 (no primary tumor), Tis (carcinoma in situ), T1-T4 (increasing size/invasion) N (Nodes) Regional lymph node involvement N0 (no nodes), N1-N3 (increasing nodal involve...","sourceLabel":"Section in Hematology / Oncology"},"1131":{"title":"Chemotherapy Principles","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s32","snippet":"Chemotherapy Principles Cell Cycle & Drug Classes Class Examples Mechanism Key Toxicities Alkylating agents Cyclophosphamide, ifosfamide, melphalan, busulfan, temozolomide Cross-link DNA; cell cycle-independent Myelosuppression, secondary MDS/AML, hemorrhagic cystitis (cyclophosphamide - prevent wit...","sourceLabel":"Section in Hematology / Oncology"},"1132":{"title":"Immunotherapy & Targeted Therapy","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s33","snippet":"Immunotherapy & Targeted Therapy Figure 36 - PD-1/PD-L1 Checkpoint Immunotherapy Mechanism. The PD-1/PD-L1 axis in tumor immune evasion: tumor cells express PD-L1 to engage PD-1 on T cells, delivering inhibitory signals that suppress anti-tumor immunity. Checkpoint inhibitors block this interaction,...","sourceLabel":"Section in Hematology / Oncology"},"1133":{"title":"Oncologic Emergencies","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s34","snippet":"Oncologic Emergencies Figure 38 - Tumor Lysis Syndrome Pathophysiology. Clinical manifestations of TLS showing rapid tumor cell death releasing intracellular contents: hyperkalemia (cardiac arrhythmias), hyperphosphatemia (calcium-phosphate deposition), hyperuricemia (acute kidney injury), and hypoc...","sourceLabel":"Section in Hematology / Oncology"},"1134":{"title":"Blood Products & Transfusion","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s35","snippet":"Blood Products & Transfusion Blood Product Indications & Thresholds Product Contents Indication / Threshold Expected Effect Packed RBCs (pRBCs) RBCs with reduced plasma; ~250 mL/unit; Hct ~55-65% Hb <7 g/dL (restrictive, most patients per TRICC trial); <8 g/dL (cardiac disease, acute coronary syndro...","sourceLabel":"Section in Hematology / Oncology"},"1135":{"title":"Transfusion Reactions","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s36","snippet":"Transfusion Reactions Reaction Timing Mechanism Signs/Symptoms Management Acute hemolytic Minutes to hours ABO incompatibility (clerical error); preformed recipient antibodies lyse donor RBCs Fever, rigors, flank pain, dark urine (hemoglobinuria), hypotension, DIC STOP transfusion immediately ; aggr...","sourceLabel":"Section in Hematology / Oncology"},"1136":{"title":"Imaging in Hematology-Oncology","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s37","snippet":"Imaging in Hematology-Oncology Modality Indications Key Points PET/CT (FDG) Staging and response assessment for lymphoma (HL, DLBCL, aggressive NHL); staging solid tumors; PET-adapted therapy Deauville 5-point scale for lymphoma response (1-3 = negative, 4-5 = positive); not useful for indolent lymp...","sourceLabel":"Section in Hematology / Oncology"},"1137":{"title":"Classification Systems","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s38","snippet":"Classification Systems System Disease Components WHO Classification All heme neoplasms Integrates morphology, immunophenotype, genetics, clinical features; updated 5th edition 2022 Ann Arbor / Lugano Hodgkin & Non-Hodgkin lymphoma Stages I-IV; A/B symptoms; Lugano adds PET-based response (Deauville ...","sourceLabel":"Section in Hematology / Oncology"},"1138":{"title":"Medications Master Table","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s39","snippet":"Medications Master Table Chemotherapy Agents Drug Class Key Toxicity Notes Doxorubicin Anthracycline Cardiotoxicity (cumulative) Max ~450 mg/m&sup2;; echo monitoring Cyclophosphamide Alkylating Hemorrhagic cystitis Mesna prophylaxis; secondary AML Cisplatin Platinum Nephrotoxicity, ototoxicity Aggre...","sourceLabel":"Section in Hematology / Oncology"},"1139":{"title":"Abbreviations Master List","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s40","snippet":"Abbreviations Master List ABVD Adriamycin, Bleomycin, Vinblastine, Dacarbazine ACS Acute Chest Syndrome ADAMTS13 A Disintegrin And Metalloproteinase with ThromboSpondin type 1 motif, member 13 ADC Antibody-Drug Conjugate AIHA Autoimmune Hemolytic Anemia ALL Acute Lymphoblastic Leukemia AML Acute Mye...","sourceLabel":"Section in Hematology / Oncology"},"1140":{"title":"Key Trials & Treatment Protocols","pageTitle":"Hematology / Oncology","pageUrl":"/medical/hematology-oncology","url":"/medical/hematology-oncology#s41","snippet":"Key Trials & Treatment Protocols Trial Disease Key Finding IRIS (2003) CML Imatinib superior to IFN-alpha + cytarabine; established TKI era for CML VIALE-A (2020) AML (unfit) Venetoclax + azacitidine improved OS vs azacitidine alone (14.7 vs 9.6 months); new standard of care for unfit AML ECHELON-1 ...","sourceLabel":"Section in Hematology / Oncology"},"1141":{"title":"Rheumatology","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology","snippet":"Specialty Reference Rheumatology Complete Specialty Reference Every autoimmune disease, crystal arthropathy, vasculitis, connective tissue disorder, classification criterion, autoantibody, DMARD, biologic, and management strategy in one place."},"1142":{"title":"Musculoskeletal & Immunologic Anatomy","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s1","snippet":"Musculoskeletal & Immunologic Anatomy Rheumatology encompasses diseases of the joints, connective tissues, and immune system. A solid understanding of joint architecture, the synovial membrane, articular cartilage, and the innate and adaptive immune responses is essential for understanding every dis...","sourceLabel":"Section in Rheumatology"},"1143":{"title":"The Rheumatologic Exam","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s2","snippet":"The Rheumatologic Exam The rheumatologic physical examination is a systematic assessment of joints, periarticular structures, skin, nails, and vascular status. It is the single most important skill in rheumatology - laboratory tests and imaging are adjuncts to, not substitutes for, a thorough exam. ...","sourceLabel":"Section in Rheumatology"},"1144":{"title":"Key Terminology & Abbreviations","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s3","snippet":"Key Terminology & Abbreviations Rheumatology uses an extensive set of abbreviations for diseases, autoantibodies, medications, and classification systems. Familiarity with these terms is essential for reading clinical documentation and understanding treatment guidelines. Abbreviation Meaning RA Rheu...","sourceLabel":"Section in Rheumatology"},"1145":{"title":"RA Pathophysiology & Diagnosis","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s4","snippet":"RA Pathophysiology & Diagnosis Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease characterized by symmetric inflammatory polyarthritis that, if untreated, leads to progressive joint destruction. It affects ~1% of the global population, with a female-to-male ratio of 3:1, and peak o...","sourceLabel":"Section in Rheumatology"},"1146":{"title":"RA Treatment","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s5","snippet":"RA Treatment The modern RA treatment paradigm is treat-to-target (T2T) : aim for remission (or low disease activity if remission is not achievable) with frequent monitoring and rapid escalation of therapy. Treat-to-Target Approach Step Intervention Timeline 1 Start methotrexate (MTX) 15-25 mg/week (...","sourceLabel":"Section in Rheumatology"},"1147":{"title":"RA Complications","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s6","snippet":"RA Complications Articular Complications Complication Mechanism Clinical Features Management Atlantoaxial subluxation Pannus erodes the transverse ligament of C1 Neck pain, occipital headache; risk of cord compression (myelopathy, quadriplegia) Flexion/extension C-spine X-ray or MRI; surgical fixati...","sourceLabel":"Section in Rheumatology"},"1148":{"title":"SLE Pathophysiology & Diagnosis","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s7","snippet":"SLE Pathophysiology & Diagnosis Systemic lupus erythematosus (SLE) is the prototypical systemic autoimmune disease, characterized by autoantibody production, immune complex deposition, and multi-organ inflammation. It affects women of childbearing age preferentially (F:M = 9:1), with higher incidenc...","sourceLabel":"Section in Rheumatology"},"1149":{"title":"SLE Organ Manifestations","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s8","snippet":"SLE Organ Manifestations Mucocutaneous Manifestation Description Key Features Acute cutaneous lupus (malar rash) Erythematous, flat or raised rash over cheeks and nasal bridge Spares nasolabial folds; photosensitive; may be transient Subacute cutaneous lupus (SCLE) Annular polycyclic or papulosquamo...","sourceLabel":"Section in Rheumatology"},"1150":{"title":"Lupus Nephritis","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s9","snippet":"Lupus Nephritis Lupus nephritis (LN) is the most important organ manifestation of SLE, occurring in 40-60% of patients. It is a major determinant of morbidity and mortality. All SLE patients should be screened with urinalysis and serum creatinine at every visit. ISN/RPS Classification (2003, revised...","sourceLabel":"Section in Rheumatology"},"1151":{"title":"SLE Treatment","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s10","snippet":"SLE Treatment Hydroxychloroquine - The Foundation HCQ should be prescribed to EVERY SLE patient unless contraindicated. Benefits include: reduced flares by 50%, reduced organ damage accrual, reduced thrombosis risk (especially in APS), improved lipid profiles, reduced infection risk, improved surviv...","sourceLabel":"Section in Rheumatology"},"1152":{"title":"Gout","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s11","snippet":"Gout Gout is the most common inflammatory arthritis, affecting ~4% of US adults. It results from deposition of monosodium urate (MSU) crystals in joints and soft tissues when serum urate exceeds the saturation threshold (~6.8 mg/dL). Figure 13 - Gouty Tophus. Clinical photograph demonstrating a toph...","sourceLabel":"Section in Rheumatology"},"1153":{"title":"Calcium Pyrophosphate Deposition Disease (CPPD)","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s12","snippet":"Calcium Pyrophosphate Deposition Disease (CPPD) CPPD (formerly \"pseudogout\") results from deposition of calcium pyrophosphate dihydrate (CPP) crystals in articular cartilage and synovium. It is predominantly a disease of the elderly - prevalence increases dramatically after age 60. Clinical Presenta...","sourceLabel":"Section in Rheumatology"},"1154":{"title":"Hydroxyapatite & Other Crystal Disease","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s13","snippet":"Hydroxyapatite & Other Crystal Disease Basic Calcium Phosphate (BCP) / Hydroxyapatite Crystal Disease Hydroxyapatite crystals are the most common cause of calcific periarthritis/tendinitis, particularly in the supraspinatus tendon (shoulder). These crystals are too small to see on standard polarized...","sourceLabel":"Section in Rheumatology"},"1155":{"title":"Ankylosing Spondylitis","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s14","snippet":"Ankylosing Spondylitis Ankylosing spondylitis (AS) is the prototype axial spondyloarthropathy, characterized by chronic inflammation of the sacroiliac joints and spine leading to progressive ankylosis (bony fusion). It typically begins in males aged 15-30 (M:F = 3:1 for radiographic AS; ratio narrow...","sourceLabel":"Section in Rheumatology"},"1156":{"title":"Psoriatic Arthritis","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s15","snippet":"Psoriatic Arthritis Psoriatic arthritis (PsA) affects ~30% of psoriasis patients. It can precede skin disease in ~15% of cases. Nail disease is the strongest clinical predictor of PsA development in a psoriasis patient. CASPAR Classification Criteria Established inflammatory articular disease (perip...","sourceLabel":"Section in Rheumatology"},"1157":{"title":"Reactive Arthritis","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s16","snippet":"Reactive Arthritis Reactive arthritis (ReA) is an aseptic inflammatory arthritis triggered by a preceding infection, classically summarized as \"can't see, can't pee, can't climb a tree\" (conjunctivitis/uveitis, urethritis, arthritis). HLA-B27 is present in 50-80% of cases. Triggering Infections Sour...","sourceLabel":"Section in Rheumatology"},"1158":{"title":"Enteropathic Arthritis & IBD-Associated","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s17","snippet":"Enteropathic Arthritis & IBD-Associated Joint disease occurs in 10-35% of patients with inflammatory bowel disease (Crohn disease and ulcerative colitis). It is classified into peripheral and axial patterns. Peripheral Arthritis Type Features Relationship to Bowel Disease Type 1 (pauciarticular) <5 ...","sourceLabel":"Section in Rheumatology"},"1159":{"title":"Large Vessel Vasculitis","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s18","snippet":"Large Vessel Vasculitis Giant Cell Arteritis (GCA) GCA is the most common systemic vasculitis in adults >50 years. It affects the aorta and its branches, with a predilection for the extracranial branches of the carotid artery (superficial temporal artery). Nearly always occurs after age 50; average ...","sourceLabel":"Section in Rheumatology"},"1160":{"title":"Medium Vessel Vasculitis","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s19","snippet":"Medium Vessel Vasculitis Polyarteritis Nodosa (PAN) PAN is a necrotizing vasculitis of medium-sized muscular arteries, typically sparing small vessels and glomeruli (distinguishes from ANCA-associated vasculitis). Associated with hepatitis B in ~10-30% of cases. ANCA is NEGATIVE in PAN. System Manif...","sourceLabel":"Section in Rheumatology"},"1161":{"title":"ANCA-Associated Vasculitis","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s20","snippet":"ANCA-Associated Vasculitis The ANCA-associated vasculitides (AAV) are small-vessel necrotizing vasculitides characterized by pauci-immune (little or no immunoglobulin deposition) glomerulonephritis and systemic inflammation. The three entities are GPA, MPA, and EGPA. Figure 17 - Chapel Hill Vasculit...","sourceLabel":"Section in Rheumatology"},"1162":{"title":"Small Vessel Vasculitis","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s21","snippet":"Small Vessel Vasculitis IgA Vasculitis (Henoch-Sch&ouml;nlein Purpura) IgA vasculitis (IgAV) is the most common vasculitis in children (peak age 3-10 years). It is mediated by IgA immune complex deposition in small vessels. Classic tetrad: (1) palpable purpura (non-thrombocytopenic, gravitationally ...","sourceLabel":"Section in Rheumatology"},"1163":{"title":"Beh&ccedil;et Disease","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s22","snippet":"Beh&ccedil;et Disease Beh&ccedil;et disease is a systemic vasculitis of variable vessel size, most prevalent along the ancient Silk Road (Turkey, Iran, Japan, China). It is the only vasculitis that can affect both arteries and veins of all sizes. HLA-B51 is associated (~60% of patients in endemic ar...","sourceLabel":"Section in Rheumatology"},"1164":{"title":"Systemic Sclerosis","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s23","snippet":"Systemic Sclerosis Systemic sclerosis (SSc/scleroderma) is characterized by vascular injury, immune activation, and progressive fibrosis of the skin and internal organs. F:M = 4:1; peak onset 30-50 years. It has the highest case-specific mortality of all rheumatic diseases. Limited vs. Diffuse SSc F...","sourceLabel":"Section in Rheumatology"},"1165":{"title":"Inflammatory Myopathies","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s24","snippet":"Inflammatory Myopathies The idiopathic inflammatory myopathies (IIM) are a heterogeneous group of autoimmune diseases targeting skeletal muscle. The major subtypes are dermatomyositis (DM), polymyositis (PM), inclusion body myositis (IBM), anti-synthetase syndrome, and immune-mediated necrotizing my...","sourceLabel":"Section in Rheumatology"},"1166":{"title":"Sj&ouml;gren Syndrome","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s25","snippet":"Sj&ouml;gren Syndrome Sj&ouml;gren syndrome (SS) is a chronic autoimmune disease characterized by lymphocytic infiltration of exocrine glands, causing sicca symptoms (dry eyes/dry mouth). It is the second most common autoimmune rheumatic disease after RA. F:M = 9:1; peak onset 40-60 years. Classific...","sourceLabel":"Section in Rheumatology"},"1167":{"title":"Mixed Connective Tissue Disease & Overlap Syndromes","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s26","snippet":"Mixed Connective Tissue Disease & Overlap Syndromes Mixed connective tissue disease (MCTD) features overlapping findings of SLE, SSc, and PM with high-titer anti-U1 RNP antibody . It was originally described as a benign overlap syndrome, but it can evolve into a dominant phenotype (most commonly scl...","sourceLabel":"Section in Rheumatology"},"1168":{"title":"Osteoarthritis","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s27","snippet":"Osteoarthritis Osteoarthritis (OA) is the most common joint disease worldwide, affecting >300 million people globally. It is a disease of the entire joint - cartilage loss, subchondral bone remodeling, osteophyte formation, synovial inflammation, and ligament/meniscal degeneration. Mechanical vs. In...","sourceLabel":"Section in Rheumatology"},"1169":{"title":"Fibromyalgia","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s28","snippet":"Fibromyalgia Fibromyalgia (FM) is a centralized pain syndrome characterized by widespread musculoskeletal pain, fatigue, sleep disturbance, and cognitive dysfunction. It affects 2-8% of the population (F:M = 2:1). It is NOT an inflammatory or autoimmune disease - it is a disorder of central pain pro...","sourceLabel":"Section in Rheumatology"},"1170":{"title":"Adult-Onset Still Disease","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s29","snippet":"Adult-Onset Still Disease Adult-onset Still disease (AOSD) is a systemic inflammatory disorder characterized by a triad of quotidian (daily) spiking fevers , evanescent salmon-pink macular rash , and arthritis . It is considered a diagnosis of exclusion. Bimodal age distribution (15-25 and 36-46 yea...","sourceLabel":"Section in Rheumatology"},"1171":{"title":"Joint Aspiration & Injection","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s30","snippet":"Joint Aspiration & Injection Arthrocentesis (joint aspiration) is one of the most important diagnostic AND therapeutic procedures in rheumatology. Synovial fluid analysis can definitively diagnose crystal arthritis and septic arthritis. Indications Diagnostic : any unexplained monoarthritis (especia...","sourceLabel":"Section in Rheumatology"},"1172":{"title":"Autoantibody Interpretation","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s31","snippet":"Autoantibody Interpretation ANA Patterns & Disease Associations Pattern Target Associated Disease Notes Homogeneous dsDNA, histones SLE, drug-induced lupus Anti-histone: drug-induced lupus (95%); anti-dsDNA: active SLE, nephritis Speckled Sm, RNP, SSA/Ro, SSB/La SLE, MCTD, Sj&ouml;gren Most common p...","sourceLabel":"Section in Rheumatology"},"1173":{"title":"Rheumatologic Imaging","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s32","snippet":"Rheumatologic Imaging X-Ray Findings by Disease Disease Characteristic X-Ray Findings Rheumatoid arthritis Periarticular osteopenia, symmetric joint space narrowing, marginal erosions (MCPs, PIPs, wrists); NO osteophytes Osteoarthritis Asymmetric joint space narrowing, subchondral sclerosis, osteoph...","sourceLabel":"Section in Rheumatology"},"1174":{"title":"Imaging in Rheumatology","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s33","snippet":"Imaging in Rheumatology Imaging Modality Selection Clinical Question First-Line Imaging Second-Line / Advanced Suspected RA erosions X-ray hands and feet MRI (early erosions, bone marrow edema); US (synovitis, power Doppler) Suspected sacroiliitis X-ray pelvis (AP view) MRI SI joints (STIR sequences...","sourceLabel":"Section in Rheumatology"},"1175":{"title":"Classification Systems & Criteria","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s34","snippet":"Classification Systems & Criteria Summary of Major Classification Criteria Disease Criteria Key Features RA 2010 ACR/EULAR Score &ge;6/10 (joint involvement, serology, acute phase reactants, duration) SLE 2019 EULAR/ACR ANA entry criterion + score &ge;10 (weighted clinical and immunologic domains) P...","sourceLabel":"Section in Rheumatology"},"1176":{"title":"Medications Master Table","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s35","snippet":"Medications Master Table Conventional Synthetic DMARDs Drug Mechanism Indications Dose Key Toxicities Monitoring Methotrexate Folate antagonist; adenosine release RA, PsA, GPA (maintenance), myositis, AOSD 15-25 mg PO/SC weekly Hepatotoxicity, cytopenias, pneumonitis, stomatitis; teratogenic CBC, LF...","sourceLabel":"Section in Rheumatology"},"1177":{"title":"Abbreviations Master List","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s36","snippet":"Abbreviations Master List ACPA Anti-citrullinated protein antibody (anti-CCP) ACR American College of Rheumatology AICAR Aminoimidazole carboxamide ribonucleotide ANA Antinuclear antibody ANCA Anti-neutrophil cytoplasmic antibody Anti-CCP Anti-cyclic citrullinated peptide APS Antiphospholipid syndro...","sourceLabel":"Section in Rheumatology"},"1178":{"title":"Risk Scores & Monitoring Guidelines","pageTitle":"Rheumatology","pageUrl":"/medical/rheumatology","url":"/medical/rheumatology#s37","snippet":"Risk Scores & Monitoring Guidelines Disease Activity Scores Score Disease Components Targets DAS28 RA 28 tender joint count, 28 swollen joint count, ESR (or CRP), patient global VAS Remission <2.6; low activity 2.6-3.2; moderate 3.2-5.1; high >5.1 CDAI RA 28 TJC + 28 SJC + patient global (0-10) + ev...","sourceLabel":"Section in Rheumatology"},"1179":{"title":"Neurology","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology","snippet":"Specialty Reference Neurology Complete Specialty Reference Every diagnosis, classification, medication, diagnostic modality, examination technique, and management strategy — from stroke to seizure, demyelinating disease to neuromuscular disorders — in one place."},"1180":{"title":"Neuroanatomy — Brain & Cranial Nerves","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s1","snippet":"Neuroanatomy — Brain & Cranial Nerves Cerebral Cortex — Lobes & Functions The frontal lobe occupies the anterior third of each hemisphere, bounded posteriorly by the central sulcus and inferiorly by the lateral (Sylvian) fissure. It contains the primary motor cortex (precentral gyrus — Brodmann area...","sourceLabel":"Section in Neurology"},"1181":{"title":"Neuroanatomy — Spinal Cord & Vascular Territories","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s2","snippet":"Neuroanatomy — Spinal Cord & Vascular Territories Spinal Cord Tracts Tract Location in Cord Function Decussation Lesion Deficit Corticospinal (lateral) Lateral column Voluntary motor — contralateral limbs Pyramidal decussation (caudal medulla) Ipsilateral UMN weakness below lesion Dorsal columns (fa...","sourceLabel":"Section in Neurology"},"1182":{"title":"The Neurological Examination","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s3","snippet":"The Neurological Examination Mental Status Assess level of consciousness (alert, lethargic, obtunded, stuporous, comatose), orientation (person, place, time, situation), attention (serial 7s, spell \"WORLD\" backwards, digit span — normal forward is 7 &plusmn; 2), language (fluency, comprehension, rep...","sourceLabel":"Section in Neurology"},"1183":{"title":"Key Terminology","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s4","snippet":"Key Terminology Term Definition Aphasia Impaired language (Broca's = non-fluent expressive; Wernicke's = fluent receptive; Global = both; Conduction = impaired repetition with preserved fluency/comprehension) Dysarthria Impaired speech articulation (motor, not language) — cerebellar, LMN, UMN, or ex...","sourceLabel":"Section in Neurology"},"1184":{"title":"Acute Ischemic Stroke","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s5","snippet":"Acute Ischemic Stroke Ischemic stroke accounts for ~87% of all strokes. Sudden occlusion of a cerebral artery causes ischemia in the downstream territory. The ischemic penumbra — tissue that is hypoperfused but not yet infarcted — is the target of acute reperfusion therapy. Every minute of untreated...","sourceLabel":"Section in Neurology"},"1185":{"title":"Hemorrhagic Stroke — ICH & SAH","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s6","snippet":"Hemorrhagic Stroke — ICH & SAH Figure 12 - Intracerebral Hemorrhage on CT. Non-contrast CT demonstrating acute intracerebral hemorrhage (hyperdense lesion) with surrounding edema. The location and morphology help distinguish hypertensive ICH from other etiologies such as cerebral amyloid angiopathy....","sourceLabel":"Section in Neurology"},"1186":{"title":"Transient Ischemic Attack (TIA)","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s7","snippet":"Transient Ischemic Attack (TIA) TIA is a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia without acute infarction on imaging. The modern (tissue-based) definition does not use a 24-hour time cutoff — any episode with DWI-positive infarction is cl...","sourceLabel":"Section in Neurology"},"1187":{"title":"Cerebral Venous Thrombosis","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s8","snippet":"Cerebral Venous Thrombosis Thrombosis of the dural venous sinuses or cortical veins. Unlike arterial stroke, CVT often presents subacutely over days to weeks. Most common in young women (OCP use, pregnancy/postpartum, hormonal factors). Other risk factors: hypercoagulable states (Factor V Leiden, pr...","sourceLabel":"Section in Neurology"},"1188":{"title":"Seizure Classification (ILAE 2017)","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s9","snippet":"Seizure Classification (ILAE 2017) The 2017 ILAE classification replaced the 1981 system. It organizes seizures by three features: (1) onset (focal, generalized, unknown), (2) awareness (aware vs impaired awareness for focal seizures), (3) motor vs non-motor manifestation. Figure 16 - Generalized Sp...","sourceLabel":"Section in Neurology"},"1189":{"title":"Status Epilepticus","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s10","snippet":"Status Epilepticus Figure 17 - EEG in Lennox-Gastaut Syndrome. Slow (<2.5 Hz) generalized spike-and-wave discharges on a diffusely abnormal background, the hallmark EEG pattern of Lennox-Gastaut syndrome, one of the most severe childhood epilepsy syndromes associated with multiple seizure types and ...","sourceLabel":"Section in Neurology"},"1190":{"title":"Epilepsy Syndromes & AED Selection","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s11","snippet":"Epilepsy Syndromes & AED Selection Figure 18 - EEG in Juvenile Myoclonic Epilepsy. Generalized 4-6 Hz polyspike-and-wave discharges seen in JME, one of the most common genetic generalized epilepsy syndromes. These discharges are often triggered by sleep deprivation and photic stimulation. Source: PM...","sourceLabel":"Section in Neurology"},"1191":{"title":"Alzheimer's Disease","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s12","snippet":"Alzheimer's Disease Alzheimer's disease (AD) is the most common cause of dementia, accounting for 60–70% of cases. Pathologically defined by extracellular amyloid-beta (A&beta;) plaques and intracellular neurofibrillary tangles (hyperphosphorylated tau protein) . These begin accumulating 15–20 years...","sourceLabel":"Section in Neurology"},"1192":{"title":"Parkinson's Disease","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s13","snippet":"Parkinson's Disease Parkinson's disease (PD) is the second most common neurodegenerative disorder. Pathology: loss of dopaminergic neurons in the substantia nigra pars compacta with intraneuronal Lewy bodies (alpha-synuclein aggregates). Symptoms appear when ~60–80% of striatal dopamine is depleted....","sourceLabel":"Section in Neurology"},"1193":{"title":"Lewy Body Dementia & Frontotemporal Dementia","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s14","snippet":"Lewy Body Dementia & Frontotemporal Dementia Dementia with Lewy Bodies (DLB) Second most common neurodegenerative dementia after AD. Core features (2 of 4 = probable DLB): (1) fluctuating cognition with pronounced variations in attention/alertness, (2) recurrent visual hallucinations (detailed, well...","sourceLabel":"Section in Neurology"},"1194":{"title":"Amyotrophic Lateral Sclerosis (ALS)","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s15","snippet":"Amyotrophic Lateral Sclerosis (ALS) ALS is the most common motor neuron disease — progressive degeneration of both upper motor neurons (cortex → corticospinal tract) and lower motor neurons (anterior horn cells → peripheral nerves). Incidence: ~2/100,000 per year. Median survival from symptom onset:...","sourceLabel":"Section in Neurology"},"1195":{"title":"Huntington's Disease","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s16","snippet":"Huntington's Disease Autosomal dominant trinucleotide repeat disorder — CAG expansion in the huntingtin gene (HTT) on chromosome 4. Normal: < 27 CAG repeats; intermediate: 27–35 (premutation); reduced penetrance: 36–39; full penetrance: &ge; 40. The age of onset inversely correlates with repeat leng...","sourceLabel":"Section in Neurology"},"1196":{"title":"Multiple Sclerosis","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s17","snippet":"Multiple Sclerosis MS is the most common demyelinating disease of the CNS, affecting ~1 million people in the US. It is an autoimmune-mediated inflammatory demyelination of the brain and spinal cord white matter, causing axonal damage and progressive neurological disability. Peak onset: 20–40 years;...","sourceLabel":"Section in Neurology"},"1197":{"title":"Neuromyelitis Optica Spectrum Disorder (NMOSD)","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s18","snippet":"Neuromyelitis Optica Spectrum Disorder (NMOSD) NMOSD is an autoimmune astrocytopathy (not a variant of MS). ~75% of patients are seropositive for aquaporin-4 IgG (AQP4-IgG) antibodies, which target AQP4 water channels on astrocyte foot processes concentrated at the optic nerve, spinal cord, and area...","sourceLabel":"Section in Neurology"},"1198":{"title":"Guillain-Barr&eacute; Syndrome","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s19","snippet":"Guillain-Barr&eacute; Syndrome GBS is an acute, immune-mediated polyradiculoneuropathy — the most common cause of acute flaccid paralysis. Incidence: ~1–2/100,000/year. Typically follows an infection by 1–4 weeks (Campylobacter jejuni gastroenteritis is the most common trigger — ~30%; also CMV, EBV,...","sourceLabel":"Section in Neurology"},"1199":{"title":"Myasthenia Gravis","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s20","snippet":"Myasthenia Gravis Figure 29 - Neuromuscular Junction in Myasthenia Gravis. Comparison of the normal neuromuscular junction (left) with MG pathology (right), showing antibody-mediated destruction of acetylcholine receptors, complement activation, and simplification of the postsynaptic membrane folds ...","sourceLabel":"Section in Neurology"},"1200":{"title":"Autoimmune Encephalitis","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s21","snippet":"Autoimmune Encephalitis A group of inflammatory brain diseases caused by antibodies against neuronal surface or intracellular antigens. The most common and treatable form is anti-NMDA receptor encephalitis — the most frequent cause of autoimmune encephalitis, predominantly affecting young women. Ass...","sourceLabel":"Section in Neurology"},"1201":{"title":"Essential Tremor","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s22","snippet":"Essential Tremor Essential tremor (ET) is the most common movement disorder — 8–10 times more common than Parkinson's disease. Bilateral, largely symmetric action tremor (postural and kinetic) at 4–12 Hz, predominantly affecting the hands and arms; may also involve the head (\"yes-yes\" or \"no-no\"), v...","sourceLabel":"Section in Neurology"},"1202":{"title":"Dystonia","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s23","snippet":"Dystonia Dystonia is characterized by sustained or intermittent muscle contractions causing abnormal postures and/or repetitive movements. Classified by: (1) body distribution: focal (one region — cervical dystonia, blepharospasm, writer's cramp), segmental (two or more contiguous regions), multifoc...","sourceLabel":"Section in Neurology"},"1203":{"title":"Chorea, Tics & Tourette's","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s24","snippet":"Chorea, Tics & Tourette's Chorea Involuntary, irregular, purposeless, non-rhythmic movements that flow from one body part to another. Key causes: Huntington's disease (see Section 16), Sydenham's chorea (post-streptococcal, associated with rheumatic fever — \"St. Vitus' dance\"), chorea gravidarum (pr...","sourceLabel":"Section in Neurology"},"1204":{"title":"Drug-Induced Movement Disorders","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s25","snippet":"Drug-Induced Movement Disorders Disorder Mechanism Culprit Drugs Features Treatment Acute dystonic reaction Dopamine receptor blockade Haloperidol, metoclopramide, prochlorperazine Hours to days after starting drug; torticollis, oculogyric crisis, trismus Diphenhydramine 50 mg IV/IM or benztropine 1...","sourceLabel":"Section in Neurology"},"1205":{"title":"Migraine","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s26","snippet":"Migraine Migraine is the second most common primary headache (after tension-type) but the most disabling — affects ~15% of the global population; female:male ratio ~3:1. Migraine is a neurovascular disorder involving cortical spreading depression, trigeminal activation, and neurogenic inflammation o...","sourceLabel":"Section in Neurology"},"1206":{"title":"Tension-Type & Cluster Headache","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s27","snippet":"Tension-Type & Cluster Headache Tension-Type Headache (TTH) The most common primary headache. Bilateral, pressing/tightening (\"band-like\") quality, mild-to-moderate intensity, not aggravated by routine physical activity. No nausea/vomiting (mild nausea allowed in chronic TTH). May have photophobia O...","sourceLabel":"Section in Neurology"},"1207":{"title":"Secondary Headache Red Flags & Medication Overuse Headache","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s28","snippet":"Secondary Headache Red Flags & Medication Overuse Headache \"SNOOP\" Red Flags for Secondary Headache Letter Red Flag Concern S Systemic symptoms (fever, weight loss, cancer history, HIV, immunosuppression) Meningitis, CNS infection, metastasis, temporal arteritis N Neurological symptoms/signs (focal ...","sourceLabel":"Section in Neurology"},"1208":{"title":"Peripheral Neuropathy","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s29","snippet":"Peripheral Neuropathy Peripheral neuropathy is damage to the peripheral nerves causing weakness, sensory loss, and/or autonomic dysfunction. The most common type is distal symmetric polyneuropathy (DSPN) , presenting with stocking-glove numbness and tingling, with the feet affected first (longest ax...","sourceLabel":"Section in Neurology"},"1209":{"title":"Myopathies","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s30","snippet":"Myopathies Myopathies present with proximal, symmetric weakness (difficulty rising from chairs, climbing stairs, overhead reaching) without sensory loss. Key distinguishing features from neuropathy: proximal > distal weakness, no fasciculations, normal or reduced reflexes (not absent unless severe),...","sourceLabel":"Section in Neurology"},"1210":{"title":"Nerve Entrapment Syndromes","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s31","snippet":"Nerve Entrapment Syndromes Nerve Entrapment Site Syndrome Motor Deficit Sensory Deficit Diagnostic Test Median Carpal tunnel Carpal tunnel syndrome Thenar atrophy (abductor pollicis brevis); weak thumb opposition Palmar digits 1–3 and radial half of 4th NCS: prolonged distal sensory/motor latency ac...","sourceLabel":"Section in Neurology"},"1211":{"title":"Meningitis","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s32","snippet":"Meningitis Inflammation of the meninges. The classic triad — headache, fever, neck stiffness — is present in only ~45% of bacterial meningitis cases; however, almost all have at least two of four signs: headache, fever, nuchal rigidity, altered mental status. Kernig's sign (resistance/pain on knee e...","sourceLabel":"Section in Neurology"},"1212":{"title":"Encephalitis & Brain Abscess","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s33","snippet":"Encephalitis & Brain Abscess Viral Encephalitis Figure 35 - Subarachnoid Hemorrhage Imaging and Aneurysm Detection. CT imaging demonstrating SAH with blood in the basal cisterns, combined with vascular imaging (CTA or conventional angiography) to identify the ruptured aneurysm. Early aneurysm identi...","sourceLabel":"Section in Neurology"},"1213":{"title":"Prion Disease","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s34","snippet":"Prion Disease Prion diseases (transmissible spongiform encephalopathies) are invariably fatal neurodegenerative disorders caused by misfolded prion protein (PrPSc). Creutzfeldt-Jakob disease (CJD) is the most common. Subtypes: sporadic (sCJD — ~85%, mean age 65, no identifiable cause), familial (fCJ...","sourceLabel":"Section in Neurology"},"1214":{"title":"Normal Pressure Hydrocephalus","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s35","snippet":"Normal Pressure Hydrocephalus Figure 37 - Normal Pressure Hydrocephalus on MRI. Axial MRI demonstrating the characteristic findings of NPH: disproportionate ventriculomegaly (Evans' index >0.3) with tight high-convexity sulci, periventricular T2 hyperintensity from transependymal CSF flow, and callo...","sourceLabel":"Section in Neurology"},"1215":{"title":"Idiopathic Intracranial Hypertension","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s36","snippet":"Idiopathic Intracranial Hypertension Also called pseudotumor cerebri. Elevated intracranial pressure without hydrocephalus or mass lesion. Classic patient: overweight woman of childbearing age. Risk factors: obesity, weight gain, vitamin A excess/retinoids, tetracyclines (doxycycline, minocycline), ...","sourceLabel":"Section in Neurology"},"1216":{"title":"Narcolepsy & Restless Legs Syndrome","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s37","snippet":"Narcolepsy & Restless Legs Syndrome Narcolepsy Narcolepsy type 1 (with cataplexy) is caused by autoimmune-mediated destruction of hypocretin/orexin-producing neurons in the lateral hypothalamus, resulting in undetectable CSF hypocretin-1 levels (< 110 pg/mL). Strongly associated with HLA-DQB1*06:02 ...","sourceLabel":"Section in Neurology"},"1217":{"title":"Neurosarcoidosis","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s38","snippet":"Neurosarcoidosis Neurological involvement occurs in ~5–10% of sarcoidosis patients but can be the presenting manifestation in ~50% of those affected. Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Neurosarcoidosis can affect any part of the nervous system. Most common presen...","sourceLabel":"Section in Neurology"},"1218":{"title":"Lumbar Puncture & CSF Analysis","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s39","snippet":"Lumbar Puncture & CSF Analysis Indications: Suspected meningitis/encephalitis, SAH (if CT negative), MS workup, NPH evaluation, IIH diagnosis, carcinomatous meningitis, Guillain-Barr&eacute;. Contraindications: Increased ICP with mass lesion (risk of herniation — get CT first), coagulopathy (INR > 1...","sourceLabel":"Section in Neurology"},"1219":{"title":"EEG Interpretation","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s40","snippet":"EEG Interpretation Electroencephalography records cortical electrical activity via scalp electrodes (standard 10-20 system with 21 electrodes). Normal adult background: alpha rhythm (8–13 Hz) predominant over the posterior regions, attenuates with eye opening. Slower rhythms: theta (4–7 Hz) and delt...","sourceLabel":"Section in Neurology"},"1220":{"title":"EMG / Nerve Conduction Studies","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s41","snippet":"EMG / Nerve Conduction Studies EMG/NCS is the electrodiagnostic study of the peripheral nervous system — the most important test for distinguishing neuropathy from myopathy and for localizing peripheral nerve lesions. Nerve Conduction Studies (NCS) Electrically stimulate a peripheral nerve and recor...","sourceLabel":"Section in Neurology"},"1221":{"title":"Neuroimaging — CT, MRI, MRA & Sequences","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s42","snippet":"Neuroimaging — CT, MRI, MRA & Sequences CT Applications Modality Indication Key Findings Non-contrast CT head Acute stroke (rule out hemorrhage), trauma, hydrocephalus Hyperdense = acute blood; hypodense = edema/infarct (may not be visible < 6–12 hours); dense MCA sign (thrombus) CT angiography (CTA...","sourceLabel":"Section in Neurology"},"1222":{"title":"Classification Systems (All)","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s43","snippet":"Classification Systems (All) System Used For Key Content TOAST Ischemic stroke etiology 5 categories: large-artery atherosclerosis, cardioembolism, small-vessel, other determined, cryptogenic NIHSS Ischemic stroke severity 0–42 scale; 11 items; &ge; 6 suggests LVO; guides tPA/thrombectomy decisions ...","sourceLabel":"Section in Neurology"},"1223":{"title":"Medications Master Table","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s44","snippet":"Medications Master Table Antiepileptic Drugs (AEDs) Drug (Brand) Mechanism Typical Dose Seizure Types Key Pearl Levetiracetam (Keppra) SV2A modulation 500–1500 mg BID Broad-spectrum (focal + generalized) No significant drug interactions; renal dosing; \"Keppra rage\" behavioral side effect Lamotrigine...","sourceLabel":"Section in Neurology"},"1224":{"title":"Abbreviations Master List","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s45","snippet":"Abbreviations Master List Anatomy ACA Anterior cerebral artery MCA Middle cerebral artery PCA Posterior cerebral artery ICA Internal carotid artery AComm Anterior communicating artery PComm Posterior communicating artery PICA Posterior inferior cerebellar artery AICA Anterior inferior cerebellar art...","sourceLabel":"Section in Neurology"},"1225":{"title":"Risk Scores & Screening Tools","pageTitle":"Neurology","pageUrl":"/medical/neurology","url":"/medical/neurology#s46","snippet":"Risk Scores & Screening Tools Commonly Used Scoring Systems GCS (Glasgow Coma Scale): Eye (1–4: none/to pain/to voice/spontaneous) + Verbal (1–5: none/incomprehensible/inappropriate/confused/oriented) + Motor (1–6: none/extension/flexion/withdrawal/localizes/obeys) = 3–15. &le; 8 = severe TBI, intub...","sourceLabel":"Section in Neurology"},"1226":{"title":"Dermatology","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology","snippet":"Specialty Reference Dermatology Complete Specialty Reference Every diagnosis, classification, procedure, medication, biopsy technique, staging system, and management strategy across the full scope of clinical dermatology in one place."},"1227":{"title":"Skin Anatomy & Physiology","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s1","snippet":"Skin Anatomy & Physiology The skin is the largest organ in the body, weighing 3.5-10 kg in adults and covering approximately 1.5-2.0 m 2 of surface area. It functions as a barrier against pathogens, UV radiation, chemical exposure, and mechanical injury; regulates temperature through vasodilation/va...","sourceLabel":"Section in Dermatology"},"1228":{"title":"Dermatologic Terminology — Lesion Morphology","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s2","snippet":"Dermatologic Terminology — Lesion Morphology Precise morphologic description is the foundation of dermatologic diagnosis. Every skin finding must be described using standard terminology for primary lesions (the initial morphology), secondary lesions (changes resulting from evolution, trauma, or mani...","sourceLabel":"Section in Dermatology"},"1229":{"title":"The Dermatologic Exam","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s3","snippet":"The Dermatologic Exam A complete skin exam (CSE) requires examination of the entire skin surface including scalp, ears, interdigital spaces, nails, oral mucosa, and genital skin. Adequate lighting is essential — a handheld magnifying lens or dermatoscope (10x polarized or non-polarized) transforms d...","sourceLabel":"Section in Dermatology"},"1230":{"title":"Atopic Dermatitis","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s4","snippet":"Atopic Dermatitis Figure 5 - Atopic Dermatitis in Children. Clinical presentation of atopic dermatitis showing (a) the classical flexural form with eczematous changes in skin creases and (b) the nummular form with coin-shaped plaques. The distribution and morphology evolve with age from facial invol...","sourceLabel":"Section in Dermatology"},"1231":{"title":"Contact Dermatitis (Allergic & Irritant)","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s5","snippet":"Contact Dermatitis (Allergic & Irritant) Figure 6 - Acute Allergic Contact Dermatitis (Poison Ivy). Classic presentation of acute allergic contact dermatitis showing erythematous, vesicular, and weeping lesions in a linear distribution characteristic of plant-induced contact dermatitis (urushiol fro...","sourceLabel":"Section in Dermatology"},"1232":{"title":"Seborrheic Dermatitis","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s6","snippet":"Seborrheic Dermatitis Seborrheic dermatitis (SD) is a chronic, relapsing inflammatory dermatosis affecting 1-3% of the general population and up to 83% of HIV/AIDS patients. It occurs in areas with high sebaceous gland density: scalp, eyebrows, nasolabial folds, ears, central chest, and intertrigino...","sourceLabel":"Section in Dermatology"},"1233":{"title":"Nummular Dermatitis & Stasis Dermatitis","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s7","snippet":"Nummular Dermatitis & Stasis Dermatitis Nummular Dermatitis (Discoid Eczema) Coin-shaped (nummular), well-demarcated, pruritic, erythematous plaques with fine scale and sometimes exudate/crusting — typically on extensor surfaces of extremities and trunk. More common in men over 50 and in winter (low...","sourceLabel":"Section in Dermatology"},"1234":{"title":"Psoriasis","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s8","snippet":"Psoriasis Figure 8 - Clinical Manifestations of Plaque Psoriasis. Well-demarcated erythematous plaques with thick silvery-white scale on extensor surfaces, the hallmark presentation of plaque psoriasis (psoriasis vulgaris), which accounts for approximately 90% of psoriasis cases. Psoriasis is a chro...","sourceLabel":"Section in Dermatology"},"1235":{"title":"Pityriasis Rosea","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s9","snippet":"Pityriasis Rosea Pityriasis rosea (PR) is an acute, self-limited papulosquamous eruption most common in adolescents and young adults (10-35 years). It is likely triggered by reactivation of HHV-6 and/or HHV-7. The classic presentation begins with a herald patch (2-10 cm oval, salmon-colored plaque w...","sourceLabel":"Section in Dermatology"},"1236":{"title":"Lichen Planus","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s10","snippet":"Lichen Planus Figure 10 - Nail Psoriasis. Characteristic nail changes in psoriasis including pitting (punctate depressions), oil-drop discoloration (salmon-colored patches beneath the nail plate), onycholysis (separation of nail from bed), and subungual hyperkeratosis. Nail involvement is present in...","sourceLabel":"Section in Dermatology"},"1237":{"title":"Secondary Syphilis & Other Papulosquamous Mimics","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s11","snippet":"Secondary Syphilis & Other Papulosquamous Mimics Secondary syphilis is the \"great imitator\" and must be considered in the differential diagnosis of virtually any papulosquamous eruption. It occurs 6-8 weeks after the primary chancre (which may have been unnoticed) when Treponema pallidum disseminate...","sourceLabel":"Section in Dermatology"},"1238":{"title":"Actinic Keratosis & Field Cancerization","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s12","snippet":"Actinic Keratosis & Field Cancerization Figure 11 - Actinic Keratosis and Field Cancerization. Dermoscopic examination of an elderly patient's scalp showing multiple actinic keratoses with white/silver scaly lesions and telangiectasia on a background of diffuse sun damage, illustrating the concept o...","sourceLabel":"Section in Dermatology"},"1239":{"title":"Basal Cell Carcinoma (BCC)","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s13","snippet":"Basal Cell Carcinoma (BCC) Figure 12 - Nodular Basal Cell Carcinoma. Classic presentation of nodular BCC: a pearly, translucent papule or nodule with surface telangiectasias and rolled borders. Nodular BCC accounts for 60-80% of all BCCs and is the most common human malignancy. BCC is the most commo...","sourceLabel":"Section in Dermatology"},"1240":{"title":"Squamous Cell Carcinoma (SCC)","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s14","snippet":"Squamous Cell Carcinoma (SCC) Figure 14 - Cutaneous Squamous Cell Carcinoma. Well-differentiated SCC presenting as a keratotic, ulcerated nodule on the nose. Cutaneous SCC is the second most common skin cancer and the most common skin cancer to metastasize, driven primarily by cumulative UV exposure...","sourceLabel":"Section in Dermatology"},"1241":{"title":"Melanoma","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s15","snippet":"Melanoma Figure 15 - Superficial Spreading Melanoma. Asymmetrical lesion with irregular borders and variegated pigment (brown, black, and tan shades), characteristic of superficial spreading melanoma, the most common melanoma subtype (~70% of cases). The ABCDE criteria (Asymmetry, Border irregularit...","sourceLabel":"Section in Dermatology"},"1242":{"title":"Merkel Cell Carcinoma","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s16","snippet":"Merkel Cell Carcinoma Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine carcinoma of the skin with approximately 3,000 cases/year in the US. Etiology: ~80% are associated with Merkel cell polyomavirus (MCPyV) integration; the remaining ~20% are UV-driven (higher mutation burden). Risk...","sourceLabel":"Section in Dermatology"},"1243":{"title":"Bacterial Skin Infections","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s17","snippet":"Bacterial Skin Infections Figure 17 - Herpes Zoster (Shingles). Unilateral, dermatomal vesicular eruption caused by reactivation of latent varicella-zoster virus (VZV) in the dorsal root ganglion. Grouped vesicles on an erythematous base confined to a single dermatome, characteristically not crossin...","sourceLabel":"Section in Dermatology"},"1244":{"title":"Viral Skin Infections","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s18","snippet":"Viral Skin Infections Herpes Simplex Virus (HSV) HSV-1 and HSV-2 produce grouped vesicles on an erythematous base that ulcerate and crust. HSV-1 classically causes orolabial herpes (cold sores); HSV-2 classically causes genital herpes (though either type can infect either site). Primary infection is...","sourceLabel":"Section in Dermatology"},"1245":{"title":"Fungal Skin Infections","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s19","snippet":"Fungal Skin Infections Figure 18 - Tinea Corporis (Ringworm). Classic annular, erythematous plaque with central clearing and a raised, scaly, advancing border, characteristic of dermatophyte infection. Diagnosis is confirmed by KOH preparation showing branching septate hyphae. Dermatophytosis (Tinea...","sourceLabel":"Section in Dermatology"},"1246":{"title":"Parasitic Infestations","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s20","snippet":"Parasitic Infestations Figure 20 - Scabies Burrows. Serpiginous burrow tracks in the web space between the thumb and index finger, a characteristic location for Sarcoptes scabiei infestation. Burrows are 2-10 mm serpentine tracks created by the female mite tunneling through the stratum corneum. Scab...","sourceLabel":"Section in Dermatology"},"1247":{"title":"Pemphigus Vulgaris","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s21","snippet":"Pemphigus Vulgaris Figure 21 - Oral Pemphigus Vulgaris. Painful erosions and ulcerations on the buccal mucosa, the initial presentation in the majority of pemphigus vulgaris cases. Intact blisters are rarely seen intraorally because the thin mucosal epithelium ruptures immediately, leaving raw erosi...","sourceLabel":"Section in Dermatology"},"1248":{"title":"Bullous Pemphigoid","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s22","snippet":"Bullous Pemphigoid Figure 22 - Bullous Pemphigoid. Widespread tense blisters and erosions on the back in an elderly patient with bullous pemphigoid. Unlike the flaccid blisters of pemphigus, BP produces tense, subepidermal blisters that do not rupture as easily, reflecting the deeper split at the de...","sourceLabel":"Section in Dermatology"},"1249":{"title":"Dermatitis Herpetiformis","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s23","snippet":"Dermatitis Herpetiformis Dermatitis herpetiformis (DH) is the cutaneous manifestation of celiac disease (gluten-sensitive enteropathy). IgA antibodies against epidermal transglutaminase (eTG) deposit in the dermal papillae, causing neutrophilic inflammation. ~90% of DH patients have underlying celia...","sourceLabel":"Section in Dermatology"},"1250":{"title":"Dermatomyositis","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s24","snippet":"Dermatomyositis Figure 23 - Dermal-Epidermal Junction Histology. Cross-section showing the interdigitating rete pegs (downward projections of epidermis) and dermal papillae (upward projections of dermis) that create the undulating DEJ. This architecture increases surface area for nutrient exchange a...","sourceLabel":"Section in Dermatology"},"1251":{"title":"Cutaneous Lupus Erythematosus","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s25","snippet":"Cutaneous Lupus Erythematosus Figure 24 - Discoid Lupus Erythematosus (DLE). Well-defined erythematous plaques on the face with follicular plugging, atrophic scarring, and dyspigmentation, characteristic of chronic cutaneous lupus erythematosus (DLE). Scalp involvement causes permanent scarring alop...","sourceLabel":"Section in Dermatology"},"1252":{"title":"Morphea & Systemic Sclerosis","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s26","snippet":"Morphea & Systemic Sclerosis Morphea (Localized Scleroderma) Morphea is a localized fibrotic condition of the skin characterized by excessive collagen deposition in the dermis and subcutis. It is NOT systemic sclerosis — morphea does not involve internal organs, does not cause Raynaud phenomenon, an...","sourceLabel":"Section in Dermatology"},"1253":{"title":"Acne Vulgaris","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s27","snippet":"Acne Vulgaris Figure 25 - Severe Nodulocystic Acne Vulgaris. Extensive inflammatory acne with deep nodules, cysts, papules, and pustules affecting the face, representing Grade III-IV (severe/conglobata) acne. This severity requires systemic treatment with isotretinoin and carries significant scarrin...","sourceLabel":"Section in Dermatology"},"1254":{"title":"Rosacea","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s28","snippet":"Rosacea Figure 26 - Rosacea Subtypes. The four recognized subtypes of rosacea: (A) erythematotelangiectatic with persistent central facial erythema and telangiectasias, (B) papulopustular with inflammatory papules and pustules, (C) phymatous with rhinophyma (nasal skin thickening), and (D) ocular wi...","sourceLabel":"Section in Dermatology"},"1255":{"title":"Hidradenitis Suppurativa","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s29","snippet":"Hidradenitis Suppurativa Figure 27 - Hidradenitis Suppurativa (Hurley Stage II-III). Active nodules, inflamed abscesses, paired pits from previously inflamed hair follicles, and scarring sinus tracts in the sacral/gluteal region. Recurrent abscesses in the same apocrine gland-bearing locations with ...","sourceLabel":"Section in Dermatology"},"1256":{"title":"Alopecia — Non-Cicatricial & Cicatricial","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s30","snippet":"Alopecia — Non-Cicatricial & Cicatricial Figure 28 - Alopecia Areata: Clinical Manifestations. Various presentations of alopecia areata showing well-defined, smooth, round patches of complete hair loss. Exclamation point hairs (short, tapered hairs 3 mm in length) at the periphery of patches are a c...","sourceLabel":"Section in Dermatology"},"1257":{"title":"Nail Disorders","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s31","snippet":"Nail Disorders Finding Description Associated Conditions Onycholysis Distal separation of nail plate from nail bed Psoriasis, onychomycosis, trauma, thyroid disease, contact irritant Pitting Small depressions in nail plate (punctate) Psoriasis (#1), alopecia areata, eczema, lichen planus Oil drop si...","sourceLabel":"Section in Dermatology"},"1258":{"title":"Vitiligo","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s32","snippet":"Vitiligo Figure 29 - Vitiligo Histopathology. Fontana Masson stain demonstrating the complete absence of melanin pigment in affected vitiligo skin. Loss of functional melanocytes from the epidermis, driven by CD8+ T-cell-mediated autoimmune destruction, results in the characteristic chalky-white dep...","sourceLabel":"Section in Dermatology"},"1259":{"title":"Melasma & Post-Inflammatory Hyperpigmentation","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s33","snippet":"Melasma & Post-Inflammatory Hyperpigmentation Figure 36 - Lentigo Maligna Melanoma. Irregularly pigmented patch with irregular borders on chronically sun-damaged skin of the face in an elderly patient. Lentigo maligna (in situ) progresses slowly over years before becoming invasive lentigo maligna me...","sourceLabel":"Section in Dermatology"},"1260":{"title":"Morbilliform Drug Eruptions & Urticaria","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s34","snippet":"Morbilliform Drug Eruptions & Urticaria Morbilliform (Exanthematous) Drug Eruption The most common cutaneous drug reaction (~95% of drug rashes), occurring 7-14 days after drug initiation (or 1-3 days on re-exposure). Presents as widespread, symmetric, erythematous macules and papules that may coale...","sourceLabel":"Section in Dermatology"},"1261":{"title":"Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s35","snippet":"Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis Figure 30 - Toxic Epidermal Necrolysis (TEN). Dusky macules reaching confluence with epithelial detachment on the face and lips in a patient with carbamazepine-induced TEN. The positive Nikolsky sign (epidermal shearing with lateral pressure) and...","sourceLabel":"Section in Dermatology"},"1262":{"title":"DRESS Syndrome, Erythema Multiforme & AGEP","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s36","snippet":"DRESS Syndrome, Erythema Multiforme & AGEP Figure 37 - Erythrodermic Psoriasis. Acute erythroderma involving over 90% of body surface area with diffuse erythema and inflammation. This is a dermatologic emergency with risks of impaired thermoregulation, high-output cardiac failure, protein loss, and ...","sourceLabel":"Section in Dermatology"},"1263":{"title":"Cutaneous T-Cell Lymphoma (Mycosis Fungoides & Sezary Syndrome)","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s37","snippet":"Cutaneous T-Cell Lymphoma (Mycosis Fungoides & Sezary Syndrome) Figure 31 - Mycosis Fungoides (Cutaneous T-Cell Lymphoma). Clinical and histopathological presentation of mycosis fungoides. The disease progresses through characteristic stages: patches (flat, erythematous, scaly), plaques (raised, ind...","sourceLabel":"Section in Dermatology"},"1264":{"title":"Granuloma Annulare & Pyoderma Gangrenosum","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s38","snippet":"Granuloma Annulare & Pyoderma Gangrenosum Granuloma Annulare (GA) GA is a benign, self-limited granulomatous dermatosis of unclear etiology. Classic presentation: annular or arcuate, flesh-colored to erythematous, non-scaly, smooth plaques and papules on the dorsal hands and feet. The lack of scale ...","sourceLabel":"Section in Dermatology"},"1265":{"title":"Sweet Syndrome & Dermatologic Signs of Systemic Disease","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s39","snippet":"Sweet Syndrome & Dermatologic Signs of Systemic Disease Sweet Syndrome (Acute Febrile Neutrophilic Dermatosis) Sweet syndrome presents with acute onset of painful, edematous, erythematous-to-violaceous papules, plaques, and nodules — classically on the face, neck, and upper extremities — accompanied...","sourceLabel":"Section in Dermatology"},"1266":{"title":"Skin Biopsy Techniques","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s40","snippet":"Skin Biopsy Techniques Figure 32 - Punch Biopsy Technique. The punch biopsy instrument is held vertically and rotated through the full thickness of the skin (epidermis, dermis, and superficial subcutis), yielding a cylindrical core of tissue. The most commonly used size is 4 mm. This is the standard...","sourceLabel":"Section in Dermatology"},"1267":{"title":"Mohs Micrographic Surgery","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s41","snippet":"Mohs Micrographic Surgery Figure 33 - Morpheaform (Infiltrative) Basal Cell Carcinoma. Scar-like, indurated, ill-defined plaque characteristic of the morpheaform BCC subtype. This aggressive variant lacks the classic pearly appearance, has poorly defined clinical margins, and requires Mohs micrograp...","sourceLabel":"Section in Dermatology"},"1268":{"title":"Cryotherapy, ED&C & Phototherapy","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s42","snippet":"Cryotherapy, ED&C & Phototherapy Figure 34 - Bowen Disease (SCC In Situ). Clinical and dermoscopic views of Bowen disease showing a well-demarcated, erythematous, scaly plaque. Dermoscopy reveals glomerular vessels (coiled capillaries) and scale, which help distinguish this premalignant condition fr...","sourceLabel":"Section in Dermatology"},"1269":{"title":"Intralesional Injections & Procedural Therapeutics","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s43","snippet":"Intralesional Injections & Procedural Therapeutics Figure 38 - Dermoscopic Progression: AK to SCC. Schematic of dermoscopic features across the spectrum from actinic keratosis to invasive squamous cell carcinoma, showing progressive vascular changes from strawberry pattern (AK) to glomerular vessels...","sourceLabel":"Section in Dermatology"},"1270":{"title":"Classification Systems (All)","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s44","snippet":"Classification Systems (All) System Used For Key Elements Fitzpatrick Skin Phototype Skin sun-sensitivity classification I (always burns, never tans) → II (burns easily, tans minimally) → III (sometimes burns, tans uniformly) → IV (burns minimally, tans easily) → V (rarely burns, tans darkly) → VI (...","sourceLabel":"Section in Dermatology"},"1271":{"title":"Medications Master Table","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s45","snippet":"Medications Master Table Topical Corticosteroids by Potency Class (US System) Class (Potency) Examples Typical Use Pearl I (Superpotent) Clobetasol propionate 0.05% (Temovate); betamethasone dipropionate 0.05% in optimized vehicle (Diprolene); halobetasol propionate 0.05% (Ultravate) Thick plaques (...","sourceLabel":"Section in Dermatology"},"1272":{"title":"Abbreviations Master List","pageTitle":"Dermatology","pageUrl":"/medical/dermatology","url":"/medical/dermatology#s46","snippet":"Abbreviations Master List Anatomy & Histology BMZ Basement membrane zone DEJ Dermal-epidermal junction BSA Body surface area SC Stratum corneum DIF Direct immunofluorescence IIF Indirect immunofluorescence H&E Hematoxylin and eosin (stain) PAS Periodic acid-Schiff (stain — highlights fungi) Diagnose...","sourceLabel":"Section in Dermatology"},"1273":{"title":"Allergy & Immunology","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology","snippet":"Specialty Reference Allergy & Immunology Complete Specialty Reference Every allergic condition, immunodeficiency, diagnostic test, immunotherapy protocol, biologic agent, classification system, and management strategy in one place."},"1274":{"title":"Immune System Anatomy & Physiology","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s1","snippet":"Immune System Anatomy & Physiology The immune system is a distributed network of organs, cells, and soluble mediators that protects the host from pathogens, toxins, and aberrant cells. It is conventionally divided into innate immunity (rapid, non-specific, no memory) and adaptive immunity (slower on...","sourceLabel":"Section in Allergy & Immunology"},"1275":{"title":"The Allergy & Immunology Evaluation","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s2","snippet":"The Allergy & Immunology Evaluation History The allergy/immunology history is the single most important diagnostic tool. Key elements include: nature and timing of symptoms (seasonal vs perennial, immediate vs delayed), suspected triggers (foods, medications, stinging insects, environmental exposure...","sourceLabel":"Section in Allergy & Immunology"},"1276":{"title":"Key Terminology & Abbreviations","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s3","snippet":"Key Terminology & Abbreviations Allergy and immunology uses a dense vocabulary of abbreviations across clinical documentation, research, and guidelines. Term Meaning Atopy Genetic predisposition to produce IgE against common environmental allergens; manifests as allergic rhinitis, asthma, and/or ato...","sourceLabel":"Section in Allergy & Immunology"},"1277":{"title":"Allergic Rhinitis","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s4","snippet":"Allergic Rhinitis Allergic rhinitis (AR) affects 10-30% of adults and up to 40% of children worldwide. It is an IgE-mediated inflammatory condition of the nasal mucosa triggered by aeroallergens, causing sneezing, rhinorrhea, nasal congestion, and pruritus. AR significantly impairs quality of life, ...","sourceLabel":"Section in Allergy & Immunology"},"1278":{"title":"Non-Allergic Rhinitis","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s5","snippet":"Non-Allergic Rhinitis Non-allergic rhinitis (NAR) accounts for ~25% of rhinitis cases and is a diagnosis of exclusion (negative skin testing/sIgE). It presents with nasal congestion and rhinorrhea but typically lacks sneezing and pruritus. Recognizing NAR subtypes prevents unnecessary allergen avoid...","sourceLabel":"Section in Allergy & Immunology"},"1279":{"title":"Chronic Rhinosinusitis & Nasal Polyps","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s6","snippet":"Chronic Rhinosinusitis & Nasal Polyps Chronic rhinosinusitis (CRS) is defined as sinonasal inflammation lasting &ge;12 weeks with at least 2 of: nasal obstruction/congestion, mucopurulent drainage, facial pain/pressure, and hyposmia/anosmia - confirmed by objective evidence (endoscopic findings or C...","sourceLabel":"Section in Allergy & Immunology"},"1280":{"title":"Asthma Pathophysiology & Phenotypes","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s7","snippet":"Asthma Pathophysiology & Phenotypes Asthma is a chronic inflammatory airway disease characterized by variable airflow obstruction, bronchial hyperresponsiveness, and airway remodeling. It affects ~300 million people worldwide with prevalence of 5-10% in adults and up to 15% in children. Pathophysiol...","sourceLabel":"Section in Allergy & Immunology"},"1281":{"title":"Asthma Severity & Stepwise Management","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s8","snippet":"Asthma Severity & Stepwise Management GINA/NAEPP Severity Classification (Treatment-Na&iuml;ve Patients) Parameter Intermittent Mild Persistent Moderate Persistent Severe Persistent Symptom frequency &le;2 days/week >2 days/week but not daily Daily Throughout the day Nighttime awakenings &le;2&times...","sourceLabel":"Section in Allergy & Immunology"},"1282":{"title":"Acute Asthma Exacerbation","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s9","snippet":"Acute Asthma Exacerbation EMERGENCY - Severe/Life-Threatening Asthma Exacerbation Signs of severity: Cannot speak in full sentences, accessory muscle use, RR >30, HR >120, SpO2 <90%, FEV1 or PEF <25% predicted, silent chest, altered mental status, cyanosis, bradycardia (impending arrest). Immediate ...","sourceLabel":"Section in Allergy & Immunology"},"1283":{"title":"Asthma Biologics & Advanced Therapies","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s10","snippet":"Asthma Biologics & Advanced Therapies Biologic therapies target specific inflammatory pathways in severe asthma (GINA Step 5) and have transformed management of patients with T2-high disease. Selection is guided by phenotyping (blood eosinophils, FeNO, IgE, comorbidities). Biologic Target Mechanism ...","sourceLabel":"Section in Allergy & Immunology"},"1284":{"title":"Asthma-COPD Overlap & Special Phenotypes","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s11","snippet":"Asthma-COPD Overlap & Special Phenotypes Asthma-COPD Overlap (ACO) ACO describes patients with persistent airflow limitation (post-bronchodilator FEV1/FVC <0.70) and features of both asthma (reversibility, eosinophilia, atopy, variable symptoms) and COPD (smoking history, age >40, progressive declin...","sourceLabel":"Section in Allergy & Immunology"},"1285":{"title":"Anaphylaxis","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s12","snippet":"Anaphylaxis Anaphylaxis is an acute, potentially fatal, multi-organ system hypersensitivity reaction. Incidence is ~50-112 episodes per 100,000 person-years; lifetime prevalence is 0.5-2%. Most common triggers are foods (children), medications (adults), and stinging insects. Mortality rate is 0.5-1%...","sourceLabel":"Section in Allergy & Immunology"},"1286":{"title":"Urticaria (Acute & Chronic)","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s13","snippet":"Urticaria (Acute & Chronic) Urticaria presents as pruritic, erythematous, raised wheals (hives) that are transient (<24 hours per individual lesion) and migratory. Classified as acute (<6 weeks duration) or chronic (&ge;6 weeks). Figure 19 - Urticarial Wheals. Clinical appearance of urticaria showin...","sourceLabel":"Section in Allergy & Immunology"},"1287":{"title":"Angioedema","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s14","snippet":"Angioedema Angioedema is localized, non-pitting swelling of deep dermal, subcutaneous, or submucosal tissue. The critical distinction is between histaminergic (mast cell-mediated) and bradykinin-mediated angioedema, as treatment differs fundamentally. Histaminergic vs Bradykinin-Mediated Angioedema ...","sourceLabel":"Section in Allergy & Immunology"},"1288":{"title":"Drug Hypersensitivity & Desensitization","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s15","snippet":"Drug Hypersensitivity & Desensitization Gell-Coombs Classification of Hypersensitivity Type Name Mechanism Timing Examples Type I Immediate / IgE-mediated IgE cross-linking on mast cells/basophils &rarr; degranulation Minutes to hours Penicillin anaphylaxis, food allergy, allergic rhinitis, allergic...","sourceLabel":"Section in Allergy & Immunology"},"1289":{"title":"Serum Sickness & Immune Complex Reactions","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s16","snippet":"Serum Sickness & Immune Complex Reactions Serum sickness is a type III hypersensitivity reaction caused by circulating immune complexes that deposit in blood vessels and tissues, activating complement and causing inflammation. Classic serum sickness follows administration of heterologous serum (e.g....","sourceLabel":"Section in Allergy & Immunology"},"1290":{"title":"IgE-Mediated Food Allergy","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s17","snippet":"IgE-Mediated Food Allergy IgE-mediated food allergy affects ~6-8% of children and ~3-4% of adults. It causes reproducible symptoms within minutes to 2 hours of ingestion. Nine foods account for >90% of food allergies in the US: milk , egg , peanut , tree nuts , wheat , soy , fish , shellfish , and s...","sourceLabel":"Section in Allergy & Immunology"},"1291":{"title":"Non-IgE Food Allergy (FPIES) & Mixed Disorders","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s18","snippet":"Non-IgE Food Allergy (FPIES) & Mixed Disorders Food Protein-Induced Enterocolitis Syndrome (FPIES) FPIES is a non-IgE-mediated food allergy presenting in infancy (typically <9 months) with profuse vomiting 1-4 hours after ingestion of a trigger food, often followed by diarrhea, lethargy, and pallor....","sourceLabel":"Section in Allergy & Immunology"},"1292":{"title":"Eosinophilic Esophagitis","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s19","snippet":"Eosinophilic Esophagitis Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated esophageal disease characterized by symptoms of esophageal dysfunction and eosinophilic infiltration of the esophageal mucosa. Prevalence has increased dramatically (~1 in 2000); predominantly affects males...","sourceLabel":"Section in Allergy & Immunology"},"1293":{"title":"Oral Allergy Syndrome & Alpha-Gal Syndrome","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s20","snippet":"Oral Allergy Syndrome & Alpha-Gal Syndrome Oral Allergy Syndrome (Pollen-Food Allergy Syndrome) OAS results from cross-reactivity between aeroallergen pollen proteins and homologous proteins in raw fruits, vegetables, and nuts. Symptoms are typically limited to the oropharynx: oral/pharyngeal prurit...","sourceLabel":"Section in Allergy & Immunology"},"1294":{"title":"Allergic Contact Dermatitis","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s21","snippet":"Allergic Contact Dermatitis Allergic contact dermatitis (ACD) is a type IV (delayed, T-cell-mediated) hypersensitivity reaction to an external substance (hapten) that contacts the skin. It requires prior sensitization (1-2 week induction period) and manifests 24-72 hours after re-exposure. ACD affec...","sourceLabel":"Section in Allergy & Immunology"},"1295":{"title":"Atopic Dermatitis","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s22","snippet":"Atopic Dermatitis Atopic dermatitis (AD) is a chronic, relapsing, intensely pruritic inflammatory skin disease affecting up to 20% of children and 7-10% of adults. It is the first manifestation of the \"atopic march\" (AD &rarr; food allergy &rarr; allergic rhinitis &rarr; asthma) and results from gen...","sourceLabel":"Section in Allergy & Immunology"},"1296":{"title":"Latex Allergy","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s23","snippet":"Latex Allergy Latex allergy is an IgE-mediated (type I) hypersensitivity to natural rubber latex proteins (Hevea brasiliensis). Prevalence: 1-6% in the general population, 10-17% in healthcare workers, up to 73% in children with spina bifida (repeated surgical exposures). Can cause contact urticaria...","sourceLabel":"Section in Allergy & Immunology"},"1297":{"title":"B-Cell (Antibody) Deficiencies","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s24","snippet":"B-Cell (Antibody) Deficiencies Antibody deficiencies are the most common primary immunodeficiencies, accounting for ~50% of all PIDs. They present with recurrent sinopulmonary infections (pneumonia, sinusitis, otitis media) from encapsulated organisms ( S. pneumoniae , H. influenzae ), GI infections...","sourceLabel":"Section in Allergy & Immunology"},"1298":{"title":"T-Cell & Combined Immunodeficiencies","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s25","snippet":"T-Cell & Combined Immunodeficiencies Figure 31 - Immunodeficiency Diagnostic Workup Algorithm. Stepwise approach to immunodeficiency evaluation from basic screening (CBC, immunoglobulins, complement) through advanced testing (lymphocyte subsets, functional assays) to molecular diagnostics. Severe Co...","sourceLabel":"Section in Allergy & Immunology"},"1299":{"title":"Phagocytic & Complement Deficiencies","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s26","snippet":"Phagocytic & Complement Deficiencies Phagocytic Defects Disorder Defect Inheritance Key Features Diagnosis Chronic Granulomatous Disease (CGD) NADPH oxidase deficiency &rarr; absent respiratory burst &rarr; cannot kill catalase-positive organisms X-linked (65-70%) or AR Recurrent infections with cat...","sourceLabel":"Section in Allergy & Immunology"},"1300":{"title":"Immunoglobulin Replacement Therapy","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s27","snippet":"Immunoglobulin Replacement Therapy Immunoglobulin replacement is the cornerstone of treatment for antibody deficiencies (XLA, CVID, specific antibody deficiency, secondary hypogammaglobulinemia). The goal is to maintain trough IgG levels &ge;500 mg/dL (some experts target &ge;700-800 mg/dL, especial...","sourceLabel":"Section in Allergy & Immunology"},"1301":{"title":"Secondary Immunodeficiency","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s28","snippet":"Secondary Immunodeficiency Secondary (acquired) immunodeficiencies are far more common than PIDs and result from external factors that impair immune function. Major Causes Category Examples Immune Defect Key Infections HIV/AIDS CD4+ T-cell depletion by HIV Progressive cellular immunodeficiency; CD4 ...","sourceLabel":"Section in Allergy & Immunology"},"1302":{"title":"Immune Dysregulation Syndromes","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s29","snippet":"Immune Dysregulation Syndromes These rare disorders involve immune system overactivity or dysregulation rather than simple deficiency, leading to autoimmunity, lymphoproliferation, and/or hyperinflammation. Key Immune Dysregulation Syndromes Syndrome Defect Key Features Treatment ALPS (Autoimmune Ly...","sourceLabel":"Section in Allergy & Immunology"},"1303":{"title":"Skin Testing & In Vitro Diagnostics","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s30","snippet":"Skin Testing & In Vitro Diagnostics Skin Prick Testing (SPT) SPT is the primary diagnostic tool for IgE-mediated sensitization. A drop of allergen extract is placed on the volar forearm or back, and the skin is pricked through the drop with a lancet. A positive result is a wheal &ge;3 mm greater tha...","sourceLabel":"Section in Allergy & Immunology"},"1304":{"title":"Pulmonary Function & Bronchial Provocation","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s31","snippet":"Pulmonary Function & Bronchial Provocation Spirometry Spirometry is essential for asthma diagnosis, severity assessment, and monitoring. Key measurements: FEV1 (forced expiratory volume in 1 second), FVC (forced vital capacity), and FEV1/FVC ratio . Asthma shows an obstructive pattern : reduced FEV1...","sourceLabel":"Section in Allergy & Immunology"},"1305":{"title":"Allergen Immunotherapy (SCIT & SLIT)","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s32","snippet":"Allergen Immunotherapy (SCIT & SLIT) Allergen immunotherapy (AIT) is the ONLY disease-modifying treatment for allergic rhinitis, allergic asthma, and stinging insect allergy. It induces immune tolerance by shifting from Th2 to Th1/Treg responses, increasing blocking IgG4 antibodies, and reducing all...","sourceLabel":"Section in Allergy & Immunology"},"1306":{"title":"Venom Immunotherapy","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s33","snippet":"Venom Immunotherapy Venom immunotherapy (VIT) is indicated for patients with a history of systemic allergic reaction to Hymenoptera stings (bees, wasps, hornets, yellow jackets, fire ants) AND positive venom-specific IgE (SPT or sIgE). VIT is the most effective form of immunotherapy: reduces risk of...","sourceLabel":"Section in Allergy & Immunology"},"1307":{"title":"Drug Challenge & Desensitization Protocols","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s34","snippet":"Drug Challenge & Desensitization Protocols Drug Provocation Testing (Drug Challenge) A graded drug challenge is used to exclude drug allergy in patients with a low-risk history or negative skin testing. The suspected drug is administered in incrementally increasing doses (typically 2-3 doses over 1-...","sourceLabel":"Section in Allergy & Immunology"},"1308":{"title":"Imaging & Diagnostics Table","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s35","snippet":"Imaging & Diagnostics Table Test / Modality Indication Key Findings Chest X-ray Asthma (exclude other diagnoses), PID evaluation Hyperinflation in acute asthma; absent thymic shadow in SCID/DiGeorge; bronchiectasis in PID CT Sinuses (non-contrast) Chronic rhinosinusitis evaluation Mucosal thickening...","sourceLabel":"Section in Allergy & Immunology"},"1309":{"title":"Classification Systems (All)","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s36","snippet":"Classification Systems (All) ARIA Classification of Allergic Rhinitis Dimension Category Definition Duration Intermittent <4 days/week OR <4 consecutive weeks Persistent &ge;4 days/week AND &ge;4 consecutive weeks Severity Mild Normal sleep, no impairment of daily activities/work/school, no troubles...","sourceLabel":"Section in Allergy & Immunology"},"1310":{"title":"Medications Master Table","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s37","snippet":"Medications Master Table Antihistamines Drug Generation Dose (Adult) Key Features Cetirizine (Zyrtec) 2nd 10 mg PO daily Fastest onset of 2nd-gen (~1 hr); mild sedation in ~10% Loratadine (Claritin) 2nd 10 mg PO daily Least sedating; available OTC; fewer drug interactions Fexofenadine (Allegra) 2nd ...","sourceLabel":"Section in Allergy & Immunology"},"1311":{"title":"Abbreviations Master List","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s38","snippet":"Abbreviations Master List Abbreviation Full Term ABPA Allergic bronchopulmonary aspergillosis ACD Allergic contact dermatitis ACO Asthma-COPD overlap AD Atopic dermatitis ADCC Antibody-dependent cell-mediated cytotoxicity AERD Aspirin-exacerbated respiratory disease AFS Allergic fungal sinusitis AHR...","sourceLabel":"Section in Allergy & Immunology"},"1312":{"title":"Risk Factors & Comorbidities","pageTitle":"Allergy & Immunology","pageUrl":"/medical/allergy-immunology","url":"/medical/allergy-immunology#s39","snippet":"Risk Factors & Comorbidities Risk Factors for Atopic Disease Factor Association Family history of atopy One atopic parent: 40% risk in child; both atopic parents: 60-80% risk; strongest risk factor Filaggrin (FLG) mutations Loss-of-function mutations in ~10% of population; 3&times; risk of AD, incre...","sourceLabel":"Section in Allergy & Immunology"},"1313":{"title":"Geriatrics","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics","snippet":"Specialty Reference Geriatrics Complete Specialty Reference Every syndrome, assessment tool, prescribing principle, classification system, functional measure, ethical framework, and management strategy in geriatric medicine in one place."},"1314":{"title":"Physiology of Aging","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s1","snippet":"Physiology of Aging Aging produces predictable physiological changes across every organ system. These changes reduce physiological reserve and narrow the margin between baseline function and clinical decompensation. Understanding normal aging is essential to distinguishing disease from senescence an...","sourceLabel":"Section in Geriatrics"},"1315":{"title":"Comprehensive Geriatric Assessment","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s2","snippet":"Comprehensive Geriatric Assessment The Comprehensive Geriatric Assessment (CGA) is the cornerstone of geriatric medicine - a multidimensional, interdisciplinary diagnostic process to determine an older person's medical, psychological, social, and functional capabilities and to develop a coordinated ...","sourceLabel":"Section in Geriatrics"},"1316":{"title":"Key Terminology & Abbreviations","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s3","snippet":"Key Terminology & Abbreviations Geriatric medicine relies on specific terminology for syndromes, functional measures, prescribing frameworks, and care settings. Mastering these terms is essential for communicating across the multidisciplinary team. Abbreviation Meaning CGA Comprehensive geriatric as...","sourceLabel":"Section in Geriatrics"},"1317":{"title":"Dementia - Alzheimer Disease","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s4","snippet":"Dementia - Alzheimer Disease Alzheimer disease (AD) accounts for 60-80% of all dementias. Prevalence doubles every 5 years after age 65 (1% at 65, 3% at 70, 6% at 75, 12% at 80, >30% at 85). It is characterized pathologically by extracellular amyloid-beta plaques and intraneuronal neurofibrillary ta...","sourceLabel":"Section in Geriatrics"},"1318":{"title":"Vascular, Lewy Body & Frontotemporal Dementias","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s5","snippet":"Vascular, Lewy Body & Frontotemporal Dementias Vascular Dementia (VaD) Figure 10 - Default Network and Amyloid Deposition Overlap. fMRI activation patterns during memory encoding (left) alongside amyloid PET retention maps (right) in cognitively normal older adults, demonstrating anatomical overlap ...","sourceLabel":"Section in Geriatrics"},"1319":{"title":"Delirium","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s6","snippet":"Delirium Delirium is an acute, fluctuating disturbance in attention and awareness, with additional cognitive disturbance (memory, orientation, language, visuospatial, perception), that develops over hours to days and is caused by a medical condition, substance, or medication. It occurs in 10-30% of ...","sourceLabel":"Section in Geriatrics"},"1320":{"title":"Depression & Behavioral Disturbances","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s7","snippet":"Depression & Behavioral Disturbances Late-Life Depression Major depression affects 1-5% of community-dwelling elders but 10-15% of hospitalized elderly and up to 25-50% of nursing home residents. Late-life depression often presents differently than in younger adults: somatic complaints predominate (...","sourceLabel":"Section in Geriatrics"},"1321":{"title":"Falls Assessment & Prevention","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s8","snippet":"Falls Assessment & Prevention Falls are the leading cause of injury, injury-related death, and emergency department visits in adults &ge;65. One-third of community-dwelling elders and two-thirds of nursing home residents fall each year. Of those who fall, 20-30% suffer moderate to severe injury (hip...","sourceLabel":"Section in Geriatrics"},"1322":{"title":"Gait Disorders & Assistive Devices","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s9","snippet":"Gait Disorders & Assistive Devices Common Gait Patterns in the Elderly Figure 13 - Classical Gait Disorder Patterns. Graphic representation of step sequences in classical gait disorders: normal gait, spastic paraparetic gait (scissoring), cerebellar ataxic gait (wide-based, irregular), parkinsonian ...","sourceLabel":"Section in Geriatrics"},"1323":{"title":"Hip Fractures","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s10","snippet":"Hip Fractures Hip fractures are a geriatric emergency. Over 300,000 occur annually in the US, with 95% in patients &ge;65. One-year mortality is 20-30% (higher in men: 37% vs 20% in women). Only 40-60% regain pre-fracture mobility, and 10-20% require long-term institutionalization. Median age at fra...","sourceLabel":"Section in Geriatrics"},"1324":{"title":"Osteoporosis","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s11","snippet":"Osteoporosis Osteoporosis is defined by the WHO as a DXA T-score &le;&minus;2.5 at the lumbar spine, femoral neck, or total hip. Prevalence: ~25% of women and ~5% of men &ge;65. Osteoporosis is responsible for >2 million fractures annually in the US (vertebral compression fractures most common, foll...","sourceLabel":"Section in Geriatrics"},"1325":{"title":"Sarcopenia & Frailty","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s12","snippet":"Sarcopenia & Frailty Sarcopenia Sarcopenia is the progressive, age-related loss of skeletal muscle mass and function. The EWGSOP2 (2019) definition requires: (1) Low muscle strength (grip strength <27 kg men, <16 kg women; or chair stand >15 sec for 5 rises) for probable sarcopenia; (2) Low muscle q...","sourceLabel":"Section in Geriatrics"},"1326":{"title":"Beers Criteria & High-Risk Medications","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s13","snippet":"Beers Criteria & High-Risk Medications The AGS Beers Criteria (updated 2023) is the most widely referenced list of potentially inappropriate medications (PIMs) in older adults (&ge;65). Polypharmacy (&ge;5 medications) affects >40% of community-dwelling elders and >90% of nursing home residents. The...","sourceLabel":"Section in Geriatrics"},"1327":{"title":"STOPP/START Criteria","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s14","snippet":"STOPP/START Criteria The STOPP/START criteria (version 3, 2023) complement the Beers list with a European evidence-based approach. STOPP (Screening Tool of Older Persons' Prescriptions) identifies PIMs to stop ; START (Screening Tool to Alert to Right Treatment) identifies beneficial medications tha...","sourceLabel":"Section in Geriatrics"},"1328":{"title":"Deprescribing & Adverse Drug Reactions","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s15","snippet":"Deprescribing & Adverse Drug Reactions Deprescribing Principles Deprescribing is the planned, supervised process of dose reduction or stopping medications that are no longer beneficial or may be causing harm. It is not simply \"stopping medications\" - it requires a systematic approach: (1) Ascertain ...","sourceLabel":"Section in Geriatrics"},"1329":{"title":"Renal Dosing & Anticholinergic Burden","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s16","snippet":"Renal Dosing & Anticholinergic Burden Renal Dosing in the Elderly Age-related GFR decline makes renal dose adjustment critical. Key drugs requiring adjustment in CKD: Drug Normal Dose CrCl 30-60 CrCl 15-30 CrCl <15 Gabapentin 300-600 mg TID 200-700 mg BID 100-300 mg daily 100-300 mg post-HD Metformi...","sourceLabel":"Section in Geriatrics"},"1330":{"title":"Urinary Incontinence","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s17","snippet":"Urinary Incontinence Urinary incontinence affects 30-50% of community-dwelling women &ge;65 and 15-30% of men &ge;65. Prevalence exceeds 50% in nursing home residents. Despite being common, it is frequently underreported and under-treated. It is a major contributor to social isolation, depression, s...","sourceLabel":"Section in Geriatrics"},"1331":{"title":"Pressure Injuries","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s18","snippet":"Pressure Injuries Pressure injuries (formerly pressure ulcers or decubitus ulcers) affect ~2.5 million patients annually in the US. Prevalence in acute care: 5-15%; long-term care: 10-25%. They result from sustained pressure over bony prominences that exceeds capillary closing pressure (~32 mmHg), c...","sourceLabel":"Section in Geriatrics"},"1332":{"title":"Malnutrition & Failure to Thrive","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s19","snippet":"Malnutrition & Failure to Thrive Malnutrition in the Elderly Malnutrition affects 5-10% of community-dwelling elders, 30-60% of hospitalized elders, and 35-85% of nursing home residents. Causes include decreased appetite (anorexia of aging), dental problems, dysphagia, depression, dementia, medicati...","sourceLabel":"Section in Geriatrics"},"1333":{"title":"Constipation, Sleep Disorders & Dizziness","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s20","snippet":"Constipation, Sleep Disorders & Dizziness Constipation Affects 30-50% of community-dwelling elders and up to 74% of nursing home residents. Defined as <3 bowel movements per week, straining, hard stools, or sense of incomplete evacuation. Causes: low fiber/fluid intake, immobility, medications (opio...","sourceLabel":"Section in Geriatrics"},"1334":{"title":"ADLs, IADLs & Functional Scales","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s21","snippet":"ADLs, IADLs & Functional Scales Katz Index of Independence in ADLs Assesses 6 basic activities of daily living. Each activity is scored as independent (1) or dependent (0). Total score: 6 = full independence; 4 = moderate impairment; &le;2 = severe functional impairment. ADL Independent Dependent Ba...","sourceLabel":"Section in Geriatrics"},"1335":{"title":"Rehabilitation Goals & Settings","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s22","snippet":"Rehabilitation Goals & Settings Levels of Post-Acute Care Setting Requirements Therapy Intensity Typical Stay Inpatient Rehabilitation Facility (IRF) Can tolerate 3 hours of therapy/day, 5-7 days/week; requires physician supervision; must have realistic functional goals High (PT, OT, SLP as needed) ...","sourceLabel":"Section in Geriatrics"},"1336":{"title":"Elder Abuse - Types & Screening","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s23","snippet":"Elder Abuse - Types & Screening Elder abuse affects an estimated 10% of community-dwelling older adults (&ge;60) annually, though only 1 in 14 cases is reported. It is associated with 300% increased risk of death within 3 years. Types of elder abuse: Type Prevalence Indicators Physical abuse ~2% Une...","sourceLabel":"Section in Geriatrics"},"1337":{"title":"Capacity, Guardianship & Advance Directives","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s24","snippet":"Capacity, Guardianship & Advance Directives Decision-Making Capacity Assessment Capacity is a clinical determination (made by the treating physician); competency is a legal determination (made by a court). Capacity is decision-specific and may fluctuate. The four components of capacity (all must be ...","sourceLabel":"Section in Geriatrics"},"1338":{"title":"Goals of Care & Hospice Eligibility","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s25","snippet":"Goals of Care & Hospice Eligibility Goals of Care Conversations Figure 28 - Palliative Care Alongside Curative Treatment. Palliative care is offered independent of prognosis and simultaneously with life-prolonging and curative therapies. As disease progresses, the focus shifts from primarily curativ...","sourceLabel":"Section in Geriatrics"},"1339":{"title":"Comfort Care & Symptom Management","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s26","snippet":"Comfort Care & Symptom Management Pain Management at End of Life Figure 29 - Modified WHO Analgesic Ladder. A generalized representation of the four-step analgesic ladder for pain management: Step 1 (non-opioids), Step 2 (weak opioids), Step 3 (strong opioids), and Step 4 (interventional procedures)...","sourceLabel":"Section in Geriatrics"},"1340":{"title":"Prognostication, Caregiver Support & Grief","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s27","snippet":"Prognostication, Caregiver Support & Grief Prognostication Tools Tool Population Key Features Palliative Performance Scale (PPS) All patients with serious illness 11-level scale (0-100% in 10% increments); assesses ambulation, activity, self-care, intake, consciousness. PPS &le;50% associated with m...","sourceLabel":"Section in Geriatrics"},"1341":{"title":"Common Bedside Procedures","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s28","snippet":"Common Bedside Procedures Joint Injections & Aspirations Corticosteroid injections for osteoarthritis in elderly: triamcinolone 40 mg (large joints: knee, shoulder) or 10-20 mg (small joints). Limit to 3-4 injections per joint per year. Contraindications: overlying cellulitis, prosthetic joint (refe...","sourceLabel":"Section in Geriatrics"},"1342":{"title":"Pre-operative Assessment in the Elderly","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s29","snippet":"Pre-operative Assessment in the Elderly Patients &ge;65 account for ~40% of all surgical procedures but have 2-3&times; higher perioperative mortality and complications than younger patients. Standard cardiac risk assessment (Revised Cardiac Risk Index, ACC/AHA guidelines) is necessary but insuffici...","sourceLabel":"Section in Geriatrics"},"1343":{"title":"Feeding Tube Decisions & Wound Care","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s30","snippet":"Feeding Tube Decisions & Wound Care Feeding Tube Decisions in Advanced Dementia Dysphagia and aspiration are nearly universal in advanced dementia. Evidence strongly shows that tube feeding in advanced dementia does NOT: prevent aspiration pneumonia, prolong survival, improve nutrition, promote woun...","sourceLabel":"Section in Geriatrics"},"1344":{"title":"Imaging & Diagnostics in the Elderly","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s31","snippet":"Imaging & Diagnostics in the Elderly Neuroimaging Brain MRI is the preferred modality for evaluating cognitive decline: hippocampal atrophy (AD), frontal/temporal atrophy (FTD), white matter hyperintensities (vascular disease), normal pressure hydrocephalus (ventricular enlargement disproportionate ...","sourceLabel":"Section in Geriatrics"},"1345":{"title":"Classification Systems (All)","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s32","snippet":"Classification Systems (All) This section consolidates all major classification and staging systems referenced throughout geriatric medicine. Mini-Mental State Examination (MMSE) - Score Interpretation Score Severity Clinical Correlation 27-30 Normal No significant cognitive impairment 21-26 Mild co...","sourceLabel":"Section in Geriatrics"},"1346":{"title":"Medications Master Table","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s33","snippet":"Medications Master Table Cholinesterase Inhibitors & NMDA Antagonists Drug Mechanism Dose Indication Key Side Effects / Pearls Donepezil (Aricept) Reversible AChE inhibitor 5 mg daily &rarr; 10 mg daily; 23 mg daily (mod-severe) AD (all stages) N/V/D, bradycardia, vivid dreams, muscle cramps; take a...","sourceLabel":"Section in Geriatrics"},"1347":{"title":"Abbreviations Master List","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s34","snippet":"Abbreviations Master List Abbreviation Meaning ACB Anticholinergic Cognitive Burden AChEI Acetylcholinesterase inhibitor ACP Advance care planning ACS-NSQIP American College of Surgeons National Surgical Quality Improvement Program AD Alzheimer disease ADL Activities of daily living ADR Adverse drug...","sourceLabel":"Section in Geriatrics"},"1348":{"title":"Risk Factors & Comorbidities","pageTitle":"Geriatrics","pageUrl":"/medical/geriatrics","url":"/medical/geriatrics#s35","snippet":"Risk Factors & Comorbidities Multimorbidity in the Elderly Approximately 67% of adults &ge;65 have &ge;2 chronic conditions and 36% have &ge;4. The most prevalent chronic conditions in order: hypertension (70%), hyperlipidemia (55%), arthritis (50%), ischemic heart disease (30%), diabetes (27%), CKD...","sourceLabel":"Section in Geriatrics"},"1349":{"title":"Palliative Care / Hospice","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care","snippet":"Specialty Reference Palliative Care & Hospice Medicine Complete Specialty Reference Every symptom management strategy, goals-of-care framework, opioid conversion, hospice eligibility criterion, prognostication tool, ethical consideration, and end-of-life protocol in one place."},"1350":{"title":"Philosophy & Scope of Palliative Care","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s1","snippet":"Philosophy & Scope of Palliative Care Palliative care is specialized medical care focused on providing relief from the symptoms, pain, and stress of serious illness, regardless of diagnosis or stage. The World Health Organization (WHO) defines it as \"an approach that improves the quality of life of ...","sourceLabel":"Section in Palliative Care / Hospice"},"1351":{"title":"Total Pain & Suffering Framework","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s2","snippet":"Total Pain & Suffering Framework Cicely Saunders introduced the concept of total pain to describe the multidimensional nature of suffering in serious illness. Total pain encompasses four interrelated domains, all of which must be assessed and addressed for effective palliation. The Four Domains of T...","sourceLabel":"Section in Palliative Care / Hospice"},"1352":{"title":"Palliative Care Triggers & Consultation Criteria","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s3","snippet":"Palliative Care Triggers & Consultation Criteria Early identification of patients who would benefit from palliative care consultation improves outcomes. Many institutions use screening tools or \"trigger criteria\" to prompt automatic palliative care referral. Common Palliative Care Trigger Criteria P...","sourceLabel":"Section in Palliative Care / Hospice"},"1353":{"title":"Key Terminology & Abbreviations","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s4","snippet":"Key Terminology & Abbreviations Term Definition Palliative care Specialized care focused on relief of suffering in serious illness at any stage Hospice Philosophy and program of comfort care for patients with prognosis &le;6 months Total pain Multidimensional suffering: physical, psychological, soci...","sourceLabel":"Section in Palliative Care / Hospice"},"1354":{"title":"Pain Assessment Tools","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s5","snippet":"Pain Assessment Tools Effective pain management requires systematic, repeated assessment using validated tools appropriate to the patient population. Pain is subjective - the patient's self-report is the gold standard when obtainable. Pain Assessment Scales Scale Population Components Scoring Numeri...","sourceLabel":"Section in Palliative Care / Hospice"},"1355":{"title":"WHO Analgesic Ladder & Opioid Pharmacology","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s6","snippet":"WHO Analgesic Ladder & Opioid Pharmacology WHO Three-Step Analgesic Ladder Step Pain Severity Agents Notes Step 1 Mild (NRS 1-3) Non-opioid analgesics: acetaminophen (&le;3 g/day; 2 g if hepatic impairment), NSAIDs (ibuprofen, naproxen, ketorolac) &plusmn; adjuvants Ceiling effect for non-opioids; N...","sourceLabel":"Section in Palliative Care / Hospice"},"1356":{"title":"Opioid Rotation & Equianalgesic Dosing","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s7","snippet":"Opioid Rotation & Equianalgesic Dosing Opioid rotation is the practice of switching from one opioid to another. Indications include: uncontrolled pain despite dose escalation, intolerable side effects (nausea, myoclonus, sedation, hallucinations), opioid-induced hyperalgesia, renal failure (avoid mo...","sourceLabel":"Section in Palliative Care / Hospice"},"1357":{"title":"Adjuvant Analgesics & Interventional Pain","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s8","snippet":"Adjuvant Analgesics & Interventional Pain Adjuvant analgesics are medications whose primary indication is not pain but which have analgesic properties for specific pain syndromes. They are essential in palliative care, particularly for neuropathic pain, bone pain, and pain refractory to opioids alon...","sourceLabel":"Section in Palliative Care / Hospice"},"1358":{"title":"Dyspnea","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s9","snippet":"Dyspnea Dyspnea is the subjective sensation of breathing discomfort. It is one of the most distressing symptoms in advanced illness, affecting up to 70% of patients with advanced cancer and >90% with end-stage COPD or CHF. Like pain, dyspnea is subjective - the patient's report is the gold standard;...","sourceLabel":"Section in Palliative Care / Hospice"},"1359":{"title":"Nausea & Vomiting","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s10","snippet":"Nausea & Vomiting Nausea and vomiting affect 40-70% of patients with advanced cancer and are common in many terminal illnesses. Effective management requires identifying the underlying mechanism to select targeted antiemetics. There are four main emetic pathways. Etiology-Based Approach to Nausea/Vo...","sourceLabel":"Section in Palliative Care / Hospice"},"1360":{"title":"Constipation & Bowel Management","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s11","snippet":"Constipation & Bowel Management Constipation affects >90% of patients on chronic opioids and is the most common opioid side effect that does NOT develop tolerance. Prevention is essential: every patient starting an opioid should simultaneously start a bowel regimen. Opioid-Induced Constipation (OIC)...","sourceLabel":"Section in Palliative Care / Hospice"},"1361":{"title":"Delirium & Terminal Agitation","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s12","snippet":"Delirium & Terminal Agitation Delirium is an acute, fluctuating disturbance of consciousness with inattention and cognitive dysfunction. It occurs in up to 88% of patients in the last weeks of life and is the most common neuropsychiatric complication in terminally ill patients. It is deeply distress...","sourceLabel":"Section in Palliative Care / Hospice"},"1362":{"title":"Fatigue, Cachexia & Anorexia","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s13","snippet":"Fatigue, Cachexia & Anorexia Cancer-related fatigue is the most common symptom in advanced cancer (60-90% prevalence) and is distinct from normal tiredness - it is not relieved by rest. Cancer cachexia is a multifactorial syndrome defined by ongoing muscle loss (with or without fat loss) that cannot...","sourceLabel":"Section in Palliative Care / Hospice"},"1363":{"title":"Secretions, Pruritus, Hiccups & Wound Care","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s14","snippet":"Secretions, Pruritus, Hiccups & Wound Care Death Rattle (Terminal Secretions) The \"death rattle\" is noisy, gurgling breathing caused by accumulation of pharyngeal secretions in a patient too weak to clear them, typically in the last hours to days of life. It occurs in 23-92% of dying patients. It is...","sourceLabel":"Section in Palliative Care / Hospice"},"1364":{"title":"Goals of Care Conversations","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s15","snippet":"Goals of Care Conversations Goals-of-care conversations are structured discussions that explore what matters most to the patient in the context of their illness, align treatment plans with patient values, and support shared decision-making. They are a core competency in palliative medicine. SPIKES P...","sourceLabel":"Section in Palliative Care / Hospice"},"1365":{"title":"Breaking Bad News & Prognostic Disclosure","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s16","snippet":"Breaking Bad News & Prognostic Disclosure Prognostic Communication Most patients with serious illness want some information about prognosis, though preferences vary. Key principles for prognostic disclosure: Ask before telling: \"Would it be helpful if I shared what I think is likely to happen?\" Fram...","sourceLabel":"Section in Palliative Care / Hospice"},"1366":{"title":"Surrogate Decision-Making & Family Meetings","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s17","snippet":"Surrogate Decision-Making & Family Meetings Surrogate Decision-Making Hierarchy When a patient lacks decision-making capacity and has no advance directive or designated healthcare proxy, state laws define a hierarchy of surrogate decision-makers (varies by state, but commonly): Court-appointed guard...","sourceLabel":"Section in Palliative Care / Hospice"},"1367":{"title":"Code Status Discussions (DNR/DNI/AND)","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s18","snippet":"Code Status Discussions (DNR/DNI/AND) Definitions Order Meaning What It Covers What It Does NOT Cover Full Code Attempt all resuscitative measures CPR, defibrillation, intubation, vasopressors, ICU transfer - DNR (Do Not Resuscitate) No CPR if cardiac/respiratory arrest occurs No chest compressions,...","sourceLabel":"Section in Palliative Care / Hospice"},"1368":{"title":"Advance Directives & Living Wills","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s19","snippet":"Advance Directives & Living Wills Types of Advance Directives Type Description Key Features Living Will Written document specifying treatment preferences if the patient becomes incapacitated Takes effect only when patient lacks capacity; typically addresses life-sustaining treatments (mechanical ven...","sourceLabel":"Section in Palliative Care / Hospice"},"1369":{"title":"POLST/MOLST Paradigm","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s20","snippet":"POLST/MOLST Paradigm The POLST (Physician Orders for Life-Sustaining Treatment) is a brightly colored (usually pink or green) medical order form that translates patient wishes into actionable medical orders. Unlike advance directives (which are legal documents), POLST is a medical order signed by a ...","sourceLabel":"Section in Palliative Care / Hospice"},"1370":{"title":"Capacity Assessment & Informed Consent","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s21","snippet":"Capacity Assessment & Informed Consent Decision-making capacity is a clinical determination (made by any physician, not just psychiatrists) that a patient can make a specific medical decision at a specific time. It is distinct from competence , which is a legal determination made by a court. Four El...","sourceLabel":"Section in Palliative Care / Hospice"},"1371":{"title":"Medicare Hospice Benefit & Eligibility","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s22","snippet":"Medicare Hospice Benefit & Eligibility The Medicare Hospice Benefit (MHB) , established in 1982, is the primary funding mechanism for hospice care in the United States. To be eligible, the patient must meet two criteria: (1) a physician certifies a prognosis of &le;6 months if the disease runs its u...","sourceLabel":"Section in Palliative Care / Hospice"},"1372":{"title":"Hospice Levels of Care","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s23","snippet":"Hospice Levels of Care The Medicare Hospice Benefit defines four levels of care, each with different per-diem reimbursement rates and staffing requirements. Level Setting Indication Staffing Duration Routine Home Care (RHC) Patient's home, nursing facility, ALF Standard hospice care; patient is stab...","sourceLabel":"Section in Palliative Care / Hospice"},"1373":{"title":"Disease-Specific Hospice Criteria","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s24","snippet":"Disease-Specific Hospice Criteria Medicare Local Coverage Determinations (LCDs) provide disease-specific guidelines for hospice eligibility. Below are the key criteria for major disease categories, based on the National Hospice and Palliative Care Organization (NHPCO) guidelines. Cancer Disease with...","sourceLabel":"Section in Palliative Care / Hospice"},"1374":{"title":"Hospice Recertification, Revocation & Discharge","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s25","snippet":"Hospice Recertification, Revocation & Discharge Recertification At the start of each new benefit period (two 90-day periods, then 60-day periods), the hospice physician and attending physician must recertify that the patient continues to have a prognosis of &le;6 months if the disease runs its usual...","sourceLabel":"Section in Palliative Care / Hospice"},"1375":{"title":"Interdisciplinary Team & Care Delivery","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s26","snippet":"Interdisciplinary Team & Care Delivery Hospice care is delivered by an interdisciplinary team (IDT) , which is distinct from a multidisciplinary team. In an IDT, team members collaborate, share expertise across disciplines, and develop a unified care plan; in a multidisciplinary team, disciplines wo...","sourceLabel":"Section in Palliative Care / Hospice"},"1376":{"title":"Cancer-Related Palliative Emergencies","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s27","snippet":"Cancer-Related Palliative Emergencies EMERGENCY - MALIGNANT SPINAL CORD COMPRESSION Presentation: Back pain (often worse when lying down), progressive lower extremity weakness, sensory level, bowel/bladder dysfunction (late). Most common: thoracic spine. Common primaries: lung, breast, prostate, mye...","sourceLabel":"Section in Palliative Care / Hospice"},"1377":{"title":"Malignant Bowel Obstruction & Effusions","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s28","snippet":"Malignant Bowel Obstruction & Effusions Malignant Bowel Obstruction (MBO) MBO occurs in 5-42% of patients with advanced abdominal/pelvic cancers (ovarian, colorectal, gastric). In patients with peritoneal carcinomatosis, surgical intervention is often not feasible and carries high morbidity/mortalit...","sourceLabel":"Section in Palliative Care / Hospice"},"1378":{"title":"Heart Failure & Device Deactivation","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s29","snippet":"Heart Failure & Device Deactivation Palliative Care in Advanced Heart Failure Heart failure follows an unpredictable trajectory with acute exacerbations and partial recovery, making prognostication difficult. Key palliative issues include refractory dyspnea, fatigue, depression, and device managemen...","sourceLabel":"Section in Palliative Care / Hospice"},"1379":{"title":"End-Stage Pulmonary, Renal & Hepatic Disease","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s30","snippet":"End-Stage Pulmonary, Renal & Hepatic Disease End-Stage COPD COPD follows a trajectory of gradual decline punctuated by acute exacerbations, any of which may be fatal. Palliative care needs are often comparable to advanced cancer but receive less palliative attention. Dyspnea: Low-dose opioids (morph...","sourceLabel":"Section in Palliative Care / Hospice"},"1380":{"title":"Neurodegenerative Disease (ALS, Dementia)","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s31","snippet":"Neurodegenerative Disease (ALS, Dementia) Amyotrophic Lateral Sclerosis (ALS) ALS is a progressive motor neuron disease with median survival of 3-5 years from diagnosis. Palliative care should be integrated from diagnosis. Key Palliative Issues in ALS Issue Management Respiratory failure Discuss NIV...","sourceLabel":"Section in Palliative Care / Hospice"},"1381":{"title":"Signs of Imminent Death","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s32","snippet":"Signs of Imminent Death Recognizing the signs of imminent death (hours to days) is critical for preparing families, discontinuing non-beneficial interventions, and intensifying comfort measures. Signs of Approaching Death Timeframe Signs Weeks before death Progressive weakness and fatigue; increasin...","sourceLabel":"Section in Palliative Care / Hospice"},"1382":{"title":"Comfort Care & Medication Rationalization","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s33","snippet":"Comfort Care & Medication Rationalization Medication Rationalization (Deprescribing) in the Last Days As a patient approaches death, many medications become unnecessary, burdensome, or impossible to administer. Systematic deprescribing is an active process of discontinuing medications that no longer...","sourceLabel":"Section in Palliative Care / Hospice"},"1383":{"title":"Palliative Sedation & VSED","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s34","snippet":"Palliative Sedation & VSED Palliative Sedation Palliative sedation is the monitored use of medications intended to reduce consciousness to relieve refractory suffering at the end of life. A symptom is refractory when all available interventions have failed or no methods are available within the acce...","sourceLabel":"Section in Palliative Care / Hospice"},"1384":{"title":"Pronouncement & Post-Mortem Care","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s35","snippet":"Pronouncement & Post-Mortem Care Pronouncement of Death When a hospice or palliative care patient dies, a healthcare provider must formally pronounce death and document the time, date, and findings. Steps for Pronouncement Confirm identity of the patient Assess for absence of responsiveness (no resp...","sourceLabel":"Section in Palliative Care / Hospice"},"1385":{"title":"Principle of Double Effect & Medical Futility","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s36","snippet":"Principle of Double Effect & Medical Futility Principle of Double Effect The principle of double effect (PDE) is an ethical framework that justifies an action with both a good effect and a foreseeable (but unintended) bad effect. It is widely invoked in palliative care to justify the use of opioids ...","sourceLabel":"Section in Palliative Care / Hospice"},"1386":{"title":"Withholding vs Withdrawing Treatment","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s37","snippet":"Withholding vs Withdrawing Treatment Ethically and legally, there is no moral distinction between withholding (not starting) and withdrawing (stopping) a life-sustaining treatment . Both are legally permissible when the patient (or surrogate) makes an informed decision or the treatment is determined...","sourceLabel":"Section in Palliative Care / Hospice"},"1387":{"title":"Medical Assistance in Dying (MAID)","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s38","snippet":"Medical Assistance in Dying (MAID) Medical Assistance in Dying (MAID) , also called physician-assisted death (PAD) or physician-assisted suicide (PAS), refers to the practice of a physician prescribing (or in some jurisdictions, administering) a lethal medication to a terminally ill patient who requ...","sourceLabel":"Section in Palliative Care / Hospice"},"1388":{"title":"Organ Donation, Autopsy & Death Certification","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s39","snippet":"Organ Donation, Autopsy & Death Certification Organ Donation in Palliative Care Hospice and palliative care patients may be eligible for organ and tissue donation Tissue donation (corneas, skin, bone, heart valves) is possible for most patients, including those with cancer (with some exclusions); ag...","sourceLabel":"Section in Palliative Care / Hospice"},"1389":{"title":"Performance & Prognostication Scales","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s40","snippet":"Performance & Prognostication Scales Palliative Performance Scale (PPS) - All 11 Levels PPS % Ambulation Activity & Evidence of Disease Self-Care Intake Conscious Level 100% Full Normal activity & work; no evidence of disease Full Normal Full 90% Full Normal activity & work; some evidence of disease...","sourceLabel":"Section in Palliative Care / Hospice"},"1390":{"title":"Opioid Equianalgesic Conversion Table","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s41","snippet":"Opioid Equianalgesic Conversion Table This comprehensive reference table provides equianalgesic doses, conversion ratios, and key clinical notes for all commonly used opioids in palliative care. Opioid Equianalgesic PO Dose (mg) Equianalgesic Parenteral Dose (mg) PO:Parenteral Ratio Duration (h) Cli...","sourceLabel":"Section in Palliative Care / Hospice"},"1391":{"title":"Medications Master Table","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s42","snippet":"Medications Master Table Opioid Analgesics Drug Route(s) Starting Dose (opioid-na&iuml;ve) Max/Notes Morphine IR PO, SL, PR 5-15 mg q4h No ceiling; titrate to effect; reduce in renal failure Morphine SR PO 15 mg q8-12h Do not crush or chew; not for opioid-na&iuml;ve PRN use Morphine concentrated sol...","sourceLabel":"Section in Palliative Care / Hospice"},"1392":{"title":"Abbreviations Master List","pageTitle":"Palliative Care / Hospice","pageUrl":"/medical/palliative-care","url":"/medical/palliative-care#s43","snippet":"Abbreviations Master List Abbreviation Full Term AAHPM American Academy of Hospice and Palliative Medicine ACP Advance care planning AD Advance directive AND Allow natural death BID Twice daily BTP Breakthrough pain CBT Cognitive behavioral therapy CHC Continuous home care CIPN Chemotherapy-induced ...","sourceLabel":"Section in Palliative Care / Hospice"},"1393":{"title":"Sports Medicine","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine","snippet":"Specialty Reference Sports Medicine Complete Specialty Reference Every musculoskeletal injury, concussion protocol, rehabilitation strategy, injection technique, classification system, exercise physiology concept, and return-to-play guideline in one place."},"1394":{"title":"Musculoskeletal Anatomy Essentials","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s1","snippet":"Musculoskeletal Anatomy Essentials Sports medicine is the clinical discipline devoted to the prevention, diagnosis, treatment, and rehabilitation of injuries related to physical activity and sport. A thorough understanding of musculoskeletal anatomy - joints, ligaments, tendons, cartilage, and muscl...","sourceLabel":"Section in Sports Medicine"},"1395":{"title":"Exercise Physiology","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s2","snippet":"Exercise Physiology Energy Systems Human movement is powered by three energy systems that operate on a continuum based on exercise intensity and duration: Figure 4 - The Three Energy Systems of Muscle ATP Regeneration. Overview of the phosphagen (ATP-PCr), glycolytic (anaerobic), and oxidative (aero...","sourceLabel":"Section in Sports Medicine"},"1396":{"title":"The Sports Medicine Evaluation","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s3","snippet":"The Sports Medicine Evaluation Pre-Participation Physical Examination (PPE) The PPE (also called \"sports physical\") is performed before athletic participation to identify conditions that may predispose to injury, illness, or sudden death. The PPE consists of: (1) medical history - the most sensitive...","sourceLabel":"Section in Sports Medicine"},"1397":{"title":"Key Terminology & Abbreviations","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s4","snippet":"Key Terminology & Abbreviations Injury Terminology Sprain - injury to a ligament (graded I-III). Strain - injury to a muscle or tendon (graded I-III). Tendinopathy - umbrella term for tendon pathology; preferred over \"tendinitis\" (which implies acute inflammation) or \"tendinosis\" (which implies chro...","sourceLabel":"Section in Sports Medicine"},"1398":{"title":"ACL Injuries","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s5","snippet":"ACL Injuries Figure 6 - Bursa Anatomy. Bursae are synovial fluid-filled sacs that reduce friction between tendons, muscles, and bony prominences. Common sites of bursitis in sports medicine include the subacromial, olecranon, prepatellar, pes anserine, and retrocalcaneal bursae. The anterior cruciat...","sourceLabel":"Section in Sports Medicine"},"1399":{"title":"PCL, MCL & LCL Injuries","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s6","snippet":"PCL, MCL & LCL Injuries Posterior Cruciate Ligament (PCL) The PCL is the strongest ligament of the knee, originating from the anterolateral medial femoral condyle and inserting on the posterior tibial sulcus. It is the primary restraint to posterior tibial translation. The most common mechanism is a...","sourceLabel":"Section in Sports Medicine"},"1400":{"title":"Meniscal Tears","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s7","snippet":"Meniscal Tears Figure 8 - Menisci In Situ on the Tibial Plateau. Superior view demonstrating the C-shaped medial meniscus (larger, firmly attached to the deep MCL) and the more circular lateral meniscus (more mobile, connected to the popliteus tendon). The menisci distribute load, absorb shock, and ...","sourceLabel":"Section in Sports Medicine"},"1401":{"title":"Patellofemoral & Other Knee Conditions","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s8","snippet":"Patellofemoral & Other Knee Conditions Patellofemoral Pain Syndrome (PFPS) PFPS is the most common cause of anterior knee pain, especially in young, active females. It is characterized by peripatellar or retropatellar pain aggravated by activities that load the patellofemoral joint: stair climbing/d...","sourceLabel":"Section in Sports Medicine"},"1402":{"title":"Rotator Cuff Pathology","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s9","snippet":"Rotator Cuff Pathology The rotator cuff consists of four muscles that stabilize the glenohumeral joint and initiate shoulder motion: Supraspinatus (abduction, most commonly torn), Infraspinatus (external rotation), Teres minor (external rotation), and Subscapularis (internal rotation). Mnemonic: SIT...","sourceLabel":"Section in Sports Medicine"},"1403":{"title":"Shoulder Instability","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s10","snippet":"Shoulder Instability Anterior Instability (95% of Traumatic Dislocations) Figure 13 - Hill-Sachs Lesion. Radiographic measurement of a Hill-Sachs compression fracture of the posterolateral humeral head, a hallmark finding of anterior shoulder dislocation. This osseous defect results from impaction o...","sourceLabel":"Section in Sports Medicine"},"1404":{"title":"SLAP Tears & Biceps Tendinopathy","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s11","snippet":"SLAP Tears & Biceps Tendinopathy SLAP Tears (Superior Labrum Anterior to Posterior) Figure 14 - Snyder SLAP Tear Classification. The four primary types of superior labrum anterior-to-posterior (SLAP) lesions: Type I (degenerative fraying), Type II (labrum and biceps anchor detached, most common), Ty...","sourceLabel":"Section in Sports Medicine"},"1405":{"title":"AC Joint Injuries & Other Shoulder Conditions","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s12","snippet":"AC Joint Injuries & Other Shoulder Conditions Acromioclavicular (AC) Joint Injuries - Rockwood Classification Figure 15 - Rockwood Classification of AC Joint Separations. Types I through VI acromioclavicular joint injuries showing progressive disruption of the AC ligaments, coracoclavicular (CC) lig...","sourceLabel":"Section in Sports Medicine"},"1406":{"title":"Ankle Sprains (Lateral & Syndesmotic)","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s13","snippet":"Ankle Sprains (Lateral & Syndesmotic) Lateral Ankle Sprain Figure 16 - Lateral Ankle Ligament Anatomy. Cadaveric dissection showing the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) with their angular relationships. The ATFL is the weakest and most commonly injured lateral ...","sourceLabel":"Section in Sports Medicine"},"1407":{"title":"Achilles Tendinopathy & Rupture","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s14","snippet":"Achilles Tendinopathy & Rupture Achilles Tendinopathy The Achilles tendon is the thickest and strongest tendon in the body, formed by the confluence of the gastrocnemius and soleus muscles, inserting on the posterior calcaneus. Insertional tendinopathy occurs at the calcaneal insertion (associated w...","sourceLabel":"Section in Sports Medicine"},"1408":{"title":"Stress Fractures, Lisfranc & Other Foot Injuries","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s15","snippet":"Stress Fractures, Lisfranc & Other Foot Injuries Stress Fractures Stress fractures result from repetitive submaximal loading that overwhelms bone's remodeling capacity. They are categorized as low-risk (compressive side of bone; tibial shaft, fibula, metatarsal shafts 2-4, calcaneus - heal well with...","sourceLabel":"Section in Sports Medicine"},"1409":{"title":"Sport-Related Concussion","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s16","snippet":"Sport-Related Concussion Sport-related concussion (SRC) is a traumatic brain injury induced by biomechanical forces, resulting in a complex pathophysiological process affecting the brain. Key features from the Amsterdam/Berlin consensus (6th International Conference on Concussion in Sport): concussi...","sourceLabel":"Section in Sports Medicine"},"1410":{"title":"Return-to-Play & Post-Concussion Syndromes","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s17","snippet":"Return-to-Play & Post-Concussion Syndromes Figure 23 - Concussion Return-to-Play Protocol. Overview of the graduated, criterion-based return-to-play framework. Athletes must be symptom-free at each step (minimum 24 hours per step) before progressing. Symptom recurrence requires returning to the prev...","sourceLabel":"Section in Sports Medicine"},"1411":{"title":"Cervical Spine Injuries & Exertional Heat Illness","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s18","snippet":"Cervical Spine Injuries & Exertional Heat Illness Cervical Spine Injury in Sports Any athlete with a mechanism suggesting cervical spine injury (axial loading, hyperflexion, hyperextension, significant head trauma with neck pain or neurological symptoms) requires immediate cervical spine immobilizat...","sourceLabel":"Section in Sports Medicine"},"1412":{"title":"Epicondylitis & UCL Injury","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s19","snippet":"Epicondylitis & UCL Injury Lateral Epicondylitis (Tennis Elbow) Lateral epicondylitis is the most common cause of lateral elbow pain, affecting 1-3% of the general population. Despite the name, the primary pathology is angiofibroblastic tendinosis (degenerative, not inflammatory) of the extensor car...","sourceLabel":"Section in Sports Medicine"},"1413":{"title":"Distal Biceps, Scaphoid & Wrist Injuries","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s20","snippet":"Distal Biceps, Scaphoid & Wrist Injuries Distal Biceps Tendon Rupture Distal biceps rupture accounts for ~3% of biceps injuries and occurs almost exclusively in men aged 30-60, during eccentric loading of a flexed elbow (e.g., catching a heavy object). Presentation: sudden \"pop\" in the antecubital f...","sourceLabel":"Section in Sports Medicine"},"1414":{"title":"Hand & Finger Injuries","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s21","snippet":"Hand & Finger Injuries Gamekeeper's/Skier's Thumb (UCL of the Thumb) UCL injury of the thumb MCP joint results from forced abduction/hyperextension of the thumb. Gamekeeper's thumb is chronic (repetitive stress, historically from Scottish gamekeepers breaking rabbits' necks). Skier's thumb is acute ...","sourceLabel":"Section in Sports Medicine"},"1415":{"title":"Femoroacetabular Impingement & Labral Tears","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s22","snippet":"Femoroacetabular Impingement & Labral Tears Femoroacetabular Impingement (FAI) Figure 29 - Types of Femoroacetabular Impingement. The three morphologic types: pincer impingement (acetabular overcoverage causing labral crush injury), cam impingement (aspherical femoral head causing outside-in labral ...","sourceLabel":"Section in Sports Medicine"},"1416":{"title":"Athletic Pubalgia & Hamstring Injuries","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s23","snippet":"Athletic Pubalgia & Hamstring Injuries Athletic Pubalgia (Sports Hernia / Core Muscle Injury) Athletic pubalgia is an umbrella term for chronic groin pain in athletes caused by injury to the musculotendinous structures of the pubic region. Unlike a true inguinal hernia, there is no palpable hernia. ...","sourceLabel":"Section in Sports Medicine"},"1417":{"title":"Lumbar Spine & Core Injuries in Athletes","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s24","snippet":"Lumbar Spine & Core Injuries in Athletes Figure 32 - Lisfranc Joint Radiographic Assessment. Normal weight-bearing radiograph demonstrating the alignment of the tarsometatarsal joint complex. Key assessments include alignment of the medial border of the 2nd metatarsal with the medial border of the m...","sourceLabel":"Section in Sports Medicine"},"1418":{"title":"Exercise-Induced Conditions","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s25","snippet":"Exercise-Induced Conditions Exercise-Induced Bronchoconstriction (EIB) EIB (previously called exercise-induced asthma) is transient airway narrowing occurring during or after vigorous exercise, affecting 5-20% of the general population and up to 90% of asthmatics. Pathophysiology: airway water loss ...","sourceLabel":"Section in Sports Medicine"},"1419":{"title":"Sudden Cardiac Death & Cardiac Screening","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s26","snippet":"Sudden Cardiac Death & Cardiac Screening Commotio Cordis Commotio cordis is sudden cardiac death caused by a blunt, non-penetrating blow to the precordium, typically from a projectile (baseball, lacrosse ball, hockey puck) striking the chest during the vulnerable phase of repolarization (the upslope...","sourceLabel":"Section in Sports Medicine"},"1420":{"title":"Overtraining Syndrome & RED-S","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s27","snippet":"Overtraining Syndrome & RED-S Overtraining Syndrome (OTS) Overtraining syndrome is a maladaptive response to excessive training without adequate recovery, resulting in persistent performance decline despite prolonged rest. It is a diagnosis of exclusion. Distinguish from: functional overreaching (sh...","sourceLabel":"Section in Sports Medicine"},"1421":{"title":"Anti-Doping & PRP/Regenerative Medicine","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s28","snippet":"Anti-Doping & PRP/Regenerative Medicine World Anti-Doping Agency (WADA) Prohibited List The WADA Code governs anti-doping in all Olympic sports and most professional leagues worldwide. The WADA Prohibited List is updated annually (effective January 1 each year) and includes: Category Substances/Meth...","sourceLabel":"Section in Sports Medicine"},"1422":{"title":"Joint & Bursa Injections","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s29","snippet":"Joint & Bursa Injections General Principles Joint and soft tissue injections are among the most common procedures in sports medicine. Indications include diagnostic (confirm pain generator via anesthetic block) and therapeutic (pain relief, anti-inflammatory). Contraindications: overlying skin infec...","sourceLabel":"Section in Sports Medicine"},"1423":{"title":"PRP & Musculoskeletal Ultrasound","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s30","snippet":"PRP & Musculoskeletal Ultrasound PRP Injection Technique Preparation: draw 15-60 mL whole blood into ACD-A or sodium citrate tubes; centrifuge (single spin: 1,500 rpm for 5-10 min to separate RBCs from platelet-rich plasma; double spin: additional centrifugation to concentrate platelets further). Yi...","sourceLabel":"Section in Sports Medicine"},"1424":{"title":"Arthrocentesis & Fracture/Dislocation Reduction","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s31","snippet":"Arthrocentesis & Fracture/Dislocation Reduction Arthrocentesis Arthrocentesis (joint aspiration) is performed for diagnostic and/or therapeutic purposes. Indications: suspected septic arthritis (emergency), crystal arthropathy, hemarthrosis, tense effusion causing pain/immobility. Analysis of aspira...","sourceLabel":"Section in Sports Medicine"},"1425":{"title":"Taping, Bracing & Rehabilitation Principles","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s32","snippet":"Taping, Bracing & Rehabilitation Principles Taping & Bracing Application Type Purpose Ankle prophylactic taping Stirrup and figure-of-8 with athletic tape Prevent lateral ankle sprain recurrence; most effective in athletes with prior ankle sprain Ankle brace (lace-up or semi-rigid) Active Ankle, ASO...","sourceLabel":"Section in Sports Medicine"},"1426":{"title":"Imaging & Diagnostics","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s33","snippet":"Imaging & Diagnostics Figure 34 - ISAKOS Meniscal Tear Classification. The International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification system incorporating rim width, tear pattern, and centrality relative to the popliteal hiatus to guide management deci...","sourceLabel":"Section in Sports Medicine"},"1427":{"title":"Classification Systems (All)","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s34","snippet":"Classification Systems (All) Ligament Sprain Grading (Universal) Grade Description Laxity Function Grade I Microscopic fiber disruption; ligament intact No laxity Minimal functional loss Grade II Partial macroscopic tear Increased laxity with firm endpoint Moderate functional loss Grade III Complete...","sourceLabel":"Section in Sports Medicine"},"1428":{"title":"Medications Master Table","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s35","snippet":"Medications Master Table NSAIDs Drug Dose Route Key Notes WADA Status Ibuprofen 200-800 mg q6-8h (max 3200 mg/day) PO OTC; GI side effects; renal risk Permitted Naproxen 250-500 mg q12h (max 1250 mg/day) PO Longer half-life; CV safety profile may be best among NSAIDs Permitted Meloxicam 7.5-15 mg da...","sourceLabel":"Section in Sports Medicine"},"1429":{"title":"Abbreviations Master List","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s36","snippet":"Abbreviations Master List Abbreviation Full Term ACL Anterior Cruciate Ligament AITFL Anterior Inferior Tibiofibular Ligament AKI Acute Kidney Injury AM / PL Anteromedial / Posterolateral (ACL bundles) ARVC Arrhythmogenic Right Ventricular Cardiomyopathy ATFL Anterior Talofibular Ligament BMAC Bone ...","sourceLabel":"Section in Sports Medicine"},"1430":{"title":"Risk Factors & Injury Prevention","pageTitle":"Sports Medicine","pageUrl":"/medical/sports-medicine","url":"/medical/sports-medicine#s37","snippet":"Risk Factors & Injury Prevention Modifiable Risk Factors for Sports Injury Risk Factor Injuries Associated Intervention Inadequate warm-up Muscle strains, ligament sprains Dynamic warm-up (10-15 min): jogging, high knees, butt kicks, lunges, sport-specific movements Muscle weakness/imbalance ACL tea...","sourceLabel":"Section in Sports Medicine"},"1431":{"title":"PM&R","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr","snippet":"Specialty Reference Physical Medicine & Rehabilitation (PM&R) Complete Specialty Reference Every diagnosis, classification system, electrodiagnostic finding, functional assessment, rehabilitation protocol, procedure, device, medication, and management strategy in one place."},"1432":{"title":"Neuroanatomy for Rehabilitation","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s1","snippet":"Neuroanatomy for Rehabilitation A thorough understanding of motor and sensory neuroanatomy is the foundation of PM&R practice. Localizing lesions to upper motor neuron (UMN) versus lower motor neuron (LMN) pathways, understanding dermatomes and myotomes, and recognizing spinal cord tract organizatio...","sourceLabel":"Section in PM&R"},"1433":{"title":"Musculoskeletal Anatomy Essentials","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s2","snippet":"Musculoskeletal Anatomy Essentials PM&R physicians must understand musculoskeletal anatomy as it relates to functional impairment, biomechanics, and rehabilitation planning. Key areas include the shoulder complex, spine, hip, knee, and hand/wrist - the most common sites of musculoskeletal complaints...","sourceLabel":"Section in PM&R"},"1434":{"title":"The PM&R Evaluation & ICF Model","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s3","snippet":"The PM&R Evaluation & ICF Model The PM&R evaluation is unique among medical specialties in its focus on function rather than solely on disease. The International Classification of Functioning, Disability, and Health (ICF) , adopted by the World Health Organization in 2001, provides the conceptual fr...","sourceLabel":"Section in PM&R"},"1435":{"title":"Key Terminology & Abbreviations","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s4","snippet":"Key Terminology & Abbreviations Core PM&R Terminology Term Definition Spasticity Velocity-dependent increase in tonic stretch reflexes (UMN pattern); distinct from rigidity (velocity-independent) Contracture Fixed shortening of muscle, tendon, or joint capsule causing loss of ROM Heterotopic Ossific...","sourceLabel":"Section in PM&R"},"1436":{"title":"Stroke Syndromes & Deficits","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s5","snippet":"Stroke Syndromes & Deficits Stroke is the leading cause of adult disability and the most common diagnosis in inpatient rehabilitation facilities. Recognizing the vascular territory involved predicts the pattern of deficits and guides rehabilitation planning. Each stroke syndrome produces a character...","sourceLabel":"Section in PM&R"},"1437":{"title":"Acute Stroke Rehab & Motor Recovery","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s6","snippet":"Acute Stroke Rehab & Motor Recovery Acute Rehabilitation Criteria Stroke patients are candidates for inpatient rehabilitation facility (IRF) admission when they are medically stable, can tolerate at least 3 hours/day of multidisciplinary therapy (PT, OT, and often SLP), have identifiable functional ...","sourceLabel":"Section in PM&R"},"1438":{"title":"Spasticity Management","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s7","snippet":"Spasticity Management Spasticity is defined as a velocity-dependent increase in tonic stretch reflexes resulting from UMN lesion, manifesting as increased resistance to passive stretch. It is one of the most common and functionally limiting sequelae of stroke, SCI, TBI, MS, and cerebral palsy. Spast...","sourceLabel":"Section in PM&R"},"1439":{"title":"Dysphagia, Aphasia & Neglect","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s8","snippet":"Dysphagia, Aphasia & Neglect Dysphagia Assessment Dysphagia occurs in 37-78% of acute stroke patients and is a major risk factor for aspiration pneumonia, malnutrition, and dehydration. Bedside assessment includes the water swallow test, oral motor exam, and cough/voice quality evaluation. Instrumen...","sourceLabel":"Section in PM&R"},"1440":{"title":"ASIA/ISNCSCI Classification","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s9","snippet":"ASIA/ISNCSCI Classification The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) , developed by the American Spinal Injury Association (ASIA), is the universal standard for classifying SCI severity. It determines the neurological level of injury and the complet...","sourceLabel":"Section in PM&R"},"1441":{"title":"Incomplete SCI Syndromes","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s10","snippet":"Incomplete SCI Syndromes Incomplete SCI syndromes result from partial spinal cord damage affecting specific tracts while sparing others. Each produces a characteristic pattern of motor and sensory deficits based on the anatomy of the affected region of the spinal cord cross-section. Figure 11 - Cent...","sourceLabel":"Section in PM&R"},"1442":{"title":"Autonomic Dysreflexia & Cardiovascular","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s11","snippet":"Autonomic Dysreflexia & Cardiovascular EMERGENCY - Autonomic Dysreflexia Autonomic dysreflexia (AD) is a potentially life-threatening medical emergency occurring in patients with SCI at T6 or above. A noxious stimulus below the level of injury triggers an uninhibited sympathetic response, causing se...","sourceLabel":"Section in PM&R"},"1443":{"title":"Neurogenic Bladder, Bowel & Skin","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s12","snippet":"Neurogenic Bladder, Bowel & Skin Neurogenic Bladder Feature UMN (Spastic/Reflex) Bladder LMN (Areflexic/Flaccid) Bladder Lesion level Above conus medullaris (suprasacral) At or below conus/cauda equina Detrusor function Overactive (spastic, involuntary contractions) Acontractile (no reflex contracti...","sourceLabel":"Section in PM&R"},"1444":{"title":"SCI Complications","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s13","snippet":"SCI Complications Figure 15 - Secondary Injury Cascade in SCI. Overview of the secondary injury processes following traumatic spinal cord injury, including vascular disruption, inflammatory cell infiltration, excitotoxicity, oxidative stress, and apoptosis. Understanding these mechanisms is critical...","sourceLabel":"Section in PM&R"},"1445":{"title":"TBI Classification & GCS","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s14","snippet":"TBI Classification & GCS Traumatic brain injury (TBI) is a leading cause of death and disability worldwide, with approximately 2.87 million emergency department visits, hospitalizations, and deaths annually in the US. Classification is based on severity (GCS), mechanism (penetrating vs closed), path...","sourceLabel":"Section in PM&R"},"1446":{"title":"Rancho Los Amigos Scale & Recovery","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s15","snippet":"Rancho Los Amigos Scale & Recovery Rancho Los Amigos Levels of Cognitive Functioning (Revised Scale, Levels I-X) Level Description Behavioral Characteristics Rehab Approach I No Response Complete absence of observable change in behavior to any stimuli Sensory stimulation program; prevent complicatio...","sourceLabel":"Section in PM&R"},"1447":{"title":"TBI Complications & Management","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s16","snippet":"TBI Complications & Management Post-Traumatic Seizures Seizures after TBI are classified by timing: immediate (<24 hours - impact seizures), early (1-7 days), and late (>7 days - post-traumatic epilepsy). Risk factors for late seizures: penetrating injury, intracranial hemorrhage, depressed skull fr...","sourceLabel":"Section in PM&R"},"1448":{"title":"Concussion & Return to Activity","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s17","snippet":"Concussion & Return to Activity Sport-Related Concussion (mTBI) Concussion is a mild TBI (GCS 13-15) caused by biomechanical forces. It is a functional rather than structural injury - standard neuroimaging is typically normal. Diagnosis is clinical. Core features: headache (most common symptom), diz...","sourceLabel":"Section in PM&R"},"1449":{"title":"Low Back Pain & Spinal Disorders","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s18","snippet":"Low Back Pain & Spinal Disorders Red Flags for Low Back Pain RED FLAGS - Low Back Pain Requiring Urgent Evaluation Cauda equina syndrome: saddle anesthesia, urinary retention/incontinence, fecal incontinence, bilateral LE weakness Cancer: history of cancer, unexplained weight loss, age >50 with new-...","sourceLabel":"Section in PM&R"},"1450":{"title":"Peripheral Nerve Injuries","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s19","snippet":"Peripheral Nerve Injuries Seddon Classification Type Pathology Motor/Sensory Loss EMG Findings Recovery Neurapraxia Focal myelin damage; axon intact; no Wallerian degeneration Conduction block at lesion site; motor/sensory loss distal to lesion Conduction block on NCS; no denervation potentials on E...","sourceLabel":"Section in PM&R"},"1451":{"title":"Upper Extremity Rehabilitation","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s20","snippet":"Upper Extremity Rehabilitation Figure 18 - Carpal Tunnel Pathophysiology. Illustration of the carpal tunnel cross-sectional anatomy showing compression of the median nerve within the osteofibrous canal bounded by the carpal bones and the transverse carpal ligament (flexor retinaculum). The nine flex...","sourceLabel":"Section in PM&R"},"1452":{"title":"Lower Extremity & Joint Replacement Rehab","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s21","snippet":"Lower Extremity & Joint Replacement Rehab Total Hip Arthroplasty (THA) Rehabilitation The surgical approach determines post-operative precautions: Approach Precautions Duration Posterior (most common) No hip flexion >90&deg;, no adduction past midline, no internal rotation (avoid combined flexion + ...","sourceLabel":"Section in PM&R"},"1453":{"title":"Tendinopathy & Myofascial Pain","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s22","snippet":"Tendinopathy & Myofascial Pain Tendinopathy Modern understanding favors the term tendinopathy over \"tendinitis\" because histopathology typically shows degenerative changes (collagen disorganization, ground substance mucoid degeneration, neovascularization) rather than inflammatory infiltrate. Common...","sourceLabel":"Section in PM&R"},"1454":{"title":"Nerve Conduction Studies","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s23","snippet":"Nerve Conduction Studies Nerve conduction studies (NCS) are the objective, quantitative component of the electrodiagnostic evaluation. They assess the integrity and function of peripheral nerves by applying electrical stimulation and recording the evoked responses. NCS evaluate both motor and sensor...","sourceLabel":"Section in PM&R"},"1455":{"title":"Needle EMG","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s24","snippet":"Needle EMG Needle electromyography (EMG) assesses the electrical activity of muscle fibers and motor units by inserting a needle electrode into the muscle. It provides information about denervation, reinnervation, myopathy, and motor unit morphology that NCS alone cannot provide. Insertional Activit...","sourceLabel":"Section in PM&R"},"1456":{"title":"Electrodiagnostic Patterns by Condition","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s25","snippet":"Electrodiagnostic Patterns by Condition Characteristic EDX Patterns Condition NCS Findings EMG Findings Carpal Tunnel Syndrome (CTS) Prolonged median sensory distal latency (most sensitive); prolonged median motor distal latency; normal ulnar NCS; normal median SNAP amplitude (early) or reduced (sev...","sourceLabel":"Section in PM&R"},"1457":{"title":"Cerebral Palsy & GMFCS","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s26","snippet":"Cerebral Palsy & GMFCS Cerebral palsy (CP) is a group of permanent disorders of movement and posture causing activity limitation, attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. It is the most common cause of childhood physical disability, affecting ...","sourceLabel":"Section in PM&R"},"1458":{"title":"Spina Bifida & Brachial Plexus Injury","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s27","snippet":"Spina Bifida & Brachial Plexus Injury Spina Bifida (Myelomeningocele) Myelomeningocele is the most severe form of spina bifida, involving herniation of the spinal cord and meninges through a vertebral defect. It is the most common neural tube defect compatible with life. Associated conditions: Arnol...","sourceLabel":"Section in PM&R"},"1459":{"title":"Muscular Dystrophies & Developmental Milestones","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s28","snippet":"Muscular Dystrophies & Developmental Milestones Figure 20 - Gowers Sign in Duchenne Muscular Dystrophy. The classic Gowers sign: a young boy uses his hands to push off the floor and then progressively climbs up his legs to achieve standing, compensating for proximal lower extremity weakness. This ma...","sourceLabel":"Section in PM&R"},"1460":{"title":"Amputation Levels & Pre-Prosthetic Management","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s29","snippet":"Amputation Levels & Pre-Prosthetic Management Lower Extremity Amputation Levels Level Description Prosthetic Considerations Energy Cost of Ambulation Toe / Ray Partial digit or metatarsal ray amputation Shoe filler; toe prosthesis Minimal increase Transmetatarsal (TMA) Through metatarsal shafts Rigi...","sourceLabel":"Section in PM&R"},"1461":{"title":"Prosthetic Components & Prescription","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s30","snippet":"Prosthetic Components & Prescription Transtibial Prosthetic Components Socket: Patellar-tendon-bearing (PTB) - primary weight bearing on patellar tendon, medial tibial flare, anterior tibia protected; Total surface bearing (TSB) - distributes pressure over the entire residual limb using gel liner (m...","sourceLabel":"Section in PM&R"},"1462":{"title":"Gait Deviations & K-Levels","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s31","snippet":"Gait Deviations & K-Levels Common Prosthetic Gait Deviations Deviation Prosthetic Cause Patient/Residual Limb Cause Lateral trunk lean Prosthesis too short; wide ML socket Weak hip abductors (Trendelenburg); short residual limb; hip pain Circumduction Prosthesis too long; excessive knee friction; in...","sourceLabel":"Section in PM&R"},"1463":{"title":"Spasticity Injections & Neurolysis","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s32","snippet":"Spasticity Injections & Neurolysis Botulinum Toxin Injection - Dosing by Muscle OnabotulinumtoxinA (Botox) dosing guidelines for common spasticity targets (doses are for onabotulinumtoxinA; conversion: 1 U Botox &asymp; 3-5 U Dysport &asymp; 1 U Xeomin): Muscle Dose Range (Units) Injection Sites Fun...","sourceLabel":"Section in PM&R"},"1464":{"title":"Intrathecal Baclofen & Guided Procedures","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s33","snippet":"Intrathecal Baclofen & Guided Procedures Intrathecal Baclofen Pump The ITB pump system consists of a programmable titanium pump (implanted subcutaneously in the abdominal wall) and an intrathecal catheter threaded into the spinal subarachnoid space (tip typically at T10-T12 for LE spasticity, C5-C7 ...","sourceLabel":"Section in PM&R"},"1465":{"title":"Therapeutic Modalities","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s34","snippet":"Therapeutic Modalities Thermal Modalities Modality Mechanism Indications Contraindications Superficial Heat (hot packs, paraffin, fluidotherapy) Conduction/convection heating; penetrates 1-2 cm; increases blood flow, extensibility, pain threshold Muscle spasm, pain, joint stiffness, before stretchin...","sourceLabel":"Section in PM&R"},"1466":{"title":"Orthotic Prescribing","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s35","snippet":"Orthotic Prescribing Figure 29 - Types of Plastic Ankle-Foot Orthoses. Common plastic AFO designs: (A) Solid ankle-foot orthosis for severe foot drop with spasticity; (B) Posterior leaf spring orthosis for pure foot drop without spasticity; (C) Hinged (articulated) ankle-foot orthosis allowing contr...","sourceLabel":"Section in PM&R"},"1467":{"title":"Wheelchair Prescription & Seating","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s36","snippet":"Wheelchair Prescription & Seating Manual vs Power Wheelchair Feature Manual Wheelchair Power Wheelchair Best for Adequate UE strength and endurance; paraplegic SCI (T1+); good cardiopulmonary fitness Tetraplegia (C4-C6); progressive neuromuscular disease; severe deconditioning; limited UE function A...","sourceLabel":"Section in PM&R"},"1468":{"title":"Functional Outcome Measures","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s37","snippet":"Functional Outcome Measures Functional Independence Measure (FIM) The FIM is the most widely used functional assessment in rehabilitation, measuring the burden of care across 18 items in 6 domains. Each item is scored 1-7; total score ranges from 18 (complete dependence) to 126 (complete independenc...","sourceLabel":"Section in PM&R"},"1469":{"title":"Classification Systems (All)","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s38","snippet":"Classification Systems (All) This section consolidates all major classification systems used in PM&R practice for rapid reference. Each is fully enumerated with all grades/levels. ASIA Impairment Scale (AIS) Grade Type Definition A Complete No sensory or motor function in S4-S5 B Sensory Incomplete ...","sourceLabel":"Section in PM&R"},"1470":{"title":"Medications Master Table","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s39","snippet":"Medications Master Table Antispasticity Agents Medication Mechanism Dosing Key Side Effects Monitoring Baclofen (oral) GABA-B agonist (spinal) 5 mg TID &rarr; max 80-120 mg/day Sedation, weakness, dizziness; withdrawal seizures (must taper) Taper gradually; never abrupt discontinuation Tizanidine Al...","sourceLabel":"Section in PM&R"},"1471":{"title":"Abbreviations Master List","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s40","snippet":"Abbreviations Master List Abbreviation Full Term AD Autonomic Dysreflexia ADL Activities of Daily Living AFO Ankle-Foot Orthosis AIS ASIA Impairment Scale AKA Above-Knee Amputation (Transfemoral) ASIA American Spinal Injury Association BBS Berg Balance Scale BKA Below-Knee Amputation (Transtibial) C...","sourceLabel":"Section in PM&R"},"1472":{"title":"Risk Factors & Comorbidities","pageTitle":"PM&R","pageUrl":"/medical/pmr","url":"/medical/pmr#s41","snippet":"Risk Factors & Comorbidities Comorbidities Affecting Rehabilitation Outcomes Comorbidity Impact on Rehabilitation Management Considerations Diabetes Mellitus Impaired wound healing, increased infection risk, neuropathy (reduced balance/sensation), retinopathy (impaired vision), nephropathy, increase...","sourceLabel":"Section in PM&R"},"1473":{"title":"Medical Genetics","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics","snippet":"Specialty Reference Medical Genetics Complete Specialty Reference Every genetic syndrome, inheritance pattern, chromosomal disorder, inborn error of metabolism, cancer predisposition syndrome, genetic test, prenatal screening modality, classification system, and therapeutic strategy in one place."},"1474":{"title":"Molecular Genetics Essentials","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s1","snippet":"Molecular Genetics Essentials Medical genetics is the branch of medicine dealing with the diagnosis and management of hereditary disorders. A firm understanding of molecular biology - from DNA structure through protein synthesis - is the foundation upon which all clinical genetics rests. The human g...","sourceLabel":"Section in Medical Genetics"},"1475":{"title":"Chromosome Structure & Karyotype Notation","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s2","snippet":"Chromosome Structure & Karyotype Notation Humans have 46 chromosomes: 22 pairs of autosomes (numbered 1-22 by size) and one pair of sex chromosomes (XX in females, XY in males). Each chromosome consists of a single, continuous DNA molecule wrapped around histone proteins forming nucleosomes, which f...","sourceLabel":"Section in Medical Genetics"},"1476":{"title":"Inheritance Patterns","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s3","snippet":"Inheritance Patterns Understanding the patterns by which genetic traits are transmitted through families is essential for genetic counseling, risk assessment, and family planning. The major Mendelian and non-Mendelian patterns are described below. Autosomal Dominant (AD) Only one mutant allele neede...","sourceLabel":"Section in Medical Genetics"},"1477":{"title":"Genetic Variation & Epigenetics","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s4","snippet":"Genetic Variation & Epigenetics Types of Genetic Variation Variant Type Definition Clinical Significance SNP (single nucleotide polymorphism) Single base change present in &ge;1% of population Pharmacogenomics, GWAS risk loci SNV (single nucleotide variant) Single base change at any frequency May be...","sourceLabel":"Section in Medical Genetics"},"1478":{"title":"Key Terminology & Abbreviations","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s5","snippet":"Key Terminology & Abbreviations Term Definition Allele One of two or more versions of a gene at a given locus Penetrance Proportion of individuals with a pathogenic variant who manifest disease; complete = 100%, reduced <100% Expressivity Variation in clinical features among individuals with the sam...","sourceLabel":"Section in Medical Genetics"},"1479":{"title":"Autosomal Trisomies (21, 18, 13)","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s6","snippet":"Autosomal Trisomies (21, 18, 13) Down Syndrome (Trisomy 21) The most common autosomal aneuploidy compatible with long-term survival, affecting ~1 in 700 live births. Three cytogenetic types: Type Frequency Karyotype Recurrence Risk Free trisomy 21 ~95% 47,XX,+21 or 47,XY,+21 ~1% or maternal age-rela...","sourceLabel":"Section in Medical Genetics"},"1480":{"title":"Sex Chromosome Disorders","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s7","snippet":"Sex Chromosome Disorders Turner Syndrome (45,X) Occurs in ~1 in 2,000-2,500 live female births. Most common sex chromosome abnormality in females. ~99% of 45,X conceptions result in spontaneous abortion (most common chromosomal cause of first-trimester miscarriage). Approximately 50% have 45,X; othe...","sourceLabel":"Section in Medical Genetics"},"1481":{"title":"Microdeletion & Microduplication Syndromes","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s8","snippet":"Microdeletion & Microduplication Syndromes Microdeletion syndromes result from submicroscopic chromosomal deletions (typically 1-5 Mb) detectable by FISH or chromosomal microarray but often below the resolution of standard G-banded karyotype (~5-10 Mb). Most occur de novo. Syndrome Locus Key Feature...","sourceLabel":"Section in Medical Genetics"},"1482":{"title":"Connective Tissue Disorders (Marfan, EDS)","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s9","snippet":"Connective Tissue Disorders (Marfan, EDS) Marfan Syndrome Autosomal dominant disorder of connective tissue caused by mutations in FBN1 (fibrillin-1) on chromosome 15q21.1. Prevalence ~1 in 5,000. ~25% de novo mutations. Fibrillin-1 is a major component of extracellular microfibrils; its deficiency l...","sourceLabel":"Section in Medical Genetics"},"1483":{"title":"Neurocutaneous Syndromes (NF, TSC)","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s10","snippet":"Neurocutaneous Syndromes (NF, TSC) Neurofibromatosis Type 1 (NF1) Autosomal dominant, caused by mutations in the NF1 gene (17q11.2) encoding neurofibromin, a RAS-GAP (tumor suppressor). Prevalence ~1 in 3,000. ~50% de novo. Complete penetrance by age 5 but highly variable expressivity. NIH Diagnosti...","sourceLabel":"Section in Medical Genetics"},"1484":{"title":"Trinucleotide Repeat & Other AD Disorders","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s11","snippet":"Trinucleotide Repeat & Other AD Disorders Huntington Disease Autosomal dominant neurodegenerative disorder caused by CAG trinucleotide repeat expansion in HTT gene (4p16.3). The expanded polyglutamine tract causes toxic gain of function. Prevalence ~5-10 per 100,000 in European populations. CAG Repe...","sourceLabel":"Section in Medical Genetics"},"1485":{"title":"Cystic Fibrosis","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s12","snippet":"Cystic Fibrosis Autosomal recessive disorder caused by mutations in the CFTR gene (7q31.2) encoding the cystic fibrosis transmembrane conductance regulator, a chloride/bicarbonate channel on epithelial cell surfaces. Most common life-shortening AR disorder in Caucasians (~1 in 2,500-3,500 births; ca...","sourceLabel":"Section in Medical Genetics"},"1486":{"title":"Sickle Cell Disease & Hemoglobinopathies","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s13","snippet":"Sickle Cell Disease & Hemoglobinopathies Sickle cell disease (SCD) is caused by a missense mutation in the HBB gene (11p15.4): Glu6Val (GAG &rarr; GTG) producing hemoglobin S (HbS). Autosomal recessive. Most common monogenic disorder worldwide; carrier frequency ~8-10% in African Americans. Figure 1...","sourceLabel":"Section in Medical Genetics"},"1487":{"title":"PKU, SMA & Other AR Disorders","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s14","snippet":"PKU, SMA & Other AR Disorders Phenylketonuria (PKU) Caused by mutations in PAH (phenylalanine hydroxylase) gene on 12q23.2. Inability to convert phenylalanine (Phe) to tyrosine &rarr; Phe accumulation causes intellectual disability if untreated. Newborn screening detects elevated Phe on dried blood ...","sourceLabel":"Section in Medical Genetics"},"1488":{"title":"Duchenne & Becker Muscular Dystrophy","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s15","snippet":"Duchenne & Becker Muscular Dystrophy X-linked recessive disorders caused by mutations in the DMD gene (Xp21.2), the largest known human gene (2.4 Mb, 79 exons), encoding dystrophin , a critical structural protein linking the cytoskeleton to the extracellular matrix in muscle fibers. Figure 18 - Dyst...","sourceLabel":"Section in Medical Genetics"},"1489":{"title":"Hemophilia, G6PD & Other X-Linked Disorders","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s16","snippet":"Hemophilia, G6PD & Other X-Linked Disorders Hemophilia A & B X-linked recessive bleeding disorders. Hemophilia A : deficiency of factor VIII (F8 gene, Xq28); ~1 in 5,000 males; ~50% due to intron 22 inversion. Hemophilia B (Christmas disease): deficiency of factor IX (F9 gene, Xq27.1); ~1 in 25,000 ...","sourceLabel":"Section in Medical Genetics"},"1490":{"title":"Fragile X & Trinucleotide X-Linked Disorders","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s17","snippet":"Fragile X & Trinucleotide X-Linked Disorders Fragile X Syndrome Most common inherited cause of intellectual disability and most common monogenic cause of autism spectrum disorder. Caused by CGG trinucleotide repeat expansion in the 5&prime; UTR of the FMR1 gene (Xq27.3), leading to promoter hypermet...","sourceLabel":"Section in Medical Genetics"},"1491":{"title":"Mitochondrial Disorders","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s18","snippet":"Mitochondrial Disorders Mitochondrial disorders can be caused by mutations in mitochondrial DNA (mtDNA) or nuclear DNA genes encoding mitochondrial proteins. mtDNA-encoded disorders follow maternal inheritance (mother transmits to all children; father cannot transmit). The clinical phenotype depends...","sourceLabel":"Section in Medical Genetics"},"1492":{"title":"Amino Acid & Organic Acid Disorders","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s19","snippet":"Amino Acid & Organic Acid Disorders Amino Acid Disorders Disorder Gene/Enzyme Key Features Treatment Phenylketonuria (PKU) PAH / phenylalanine hydroxylase Intellectual disability, fair skin/hair (reduced melanin), musty odor, eczema, seizures (if untreated) Low-Phe diet, sapropterin, pegvaliase Mapl...","sourceLabel":"Section in Medical Genetics"},"1493":{"title":"Urea Cycle Defects","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s20","snippet":"Urea Cycle Defects The urea cycle converts toxic ammonia (from protein catabolism) to urea for renal excretion. Six enzymes are involved; deficiency of any leads to hyperammonemia . Overall incidence ~1 in 30,000. OTC deficiency (ornithine transcarbamylase, X-linked) is the most common (~1 in 14,000...","sourceLabel":"Section in Medical Genetics"},"1494":{"title":"Fatty Acid Oxidation Disorders","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s21","snippet":"Fatty Acid Oxidation Disorders Mitochondrial fatty acid oxidation (FAO) provides energy during fasting and prolonged exercise by converting fatty acids to acetyl-CoA for ketone body production. FAO disorders present with hypoketotic hypoglycemia (the hallmark - inability to generate ketones during f...","sourceLabel":"Section in Medical Genetics"},"1495":{"title":"Lysosomal Storage Diseases","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s22","snippet":"Lysosomal Storage Diseases Lysosomes are membrane-bound organelles containing acid hydrolases that degrade macromolecules. Deficiency of specific lysosomal enzymes leads to substrate accumulation and progressive cellular dysfunction. Most are autosomal recessive (exceptions: Fabry and Hunter - X-lin...","sourceLabel":"Section in Medical Genetics"},"1496":{"title":"Glycogen Storage Diseases","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s23","snippet":"Glycogen Storage Diseases Glycogen storage diseases (GSD) result from defects in glycogen synthesis, degradation, or regulation. Most are autosomal recessive. Classification is by the affected enzyme. Figure 26 - Glycogen Metabolism and Sites of Enzymatic Defects. The cascade of glycogen breakdown b...","sourceLabel":"Section in Medical Genetics"},"1497":{"title":"Peroxisomal Disorders & Newborn Screening","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s24","snippet":"Peroxisomal Disorders & Newborn Screening Peroxisomal Disorders Peroxisomes are organelles involved in very long-chain fatty acid (VLCFA) &beta;-oxidation, bile acid synthesis, plasmalogen biosynthesis, and reactive oxygen species metabolism. Zellweger spectrum disorders (ZSD) : peroxisome biogenesi...","sourceLabel":"Section in Medical Genetics"},"1498":{"title":"Hereditary Breast & Ovarian Cancer","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s25","snippet":"Hereditary Breast & Ovarian Cancer BRCA1 (17q21) and BRCA2 (13q13) encode proteins essential for homologous recombination DNA repair. Autosomal dominant with high penetrance. BRCA1: lifetime breast cancer risk ~55-72%, ovarian cancer ~39-44%. BRCA2: lifetime breast cancer risk ~45-69%, ovarian cance...","sourceLabel":"Section in Medical Genetics"},"1499":{"title":"Lynch Syndrome & GI Cancer Genetics","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s26","snippet":"Lynch Syndrome & GI Cancer Genetics Lynch Syndrome (Hereditary Nonpolyposis Colorectal Cancer - HNPCC) Autosomal dominant; caused by germline mutations in DNA mismatch repair (MMR) genes: MLH1 (most common), MSH2 , MSH6 , PMS2 , or EPCAM (deletions silencing MSH2). Most common hereditary colorectal ...","sourceLabel":"Section in Medical Genetics"},"1500":{"title":"MEN Syndromes, VHL & Other Cancer Predisposition","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s27","snippet":"MEN Syndromes, VHL & Other Cancer Predisposition Multiple Endocrine Neoplasia (MEN) Syndromes Syndrome Gene Inheritance Components MEN1 (Wermer syndrome) MEN1 (menin, tumor suppressor) AD 3 P's : (1) Parathyroid adenomas (~90%, primary hyperparathyroidism - usually first manifestation); (2) Pancreat...","sourceLabel":"Section in Medical Genetics"},"1501":{"title":"Tumor Suppressor Genes vs Oncogenes","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s28","snippet":"Tumor Suppressor Genes vs Oncogenes Understanding the two major classes of cancer genes is fundamental to cancer genetics. Feature Tumor Suppressor Genes Oncogenes Normal function Inhibit cell growth, promote apoptosis, repair DNA (\"brakes\") Promote cell growth, proliferation, survival (\"accelerator...","sourceLabel":"Section in Medical Genetics"},"1502":{"title":"Carrier Screening & Prenatal Screening","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s29","snippet":"Carrier Screening & Prenatal Screening Carrier Screening ACOG recommends offering carrier screening to all pregnant individuals (or those planning pregnancy). Two approaches: Ethnicity-based screening (traditional): targeted to high-prevalence conditions in specific populations - CF (all), SCD/hemog...","sourceLabel":"Section in Medical Genetics"},"1503":{"title":"Prenatal Diagnostic Testing & PGT","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s30","snippet":"Prenatal Diagnostic Testing & PGT Invasive Prenatal Diagnostic Tests Feature Chorionic Villus Sampling (CVS) Amniocentesis Timing 10-13 weeks 15-20 weeks (typically 16-18) Specimen Placental trophoblast (chorionic villi) Amniotic fluid (fetal cells - desquamated skin, urinary tract, respiratory epit...","sourceLabel":"Section in Medical Genetics"},"1504":{"title":"Teratology & Genetic Counseling","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s31","snippet":"Teratology & Genetic Counseling Teratology A teratogen is any agent that causes structural or functional abnormalities in the developing embryo/fetus. The effect depends on: timing of exposure (critical period), dose, genetic susceptibility, and the specific agent. Critical periods : weeks 3-8 of ge...","sourceLabel":"Section in Medical Genetics"},"1505":{"title":"Cytogenetic & Molecular Cytogenetic Testing","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s32","snippet":"Cytogenetic & Molecular Cytogenetic Testing Conventional Karyotype (G-banding) Gold standard cytogenetic test. Cells are cultured (from blood, amniotic fluid, or tissue), arrested in metaphase with colchicine, stained with Giemsa to produce characteristic banding patterns. Resolution : ~5-10 Mb (can...","sourceLabel":"Section in Medical Genetics"},"1506":{"title":"Molecular Genetic Testing (Sequencing)","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s33","snippet":"Molecular Genetic Testing (Sequencing) Sanger Sequencing The original DNA sequencing method (chain termination). Reads one gene (or one exon) at a time. Resolution : single nucleotide. Used for: confirmatory testing, targeted testing of known familial variants, sequencing of small genes, and validat...","sourceLabel":"Section in Medical Genetics"},"1507":{"title":"Pharmacogenomics","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s34","snippet":"Pharmacogenomics Pharmacogenomics studies how genetic variation affects drug response, including efficacy and toxicity. Implementation of pharmacogenomic testing can optimize drug selection and dosing, reduce adverse drug reactions, and improve clinical outcomes. The Clinical Pharmacogenetics Implem...","sourceLabel":"Section in Medical Genetics"},"1508":{"title":"ACMG Variant Classification & Pedigree Symbols","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s35","snippet":"ACMG Variant Classification & Pedigree Symbols ACMG/AMP Variant Classification (2015 Standards and Guidelines) The American College of Medical Genetics and Genomics (ACMG) and Association for Molecular Pathology (AMP) established a five-tier classification system for sequence variants, using defined...","sourceLabel":"Section in Medical Genetics"},"1509":{"title":"Genetic Testing Algorithm by Clinical Scenario","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s36","snippet":"Genetic Testing Algorithm by Clinical Scenario TESTING ALGORITHM BY CLINICAL PRESENTATION Clinical Scenario First-Line Test Second-Line / Follow-Up Suspected aneuploidy (e.g., Down syndrome features) Karyotype (G-banding) FISH for rapid confirmation; CMA if mosaic suspected Unexplained intellectual ...","sourceLabel":"Section in Medical Genetics"},"1510":{"title":"Medications in Genetics","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s37","snippet":"Medications in Genetics Enzyme Replacement Therapy (ERT) Disease Drug Target/Enzyme Replaced Route / Key Notes Gaucher type I Imiglucerase (Cerezyme), velaglucerase alfa (VPRIV), taliglucerase alfa (Elelyso) Glucocerebrosidase IV every 2 weeks; dramatic improvement in visceral and hematologic diseas...","sourceLabel":"Section in Medical Genetics"},"1511":{"title":"Abbreviations Master List & Reference Tables","pageTitle":"Medical Genetics","pageUrl":"/medical/medical-genetics","url":"/medical/medical-genetics#s38","snippet":"Abbreviations Master List & Reference Tables Abbreviations Abbreviation Full Term ACMG American College of Medical Genetics and Genomics AD Autosomal dominant AFLP Acute fatty liver of pregnancy AMP Association for Molecular Pathology AR Autosomal recessive ASD Autism spectrum disorder (or atrial se...","sourceLabel":"Section in Medical Genetics"},"1512":{"title":"General Surgery","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery","snippet":"Specialty Reference General Surgery Complete Specialty Reference Every diagnosis, classification, procedure, technique, medication, complication, and management algorithm across the full scope of general surgery in one place."},"1513":{"title":"Surgical Anatomy — Abdominal Wall & Peritoneum","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s1","snippet":"Surgical Anatomy — Abdominal Wall & Peritoneum The abdominal wall is the barrier a surgeon must traverse for every open and laparoscopic procedure. Understanding its layers, neurovascular supply, and weak points (where hernias form) is foundational to general surgery practice. Layers of the Anterior...","sourceLabel":"Section in General Surgery"},"1514":{"title":"Surgical Anatomy — GI Tract, Biliary, & Hepatic","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s2","snippet":"Surgical Anatomy — GI Tract, Biliary, & Hepatic GI Tract Blood Supply Three major arteries from the aorta supply the GI tract. The celiac trunk (T12) supplies the foregut (distal esophagus to the second portion of the duodenum, plus liver, spleen, and pancreas) via three branches: left gastric arter...","sourceLabel":"Section in General Surgery"},"1515":{"title":"The Surgical Physical Exam","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s3","snippet":"The Surgical Physical Exam Abdominal Examination The surgical abdominal exam follows inspection → auscultation → percussion → palpation (auscultation before palpation/percussion to avoid stimulating bowel sounds). Inspection: distension, scars (prior surgery determines adhesion risk), visible perist...","sourceLabel":"Section in General Surgery"},"1516":{"title":"Surgical Principles — Wound Healing, Sutures, Hemostasis","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s4","snippet":"Surgical Principles — Wound Healing, Sutures, Hemostasis Phases of Wound Healing Phase Timing Key Events Clinical Significance Hemostasis Minutes Vasoconstriction, platelet plug, fibrin clot Immediate hemostasis; foundation for subsequent phases Inflammatory Days 1–5 Neutrophils (peak day 1–2), macr...","sourceLabel":"Section in General Surgery"},"1517":{"title":"Acute Appendicitis","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s5","snippet":"Acute Appendicitis The most common surgical emergency worldwide, with a lifetime risk of ~7–8%. Appendicitis results from luminal obstruction — fecalith (most common in adults), lymphoid hyperplasia (most common in children/young adults), neoplasm (consider in patients >40, especially if recurrent),...","sourceLabel":"Section in General Surgery"},"1518":{"title":"Acute Cholecystitis","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s6","snippet":"Acute Cholecystitis Inflammation of the gallbladder, most commonly (90–95%) from gallstone impaction in the cystic duct. The obstructed gallbladder distends, wall becomes edematous and ischemic, and secondary bacterial infection often follows. Left untreated, progresses to gangrenous cholecystitis, ...","sourceLabel":"Section in General Surgery"},"1519":{"title":"Small Bowel Obstruction","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s7","snippet":"Small Bowel Obstruction SBO accounts for ~15% of emergency surgical admissions. The bowel proximal to the obstruction dilates with gas and fluid, while the distal bowel decompresses. If the obstruction is not relieved, intraluminal pressure rises → venous congestion → arterial ischemia → necrosis → ...","sourceLabel":"Section in General Surgery"},"1520":{"title":"Large Bowel Obstruction & Volvulus","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s8","snippet":"Large Bowel Obstruction & Volvulus LBO is less common than SBO but is more often caused by malignancy (~60%), followed by volvulus (~15%), diverticular stricture (~10%), and other causes (fecal impaction, Ogilvie's syndrome). The ileocecal valve determines whether the obstruction is \"closed-loop\" — ...","sourceLabel":"Section in General Surgery"},"1521":{"title":"Perforated Viscus","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s9","snippet":"Perforated Viscus Perforation of a hollow viscus is a surgical emergency. Free air on imaging (upright CXR shows subdiaphragmatic air; CT is more sensitive) confirms the diagnosis. The peritoneal contamination triggers chemical peritonitis (gastric acid in peptic ulcer perforation) and then bacteria...","sourceLabel":"Section in General Surgery"},"1522":{"title":"Mesenteric Ischemia","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s10","snippet":"Mesenteric Ischemia Mesenteric ischemia is a vascular emergency with mortality rates of 60–80% if bowel infarction occurs. The hallmark is \"pain out of proportion to exam\" — severe periumbilical pain with a relatively soft, non-tender abdomen early in the course. By the time peritoneal signs develop...","sourceLabel":"Section in General Surgery"},"1523":{"title":"Acute Pancreatitis","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s11","snippet":"Acute Pancreatitis Acute inflammation of the pancreas, most commonly from gallstones (40%) and alcohol (30%). Other causes: hypertriglyceridemia (>1000 mg/dL), post-ERCP, medications (azathioprine, valproic acid, didanosine), autoimmune, trauma, scorpion stings. Diagnosis requires 2 of 3 criteria: (...","sourceLabel":"Section in General Surgery"},"1524":{"title":"Gastrointestinal Hemorrhage","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s12","snippet":"Gastrointestinal Hemorrhage Upper GI Hemorrhage Defined as bleeding proximal to the ligament of Treitz. Presents with hematemesis (bright red or \"coffee ground\"), melena, or both. Most common causes: peptic ulcer disease (35–50%), esophageal/gastric varices (10–20%), Mallory-Weiss tear (5–10%), eros...","sourceLabel":"Section in General Surgery"},"1525":{"title":"Inguinal Hernia","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s13","snippet":"Inguinal Hernia Inguinal hernias account for ~75% of all abdominal wall hernias. Lifetime risk: 27% for men, 3% for women. They are classified as indirect (through the deep inguinal ring, lateral to the inferior epigastric vessels — congenital, from a patent processus vaginalis; most common type ove...","sourceLabel":"Section in General Surgery"},"1526":{"title":"Femoral Hernia","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s14","snippet":"Femoral Hernia Protrusion through the femoral canal , located below the inguinal ligament, medial to the femoral vein, lateral to the lacunar ligament. Accounts for only ~5% of groin hernias but carries the highest strangulation risk of any hernia (~30–40% present with incarceration/strangulation). ...","sourceLabel":"Section in General Surgery"},"1527":{"title":"Ventral & Incisional Hernia","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s15","snippet":"Ventral & Incisional Hernia Ventral hernias include umbilical, epigastric, and incisional hernias. Incisional hernias occur in 10–20% of midline laparotomy closures (higher with emergency surgery, wound infection, obesity, diabetes, malnutrition, immunosuppression, tobacco use). They tend to enlarge...","sourceLabel":"Section in General Surgery"},"1528":{"title":"Hiatal Hernia & Fundoplication","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s16","snippet":"Hiatal Hernia & Fundoplication Hiatal Hernia Classification Type Description Frequency Management I — Sliding GE junction migrates upward through the hiatus; the stomach remains in its normal axial alignment ~95% Medical GERD management; surgery (fundoplication) if refractory II — Paraesophageal (ro...","sourceLabel":"Section in General Surgery"},"1529":{"title":"Rare Hernias","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s17","snippet":"Rare Hernias Hernia Location / Definition Key Features Spigelian hernia Through the spigelian fascia (lateral border of the rectus sheath) at the arcuate line level Interparietal (between muscle layers) — often not palpable; high incarceration risk; diagnosed by CT or US; laparoscopic repair preferr...","sourceLabel":"Section in General Surgery"},"1530":{"title":"Cholelithiasis & Biliary Disease","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s18","snippet":"Cholelithiasis & Biliary Disease Gallstones are present in 10–15% of the US population; most (80%) are asymptomatic. Cholesterol stones (80%) form from supersaturated bile (excess cholesterol, decreased bile salts, gallbladder hypomotility). Pigment stones (20%) — black pigment stones (chronic hemol...","sourceLabel":"Section in General Surgery"},"1531":{"title":"Hepatocellular Carcinoma","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s19","snippet":"Hepatocellular Carcinoma HCC is the most common primary liver malignancy worldwide. Major risk factors: chronic hepatitis B (even without cirrhosis — the virus is directly oncogenic), chronic hepatitis C, cirrhosis of any etiology (alcohol, NASH/MAFLD, autoimmune), aflatoxin B1 exposure (Aspergillus...","sourceLabel":"Section in General Surgery"},"1532":{"title":"Liver Metastases","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s20","snippet":"Liver Metastases The liver is the most common site of distant metastases from GI malignancies due to portal venous drainage. Colorectal liver metastases (CRLM) are the most important surgical indication — up to 25% of CRC patients have synchronous liver metastases at diagnosis, and another 25% devel...","sourceLabel":"Section in General Surgery"},"1533":{"title":"Pancreatic Cancer","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s21","snippet":"Pancreatic Cancer Pancreatic ductal adenocarcinoma (PDAC) is the third-leading cause of cancer death in the US with a 5-year survival of ~12%. Approximately 80% present with locally advanced or metastatic disease. Risk factors: smoking (2× risk), chronic pancreatitis, family history (BRCA2, PALB2, L...","sourceLabel":"Section in General Surgery"},"1534":{"title":"Pancreatic Cysts & IPMN","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s22","snippet":"Pancreatic Cysts & IPMN Pancreatic cysts are found incidentally in 2–15% of abdominal imaging studies. The critical question is always: does this cyst harbor or risk developing malignancy? Cyst Type Demographics Location Fluid Analysis Malignant Potential Management Serous cystadenoma (SCA) Women, 6...","sourceLabel":"Section in General Surgery"},"1535":{"title":"Colorectal Cancer","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s23","snippet":"Colorectal Cancer Third most common cancer and second leading cause of cancer death in the US. The adenoma-carcinoma sequence (APC → KRAS → p53) accounts for ~70% of CRC; the microsatellite instability (MSI-H / Lynch syndrome) pathway accounts for ~15%. Screening: colonoscopy every 10 years beginnin...","sourceLabel":"Section in General Surgery"},"1536":{"title":"Diverticular Disease","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s24","snippet":"Diverticular Disease Colonic diverticula are acquired pseudodiverticula (mucosa and submucosa herniating through the muscular wall at points of penetration of the vasa recta). Most common in the sigmoid colon (highest intraluminal pressure due to smallest diameter — Laplace's law). Prevalence increa...","sourceLabel":"Section in General Surgery"},"1537":{"title":"Inflammatory Bowel Disease — Surgical Management","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s25","snippet":"Inflammatory Bowel Disease — Surgical Management Crohn's Disease Transmural, skip-lesion inflammation that can affect any part of the GI tract (most commonly the terminal ileum and colon). Surgical indications: failure of medical therapy, stricture causing obstruction, abscess, fistula (enteroenteri...","sourceLabel":"Section in General Surgery"},"1538":{"title":"Anorectal Disease","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s26","snippet":"Anorectal Disease Hemorrhoids Internal hemorrhoids arise above the dentate line (visceral innervation — painless unless thrombosed/strangulated); graded I (bleeding only), II (prolapse with spontaneous reduction), III (prolapse requiring manual reduction), IV (irreducible). Treatment: Grade I–II → d...","sourceLabel":"Section in General Surgery"},"1539":{"title":"Breast Cancer","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s27","snippet":"Breast Cancer Breast cancer is the most common cancer in women (excluding skin cancer) and the second leading cause of cancer death in women. Lifetime risk: ~13% (1 in 8 women). Screening mammography (annual or biennial beginning at age 40–50, depending on guidelines) reduces breast cancer mortality...","sourceLabel":"Section in General Surgery"},"1540":{"title":"Benign Breast Disease","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s28","snippet":"Benign Breast Disease Condition Age/Demographics Features Cancer Risk Management Fibroadenoma 15–35 years Firm, rubbery, well-circumscribed, mobile (\"breast mouse\"); hormonally responsive (may enlarge during pregnancy) No increased risk (unless complex/proliferative) Observation if <2 cm and classic...","sourceLabel":"Section in General Surgery"},"1541":{"title":"Thyroid — Nodules, Cancer, & Thyroidectomy","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s29","snippet":"Thyroid — Nodules, Cancer, & Thyroidectomy Figure 19 - Berry Ligament and Recurrent Laryngeal Nerve Anatomy. Illustration showing the formation of the Berry (posterior suspensory) ligament through condensation of the pretracheal fascia, and its critical relationship to the recurrent laryngeal nerve....","sourceLabel":"Section in General Surgery"},"1542":{"title":"Parathyroid & Hyperparathyroidism","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s30","snippet":"Parathyroid & Hyperparathyroidism Primary hyperparathyroidism is the most common cause of hypercalcemia in the outpatient setting. Caused by a single parathyroid adenoma in 85%, four-gland hyperplasia in 10–15% (especially in MEN1/2A and familial hyperparathyroidism), double adenoma in 3–5%, and par...","sourceLabel":"Section in General Surgery"},"1543":{"title":"Adrenal Surgery","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s31","snippet":"Adrenal Surgery Figure 32 - Adrenal Gland Anatomy. Illustration depicting the bilateral adrenal (suprarenal) glands situated on the superior poles of the kidneys. Each adrenal gland consists of a cortex (producing aldosterone, cortisol, and androgens) and a medulla (producing catecholamines). Laparo...","sourceLabel":"Section in General Surgery"},"1544":{"title":"Melanoma","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s32","snippet":"Melanoma The most lethal skin cancer, accounting for only ~5% of skin cancers but the majority of skin cancer deaths. Incidence is rising. Risk factors: UV exposure (intermittent intense exposure → sunburns), fair skin (Fitzpatrick types I–II), numerous moles (>50), atypical/dysplastic nevi, family ...","sourceLabel":"Section in General Surgery"},"1545":{"title":"Soft Tissue Sarcoma","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s33","snippet":"Soft Tissue Sarcoma Soft tissue sarcomas (STS) are rare (<1% of adult cancers) mesenchymal tumors arising from muscle, fat, fibrous tissue, nerves, or blood vessels. Over 50 histologic subtypes exist; the most common in adults are undifferentiated pleomorphic sarcoma (formerly MFH), liposarcoma, lei...","sourceLabel":"Section in General Surgery"},"1546":{"title":"ATLS & Initial Assessment","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s34","snippet":"ATLS & Initial Assessment Primary Survey (ABCDE) Step Assessment Interventions A — Airway with C-spine protection Is the airway patent? Can the patient speak? Stridor? Facial/neck trauma? Jaw thrust, chin lift, oropharyngeal/nasopharyngeal airway, endotracheal intubation, surgical airway (cricothyro...","sourceLabel":"Section in General Surgery"},"1547":{"title":"Solid Organ Injury — Spleen & Liver","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s35","snippet":"Solid Organ Injury — Spleen & Liver Splenic Injury (AAST Grading) Grade Description Management I Subcapsular hematoma <10% surface area; capsular laceration <1 cm deep Non-operative management (NOM) — observation, serial exams, serial Hgb II Subcapsular hematoma 10–50% surface area; intraparenchymal...","sourceLabel":"Section in General Surgery"},"1548":{"title":"Damage Control Surgery","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s36","snippet":"Damage Control Surgery Damage control surgery (DCS) is a staged approach used in severely injured patients who are developing or at risk for the \"lethal triad\" of hypothermia (core temp <35°C), acidosis (pH <7.2, lactate >5, base deficit > −6), and coagulopathy (INR >1.5, fibrinogen <100). The goal ...","sourceLabel":"Section in General Surgery"},"1549":{"title":"Laparoscopic Surgery Fundamentals","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s37","snippet":"Laparoscopic Surgery Fundamentals Insufflation & Pneumoperitoneum CO2 is the standard insufflation gas (rapidly absorbed, does not support combustion, inexpensive). Target intra-abdominal pressure: 12–15 mmHg . Pressures >15 mmHg impair venous return (decreased preload), decrease cardiac output, and...","sourceLabel":"Section in General Surgery"},"1550":{"title":"Bowel Anastomosis","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s38","snippet":"Bowel Anastomosis Principles A successful bowel anastomosis requires: adequate blood supply to both ends (healthy pink bowel, mesenteric pulsation), absence of tension, no distal obstruction, and a well-nourished/non-septic patient. The anastomosis can be performed hand-sewn (interrupted or running ...","sourceLabel":"Section in General Surgery"},"1551":{"title":"Ostomy Creation & Management","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s39","snippet":"Ostomy Creation & Management Types Ostomy Type Location Output Indications End ileostomy RLQ Liquid, high-volume (800–1200 mL/day), enzyme-rich (corrosive to skin) Total proctocolectomy (UC), protection of distal anastomosis if loop not feasible, Crohn's disease Loop ileostomy RLQ Same character as ...","sourceLabel":"Section in General Surgery"},"1552":{"title":"Central Lines & Surgical Access","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s40","snippet":"Central Lines & Surgical Access Central Venous Catheter (CVC) Insertion Standard sites: internal jugular vein (IJV) — preferred for most indications, easy ultrasound visualization, compressible; subclavian vein — lowest infection rate, higher pneumothorax risk, not easily compressible (avoid in coag...","sourceLabel":"Section in General Surgery"},"1553":{"title":"Imaging & Diagnostics","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s41","snippet":"Imaging & Diagnostics Modality Primary Use in General Surgery Key Notes Ultrasound (US) RUQ (gallstones, cholecystitis), FAST (trauma), hernia, breast masses, thyroid nodules, guided procedures First-line for RUQ pain; operator-dependent; no radiation; real-time guided biopsy/drainage CT abdomen/pel...","sourceLabel":"Section in General Surgery"},"1554":{"title":"Classification Systems (All)","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s42","snippet":"Classification Systems (All) System Used For Key Features Alvarado (MANTRELS) score Acute appendicitis 10-point scoring system; ≥7 = highly probable (see Section 05) Tokyo Guidelines (TG18) Acute cholecystitis severity Grade I (mild), II (moderate), III (severe with organ dysfunction) (see Section 0...","sourceLabel":"Section in General Surgery"},"1555":{"title":"Medications Master Table","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s43","snippet":"Medications Master Table Antibiotics — Surgical Prophylaxis & Treatment Drug (Generic) Brand Dose Indication Pearl Cefazolin Ancef 2 g IV (3 g if >120 kg); redose q4h intraop First-line surgical prophylaxis for clean and clean-contaminated cases Administer within 60 min of incision; most cost-effect...","sourceLabel":"Section in General Surgery"},"1556":{"title":"Abbreviations Master List","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s44","snippet":"Abbreviations Master List Anatomy & Landmarks CBD Common bile duct CHD Common hepatic duct GE / GEJ Gastroesophageal / gastroesophageal junction SMA Superior mesenteric artery IMA Inferior mesenteric artery SMV Superior mesenteric vein IVC Inferior vena cava RLN Recurrent laryngeal nerve CVS Critica...","sourceLabel":"Section in General Surgery"},"1557":{"title":"Risk Factors & Perioperative Management","pageTitle":"General Surgery","pageUrl":"/surgical/general-surgery","url":"/surgical/general-surgery#s45","snippet":"Risk Factors & Perioperative Management Perioperative Risk Assessment & Optimization Cardiac risk: Use the Revised Cardiac Risk Index (RCRI/Lee Index) — 6 predictors each scored 1 point: high-risk surgery (intraperitoneal, intrathoracic, suprainguinal vascular), ischemic heart disease, CHF, cerebrov...","sourceLabel":"Section in General Surgery"},"1558":{"title":"Trauma Surgery","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery","snippet":"Specialty Reference Trauma Surgery Complete Specialty Reference Every diagnosis, classification, procedure, technique, medication, complication, and management algorithm across the full scope of trauma surgery and acute care in one place."},"1559":{"title":"Trauma Anatomy — Zones, Regions, & Vascular Landmarks","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s1","snippet":"Trauma Anatomy — Zones, Regions, & Vascular Landmarks Trauma surgery demands rapid anatomical reasoning under pressure. Knowing regional anatomy — the zones of the neck, thoracic landmarks, abdominal quadrants and retroperitoneal zones, and vascular territories — determines the operative approach, t...","sourceLabel":"Section in Trauma Surgery"},"1560":{"title":"Trauma Physiology — Hemorrhagic Shock & the Lethal Triad","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s2","snippet":"Trauma Physiology — Hemorrhagic Shock & the Lethal Triad Classes of Hemorrhagic Shock (ATLS) Parameter Class I Class II Class III Class IV Blood loss (mL) <750 750–1500 1500–2000 >2000 Blood loss (% BV) <15% 15–30% 30–40% >40% Heart rate <100 100–120 120–140 >140 Blood pressure Normal Normal Decreas...","sourceLabel":"Section in Trauma Surgery"},"1561":{"title":"Trauma Assessment Principles & Injury Mechanisms","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s3","snippet":"Trauma Assessment Principles & Injury Mechanisms Mechanism of Injury Blunt trauma accounts for ~80% of trauma in civilian settings (motor vehicle collisions, falls, assaults, pedestrian strikes). Key kinematics: frontal impact MVC — down-and-under (femur fracture, posterior hip dislocation, patellar...","sourceLabel":"Section in Trauma Surgery"},"1562":{"title":"ATLS Primary Survey (ABCDE)","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s4","snippet":"ATLS Primary Survey (ABCDE) The ATLS primary survey is a systematic, priority-based approach to identifying and treating immediately life-threatening injuries. Each step must be completed before moving to the next, and the survey is repeated if the patient deteriorates. Figure 8 - Trauma Resuscitati...","sourceLabel":"Section in Trauma Surgery"},"1563":{"title":"Secondary Survey & Adjuncts","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s5","snippet":"Secondary Survey & Adjuncts The secondary survey is a head-to-toe physical examination performed only after the primary survey is complete and the patient is hemodynamically responding to resuscitation. It includes a complete history (AMPLE: Allergies, Medications, Past medical history, Last meal, E...","sourceLabel":"Section in Trauma Surgery"},"1564":{"title":"FAST & eFAST Examination","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s6","snippet":"FAST & eFAST Examination The Focused Assessment with Sonography in Trauma (FAST) is a bedside ultrasound performed during the primary survey to detect free intraperitoneal fluid (a surrogate for hemoperitoneum). The extended FAST (eFAST) adds bilateral thoracic views to evaluate for pneumothorax and...","sourceLabel":"Section in Trauma Surgery"},"1565":{"title":"Massive Transfusion & Damage Control Resuscitation","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s7","snippet":"Massive Transfusion & Damage Control Resuscitation Massive Transfusion Protocol (MTP) Definition: transfusion of ≥10 units of pRBCs within 24 hours, or ≥4 units in 1 hour with ongoing hemorrhage. Modern MTP delivers blood products in a 1:1:1 ratio of pRBC:FFP:platelets (the PROPPR trial standard). C...","sourceLabel":"Section in Trauma Surgery"},"1566":{"title":"Traumatic Brain Injury","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s8","snippet":"Traumatic Brain Injury Glasgow Coma Scale (GCS) Component Response Score Eye Opening (E) Spontaneous 4 To voice 3 To pain 2 None 1 Verbal (V) Oriented 5 Confused 4 Inappropriate words 3 Incomprehensible sounds 2 None 1 Motor (M) Obeys commands 6 Localizes pain 5 Withdraws from pain 4 Abnormal flexio...","sourceLabel":"Section in Trauma Surgery"},"1567":{"title":"Cervical Spine Injury & Clearance","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s9","snippet":"Cervical Spine Injury & Clearance Figure 16 - The Canadian C-Spine Rule Algorithm. Clinical decision flowchart for cervical spine clearance in alert trauma patients, showing the stepwise assessment of high-risk factors, low-risk factors permitting range-of-motion testing, and active neck rotation ev...","sourceLabel":"Section in Trauma Surgery"},"1568":{"title":"Penetrating Neck Trauma","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s10","snippet":"Penetrating Neck Trauma Hard vs Soft Signs Hard Signs (mandate exploration) Soft Signs (require workup) Active arterial hemorrhage or expanding/pulsatile hematoma History of significant hemorrhage at scene Airway compromise (stridor, hoarseness, air bubbling from wound) Non-expanding, stable hematom...","sourceLabel":"Section in Trauma Surgery"},"1569":{"title":"Maxillofacial Trauma","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s11","snippet":"Maxillofacial Trauma Figure 17 - Le Fort Fracture Classification. Illustration of the three Le Fort fracture patterns: Type I (horizontal, separating the palate), Type II (pyramidal, through the nasion and infraorbital rim), and Type III (craniofacial disjunction through the orbits and zygomatic arc...","sourceLabel":"Section in Trauma Surgery"},"1570":{"title":"Pneumothorax & Hemothorax","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s12","snippet":"Pneumothorax & Hemothorax Pneumothorax Types Type Pathophysiology Clinical Features Immediate Management Simple pneumothorax Air in pleural space without mediastinal shift Decreased breath sounds, hyperresonance on ipsilateral side; may be asymptomatic if small Small (<20%, asymptomatic) → observati...","sourceLabel":"Section in Trauma Surgery"},"1571":{"title":"Cardiac Injury & Tamponade","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s13","snippet":"Cardiac Injury & Tamponade Cardiac Tamponade Accumulation of blood in the pericardial sac (as little as 75–100 mL acutely) compresses the heart, impairs diastolic filling, and causes obstructive shock. Beck's Triad & Diagnosis Beck's triad (present in only ~30% of cases): hypotension, distended neck...","sourceLabel":"Section in Trauma Surgery"},"1572":{"title":"Aortic & Great Vessel Injury","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s14","snippet":"Aortic & Great Vessel Injury Traumatic Aortic Injury (TAI) The second leading cause of death in blunt trauma (after TBI). Mechanism: rapid deceleration (high-speed MVC, fall from height) → shearing force at points of anatomic fixation. The aortic isthmus (just distal to the left subclavian artery, a...","sourceLabel":"Section in Trauma Surgery"},"1573":{"title":"Pulmonary & Airway Injury","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s15","snippet":"Pulmonary & Airway Injury Pulmonary Contusion The most common potentially lethal chest injury. Hemorrhage and edema within the lung parenchyma from blunt force — appears on CXR/CT as a non-anatomic (non-lobar) opacity in the lung underlying the site of impact, often with rib fractures. Worsens over ...","sourceLabel":"Section in Trauma Surgery"},"1574":{"title":"Resuscitative Thoracotomy","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s16","snippet":"Resuscitative Thoracotomy Indications ED / Resuscitative Thoracotomy — Indications & Survival Indicated (highest survival): penetrating cardiac injury with witnessed cardiac arrest or signs of life within the past 15 minutes — survival up to 35%. Selectively indicated: penetrating thoracic injury wi...","sourceLabel":"Section in Trauma Surgery"},"1575":{"title":"Splenic Injury","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s17","snippet":"Splenic Injury AAST Spleen Injury Scale Grade Injury Description Management I Subcapsular hematoma <10% surface area; capsular laceration <1 cm depth NOM II Subcapsular hematoma 10–50% surface area; intraparenchymal hematoma <5 cm; laceration 1–3 cm depth NOM III Subcapsular hematoma >50% or expandi...","sourceLabel":"Section in Trauma Surgery"},"1576":{"title":"Liver Injury","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s18","snippet":"Liver Injury AAST Liver Injury Scale Grade Injury Description Management I Subcapsular hematoma <10%; laceration <1 cm depth NOM II Subcapsular hematoma 10–50%; intraparenchymal hematoma <10 cm; laceration 1–3 cm depth, <10 cm length NOM III Subcapsular hematoma >50% or expanding/ruptured; intrapare...","sourceLabel":"Section in Trauma Surgery"},"1577":{"title":"Hollow Viscus & Mesenteric Injury","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s19","snippet":"Hollow Viscus & Mesenteric Injury Small Bowel Injury The most commonly injured hollow viscus in penetrating abdominal trauma. In blunt trauma, small bowel injuries are uncommon (~5% of laparotomies for blunt trauma) but easily missed — the CT finding of free intraperitoneal fluid WITHOUT solid organ...","sourceLabel":"Section in Trauma Surgery"},"1578":{"title":"Pancreatic & Duodenal Injury","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s20","snippet":"Pancreatic & Duodenal Injury Pancreatic Injury Uncommon (~2% of abdominal trauma) but high morbidity. Mechanism: blunt epigastric force compressing the pancreas against the spine (classically, bicycle handlebar injury in children, steering wheel in adults, or assault). The key determinant of managem...","sourceLabel":"Section in Trauma Surgery"},"1579":{"title":"Renal & Urologic Trauma","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s21","snippet":"Renal & Urologic Trauma AAST Kidney Injury Scale Grade Description Management I Contusion or non-expanding subcapsular hematoma; no laceration NOM — observation II Non-expanding perirenal hematoma; cortical laceration <1 cm without collecting system involvement NOM III Cortical laceration >1 cm with...","sourceLabel":"Section in Trauma Surgery"},"1580":{"title":"Retroperitoneal Hematoma","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s22","snippet":"Retroperitoneal Hematoma Retroperitoneal hematomas (RPH) found during trauma laparotomy require a zone-based management strategy (see Section 01 for zone anatomy). Zone-Based Management of Retroperitoneal Hematomas Zone 1 (central/midline) — ALWAYS explore regardless of mechanism. Central hematomas ...","sourceLabel":"Section in Trauma Surgery"},"1581":{"title":"Peripheral Vascular Injury","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s23","snippet":"Peripheral Vascular Injury Hard vs Soft Signs of Vascular Injury Hard Signs (mandate exploration) Soft Signs (require CTA/ABI) Pulsatile hemorrhage History of hemorrhage at scene (now controlled) Expanding or pulsatile hematoma Stable, non-expanding hematoma Absent distal pulses Diminished (but pres...","sourceLabel":"Section in Trauma Surgery"},"1582":{"title":"Compartment Syndrome & Fasciotomy","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s24","snippet":"Compartment Syndrome & Fasciotomy Pathophysiology Elevated pressure within a closed fascial compartment compromises tissue perfusion, leading to ischemia and necrosis of muscle and nerve. Ischemic time >6 hours causes irreversible damage. Common causes: fractures (tibial shaft most common), crush in...","sourceLabel":"Section in Trauma Surgery"},"1583":{"title":"Pelvic Fractures & Hemorrhage Control","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s25","snippet":"Pelvic Fractures & Hemorrhage Control Figure 27 - Young-Burgess Classification of Pelvic Ring Injuries. Illustration of the major pelvic fracture patterns classified by mechanism of injury: lateral compression (LC), anteroposterior compression (APC), and vertical shear (VS). Each pattern has distinc...","sourceLabel":"Section in Trauma Surgery"},"1584":{"title":"Orthopedic Trauma Principles","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s26","snippet":"Orthopedic Trauma Principles Gustilo-Anderson Classification of Open Fractures Type Wound Size Soft Tissue Injury Contamination Infection Rate I <1 cm Minimal, clean wound, inside-out mechanism Minimal 0–2% II 1–10 cm Moderate soft tissue damage, no flap or avulsion Moderate 2–10% IIIA >10 cm Extens...","sourceLabel":"Section in Trauma Surgery"},"1585":{"title":"Damage Control Laparotomy","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s27","snippet":"Damage Control Laparotomy Indications for Damage Control Physiologic Triggers for Damage Control Surgery Damage control is triggered by the patient's physiology, NOT the anatomic injury severity: Hypothermia: core temperature <35 C (especially <34 C) Acidosis: pH <7.2 or base deficit worse than −8 C...","sourceLabel":"Section in Trauma Surgery"},"1586":{"title":"ICU Resuscitation & Planned Reoperation","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s28","snippet":"ICU Resuscitation & Planned Reoperation ICU Phase Goals The ICU phase of damage control focuses on correcting the lethal triad before returning to the OR: Parameter Goal Interventions Temperature >36 C Forced-air warming, warm IV fluids, warm ventilator circuit, bladder/peritoneal warm lavage if sev...","sourceLabel":"Section in Trauma Surgery"},"1587":{"title":"Open Abdomen Management","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s29","snippet":"Open Abdomen Management Temporary Abdominal Closure Techniques Technique Description Advantages Disadvantages Negative pressure wound therapy (NPWT / VAC) Polyurethane sponge placed over viscera (with plastic layer separating sponge from bowel), covered with adhesive drape, connected to suction at −...","sourceLabel":"Section in Trauma Surgery"},"1588":{"title":"Burn Assessment & Fluid Resuscitation","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s30","snippet":"Burn Assessment & Fluid Resuscitation Burn Depth Classification Depth Old Terminology Appearance Sensation Healing Superficial 1st degree Erythema, dry, no blisters (sunburn) Painful 3–5 days; no scarring Superficial partial-thickness 2nd degree (superficial) Blisters, pink/red moist base, blanches ...","sourceLabel":"Section in Trauma Surgery"},"1589":{"title":"Inhalation Injury, Hypothermia, & Frostbite","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s31","snippet":"Inhalation Injury, Hypothermia, & Frostbite Inhalation Injury Three components: supraglottic thermal injury (heat is efficiently dissipated by the oropharynx — direct thermal injury is rare below the glottis unless steam exposure); lower airway chemical injury (combustion products — acrolein, aldehy...","sourceLabel":"Section in Trauma Surgery"},"1590":{"title":"Chest Tube, Cricothyroidotomy, & DPL","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s32","snippet":"Chest Tube, Cricothyroidotomy, & DPL Chest Tube Thoracostomy Indication: pneumothorax (symptomatic or tension), hemothorax, post-thoracotomy. Position: 4th or 5th intercostal space, anterior to mid-axillary line, in the \"safe triangle\" (anterior border of latissimus dorsi, lateral border of pectoral...","sourceLabel":"Section in Trauma Surgery"},"1591":{"title":"REBOA","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s33","snippet":"REBOA Resuscitative Endovascular Balloon Occlusion of the Aorta REBOA is an endovascular adjunct for temporary aortic occlusion to control non-compressible torso hemorrhage (NCTH), serving as a less-invasive alternative to resuscitative thoracotomy with aortic cross-clamp. Figure 32 - REBOA Aortic Z...","sourceLabel":"Section in Trauma Surgery"},"1592":{"title":"Fasciotomy Techniques","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s34","snippet":"Fasciotomy Techniques Fasciotomy technique for the four-compartment lower leg release is detailed in Section 24. Additional fasciotomy sites: Figure 34 - Two-Incision Four-Compartment Fasciotomy Technique. Surgical approach for lower leg fasciotomy showing the lateral incision (2 cm anterior to fibu...","sourceLabel":"Section in Trauma Surgery"},"1593":{"title":"Blood Products & Tranexamic Acid","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s35","snippet":"Blood Products & Tranexamic Acid Blood Product Overview Product Contents Volume Effect Key Notes Packed RBCs (pRBC) RBCs in additive solution (CPDA or AS-1), Hct ~55–80% ~300 mL 1 unit raises Hgb by ~1 g/dL Universal donor: O-negative (females of childbearing age) or O-positive (males and post-menop...","sourceLabel":"Section in Trauma Surgery"},"1594":{"title":"Reversal Agents, Vasopressors, & Adjuncts","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s36","snippet":"Reversal Agents, Vasopressors, & Adjuncts Anticoagulant Reversal Agents Anticoagulant Reversal Agent Dose Notes Warfarin 4-Factor PCC (Kcentra) + Vitamin K PCC: INR 2–4 → 25 U/kg; INR 4–6 → 35 U/kg; INR >6 → 50 U/kg. Vitamin K 10 mg IV slow push PCC works in minutes; Vitamin K takes 6–12 hours but p...","sourceLabel":"Section in Trauma Surgery"},"1595":{"title":"Classification Systems (All)","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s37","snippet":"Classification Systems (All) AAST Organ Injury Scales — Summary AAST grading for spleen (Section 17), liver (Section 18), kidney (Section 21), and pancreas (Section 20) are detailed in their respective sections. The grading system (I–V or I–VI) is universally used for operative decision-making and r...","sourceLabel":"Section in Trauma Surgery"},"1596":{"title":"Complications — Missed Injury, ACS, ARDS, & DVT/PE","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s38","snippet":"Complications — Missed Injury, ACS, ARDS, & DVT/PE Missed Injury Missed injury rate in major trauma: 2–10%. Most commonly missed: thoracolumbar spine fractures, small pneumothoraces, extremity fractures (especially in obtunded/intubated patients), hollow viscus injuries (CT sensitivity for bowel inj...","sourceLabel":"Section in Trauma Surgery"},"1597":{"title":"Abbreviations Master List","pageTitle":"Trauma Surgery","pageUrl":"/surgical/trauma-surgery","url":"/surgical/trauma-surgery#s39","snippet":"Abbreviations Master List Abbreviation Full Term AAST American Association for the Surgery of Trauma ABI Ankle-Brachial Index ACS Abdominal Compartment Syndrome APC Anteroposterior Compression (pelvic fracture) ARDS Acute Respiratory Distress Syndrome ATC Acute Traumatic Coagulopathy ATLS Advanced T...","sourceLabel":"Section in Trauma Surgery"},"1598":{"title":"Orthopedic Surgery","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery","snippet":"Specialty Reference Orthopedic Surgery Complete Specialty Reference Every fracture, joint pathology, classification system, implant, surgical approach, physical exam maneuver, medication, and management strategy in one place."},"1599":{"title":"Musculoskeletal Anatomy","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s1","snippet":"Musculoskeletal Anatomy Orthopedic surgery covers the entire musculoskeletal system: bones, joints, ligaments, tendons, muscles, cartilage, and the peripheral nerves that innervate them. The specialty's scope extends from skull base (craniocervical junction) to the tips of the fingers and toes, and ...","sourceLabel":"Section in Orthopedic Surgery"},"1600":{"title":"The Orthopedic Physical Exam","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s2","snippet":"The Orthopedic Physical Exam The orthopedic exam follows a systematic approach: Look (alignment, deformity, swelling, ecchymosis, skin integrity, muscle wasting), Feel (point tenderness, crepitus, effusion, temperature, pulses), Move (active and passive range of motion, stability testing), and Neuro...","sourceLabel":"Section in Orthopedic Surgery"},"1601":{"title":"Fracture Fundamentals","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s3","snippet":"Fracture Fundamentals Fracture Description System Every fracture is described using a standardized system. The complete description includes: which bone , location (proximal, mid-shaft, distal; metaphyseal vs diaphyseal vs epiphyseal), pattern (transverse, oblique, spiral, comminuted, segmental, but...","sourceLabel":"Section in Orthopedic Surgery"},"1602":{"title":"Shoulder Pathology","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s4","snippet":"Shoulder Pathology Rotator Cuff Disease The rotator cuff consists of four muscles — supraspinatus (abduction initiation), infraspinatus (external rotation), teres minor (external rotation), and subscapularis (internal rotation) — forming a musculotendinous cuff that dynamically stabilizes the humera...","sourceLabel":"Section in Orthopedic Surgery"},"1603":{"title":"Proximal Humerus & Clavicle Fractures","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s5","snippet":"Proximal Humerus & Clavicle Fractures Proximal Humerus Fractures — Neer Classification The proximal humerus has four \"parts\" (Neer's parts): greater tuberosity , lesser tuberosity , articular segment (humeral head) , and shaft . A part is considered displaced when there is >1 cm of displacement or >...","sourceLabel":"Section in Orthopedic Surgery"},"1604":{"title":"Elbow Pathology & Fractures","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s6","snippet":"Elbow Pathology & Fractures Distal Humerus Fractures Distal humerus fractures in adults are complex intra-articular injuries, often from falls or high-energy trauma. The distal humerus forms two columns (medial and lateral) supporting the trochlea and capitellum. The AO/OTA classification divides th...","sourceLabel":"Section in Orthopedic Surgery"},"1605":{"title":"Wrist & Hand","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s7","snippet":"Wrist & Hand Distal Radius Fractures Figure 11 - Named Distal Radius Fracture Patterns. Illustration of the classic distal radius fracture patterns: Colles' fracture (dorsal displacement), Smith's fracture (volar displacement), Barton's fracture (intra-articular fracture-subluxation), and chauffeur'...","sourceLabel":"Section in Orthopedic Surgery"},"1606":{"title":"Hip Pathology & Fractures","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s8","snippet":"Hip Pathology & Fractures Hip Fracture Overview Hip fractures are one of the most consequential injuries in orthopedics — 1-year mortality ranges from 15–30% in the elderly. The primary distinction is intracapsular (femoral neck) vs extracapsular (intertrochanteric, subtrochanteric). This distinctio...","sourceLabel":"Section in Orthopedic Surgery"},"1607":{"title":"Knee Pathology & Fractures","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s9","snippet":"Knee Pathology & Fractures ACL Tear The anterior cruciate ligament (ACL) is the primary restraint to anterior tibial translation and a secondary stabilizer to rotation. It originates from the posteromedial aspect of the lateral femoral condyle and inserts on the anterior tibial spine. Mechanism of i...","sourceLabel":"Section in Orthopedic Surgery"},"1608":{"title":"Ankle & Foot","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s10","snippet":"Ankle & Foot Figure 19 - Weber Classification of Ankle Fractures. Classification based on fibular fracture level relative to the syndesmosis: Type A (below, stable), Type B (at level, potentially unstable), and Type C (above, unstable with syndesmotic disruption requiring fixation). Ankle Fractures ...","sourceLabel":"Section in Orthopedic Surgery"},"1609":{"title":"Cervical Spine","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s11","snippet":"Cervical Spine Cervical Spine Fractures Atlas (C1) fractures — Jefferson fracture: Axial load (diving, fall onto head) fractures the C1 ring at 2–4 points. Lateral mass overhang >6.9 mm (combined bilateral) on open-mouth odontoid view indicates transverse ligament rupture (unstable — Rule of Spence ...","sourceLabel":"Section in Orthopedic Surgery"},"1610":{"title":"Thoracolumbar Spine","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s12","snippet":"Thoracolumbar Spine Thoracolumbar Fractures The thoracolumbar junction (T11–L2) is the most common site of spinal fractures — it is the transition zone between the rigid thoracic spine (stabilized by the rib cage) and the mobile lumbar spine. The Denis three-column model divides the spine into: ante...","sourceLabel":"Section in Orthopedic Surgery"},"1611":{"title":"Degenerative Disc Disease & Spondylolisthesis","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s13","snippet":"Degenerative Disc Disease & Spondylolisthesis Degenerative Disc Disease (DDD) The intervertebral disc consists of the nucleus pulposus (gelatinous center, high water content, provides compressive resistance) and the annulus fibrosus (concentric collagen lamellae providing tensile strength). Disc deg...","sourceLabel":"Section in Orthopedic Surgery"},"1612":{"title":"Pelvic & Acetabular Fractures","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s14","snippet":"Pelvic & Acetabular Fractures Pelvic Ring Fractures — Young-Burgess Classification Figure 25 - Young-Burgess Pelvic Fracture Classification. Mechanism-based classification showing lateral compression (LC I-III), anteroposterior compression (APC I-III, including open-book injury), and vertical shear ...","sourceLabel":"Section in Orthopedic Surgery"},"1613":{"title":"Femoral & Tibial Shaft Fractures","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s15","snippet":"Femoral & Tibial Shaft Fractures Femoral Shaft Fractures Figure 26 - Intramedullary Nail Fixation. Antegrade intramedullary nailing is the gold standard for femoral shaft fractures. The nail is inserted through a proximal entry point (piriformis fossa or greater trochanter tip), reamed to fit the ca...","sourceLabel":"Section in Orthopedic Surgery"},"1614":{"title":"Open Fractures","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s16","snippet":"Open Fractures Open fractures involve a breach in the skin and soft tissues communicating with the fracture site. The management principles are detailed in Section 03 (Gustilo-Anderson classification and acute management protocol). This section covers additional operative principles and special cons...","sourceLabel":"Section in Orthopedic Surgery"},"1615":{"title":"Pathologic Fractures & Polytrauma","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s17","snippet":"Pathologic Fractures & Polytrauma Pathologic Fractures A pathologic fracture occurs through bone weakened by an underlying process — most commonly metastatic disease (breast, prostate, lung, kidney, thyroid — \"BLT with a Kosher Pickle\"), multiple myeloma , osteoporosis , Paget's disease , or primary...","sourceLabel":"Section in Orthopedic Surgery"},"1616":{"title":"Total Hip Arthroplasty (THA)","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s18","snippet":"Total Hip Arthroplasty (THA) Indications End-stage osteoarthritis (most common), inflammatory arthritis (RA), AVN, post-traumatic arthritis, displaced femoral neck fracture in the elderly, failed prior fixation, dysplasia, and tumor reconstruction. Non-operative management should be exhausted before...","sourceLabel":"Section in Orthopedic Surgery"},"1617":{"title":"Total Knee Arthroplasty (TKA)","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s19","snippet":"Total Knee Arthroplasty (TKA) Indications & Planning End-stage knee OA (most common), inflammatory arthritis, post-traumatic arthritis, and severe valgus/varus deformity with pain. Pre-operative planning includes weight-bearing full-length standing radiographs (hip-to-ankle mechanical axis film) to ...","sourceLabel":"Section in Orthopedic Surgery"},"1618":{"title":"Revision Arthroplasty, Periprosthetic Fractures & PJI","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s20","snippet":"Revision Arthroplasty, Periprosthetic Fractures & PJI Periprosthetic Joint Infection (PJI) PJI is the most devastating complication of joint replacement, occurring in 1–2% of primary THA/TKA. The Musculoskeletal Infection Society (MSIS) 2018 criteria define PJI with major and minor criteria. Major c...","sourceLabel":"Section in Orthopedic Surgery"},"1619":{"title":"Bone Tumors","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s21","snippet":"Bone Tumors Approach to Bone Lesions The initial evaluation of a bone lesion uses radiographic features to narrow the differential. Key descriptors: location in bone (epiphyseal, metaphyseal, diaphyseal), pattern of bone destruction (geographic [well-defined, slow-growing], moth-eaten [intermediate ...","sourceLabel":"Section in Orthopedic Surgery"},"1620":{"title":"Metabolic Bone Disease","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s22","snippet":"Metabolic Bone Disease Osteoporosis Systemic skeletal disease characterized by low bone mass and microarchitectural deterioration, leading to increased fracture risk. Affects ~10 million Americans; causes ~2 million fractures annually (hip, vertebral compression, distal radius). Diagnosis: DEXA scan...","sourceLabel":"Section in Orthopedic Surgery"},"1621":{"title":"Pediatric Orthopedics","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s23","snippet":"Pediatric Orthopedics Growth Plate (Physis) Injuries — Salter-Harris Classification The physis (growth plate) is the weakest link in the pediatric musculoskeletal system — it is 2–5x weaker than surrounding ligaments and bone. Physeal injuries account for 15–30% of childhood fractures. The Salter-Ha...","sourceLabel":"Section in Orthopedic Surgery"},"1622":{"title":"Compartment Syndrome & CRPS","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s24","snippet":"Compartment Syndrome & CRPS Acute Compartment Syndrome A limb-threatening emergency where increased pressure within a closed fascial compartment compromises tissue perfusion. Most common in the leg (four compartments: anterior, lateral, superficial posterior, deep posterior) and forearm (three compa...","sourceLabel":"Section in Orthopedic Surgery"},"1623":{"title":"Fracture Fixation Hardware","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s25","snippet":"Fracture Fixation Hardware Plates & Screws Cortical screws: Fully threaded, engage both cortices. Thread pitch designed for dense cortical bone. Used for interfragmentary compression (lag technique — gliding hole in near cortex, threads engage only far cortex → compression). Cancellous screws: Parti...","sourceLabel":"Section in Orthopedic Surgery"},"1624":{"title":"Arthroscopy","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s26","snippet":"Arthroscopy General Principles Arthroscopy is the insertion of a small camera (arthroscope, typically 4.0 mm, 30&deg; angled lens) and instruments through small portals into a joint for diagnostic and therapeutic purposes. Benefits over open surgery: smaller incisions, less soft tissue damage, faste...","sourceLabel":"Section in Orthopedic Surgery"},"1625":{"title":"Arthroplasty Implants & Bearing Surfaces","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s27","snippet":"Arthroplasty Implants & Bearing Surfaces Implant details for THA and TKA are covered in Sections 18 and 19. This section covers additional arthroplasty concepts. Cemented vs Uncemented Fixation Cemented fixation uses polymethylmethacrylate (PMMA) bone cement to fill the gap between the implant and b...","sourceLabel":"Section in Orthopedic Surgery"},"1626":{"title":"Spine Surgery Techniques","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s28","snippet":"Spine Surgery Techniques Anterior Cervical Discectomy and Fusion (ACDF) The most commonly performed cervical spine surgery. Approach: Smith-Robinson anterior approach — transverse skin incision on the left side of the neck (protects the recurrent laryngeal nerve, which has a more consistent course o...","sourceLabel":"Section in Orthopedic Surgery"},"1627":{"title":"Imaging & Diagnostics","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s29","snippet":"Imaging & Diagnostics Imaging Modalities in Orthopedics Modality Best For Key Points Plain Radiography (X-ray) First-line for all fractures, arthritis, alignment, hardware Always obtain ≥2 orthogonal views. Weight-bearing views for arthritis (joint space narrowing not apparent on non-weight-bearing)...","sourceLabel":"Section in Orthopedic Surgery"},"1628":{"title":"Classification Systems (All)","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s30","snippet":"Classification Systems (All) This section consolidates all major classification systems in orthopedic surgery for quick reference. Detailed descriptions are found in the relevant clinical sections. Fracture Classifications Classification Structure Categories Section AO/OTA Universal fracture classif...","sourceLabel":"Section in Orthopedic Surgery"},"1629":{"title":"Medications Master Table","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s31","snippet":"Medications Master Table Class Drug (Brand) Mechanism Dose Indication Critical Pearl NSAID Ketorolac (Toradol) Non-selective COX inhibitor 15–30 mg IV/IM q6h (max 5 days) Acute post-op pain, fracture pain Limit to 5 days; avoid in renal impairment. Theoretical concern for fracture healing impairment...","sourceLabel":"Section in Orthopedic Surgery"},"1630":{"title":"Abbreviations Master List","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s32","snippet":"Abbreviations Master List Abbreviation Meaning ACL Anterior cruciate ligament ACDF Anterior cervical discectomy and fusion ACI Autologous chondrocyte implantation AIN Anterior interosseous nerve ALIF Anterior lumbar interbody fusion ALP Alkaline phosphatase AO/OTA Arbeitsgemeinschaft fur Osteosynthe...","sourceLabel":"Section in Orthopedic Surgery"},"1631":{"title":"Risk Factors & Comorbidities","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s33","snippet":"Risk Factors & Comorbidities Fracture Risk Factors Risk Factor Mechanism / Relevance Osteoporosis Reduced bone mineral density → fragility fractures (vertebral compression, hip, distal radius) with minimal trauma. T-score ≤ -2.5 on DEXA Advanced age Progressive bone loss, sarcopenia (fall risk), imp...","sourceLabel":"Section in Orthopedic Surgery"},"1632":{"title":"Key References","pageTitle":"Orthopedic Surgery","pageUrl":"/surgical/orthopedic-surgery","url":"/surgical/orthopedic-surgery#s34","snippet":"Key References The following landmark studies and guidelines are referenced throughout this specialty page and form the evidence base for modern orthopedic practice. Reference Topic Key Finding Canadian Orthopaedic Trauma Society, JBJS 2007 Displaced midshaft clavicle fractures Operative fixation re...","sourceLabel":"Section in Orthopedic Surgery"},"1633":{"title":"Neurosurgery","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery","snippet":"Specialty Reference Neuro surgery Complete Specialty Reference Every diagnosis, classification, procedure, technique, medication, complication, and management algorithm across the full scope of neurosurgery in one place."},"1634":{"title":"Neuroanatomy — Cranial, Ventricular, & Vascular","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s1","snippet":"Neuroanatomy — Cranial, Ventricular, & Vascular A thorough understanding of cranial anatomy is the foundation of neurosurgical practice. The skull base, cerebral vasculature, and ventricular system define the corridors and constraints of every neurosurgical approach. Cranial Fossae Figure 1 - Skull ...","sourceLabel":"Section in Neurosurgery"},"1635":{"title":"Neuroanatomy — Spinal Cord & Peripheral Nerves","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s2","snippet":"Neuroanatomy — Spinal Cord & Peripheral Nerves Spinal Cord Anatomy Figure 6 - Spinal Cord Tracts. Schematic illustration of the major motor and sensory functions of the spinal cord organized by developmental stage. The diagram categorizes the ascending sensory and descending motor pathways according...","sourceLabel":"Section in Neurosurgery"},"1636":{"title":"The Neurosurgical Physical Exam","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s3","snippet":"The Neurosurgical Physical Exam Glasgow Coma Scale (GCS) The GCS is the most widely used scale for assessing level of consciousness in neurosurgical patients. Score ranges from 3 (worst) to 15 (best). It is composed of three components: Component Response Score Eye Opening (E) Spontaneous 4 To voice...","sourceLabel":"Section in Neurosurgery"},"1637":{"title":"Neurosurgical Principles — ICP, CPP, & Brain Relaxation","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s4","snippet":"Neurosurgical Principles — ICP, CPP, & Brain Relaxation Intracranial Pressure (ICP) Normal ICP in adults is 5–15 mmHg (supine). The Monro-Kellie doctrine states that the cranial vault is a fixed volume; the sum of brain parenchyma (~80%), blood (~10%), and CSF (~10%) must remain constant. An increas...","sourceLabel":"Section in Neurosurgery"},"1638":{"title":"Gliomas — WHO Classification & Management","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s5","snippet":"Gliomas — WHO Classification & Management Gliomas are the most common primary malignant brain tumors in adults, arising from glial cells (astrocytes, oligodendrocytes, ependymal cells). The 2021 WHO Classification of CNS tumors integrates molecular markers — particularly IDH mutation status and 1p/1...","sourceLabel":"Section in Neurosurgery"},"1639":{"title":"Meningiomas","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s6","snippet":"Meningiomas Meningiomas are the most common primary intracranial tumors overall (~37% of all CNS tumors), arising from arachnoid cap cells. Most are benign (WHO grade 1, ~80%), slow-growing, and affect women more than men (2:1). They express progesterone receptors (may grow during pregnancy). Risk f...","sourceLabel":"Section in Neurosurgery"},"1640":{"title":"Pituitary Tumors","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s7","snippet":"Pituitary Tumors Pituitary adenomas account for ~15% of intracranial tumors. They are classified by size ( microadenoma <10 mm vs macroadenoma ≥10 mm) and by hormonal activity ( functioning vs non-functioning ). Functioning Adenomas Type Hormone Frequency Clinical Features First-Line Treatment Prola...","sourceLabel":"Section in Neurosurgery"},"1641":{"title":"Metastatic Brain Tumors","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s8","snippet":"Metastatic Brain Tumors Brain metastases are the most common intracranial tumors overall, outnumbering primary brain tumors ~10:1. The most common primary sources are lung (~40–50%), breast (~15–25%), melanoma (~5–20%), renal cell carcinoma , and colorectal cancer . Metastases tend to occur at the g...","sourceLabel":"Section in Neurosurgery"},"1642":{"title":"Posterior Fossa Tumors","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s9","snippet":"Posterior Fossa Tumors Figure 18 - Vestibular Schwannoma on MRI. Post-contrast T1-weighted MRI demonstrating a homogeneously enhancing mass in the cerebellopontine angle with extension into the internal auditory canal, characteristic of vestibular schwannoma (acoustic neuroma). Vestibular Schwannoma...","sourceLabel":"Section in Neurosurgery"},"1643":{"title":"Intracranial Aneurysms & Subarachnoid Hemorrhage","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s10","snippet":"Intracranial Aneurysms & Subarachnoid Hemorrhage Intracranial aneurysms are present in ~2–3% of the general population. Most are saccular (\"berry\") aneurysms at arterial bifurcations in the Circle of Willis. Risk factors for rupture: size (>7 mm significantly increases risk), location (posterior cir...","sourceLabel":"Section in Neurosurgery"},"1644":{"title":"Arteriovenous Malformations & Cavernous Malformations","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s11","snippet":"Arteriovenous Malformations & Cavernous Malformations Arteriovenous Malformations (AVMs) AVMs are congenital tangles of abnormal arteries and veins without an intervening capillary bed, resulting in high-flow arteriovenous shunting. The nidus is the core of the AVM. Annual hemorrhage risk is ~2–4% p...","sourceLabel":"Section in Neurosurgery"},"1645":{"title":"Stroke — Surgical Management","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s12","snippet":"Stroke — Surgical Management Figure 24 - Craniotomy Approaches Overview. Schematic illustration of the major neurosurgical craniotomy approaches and their operative corridors, demonstrating how different skull base and convexity approaches provide access to specific intracranial regions. Decompressi...","sourceLabel":"Section in Neurosurgery"},"1646":{"title":"Degenerative Disc Disease & Cervical Myelopathy","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s13","snippet":"Degenerative Disc Disease & Cervical Myelopathy Figure 25 - Lumbar Disc Herniation on MRI. Sagittal and axial T2-weighted MRI of the lumbar spine showing a disc herniation causing neural compression. MRI is the imaging modality of choice for evaluating disc pathology, neural compression, and plannin...","sourceLabel":"Section in Neurosurgery"},"1647":{"title":"Lumbar Stenosis & Spondylolisthesis","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s14","snippet":"Lumbar Stenosis & Spondylolisthesis Lumbar Spinal Stenosis Narrowing of the spinal canal, lateral recesses, or neural foramina, most commonly from degenerative changes (facet hypertrophy, ligamentum flavum thickening, disc bulging). Classic presentation: neurogenic claudication — bilateral leg pain,...","sourceLabel":"Section in Neurosurgery"},"1648":{"title":"Spinal Cord Tumors","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s15","snippet":"Spinal Cord Tumors Classification by Compartment Compartment Common Tumors Clinical Features Surgical Principles Extradural (~55%) Metastases (most common), lymphoma, primary vertebral tumors (chordoma, osteosarcoma, giant cell tumor) Pain (often first symptom), progressive myelopathy, radiculopathy...","sourceLabel":"Section in Neurosurgery"},"1649":{"title":"Traumatic Brain Injury","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s16","snippet":"Traumatic Brain Injury Figure 27 - Epidural Hematoma — CT Imaging. CT scan demonstrating an epidural hematoma with the characteristic biconvex (lenticular) hyperdense collection in the temporal region. The hematoma does not cross suture lines due to the dura's firm attachment at the cranial sutures....","sourceLabel":"Section in Neurosurgery"},"1650":{"title":"Spinal Trauma & Spinal Cord Injury","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s17","snippet":"Spinal Trauma & Spinal Cord Injury ASIA (American Spinal Injury Association) Impairment Scale Grade Definition A — Complete No motor or sensory function preserved in S4–S5 segments B — Sensory incomplete Sensory but not motor function preserved below the neurologic level, including S4–S5 C — Motor i...","sourceLabel":"Section in Neurosurgery"},"1651":{"title":"Deep Brain Stimulation & Functional Procedures","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s18","snippet":"Deep Brain Stimulation & Functional Procedures Figure 29 - Deep Brain Stimulation System. Illustration of the DBS system components: stereotactically implanted electrodes in target deep brain nuclei (STN or GPi for Parkinson disease, VIM for essential tremor), connected via subcutaneous extension wi...","sourceLabel":"Section in Neurosurgery"},"1652":{"title":"Epilepsy Surgery","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s19","snippet":"Epilepsy Surgery Epilepsy surgery is indicated for drug-resistant epilepsy (failure of ≥2 appropriate antiseizure medications at adequate doses). Approximately one-third of epilepsy patients are drug-resistant. Presurgical evaluation includes: video-EEG monitoring (seizure semiology and EEG localiza...","sourceLabel":"Section in Neurosurgery"},"1653":{"title":"Hydrocephalus","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s20","snippet":"Hydrocephalus Classification Obstructive (non-communicating): blockage within the ventricular system (e.g., aqueductal stenosis, posterior fossa tumor obstructing the fourth ventricle, colloid cyst blocking the foramen of Monro). Communicating: impaired CSF absorption at the arachnoid granulations (...","sourceLabel":"Section in Neurosurgery"},"1654":{"title":"Pediatric Neurosurgery","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s21","snippet":"Pediatric Neurosurgery Craniosynostosis Premature fusion of one or more cranial sutures, resulting in abnormal head shape. Incidence ~1 in 2,000 births. Classified by the suture involved: Suture Head Shape Frequency Key Features Sagittal Scaphocephaly (dolichocephaly — long, narrow) ~40–55% Most com...","sourceLabel":"Section in Neurosurgery"},"1655":{"title":"Craniotomy Approaches","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s22","snippet":"Craniotomy Approaches Major Craniotomy Approaches Approach Indications Key Steps / Landmarks Structures at Risk Pterional (frontotemporal) Most versatile: anterior circulation aneurysms, Sylvian fissure pathology, sellar/parasellar tumors, anterior skull base lesions Curvilinear incision behind the ...","sourceLabel":"Section in Neurosurgery"},"1656":{"title":"Stereotactic & Endoscopic Neurosurgery","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s23","snippet":"Stereotactic & Endoscopic Neurosurgery Stereotactic Surgery Stereotactic surgery uses a coordinate system (frame-based or frameless) to precisely target intracranial structures for biopsy, ablation, or electrode placement. Frame-based stereotaxy: a rigid frame (Leksell, CRW, or BRW) is fixed to the ...","sourceLabel":"Section in Neurosurgery"},"1657":{"title":"Minimally Invasive Spine Surgery","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s24","snippet":"Minimally Invasive Spine Surgery MIS Principles Minimally invasive spine surgery (MISS) uses tubular retractors, endoscopes, and specialized instruments to achieve the same surgical goals (decompression, fusion, stabilization) through smaller incisions with less muscle disruption. Benefits: reduced ...","sourceLabel":"Section in Neurosurgery"},"1658":{"title":"Neuroimaging — CT, MRI, & Angiography","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s25","snippet":"Neuroimaging — CT, MRI, & Angiography CT — Key Neurosurgical Applications CT is the first-line imaging for acute neurosurgical emergencies. Non-contrast CT (NCCT): acute blood appears hyperdense (white) for approximately 1–2 weeks, then becomes isodense, then hypodense (chronic SDH is dark). Air (pn...","sourceLabel":"Section in Neurosurgery"},"1659":{"title":"Electrophysiological Monitoring","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s26","snippet":"Electrophysiological Monitoring Intraoperative Neuromonitoring (IONM) IONM is used during neurosurgical and spine procedures to detect impending neurologic injury in real time, allowing the surgeon to modify the approach before permanent damage occurs. Modality What It Monitors Key Applications Aler...","sourceLabel":"Section in Neurosurgery"},"1660":{"title":"Antiepileptics & Osmotic Agents","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s27","snippet":"Antiepileptics & Osmotic Agents Antiepileptic Drugs (AEDs) in Neurosurgery Drug Mechanism Dosing Key Points Levetiracetam (Keppra) SV2A modulation 500–1500 mg IV/PO BID; load 20–60 mg/kg IV First-line perioperative AED; no hepatic enzyme induction; no drug level monitoring needed; renal dose adjustm...","sourceLabel":"Section in Neurosurgery"},"1661":{"title":"Steroids, Anticoagulation Reversal, & Chemotherapy","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s28","snippet":"Steroids, Anticoagulation Reversal, & Chemotherapy Dexamethasone The primary corticosteroid used in neurosurgery. Mechanism: reduces vasogenic edema by stabilizing the blood-brain barrier (decreases capillary permeability). Onset ~4–6 hours for edema reduction (maximal effect 24–72 hours). Dosing: b...","sourceLabel":"Section in Neurosurgery"},"1662":{"title":"Classification Systems Master Table","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s29","snippet":"Classification Systems Master Table Classification Application Key Grades / Scores WHO CNS Tumor Grading (2021) Brain tumor malignancy Grade 1 (low proliferative potential, possible cure) → Grade 4 (malignant, rapid growth, necrosis); integrated with molecular markers (IDH, 1p/19q, TERT, EGFR) Hunt-...","sourceLabel":"Section in Neurosurgery"},"1663":{"title":"Complications & Management","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s30","snippet":"Complications & Management Surgical Site Infection Craniotomy wound infection rate ~1–3%. Superficial wound infection: erythema, swelling, drainage — antibiotics ± wound opening and irrigation. Bone flap infection / osteomyelitis: requires bone flap removal, prolonged IV antibiotics (6–8 weeks), and...","sourceLabel":"Section in Neurosurgery"},"1664":{"title":"Medications Master Table","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s31","snippet":"Medications Master Table Drug Class Indication Dose Key Monitoring / Notes Levetiracetam Antiepileptic Seizure prophylaxis / treatment 500–1500 mg IV/PO BID Renal dosing; behavioral side effects; no drug interactions Phenytoin / Fosphenytoin Antiepileptic Seizure prophylaxis / status epilepticus Loa...","sourceLabel":"Section in Neurosurgery"},"1665":{"title":"Abbreviations Master List","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#s32","snippet":"Abbreviations Master List Abbreviation Full Term ACA Anterior cerebral artery ACDF Anterior cervical discectomy and fusion AICA Anterior inferior cerebellar artery ASIA American Spinal Injury Association AVM Arteriovenous malformation BBB Blood-brain barrier BTF Brain Trauma Foundation CBF Cerebral ...","sourceLabel":"Section in Neurosurgery"},"1666":{"title":"References","pageTitle":"Neurosurgery","pageUrl":"/surgical/neurosurgery","url":"/surgical/neurosurgery#references","snippet":"References Figures Figure 1 — Circle of Willis. Wikimedia Commons. Public domain. Figure 2 — Ventricular System. Gray's Anatomy (1918). Wikimedia Commons. Public domain. Figure 3 — Spinal Cord Cross-Section. Wikimedia Commons. Public domain. Key Trials & Guidelines Stupp R, et al. Radiotherapy plus ...","sourceLabel":"Section in Neurosurgery"},"1667":{"title":"Vascular Surgery","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery","snippet":"Specialty Reference Vascular Surgery Complete Specialty Reference Every diagnosis, condition, procedure, complication, medication, classification, waveform, graft detail, wound care protocol, and management strategy in one place."},"1668":{"title":"Vascular Anatomy — Arterial","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s1","snippet":"Vascular Anatomy — Arterial Vascular surgery covers every blood vessel in the body except the coronary arteries (cardiothoracic/interventional cardiology) and the intracranial vessels (neurosurgery). The domain includes the entire aorta, all carotid, visceral, renal, iliac, extremity arteries, and a...","sourceLabel":"Section in Vascular Surgery"},"1669":{"title":"Vascular Anatomy — Venous & Lymphatic","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s2","snippet":"Vascular Anatomy — Venous & Lymphatic Deep Venous System (Lower Extremity) Mirrors the arterial tree: posterior tibial veins, peroneal veins, anterior tibial veins → popliteal vein → femoral vein (FV) (formerly \"superficial femoral vein\" — this confusing name caused errors, now officially just \"femo...","sourceLabel":"Section in Vascular Surgery"},"1670":{"title":"The Vascular Physical Exam","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s3","snippet":"The Vascular Physical Exam Pulse Examination Pulses are assessed bilaterally and graded: 0 = absent, 1+ = diminished/thready, 2+ = normal, 3+ = bounding, D = detectable by Doppler only. Standard vascular pulse points: carotid, brachial, radial, ulnar, femoral, popliteal, dorsalis pedis (DP), posteri...","sourceLabel":"Section in Vascular Surgery"},"1671":{"title":"Peripheral Arterial Disease (PAD)","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s4","snippet":"Peripheral Arterial Disease (PAD) PAD is the single most common diagnosis in vascular surgery — atherosclerotic narrowing/occlusion of the arteries supplying the extremities, overwhelmingly the lower limbs. PAD is a systemic marker of atherosclerosis: patients have a 5–7× increased risk of MI, strok...","sourceLabel":"Section in Vascular Surgery"},"1672":{"title":"Chronic Limb-Threatening Ischemia (CLTI)","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s5","snippet":"Chronic Limb-Threatening Ischemia (CLTI) CLTI is the advanced stage of PAD — ischemic rest pain, non-healing ulceration, or gangrene present for >2 weeks with objective evidence of arterial insufficiency. This is the modern term replacing \"critical limb ischemia (CLI).\" Without revascularization, 25...","sourceLabel":"Section in Vascular Surgery"},"1673":{"title":"Acute Limb Ischemia (ALI)","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s6","snippet":"Acute Limb Ischemia (ALI) ALI is a surgical emergency — sudden decrease in limb perfusion threatening limb viability, typically within 14 days of onset. The 6 P's : Pain, Pallor, Pulselessness, Poikilothermia (cold), Paresthesia, Paralysis. Paresthesia and paralysis are the most ominous — indicating...","sourceLabel":"Section in Vascular Surgery"},"1674":{"title":"Carotid Artery Disease","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s7","snippet":"Carotid Artery Disease Atherosclerotic stenosis at the carotid bifurcation/ICA. The symptomatic vs asymptomatic distinction is the single most important factor in treatment decisions. Symptomatic: Ipsilateral stroke, TIA, or amaurosis fugax within the past 6 months. TIA symptoms: sudden onset contra...","sourceLabel":"Section in Vascular Surgery"},"1675":{"title":"Subclavian Steal Syndrome","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s8","snippet":"Subclavian Steal Syndrome Caused by significant stenosis or occlusion of the proximal subclavian artery (before the vertebral artery origin). The pressure distal to the stenosis drops, and during arm exercise, blood \"steals\" from the brain by flowing retrograde down the vertebral artery to supply th...","sourceLabel":"Section in Vascular Surgery"},"1676":{"title":"Upper Extremity Arterial Disease","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s9","snippet":"Upper Extremity Arterial Disease Much less common than lower extremity PAD but still seen. Etiologies include atherosclerosis (subclavian/axillary arteries), emboli (from cardiac or proximal sources — causing acute hand ischemia with \"blue finger\" or \"trash hand\"), thoracic outlet syndrome (compress...","sourceLabel":"Section in Vascular Surgery"},"1677":{"title":"Raynaud's Phenomenon","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s10","snippet":"Raynaud's Phenomenon Episodic vasospasm of digital arteries causing the classic triphasic color change : white (pallor — vasospasm), blue (cyanosis — deoxygenation), red (rubor — reactive hyperemia on rewarming). Triggered by cold exposure or emotional stress. Primary Raynaud's (Raynaud's disease): ...","sourceLabel":"Section in Vascular Surgery"},"1678":{"title":"Buerger's Disease (Thromboangiitis Obliterans)","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s11","snippet":"Buerger's Disease (Thromboangiitis Obliterans) Inflammatory, non-atherosclerotic, segmental thrombotic occlusion of small and medium arteries and veins of the distal extremities. Almost exclusively in young (20–45 years) male smokers (or users of any form of tobacco, including smokeless tobacco and ...","sourceLabel":"Section in Vascular Surgery"},"1679":{"title":"Popliteal Entrapment Syndrome","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s12","snippet":"Popliteal Entrapment Syndrome Anatomic compression of the popliteal artery by an aberrant medial head of the gastrocnemius muscle (or other musculotendinous structures) in the popliteal fossa. Classically presents in young, athletic males (20–30s) — often runners, cyclists, or military personnel — w...","sourceLabel":"Section in Vascular Surgery"},"1680":{"title":"Abdominal Aortic Aneurysm (AAA)","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s13","snippet":"Abdominal Aortic Aneurysm (AAA) An aneurysm is dilation of an artery to ≥ 1.5× its normal diameter. For the infrarenal aorta (normal ~2.0 cm), AAA is defined as ≥ 3.0 cm. AAAs are the 13th leading cause of death in the US. Rupture mortality: > 80% (most die before reaching the OR); even with emergen...","sourceLabel":"Section in Vascular Surgery"},"1681":{"title":"Thoracic & Thoracoabdominal Aneurysms","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s14","snippet":"Thoracic & Thoracoabdominal Aneurysms Thoracic aortic aneurysms (TAA) affect the ascending aorta, arch, or descending thoracic aorta (DTA). Vascular surgeons primarily manage DTA aneurysms; ascending aortic and arch aneurysms are usually managed by cardiothoracic surgery. Repair threshold: generally...","sourceLabel":"Section in Vascular Surgery"},"1682":{"title":"Aortic Dissection & Acute Aortic Syndromes","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s15","snippet":"Aortic Dissection & Acute Aortic Syndromes Tear in the aortic intima allowing blood to dissect between layers, creating a true lumen and false lumen. Stanford Type A = involves ascending aorta → emergent open repair (cardiac surgery). Stanford Type B = descending aorta only (distal to left subclavia...","sourceLabel":"Section in Vascular Surgery"},"1683":{"title":"Popliteal Artery Aneurysm","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s16","snippet":"Popliteal Artery Aneurysm The most common peripheral aneurysm (70% of all peripheral aneurysms). Defined as popliteal artery diameter ≥ 2 cm (normal ~0.7–1.0 cm). Strong association with AAA — 40–50% of patients with popliteal aneurysms have a concomitant AAA , and 50–70% have bilateral popliteal an...","sourceLabel":"Section in Vascular Surgery"},"1684":{"title":"Visceral Artery Aneurysms","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s17","snippet":"Visceral Artery Aneurysms Aneurysms of the celiac, splenic, hepatic, SMA, renal, or other visceral arteries. The most common visceral artery aneurysm is splenic artery aneurysm (60% of all visceral aneurysms), followed by hepatic artery aneurysm. Splenic artery aneurysms are more common in women and...","sourceLabel":"Section in Vascular Surgery"},"1685":{"title":"Pseudoaneurysms","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s18","snippet":"Pseudoaneurysms A pseudoaneurysm (false aneurysm) is a contained rupture — blood leaks through a breach in the arterial wall but is contained by surrounding tissue (adventitia and/or hematoma), creating a pulsatile sac that communicates with the arterial lumen through a \"neck.\" Unlike true aneurysms...","sourceLabel":"Section in Vascular Surgery"},"1686":{"title":"Mycotic / Infected Aneurysms & Graft Infections","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s19","snippet":"Mycotic / Infected Aneurysms & Graft Infections Mycotic aneurysms are infected aneurysms (the name is misleading — they are usually bacterial, not fungal). Common organisms: Staphylococcus aureus (most common), Salmonella (especially in patients with pre-existing atherosclerosis), Streptococcus spec...","sourceLabel":"Section in Vascular Surgery"},"1687":{"title":"Deep Vein Thrombosis (DVT)","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s20","snippet":"Deep Vein Thrombosis (DVT) Figure 18 - Venous Duplex Ultrasound of DVT. Color-flow Doppler demonstrating complete occlusion of the femoral vein by a heterogeneous thrombus, with absence of normal venous flow signal within the occluded segment. Compression ultrasound is the first-line diagnostic stud...","sourceLabel":"Section in Vascular Surgery"},"1688":{"title":"Pulmonary Embolism (PE) — Vascular Role","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s21","snippet":"Pulmonary Embolism (PE) — Vascular Role PE is primarily managed by emergency medicine, pulmonology, and critical care, but vascular surgeons are involved when: catheter-directed thrombolysis is needed for massive/submassive PE, IVC filter placement is indicated, or surgical pulmonary embolectomy is ...","sourceLabel":"Section in Vascular Surgery"},"1689":{"title":"Chronic Venous Insufficiency (CVI)","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s22","snippet":"Chronic Venous Insufficiency (CVI) Figure 19 - MR Venography for Venous Assessment. MR venography demonstrating venous anatomy of the iliocaval system, used for evaluation of deep venous obstruction, post-thrombotic changes, and compression syndromes that contribute to chronic venous insufficiency. ...","sourceLabel":"Section in Vascular Surgery"},"1690":{"title":"Varicose Veins & Superficial Venous Disease","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s23","snippet":"Varicose Veins & Superficial Venous Disease Dilated, tortuous superficial veins ≥ 3 mm from incompetent valves in the GSV, SSV, or tributaries. Symptoms: heaviness, aching, throbbing, burning, itching, night cramps, restless legs. Complications: superficial thrombophlebitis, bleeding (can be dramati...","sourceLabel":"Section in Vascular Surgery"},"1691":{"title":"Superficial Thrombophlebitis","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s24","snippet":"Superficial Thrombophlebitis Thrombosis and inflammation of a superficial vein. Presents as a palpable, tender, indurated, erythematous cord along the course of a superficial vein. Most commonly affects the GSV or its tributaries. Risk factors: varicose veins, IV catheters, trauma, immobilization, h...","sourceLabel":"Section in Vascular Surgery"},"1692":{"title":"Post-Thrombotic Syndrome (PTS)","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s25","snippet":"Post-Thrombotic Syndrome (PTS) The chronic sequela of DVT. After DVT, the thrombus either recanalizes (partially or completely) with residual valve damage, or persists as a chronic obstruction. The result is chronic deep venous reflux and/or obstruction → chronic venous hypertension → all the featur...","sourceLabel":"Section in Vascular Surgery"},"1693":{"title":"May-Thurner Syndrome","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s26","snippet":"May-Thurner Syndrome Compression of the left common iliac vein by the overlying right common iliac artery against the lumbar spine. This anatomic compression causes intimal hyperplasia (spur formation) within the left iliac vein, predisposing to left-sided iliofemoral DVT. Classically seen in young ...","sourceLabel":"Section in Vascular Surgery"},"1694":{"title":"Nutcracker Syndrome","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s27","snippet":"Nutcracker Syndrome Compression of the left renal vein between the superior mesenteric artery (anteriorly) and the aorta (posteriorly). This causes left renal venous hypertension, leading to: hematuria (often microscopic but can be gross), left flank pain, left-sided varicocele (in men), pelvic cong...","sourceLabel":"Section in Vascular Surgery"},"1695":{"title":"Pelvic Congestion Syndrome","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s28","snippet":"Pelvic Congestion Syndrome Chronic pelvic pain in women caused by dilated, incompetent pelvic (ovarian/internal iliac) veins — essentially \"pelvic varicose veins.\" Presents with dull, aching pelvic pain worse with prolonged standing, worse premenstrually, associated with dyspareunia, and often with ...","sourceLabel":"Section in Vascular Surgery"},"1696":{"title":"Mesenteric Ischemia","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s29","snippet":"Mesenteric Ischemia Acute Mesenteric Ischemia (AMI) Surgical emergency with 60–80% mortality. Causes: SMA embolism (~50% — usually cardiac source), SMA thrombosis (~25% — on pre-existing atherosclerosis), mesenteric venous thrombosis (~10% — hypercoagulable states), non-occlusive mesenteric ischemia...","sourceLabel":"Section in Vascular Surgery"},"1697":{"title":"Median Arcuate Ligament Syndrome (MALS)","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s30","snippet":"Median Arcuate Ligament Syndrome (MALS) The median arcuate ligament (MAL) is a fibrous arch connecting the diaphragmatic crura. In some patients, it crosses low, compressing the celiac trunk extrinsically. This can cause postprandial abdominal pain, nausea, and weight loss — mimicking CMI but in you...","sourceLabel":"Section in Vascular Surgery"},"1698":{"title":"Renal Artery Stenosis & FMD","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s31","snippet":"Renal Artery Stenosis & FMD Atherosclerotic RAS Ostial/proximal renal artery narrowing due to aortic atherosclerotic plaque. Typically in older patients with other atherosclerotic disease. Causes renovascular hypertension (suspect when: HTN onset > 55 years, resistant HTN requiring 3+ meds, flash pu...","sourceLabel":"Section in Vascular Surgery"},"1699":{"title":"Thoracic Outlet Syndrome (TOS)","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s32","snippet":"Thoracic Outlet Syndrome (TOS) Figure 21 - Three Spaces of the Thoracic Outlet. Anatomical illustration demonstrating the three potential sites of neurovascular compression in thoracic outlet syndrome: the interscalene triangle (between anterior and middle scalene muscles), the costoclavicular space...","sourceLabel":"Section in Vascular Surgery"},"1700":{"title":"Dialysis Access (AVF, AVG, CVC)","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s33","snippet":"Dialysis Access (AVF, AVG, CVC) Preferred order (Fistula First initiative): AVF > AVG > CVC . AVF: Direct artery-to-vein anastomosis. Forearm: radiocephalic (Brescia-Cimino). Upper arm: brachiocephalic, brachiobasilic (basilic vein must be transposed superficially). Rule of 6's for maturity: ≥ 600 m...","sourceLabel":"Section in Vascular Surgery"},"1701":{"title":"Carotid Body Tumors (Paragangliomas)","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s34","snippet":"Carotid Body Tumors (Paragangliomas) Rare, typically benign, hypervascular tumors arising from the carotid body (a chemoreceptor at the carotid bifurcation). Present as a slowly enlarging, painless lateral neck mass at the angle of the mandible. The mass is pulsatile, has a transmitted bruit, and ch...","sourceLabel":"Section in Vascular Surgery"},"1702":{"title":"Vasculitis — Takayasu's & Giant Cell Arteritis","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s35","snippet":"Vasculitis — Takayasu's & Giant Cell Arteritis Takayasu's Arteritis Large-vessel vasculitis affecting the aorta and its branches. Classically in young Asian women < 40 years . Causes stenosis, occlusion, and aneurysmal dilation of the aorta, arch branches (carotid, subclavian), renal, and mesenteric...","sourceLabel":"Section in Vascular Surgery"},"1703":{"title":"Arteriovenous Malformations (AVM)","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s36","snippet":"Arteriovenous Malformations (AVM) Congenital vascular anomalies with abnormal direct connections between arteries and veins without an intervening capillary bed. Can occur anywhere in the body (extremities, pelvis, viscera, brain/spinal cord — the latter managed by neurosurgery). Classified by the S...","sourceLabel":"Section in Vascular Surgery"},"1704":{"title":"Lymphedema","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s37","snippet":"Lymphedema Protein-rich interstitial fluid accumulation from impaired lymphatic drainage. Primary: congenital lymphatic malformation (lymphedema praecox < 35 yrs; lymphedema tarda > 35 yrs). Secondary (far more common): surgery (axillary/inguinal lymph node dissection), radiation, infection (filaria...","sourceLabel":"Section in Vascular Surgery"},"1705":{"title":"Diabetic Foot Disease","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s38","snippet":"Diabetic Foot Disease The diabetic foot is a convergence of three pathologies: peripheral neuropathy (loss of protective sensation → unrecognized trauma → ulceration), PAD (diabetics preferentially develop tibial artery disease → impaired healing), and immunopathy (impaired WBC function → susceptibi...","sourceLabel":"Section in Vascular Surgery"},"1706":{"title":"Wound Care — Dressings, VAC, HBO","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s39","snippet":"Wound Care — Dressings, VAC, HBO Wound Healing Principles Wound healing requires: adequate blood supply (revascularize if ischemic), absence of infection (debride and treat), moist wound environment (not too wet, not too dry), offloading of pressure (total contact cast, diabetic shoes, wheelchair fo...","sourceLabel":"Section in Vascular Surgery"},"1707":{"title":"Amputation Levels & Limb Salvage","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s40","snippet":"Amputation Levels & Limb Salvage Level Description Key Considerations Toe amputation Single or multiple toe removal Preserve as much length as possible; \"fillet\" flap can close over bone Ray amputation Toe + corresponding metatarsal Usually 1st or 5th ray; alters foot biomechanics less than central ...","sourceLabel":"Section in Vascular Surgery"},"1708":{"title":"Endovascular Procedures","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s41","snippet":"Endovascular Procedures Balloon Angioplasty (PTA) A catheter with a deflated balloon is advanced across the stenosis under fluoroscopic guidance. The balloon is inflated to compress the plaque against the arterial wall, widening the lumen. Used alone for short, focal lesions (especially iliac, tibia...","sourceLabel":"Section in Vascular Surgery"},"1709":{"title":"Bypass Grafting","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s42","snippet":"Bypass Grafting Conduit Choices Conduit Advantages Disadvantages Typical Use Autologous great saphenous vein (reversed or in-situ) Best long-term patency (especially below knee), lowest infection rate Requires adequate vein (≥ 3 mm), harvest site morbidity, not always available Infrainguinal bypass ...","sourceLabel":"Section in Vascular Surgery"},"1710":{"title":"Carotid Procedures (CEA, CAS, TCAR)","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s43","snippet":"Carotid Procedures (CEA, CAS, TCAR) Covered in depth in Section 07. Key procedural details: CEA: Key operative details: type of anesthesia (general vs cervical block), use of intraoperative shunt (yes/no), type of arteriotomy closure (primary vs patch — bovine pericardium, Dacron, ePTFE), intraopera...","sourceLabel":"Section in Vascular Surgery"},"1711":{"title":"Aortic Repair (EVAR, TEVAR, Open)","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s44","snippet":"Aortic Repair (EVAR, TEVAR, Open) Covered in depth in Sections 13–15. Key management and follow-up points: EVAR: Key operative details: device manufacturer/model (Cook Zenith, Gore Excluder, Medtronic Endurant), main body and limb sizes, deployment accuracy, completion angiogram findings (endoleak t...","sourceLabel":"Section in Vascular Surgery"},"1712":{"title":"Venous Procedures","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s45","snippet":"Venous Procedures Endovenous ablation (RFA/EVLT): GSV or SSV accessed percutaneously under ultrasound guidance near the knee. Catheter advanced to the SFJ (positioned 2 cm below the junction to avoid extension into deep system). Tumescent anesthesia injected around the vein. Thermal energy delivered...","sourceLabel":"Section in Vascular Surgery"},"1713":{"title":"Drug-Coated Devices (DCB & DES)","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s46","snippet":"Drug-Coated Devices (DCB & DES) Drug-coated balloons (DCB) and drug-eluting stents (DES) deliver anti-proliferative drugs (primarily paclitaxel for peripheral, sirolimus for coronary) directly to the vessel wall during angioplasty or stenting to inhibit neointimal hyperplasia (the smooth muscle cell...","sourceLabel":"Section in Vascular Surgery"},"1714":{"title":"Post-Op Management by Procedure","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s47","snippet":"Post-Op Management by Procedure Procedure Key Post-Op Monitoring Common Complications CEA Neuro checks q1hr × 24hr (speech, motor, CN function), BP management (avoid hypo/hypertension — both dangerous), drain output, neck swelling (hematoma) Stroke (1–3%), cranial nerve injury (hypoglossal, vagus), ...","sourceLabel":"Section in Vascular Surgery"},"1715":{"title":"Graft Complications","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s48","snippet":"Graft Complications Complication Timing Presentation Management Graft thrombosis Early (< 30 days) or late Return of ischemic symptoms, absent pulse/thrill Surgical or endovascular thrombectomy → identify and treat cause (kink, stenosis, poor runoff) Anastomotic stenosis (intimal hyperplasia) 6 mont...","sourceLabel":"Section in Vascular Surgery"},"1716":{"title":"Perioperative Cardiac Risk","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s49","snippet":"Perioperative Cardiac Risk Vascular surgery patients have extremely high rates of coexisting coronary artery disease (often asymptomatic due to limited exercise capacity). Major vascular surgery carries the highest cardiac risk of any surgical category. The Revised Cardiac Risk Index (RCRI / Lee Ind...","sourceLabel":"Section in Vascular Surgery"},"1717":{"title":"Imaging & Diagnostics","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s50","snippet":"Imaging & Diagnostics Modality What It Shows Clinical Interpretation Notes ABI Ratio of ankle:arm systolic BP Record exact bilateral values; note exercise ABI if done TBI Toe:arm systolic BP ratio Used when ABI > 1.4 (calcified); TBI < 0.7 = PAD Arterial duplex Anatomy + flow velocities (PSV, EDV) R...","sourceLabel":"Section in Vascular Surgery"},"1718":{"title":"Arterial Waveforms & Duplex Interpretation","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s51","snippet":"Arterial Waveforms & Duplex Interpretation You will hear the terms \"triphasic,\" \"biphasic,\" and \"monophasic\" on every single duplex ultrasound report. Understanding these waveforms is fundamental. Waveform Components What It Means Triphasic (normal) 1. Sharp systolic forward flow peak 2. Brief early...","sourceLabel":"Section in Vascular Surgery"},"1719":{"title":"Classification Systems — All in One Place","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s52","snippet":"Classification Systems — All in One Place System Classifies Key Features Fontaine Chronic PAD (symptoms) I (asymptomatic), IIa (claudication >200m), IIb (<200m), III (rest pain), IV (tissue loss) Rutherford (chronic) Chronic PAD (symptoms + hemodynamics) 0–6; adds objective ABI/PVR/treadmill data to...","sourceLabel":"Section in Vascular Surgery"},"1720":{"title":"Medications Master Table","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s53","snippet":"Medications Master Table Antiplatelet Agents Drug (Brand) Mechanism Dose Vascular Use Hold Before Surgery Aspirin Irreversible COX-1 inhibitor 81 or 325 mg daily All PAD, post-CEA, post-stent 7 days (often continued perioperatively) Clopidogrel (Plavix) Irreversible P2Y12 blocker 75 mg daily PAD, DA...","sourceLabel":"Section in Vascular Surgery"},"1721":{"title":"Abbreviations Master List","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s54","snippet":"Abbreviations Master List Anatomy CCA Common carotid artery ICA Internal carotid artery ECA External carotid artery CFA Common femoral artery SFA Superficial femoral artery DFA Deep femoral artery (profunda) AT Anterior tibial artery PT Posterior tibial artery DP Dorsalis pedis artery GSV Great saph...","sourceLabel":"Section in Vascular Surgery"},"1722":{"title":"Risk Factors & Comorbidities","pageTitle":"Vascular Surgery","pageUrl":"/surgical/vascular-surgery","url":"/surgical/vascular-surgery#s55","snippet":"Risk Factors & Comorbidities Core Risk Factors in Every Vascular Patient Smoking: Pack-years + quit date. Active smoking is the #1 modifiable risk factor for PAD, AAA, carotid disease, graft failure, and amputation. Smoking cessation counseling should occur at every visit. Diabetes mellitus: Type 1 ...","sourceLabel":"Section in Vascular Surgery"},"1723":{"title":"Cardiothoracic Surgery","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery","snippet":"Specialty Reference Cardiothoracic Surgery Complete Specialty Reference Every diagnosis, classification, procedure, technique, medication, complication, and management algorithm across the full scope of cardiothoracic surgery in one place."},"1724":{"title":"Cardiac Anatomy","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s1","snippet":"Cardiac Anatomy Coronary Circulation The heart receives its blood supply from two coronary arteries arising from the aortic root just above the aortic valve cusps (the sinuses of Valsalva). The left main coronary artery (LMCA) arises from the left coronary sinus and bifurcates (after 1-2 cm) into th...","sourceLabel":"Section in Cardiothoracic Surgery"},"1725":{"title":"Thoracic & Pulmonary Anatomy","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s2","snippet":"Thoracic & Pulmonary Anatomy Bronchopulmonary Segments The right lung has three lobes (upper, middle, lower) separated by the oblique and horizontal fissures, with 10 bronchopulmonary segments. The left lung has two lobes (upper — includes the lingula, and lower) separated by the oblique fissure, wi...","sourceLabel":"Section in Cardiothoracic Surgery"},"1726":{"title":"Cardiopulmonary Physiology","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s3","snippet":"Cardiopulmonary Physiology Cardiac Output Determinants Cardiac output (CO) = Heart rate (HR) &times; Stroke volume (SV). Normal CO is ~5 L/min. Stroke volume is determined by three factors: preload (end-diastolic volume — Frank-Starling mechanism), afterload (wall stress, approximated by SVR), and c...","sourceLabel":"Section in Cardiothoracic Surgery"},"1727":{"title":"The Cardiothoracic Exam & Preoperative Assessment","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s4","snippet":"The Cardiothoracic Exam & Preoperative Assessment Cardiac Risk Stratification Two primary scoring systems dominate cardiothoracic surgical risk assessment: EuroSCORE II The European System for Cardiac Operative Risk Evaluation II is a logistic regression model that predicts operative mortality for c...","sourceLabel":"Section in Cardiothoracic Surgery"},"1728":{"title":"Coronary Artery Bypass Grafting (CABG)","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s5","snippet":"Coronary Artery Bypass Grafting (CABG) Indications for CABG Current ACC/AHA guideline class I indications for CABG include: Left main disease (&ge; 50% stenosis) — CABG is superior to PCI (EXCEL trial controversy notwithstanding; 5-year data favor CABG) Three-vessel disease — especially with reduced...","sourceLabel":"Section in Cardiothoracic Surgery"},"1729":{"title":"Landmark Trials & Revascularization Strategy","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s6","snippet":"Landmark Trials & Revascularization Strategy Landmark Coronary Revascularization Trials SYNTAX Trial (2009; PMID: 19228612 ): Left main or 3-vessel disease randomized to PCI (TAXUS stent) vs CABG. At 5 years, CABG had lower MACCE in 3-vessel disease and intermediate/high SYNTAX scores. PCI was non-i...","sourceLabel":"Section in Cardiothoracic Surgery"},"1730":{"title":"Aortic Valve Disease","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s7","snippet":"Aortic Valve Disease Aortic Stenosis (AS) The most common valvular indication for surgery in adults. Etiologies: degenerative/calcific (most common in elderly, typically > 65), bicuspid aortic valve (most common congenital cardiac anomaly, prevalence ~1-2%, presents earlier at age 40-60), and rheuma...","sourceLabel":"Section in Cardiothoracic Surgery"},"1731":{"title":"Mitral Valve Disease","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s8","snippet":"Mitral Valve Disease Mitral Regurgitation (MR) MR is classified by the Carpentier classification based on leaflet motion: Type I — normal leaflet motion (annular dilation, leaflet perforation from endocarditis); Type II — excessive leaflet motion (leaflet prolapse from myxomatous degeneration/Barlow...","sourceLabel":"Section in Cardiothoracic Surgery"},"1732":{"title":"Tricuspid Valve Disease & Endocarditis","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s9","snippet":"Tricuspid Valve Disease & Endocarditis Tricuspid Regurgitation (TR) The \"forgotten valve\" — TR is commonly functional (secondary) due to right ventricular dilation from pulmonary hypertension, left-sided heart disease, or atrial fibrillation. Significant TR is present in ~4% of the population and is...","sourceLabel":"Section in Cardiothoracic Surgery"},"1733":{"title":"Thoracic Aortic Aneurysm","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s10","snippet":"Thoracic Aortic Aneurysm Definition & Etiology A thoracic aortic aneurysm (TAA) is defined as dilation of the thoracic aorta to &ge; 1.5 times the expected normal diameter (approximately &ge; 4.5 cm for the ascending aorta in adults). Etiologies: degenerative (medial degeneration — most common), con...","sourceLabel":"Section in Cardiothoracic Surgery"},"1734":{"title":"Acute Aortic Dissection","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s11","snippet":"Acute Aortic Dissection Classification Systems Stanford & DeBakey Classifications Stanford Type A: Any dissection involving the ascending aorta (regardless of the entry tear site). This is a surgical emergency — mortality increases ~1-2% per hour without surgery. Stanford Type B: Dissection involvin...","sourceLabel":"Section in Cardiothoracic Surgery"},"1735":{"title":"Aortic Root Surgery & TEVAR","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s12","snippet":"Aortic Root Surgery & TEVAR Bentall Procedure (Composite Valve-Graft Replacement) The Bentall procedure replaces the aortic root entirely: the aortic valve, sinuses of Valsalva, and ascending aorta are replaced with a composite graft (a valved conduit — mechanical or bioprosthetic valve sewn into a ...","sourceLabel":"Section in Cardiothoracic Surgery"},"1736":{"title":"Lung Cancer — Staging & Surgical Management","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s13","snippet":"Lung Cancer — Staging & Surgical Management Non-Small Cell Lung Cancer (NSCLC) Staging Lung cancer is the leading cause of cancer death worldwide. NSCLC (~85% of lung cancers) includes adenocarcinoma (most common, ~40%), squamous cell carcinoma (~25%), and large cell carcinoma (~10%). Small cell lun...","sourceLabel":"Section in Cardiothoracic Surgery"},"1737":{"title":"Esophageal Cancer & Esophagectomy","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s14","snippet":"Esophageal Cancer & Esophagectomy Esophageal Cancer Overview Two main histologic types: squamous cell carcinoma (SCC) — associated with smoking and alcohol, more common in upper/mid esophagus, higher incidence in Asia and Africa — and adenocarcinoma — associated with GERD, Barrett's esophagus, and o...","sourceLabel":"Section in Cardiothoracic Surgery"},"1738":{"title":"Mediastinal Masses","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s15","snippet":"Mediastinal Masses The \"4 T's\" of the Anterior Mediastinum The most common anterior mediastinal masses are: Thymoma , Teratoma (and other germ cell tumors), Terrible lymphoma (Hodgkin's and non-Hodgkin's), and Thyroid (substernal goiter). Approach: CT chest with contrast is the initial imaging study...","sourceLabel":"Section in Cardiothoracic Surgery"},"1739":{"title":"Pleural Disease & Chest Wall Tumors","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s16","snippet":"Pleural Disease & Chest Wall Tumors Pleural Effusion Categorized as transudative (CHF, cirrhosis, nephrotic syndrome — Light's criteria: protein ratio < 0.5, LDH ratio < 0.6, LDH < 2/3 upper limit of normal) or exudative (infection, malignancy, PE, autoimmune — meets one or more Light's criteria). M...","sourceLabel":"Section in Cardiothoracic Surgery"},"1740":{"title":"Heart Transplantation","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s17","snippet":"Heart Transplantation Listing Criteria Heart transplantation is indicated for end-stage heart failure (NYHA class III-IV) refractory to maximal medical therapy, with an expected 1-year survival < 50% without transplant. Specific indications include: VO2max < 12-14 mL/kg/min on cardiopulmonary exerci...","sourceLabel":"Section in Cardiothoracic Surgery"},"1741":{"title":"Mechanical Circulatory Support","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s18","snippet":"Mechanical Circulatory Support Left Ventricular Assist Device (LVAD) The HeartMate 3 (HM3) is the current-generation LVAD — a centrifugal-flow, fully magnetically levitated pump. The impeller is suspended without mechanical bearings, reducing shear stress on blood elements and significantly lowering...","sourceLabel":"Section in Cardiothoracic Surgery"},"1742":{"title":"Congenital Heart Disease, Pericardial Disease & Cardiac Tumors","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s19","snippet":"Congenital Heart Disease, Pericardial Disease & Cardiac Tumors Adult Congenital Heart Disease (ACHD) Atrial septal defect (ASD): Secundum (most common, ~70%) — amenable to device closure (Amplatzer) or surgical patch closure. Primum — associated with AV canal defects, requires surgical repair. Sinus...","sourceLabel":"Section in Cardiothoracic Surgery"},"1743":{"title":"Cardiopulmonary Bypass & Myocardial Protection","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s20","snippet":"Cardiopulmonary Bypass & Myocardial Protection CPB Circuit The cardiopulmonary bypass (CPB) circuit consists of: venous cannula(e) (right atrial — two-stage cannula for most cases; bicaval cannulation for open-heart procedures requiring right atriotomy), venous reservoir , membrane oxygenator (provi...","sourceLabel":"Section in Cardiothoracic Surgery"},"1744":{"title":"Postoperative ICU Management","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s21","snippet":"Postoperative ICU Management Hemodynamic Management After cardiac surgery, patients are monitored with arterial line, PA catheter (in complex cases), central venous catheter, and TEE as needed. Target parameters: MAP 65-80 mmHg, CI > 2.2 L/min/m&sup2;, CVP 8-12 mmHg, SvO2 > 65%, urine output > 0.5 m...","sourceLabel":"Section in Cardiothoracic Surgery"},"1745":{"title":"Surgical Approaches & Key Procedures","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s22","snippet":"Surgical Approaches & Key Procedures Median Sternotomy The median sternotomy is the most common approach in cardiac surgery. An incision from the sternal notch to the xiphoid process; the sternum is divided with an oscillating saw. Provides excellent exposure to the heart, great vessels, and both pl...","sourceLabel":"Section in Cardiothoracic Surgery"},"1746":{"title":"ECMO Cannulation & Management","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s23","snippet":"ECMO Cannulation & Management VA ECMO Cannulation Peripheral VA ECMO: Femoral vein (drainage) + femoral artery (return). Most common configuration for emergent cannulation. Key complication: limb ischemia distal to the femoral arterial cannula — a distal perfusion cannula (DPC) (antegrade cannula in...","sourceLabel":"Section in Cardiothoracic Surgery"},"1747":{"title":"Inotropes, Vasopressors & Hemodynamic Agents","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s24","snippet":"Inotropes, Vasopressors & Hemodynamic Agents Agent Mechanism Dose Range Hemodynamic Effect Key Notes Milrinone PDE-3 inhibitor (inodilator) 0.125-0.75 mcg/kg/min (load 50 mcg/kg over 10 min — often omitted due to hypotension) &uarr; inotropy, &darr; SVR, &darr; PVR Ideal for low CO + elevated PVR (R...","sourceLabel":"Section in Cardiothoracic Surgery"},"1748":{"title":"Anticoagulation, Antiarrhythmics & Immunosuppression","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s25","snippet":"Anticoagulation, Antiarrhythmics & Immunosuppression Anticoagulation for Prosthetic Valves Valve Type / Position Anticoagulation Target INR Mechanical aortic valve (low risk — On-X, St. Jude bileaflet) Warfarin + aspirin 81 mg 2.0-3.0 (On-X: 1.5-2.0 after 3 months per PROACT trial) Mechanical mitral...","sourceLabel":"Section in Cardiothoracic Surgery"},"1749":{"title":"Classification Systems","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s26","snippet":"Classification Systems Cardiac Surgery Risk Scores Score Purpose Key Variables EuroSCORE II Predicted operative mortality for cardiac surgery Age, sex, CrCl, LVEF, NYHA, CCS, PA pressure, urgency, thoracic aorta surgery, prior cardiac surgery STS Risk Score Predicted mortality + morbidity for CABG, ...","sourceLabel":"Section in Cardiothoracic Surgery"},"1750":{"title":"Complications","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s27","snippet":"Complications Complication Incidence Recognition Management Postoperative bleeding 3-5% require re-exploration Chest tube output > 200 mL/hr &times; 2 hrs; hemodynamic instability Correct coagulopathy (protamine, FFP, platelets, cryo, TXA); re-exploration if medical management fails Cardiac tamponad...","sourceLabel":"Section in Cardiothoracic Surgery"},"1751":{"title":"Medications Master Table","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s28","snippet":"Medications Master Table Drug Class Typical Dose Key Indication in CT Surgery Heparin (UFH) Anticoagulant 300-400 U/kg for CPB; 80 U/kg bolus + 18 U/kg/hr for treatment CPB anticoagulation; ECMO; VTE treatment Protamine Heparin reversal 1-1.3 mg per 100 U heparin; slow IV push Reversal of heparin af...","sourceLabel":"Section in Cardiothoracic Surgery"},"1752":{"title":"Abbreviations Master List","pageTitle":"Cardiothoracic Surgery","pageUrl":"/surgical/cardiothoracic-surgery","url":"/surgical/cardiothoracic-surgery#s29","snippet":"Abbreviations Master List Abbreviations ACT Activated clotting time AF / AFib Atrial fibrillation AR Aortic regurgitation ARDS Acute respiratory distress syndrome AS Aortic stenosis ASD Atrial septal defect AVA Aortic valve area AVR Aortic valve replacement BIMA Bilateral internal mammary artery BPF...","sourceLabel":"Section in Cardiothoracic Surgery"},"1753":{"title":"Surgical Oncology","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology","snippet":"Specialty Reference Surgical Oncology Complete Specialty Reference Every diagnosis, classification, procedure, technique, medication, complication, and management algorithm across the full scope of surgical oncology in one place."},"1754":{"title":"Cancer Biology & Tumor Kinetics","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s1","snippet":"Cancer Biology & Tumor Kinetics Surgical oncology is built on an understanding of tumor biology. The decision to operate, the extent of resection, the role of neoadjuvant or adjuvant therapy, and the approach to surveillance all derive from fundamental principles of how cancers grow, invade, and met...","sourceLabel":"Section in Surgical Oncology"},"1755":{"title":"Surgical Oncology Principles","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s2","snippet":"Surgical Oncology Principles Resection Classification The completeness of surgical resection is the single most important prognostic factor for most solid tumors. Classification Definition Clinical Implications R0 Microscopically negative margins — no tumor at the inked resection margin Goal of cura...","sourceLabel":"Section in Surgical Oncology"},"1756":{"title":"Oncologic Staging & Molecular Markers","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s3","snippet":"Oncologic Staging & Molecular Markers TNM Staging System The AJCC/UICC TNM system (currently 8th edition, 2017) is the universal framework for cancer staging. T = extent of the primary tumor (size, depth of invasion, or local extension), N = regional lymph node involvement (number and/or location), ...","sourceLabel":"Section in Surgical Oncology"},"1757":{"title":"Breast Anatomy & Pathology","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s4","snippet":"Breast Anatomy & Pathology Breast Anatomy The breast extends from the 2nd to the 6th rib vertically and from the sternal edge to the midaxillary line horizontally. It lies on the pectoralis major fascia with a retromammary bursa (potential space) separating breast tissue from the pectoral muscles. T...","sourceLabel":"Section in Surgical Oncology"},"1758":{"title":"Breast-Conserving Surgery & Mastectomy","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s5","snippet":"Breast-Conserving Surgery & Mastectomy Breast-Conserving Surgery (BCS / Lumpectomy) The NSABP B-06 trial (Fisher, 1985; 20-year follow-up PMID: 12065600 ) established that lumpectomy + whole-breast radiation provides equivalent overall survival to mastectomy for stage I–II breast cancer. BCS is now ...","sourceLabel":"Section in Surgical Oncology"},"1759":{"title":"Axillary Management & SLNB","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s6","snippet":"Axillary Management & SLNB Sentinel Lymph Node Biopsy for Breast Cancer SLNB has replaced routine axillary lymph node dissection (ALND) for clinically node-negative breast cancer. The dual-tracer technique (radiotracer + blue dye) achieves identification rates >97% and false-negative rates <5%. At l...","sourceLabel":"Section in Surgical Oncology"},"1760":{"title":"Neoadjuvant Therapy & Special Situations","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s7","snippet":"Neoadjuvant Therapy & Special Situations Figure 39 - Medial Visceral Rotation (Kocher Maneuver). Illustration of the initial mobilization step in pancreaticoduodenectomy. The Kocher maneuver involves medial reflection of the duodenum and pancreatic head to expose the inferior vena cava, left renal v...","sourceLabel":"Section in Surgical Oncology"},"1761":{"title":"Esophageal Cancer","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s8","snippet":"Esophageal Cancer Epidemiology & Pathology Two main histologic types: squamous cell carcinoma (SCC) — associated with smoking and alcohol, most common in the upper/middle esophagus and worldwide; adenocarcinoma — associated with Barrett's esophagus and GERD, most common in the distal esophagus/GEJ a...","sourceLabel":"Section in Surgical Oncology"},"1762":{"title":"Gastric Cancer","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s9","snippet":"Gastric Cancer Staging & Preoperative Evaluation EUS for T-staging, CT CAP for distant metastases, and diagnostic laparoscopy with peritoneal washings (positive cytology upstages to M1 in AJCC 8th edition) are standard. Lauren classification divides gastric cancer into intestinal (glandular, more di...","sourceLabel":"Section in Surgical Oncology"},"1763":{"title":"Pancreatic Cancer","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s10","snippet":"Pancreatic Cancer Resectability Assessment Pancreatic ductal adenocarcinoma (PDAC) is resectable in only ~15–20% of patients at diagnosis. Classification: Category Definition (Vessel Involvement) Management Resectable No arterial contact (celiac, SMA, CHA); no venous involvement or &le;180° SMV/PV c...","sourceLabel":"Section in Surgical Oncology"},"1764":{"title":"Colorectal Cancer Surgery","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s11","snippet":"Colorectal Cancer Surgery Surgical Principles Curative colorectal cancer resection requires: adequate margins (5-cm proximal/distal margins for colon cancer; for rectal cancer, a 1–2 cm distal margin is acceptable with TME), adequate lymphadenectomy (minimum 12 lymph nodes examined for accurate stag...","sourceLabel":"Section in Surgical Oncology"},"1765":{"title":"GIST & Neuroendocrine Tumors","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s12","snippet":"GIST & Neuroendocrine Tumors Gastrointestinal Stromal Tumors (GIST) GISTs are the most common mesenchymal tumors of the GI tract, arising from the interstitial cells of Cajal. Most common location: stomach (60%) > small bowel (30%) > colorectal (5%) > esophagus (<5%). Driven by gain-of-function muta...","sourceLabel":"Section in Surgical Oncology"},"1766":{"title":"Hepatocellular Carcinoma","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s13","snippet":"Hepatocellular Carcinoma BCLC Staging & Treatment Algorithm The Barcelona Clinic Liver Cancer (BCLC) staging system integrates tumor burden, liver function (Child-Pugh), and performance status to guide treatment: BCLC Stage Tumor Status Liver Function / PS Treatment 0 (Very early) Single &le;2 cm Ch...","sourceLabel":"Section in Surgical Oncology"},"1767":{"title":"Liver Metastases & Cholangiocarcinoma","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s14","snippet":"Liver Metastases & Cholangiocarcinoma Colorectal Liver Metastases (CRLM) The liver is the most common site of colorectal cancer metastasis (~50% of patients). Surgical resection of CRLM offers 5-year survival of 40–58%, compared with <5% without treatment. Resectability criteria have evolved from tu...","sourceLabel":"Section in Surgical Oncology"},"1768":{"title":"Gallbladder Cancer & Peritoneal Surface Malignancies","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s15","snippet":"Gallbladder Cancer & Peritoneal Surface Malignancies Gallbladder Cancer Gallbladder cancer is frequently an incidental finding after cholecystectomy for presumed benign disease (~0.2–0.7% of cholecystectomies). Management depends on T-stage: T-Stage Depth of Invasion Management Tis / T1a Carcinoma i...","sourceLabel":"Section in Surgical Oncology"},"1769":{"title":"Melanoma — Staging, Excision, & SLNB","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s16","snippet":"Melanoma — Staging, Excision, & SLNB Melanoma Staging Melanoma staging relies on Breslow depth (measured in mm from the granular layer of the epidermis to the deepest point of tumor invasion — the single most important prognostic factor for localized melanoma), Clark level (I–V based on anatomic dep...","sourceLabel":"Section in Surgical Oncology"},"1770":{"title":"Advanced Melanoma & Non-Melanoma Skin Cancer","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s17","snippet":"Advanced Melanoma & Non-Melanoma Skin Cancer Melanoma AJCC 8th Edition — T-Stage Summary T Category Breslow Depth Ulceration T1a <0.8 mm Without ulceration T1b <0.8 mm with ulceration, or 0.8–1.0 mm with or without ulceration — T2a >1.0–2.0 mm Without ulceration T2b >1.0–2.0 mm With ulceration T3a >...","sourceLabel":"Section in Surgical Oncology"},"1771":{"title":"Soft Tissue Sarcoma & Retroperitoneal Sarcoma","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s18","snippet":"Soft Tissue Sarcoma & Retroperitoneal Sarcoma Figure 28 - CT-Guided Core Needle Biopsy for Soft Tissue Sarcoma. Image-guided core needle biopsy of a suspected soft tissue sarcoma. The biopsy tract must be planned along the axis of the potential future definitive resection so it can be excised en blo...","sourceLabel":"Section in Surgical Oncology"},"1772":{"title":"Desmoid Tumors & GIST (Sarcoma Context)","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s19","snippet":"Desmoid Tumors & GIST (Sarcoma Context) Desmoid Tumors (Aggressive Fibromatosis) Desmoid tumors are locally aggressive, non-metastasizing fibroproliferative neoplasms arising from musculoaponeurotic tissues. They are associated with familial adenomatous polyposis (FAP) / Gardner syndrome (mesenteric...","sourceLabel":"Section in Surgical Oncology"},"1773":{"title":"Thyroid Cancer & Adrenal Tumors","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s20","snippet":"Thyroid Cancer & Adrenal Tumors Thyroid Nodule Evaluation — Bethesda System Thyroid nodules are evaluated by ultrasound (ACR TI-RADS scoring) and FNA biopsy, reported using the Bethesda System for Reporting Thyroid Cytopathology : Bethesda Category Description Malignancy Risk Management I Non-diagno...","sourceLabel":"Section in Surgical Oncology"},"1774":{"title":"Parathyroid Cancer & MEN Syndromes","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s21","snippet":"Parathyroid Cancer & MEN Syndromes Parathyroid Carcinoma Rare (<1% of primary hyperparathyroidism). Suspect when: markedly elevated calcium (>14 mg/dL), very high PTH (>5–10 times normal), palpable neck mass, and renal/skeletal complications. Surgery: en bloc resection (parathyroidectomy with ipsila...","sourceLabel":"Section in Surgical Oncology"},"1775":{"title":"Sentinel Lymph Node Biopsy Technique","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s22","snippet":"Sentinel Lymph Node Biopsy Technique Tracers & Mapping Agents Agent Mechanism Timing Advantages / Disadvantages Technetium-99m sulfur colloid Radiotracer detected by gamma probe Injected 1–4 hours preoperatively (or day before for lymphoscintigraphy) Gold standard; allows preoperative lymphoscintigr...","sourceLabel":"Section in Surgical Oncology"},"1776":{"title":"Completion Lymphadenectomy & Lymphedema","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s23","snippet":"Completion Lymphadenectomy & Lymphedema When to Perform Completion Lymph Node Dissection (CLND) Tumor Type CLND After Positive SLN? Key Trial / Evidence Breast cancer Often omitted (Z0011 criteria); axillary RT as alternative (AMAROS) ACOSOG Z0011, AMAROS Melanoma No — observation with US surveillan...","sourceLabel":"Section in Surgical Oncology"},"1777":{"title":"Margin Assessment & Intraoperative Pathology","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s24","snippet":"Margin Assessment & Intraoperative Pathology Frozen Section Analysis Intraoperative frozen section provides rapid (~20 min) histologic assessment of surgical margins or tissue identification. The tissue is snap-frozen (cryostat at −20 to −30°C), sectioned (5–10 micrometers), and stained with H&E. Ad...","sourceLabel":"Section in Surgical Oncology"},"1778":{"title":"Ablation, HIPEC, & Minimally Invasive Oncologic Surgery","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s25","snippet":"Ablation, HIPEC, & Minimally Invasive Oncologic Surgery Ablation Techniques Technique Mechanism Best For Key Considerations RFA Alternating current → ionic agitation → frictional heat (60–100°C) HCC &le;3 cm, CRLM &le;3 cm, renal tumors Heat-sink effect near vessels >3 mm reduces efficacy; multiple ...","sourceLabel":"Section in Surgical Oncology"},"1779":{"title":"Neoadjuvant & Adjuvant Chemotherapy","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s26","snippet":"Neoadjuvant & Adjuvant Chemotherapy Neoadjuvant Regimens by Tumor Type Tumor Regimen Key Trial Breast (HER2+) TCHP (docetaxel, carboplatin, trastuzumab, pertuzumab) NeoSphere, TRYPHAENA Breast (TNBC) AC-T + pembrolizumab (anthracycline, cyclophosphamide → paclitaxel + pembrolizumab) KEYNOTE-522 Esop...","sourceLabel":"Section in Surgical Oncology"},"1780":{"title":"Targeted Therapy, Immunotherapy, & Hormonal Therapy","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s27","snippet":"Targeted Therapy, Immunotherapy, & Hormonal Therapy Targeted Therapies Agent Target Indication Key Side Effects Imatinib (Gleevec) KIT, PDGFRA, BCR-ABL GIST (adjuvant, neoadjuvant, metastatic); CML; DFSP Edema, diarrhea, nausea, muscle cramps; hepatotoxicity Trastuzumab (Herceptin) HER2 HER2+ breast...","sourceLabel":"Section in Surgical Oncology"},"1781":{"title":"Staging Systems Master Table","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s28","snippet":"Staging Systems Master Table System Application Key Components AJCC TNM (8th ed.) All solid tumors T (primary tumor), N (nodes), M (metastasis) → Stage I–IV; site-specific criteria BCLC HCC Stages 0, A, B, C, D; integrates tumor burden, liver function (Child-Pugh), performance status Bismuth-Corlett...","sourceLabel":"Section in Surgical Oncology"},"1782":{"title":"Complications & Management","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s29","snippet":"Complications & Management Surgical Complications in Oncologic Surgery Complication Incidence Prevention / Management Surgical site infection (SSI) 5–15% (varies by wound class) Prophylactic antibiotics within 60 min of incision; normothermia; glycemic control; wound opening and drainage if infected...","sourceLabel":"Section in Surgical Oncology"},"1783":{"title":"Key Landmark Trials","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s30","snippet":"Key Landmark Trials Trial Tumor Question Key Finding NSABP B-06 Breast Lumpectomy + RT vs mastectomy Equivalent OS at 20 years; BCS became standard of care ACOSOG Z0011 Breast SLNB alone vs ALND for 1–2 positive SLN No OS or DFS difference; ALND can be omitted (with BCS + RT) AMAROS Breast Axillary ...","sourceLabel":"Section in Surgical Oncology"},"1784":{"title":"Medications Master Table","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s31","snippet":"Medications Master Table Drug Class Mechanism Primary Indications Key Toxicity 5-Fluorouracil (5-FU) Antimetabolite Thymidylate synthase inhibitor CRC, gastric, esophageal, anal, breast Mucositis, diarrhea, hand-foot syndrome; DPD deficiency → fatal toxicity Capecitabine (Xeloda) Antimetabolite (ora...","sourceLabel":"Section in Surgical Oncology"},"1785":{"title":"Abbreviations & References","pageTitle":"Surgical Oncology","pageUrl":"/surgical/surgical-oncology","url":"/surgical/surgical-oncology#s32","snippet":"Abbreviations & References Abbreviations Abbreviation Meaning AJCC American Joint Committee on Cancer ALND Axillary lymph node dissection APR Abdominoperineal resection BCS Breast-conserving surgery BCLC Barcelona Clinic Liver Cancer BI-RADS Breast Imaging Reporting and Data System CAPOX Capecitabin...","sourceLabel":"Section in Surgical Oncology"},"1786":{"title":"Colorectal Surgery","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery","snippet":"Specialty Reference Colorectal Surgery Complete Specialty Reference Every diagnosis, classification, procedure, technique, medication, complication, and management algorithm across the full scope of colorectal surgery in one place."},"1787":{"title":"Colorectal Anatomy","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s1","snippet":"Colorectal Anatomy The large intestine extends from the ileocecal valve to the anus, measuring approximately 150 cm in length. Understanding segmental anatomy, blood supply, and lymphatic drainage is essential for oncologic resection, vascular ligation, and stoma formation. Figure 1 - Anatomy of the...","sourceLabel":"Section in Colorectal Surgery"},"1788":{"title":"Anorectal Anatomy","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s2","snippet":"Anorectal Anatomy The anal canal is approximately 4 cm in length and extends from the anorectal ring (puborectalis sling) to the anal verge. Precise knowledge of anorectal anatomy is essential for managing hemorrhoids, fissures, fistulae, and anal cancer. Figure 7 - Coronal Section of the Anal Canal...","sourceLabel":"Section in Colorectal Surgery"},"1789":{"title":"Colorectal Physiology","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s3","snippet":"Colorectal Physiology Water & Electrolyte Absorption The colon receives approximately 1,000–1,500 mL of ileal effluent per day and absorbs 90% of the water and electrolytes, producing 100–200 mL of stool. The right colon is the primary site of water and sodium absorption (active sodium transport via...","sourceLabel":"Section in Colorectal Surgery"},"1790":{"title":"The Colorectal Exam","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s4","snippet":"The Colorectal Exam Digital Rectal Exam (DRE) The DRE is the cornerstone of anorectal assessment. With the patient in the left lateral decubitus (Sims') position or prone jackknife, inspect the perianal skin (tags, fissures, fistula openings, condylomata, dermatitis, excoriation). Then perform a lub...","sourceLabel":"Section in Colorectal Surgery"},"1791":{"title":"Epidemiology, Risk Factors & Screening","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s5","snippet":"Epidemiology, Risk Factors & Screening Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer death worldwide. In the United States, there are approximately 150,000 new cases and 53,000 deaths annually. The median age at diagnosis is 66, but incidence in adult...","sourceLabel":"Section in Colorectal Surgery"},"1792":{"title":"Hereditary Colorectal Cancer Syndromes","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s6","snippet":"Hereditary Colorectal Cancer Syndromes Lynch Syndrome (Hereditary Nonpolyposis Colorectal Cancer — HNPCC) Lynch syndrome is the most common hereditary CRC syndrome, accounting for 2–4% of all CRC. It is caused by germline mutations in DNA mismatch repair (MMR) genes: MLH1 , MSH2 , MSH6 , PMS2 , or E...","sourceLabel":"Section in Colorectal Surgery"},"1793":{"title":"TNM Staging & Pathology","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s7","snippet":"TNM Staging & Pathology AJCC 8th Edition TNM Staging for Colorectal Cancer T Stage Definition Tis Carcinoma in situ — intramucosal carcinoma (involvement of lamina propria with no extension through muscularis mucosae) T1 Tumor invades the submucosa T2 Tumor invades the muscularis propria T3 Tumor in...","sourceLabel":"Section in Colorectal Surgery"},"1794":{"title":"Surgical Management of Colon Cancer","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s8","snippet":"Surgical Management of Colon Cancer Principles of Oncologic Resection The goal of curative resection is complete removal of the tumor with adequate margins (at least 5 cm longitudinal margin, though 2 cm is accepted distally for rectal cancer) and complete lymphadenectomy along the primary feeding v...","sourceLabel":"Section in Colorectal Surgery"},"1795":{"title":"Rectal Cancer — TME, Neoadjuvant Therapy & Organ Preservation","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s9","snippet":"Rectal Cancer — TME, Neoadjuvant Therapy & Organ Preservation Total Mesorectal Excision (TME) Figure 11 - Lines of Mesorectal Excision. Illustration demonstrating the extent of total mesorectal excision (TME) and partial mesorectal excision. TME involves sharp dissection in the avascular plane betwe...","sourceLabel":"Section in Colorectal Surgery"},"1796":{"title":"Metastatic Colorectal Cancer — Liver & Lung","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s10","snippet":"Metastatic Colorectal Cancer — Liver & Lung Colorectal Liver Metastases (CRLM) The liver is the most common site of CRC metastasis (portal venous drainage). Approximately 15–25% of patients have synchronous liver metastases at diagnosis, and 50% will develop liver metastases during their disease cou...","sourceLabel":"Section in Colorectal Surgery"},"1797":{"title":"Crohn's Disease — Surgical Management","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s11","snippet":"Crohn's Disease — Surgical Management Approximately 70–80% of Crohn's disease (CD) patients will require at least one surgical procedure during their lifetime, though surgery is not curative — postoperative recurrence occurs in 50–60% within 10 years. The guiding principle is bowel conservation : re...","sourceLabel":"Section in Colorectal Surgery"},"1798":{"title":"Ulcerative Colitis — IPAA & J-Pouch","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s12","snippet":"Ulcerative Colitis — IPAA & J-Pouch Unlike Crohn's disease, UC is surgically curable. Approximately 15–30% of UC patients ultimately require colectomy. Indications for Surgery Emergency: Fulminant colitis/toxic megacolon unresponsive to IV steroids + rescue therapy (infliximab or cyclosporine) withi...","sourceLabel":"Section in Colorectal Surgery"},"1799":{"title":"Pouchitis & Pouch Complications","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s13","snippet":"Pouchitis & Pouch Complications Pouchitis Pouchitis is the most common long-term complication of IPAA, affecting 30–50% of patients within 5 years. It is non-specific inflammation of the ileal pouch reservoir. Symptoms: increased stool frequency, urgency, watery stool, cramping, pelvic discomfort, a...","sourceLabel":"Section in Colorectal Surgery"},"1800":{"title":"Diverticulitis — Classification & Management","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s14","snippet":"Diverticulitis — Classification & Management Diverticular disease is the most common condition of the colon in Western populations, affecting up to 60% of adults over 60. Diverticulosis is the presence of diverticula (false diverticula — outpouchings of mucosa and submucosa through the colonic wall ...","sourceLabel":"Section in Colorectal Surgery"},"1801":{"title":"Emergency Surgery for Complicated Diverticulitis","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s15","snippet":"Emergency Surgery for Complicated Diverticulitis Hartmann Procedure vs Primary Anastomosis For decades, the Hartmann procedure (sigmoid resection, end colostomy, rectal stump closure) was the default emergency operation for Hinchey III/IV diverticulitis. The alternative is sigmoid resection with pri...","sourceLabel":"Section in Colorectal Surgery"},"1802":{"title":"Diverticular Bleeding","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s16","snippet":"Diverticular Bleeding Diverticular bleeding is the most common cause of lower GI hemorrhage (30–40% of cases). It occurs when a vasa rectum erodes into the dome of a diverticulum. Bleeding is typically painless, acute, and self-limited (stops spontaneously in 70–80%). The right colon is the most com...","sourceLabel":"Section in Colorectal Surgery"},"1803":{"title":"Hemorrhoids","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s17","snippet":"Hemorrhoids Hemorrhoids are normal vascular cushions in the anal canal (left lateral, right anterolateral, right posterolateral positions) that contribute to fine continence. Hemorrhoidal disease occurs when these cushions become symptomatic — engorged, prolapsed, thrombosed, or bleeding. Figure 21 ...","sourceLabel":"Section in Colorectal Surgery"},"1804":{"title":"Anal Fissure","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s18","snippet":"Anal Fissure An anal fissure is a longitudinal tear in the anoderm of the anal canal, typically in the posterior midline (90% of cases; 10% anterior — more common in women). The classic triad is pain during and after defecation (can last hours), bright red blood on toilet paper, and a visible tear a...","sourceLabel":"Section in Colorectal Surgery"},"1805":{"title":"Anorectal Abscess & Fistula-in-Ano","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s19","snippet":"Anorectal Abscess & Fistula-in-Ano Anorectal Abscess Most anorectal abscesses originate from infection of an anal crypt gland (cryptoglandular theory). The infected gland drains into the intersphincteric space and can then extend to other spaces. Treatment is incision and drainage — antibiotics alon...","sourceLabel":"Section in Colorectal Surgery"},"1806":{"title":"Pilonidal Disease","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s20","snippet":"Pilonidal Disease Pilonidal disease affects the natal cleft (gluteal crease) and is caused by penetration of shed hairs into the subcutaneous tissue, creating a foreign body reaction, chronic sinus tracts, and recurrent abscesses. Most common in young males (15–30 years), with risk factors including...","sourceLabel":"Section in Colorectal Surgery"},"1807":{"title":"Anal Cancer","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s21","snippet":"Anal Cancer Anal canal cancer is uncommon (2–3% of GI malignancies) but increasing in incidence. The majority (85%) are squamous cell carcinomas (SCC) , strongly associated with HPV infection (types 16 and 18). Risk factors: HPV, receptive anal intercourse, multiple sexual partners, HIV/immunosuppre...","sourceLabel":"Section in Colorectal Surgery"},"1808":{"title":"Rectal Prolapse","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s22","snippet":"Rectal Prolapse Rectal prolapse (procidentia) is a full-thickness intussusception of the rectal wall through the anus. Most common in elderly women (6:1 female-to-male ratio). Associated with chronic constipation/straining, pelvic floor weakness, pudendal neuropathy, and multiparous women. Types Ful...","sourceLabel":"Section in Colorectal Surgery"},"1809":{"title":"Condylomata Acuminata & Fecal Incontinence","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s23","snippet":"Condylomata Acuminata & Fecal Incontinence Condylomata Acuminata (Anal Warts) Caused by HPV (types 6 and 11 are the most common — these are low-risk types causing warts, not cancer). Present as flesh-colored, papillomatous lesions in the perianal and intra-anal area. Treatment depends on extent: lim...","sourceLabel":"Section in Colorectal Surgery"},"1810":{"title":"Ileostomy & Colostomy — Types & Technique","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s24","snippet":"Ileostomy & Colostomy — Types & Technique Types of Stomas Type Description Common Indications Output End ileostomy (Brooke) Terminal ileum divided; proximal end matured as stoma; distal end resected or as Hartmann's stump Total proctocolectomy (UC, FAP); Crohn's after proctectomy 500–1500 mL/day; li...","sourceLabel":"Section in Colorectal Surgery"},"1811":{"title":"Stoma Complications & Reversal","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s25","snippet":"Stoma Complications & Reversal Stoma Complications Complication Incidence Presentation Management Parastomal hernia 30–50% (most common late complication) Bulge around stoma; may cause obstruction, incarceration Sugarbaker or Keyhole mesh repair (open or laparoscopic); stoma relocation Stoma prolaps...","sourceLabel":"Section in Colorectal Surgery"},"1812":{"title":"Obstructed Defecation & Pelvic Organ Prolapse","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s26","snippet":"Obstructed Defecation & Pelvic Organ Prolapse Obstructed Defecation Syndrome (ODS) ODS is the inability to effectively evacuate rectal contents despite the urge to defecate. Causes include dyssynergic defecation (paradoxical contraction of the puborectalis/EAS during attempted defecation — the most ...","sourceLabel":"Section in Colorectal Surgery"},"1813":{"title":"Chronic Constipation & Colonic Inertia","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s27","snippet":"Chronic Constipation & Colonic Inertia Evaluation of Chronic Constipation Chronic constipation is defined by Rome IV criteria: two or more of the following for at least 3 months with onset at least 6 months prior: straining >25% of defecations, lumpy/hard stools >25%, sensation of incomplete evacuat...","sourceLabel":"Section in Colorectal Surgery"},"1814":{"title":"Colonoscopy & Polypectomy","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s28","snippet":"Colonoscopy & Polypectomy Colonoscopy Diagnostic and therapeutic colonoscopy is the most fundamental procedure in colorectal surgery. The colonoscope (typically 130–170 cm) is advanced from the anus to the cecum (identified by the appendiceal orifice, ileocecal valve, and triradiate fold/crow's foot...","sourceLabel":"Section in Colorectal Surgery"},"1815":{"title":"Open, Laparoscopic & Robotic Colorectal Surgery","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s29","snippet":"Open, Laparoscopic & Robotic Colorectal Surgery Minimally Invasive Surgery (MIS) for Colorectal Disease Laparoscopic and robotic-assisted approaches are now the standard for most elective colorectal operations. Benefits over open surgery include shorter hospital stay (by 1–3 days), less postoperativ...","sourceLabel":"Section in Colorectal Surgery"},"1816":{"title":"Transanal Approaches — TAMIS, TEM & taTME","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s30","snippet":"Transanal Approaches — TAMIS, TEM & taTME Transanal Endoscopic Microsurgery (TEM) Developed by Gerhard Buess in the 1980s, TEM uses a specialized rigid operating rectoscope (4 cm diameter) with magnified stereoscopic visualization and CO2 insufflation to perform full-thickness excision of rectal les...","sourceLabel":"Section in Colorectal Surgery"},"1817":{"title":"Enhanced Recovery After Surgery (ERAS)","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s31","snippet":"Enhanced Recovery After Surgery (ERAS) The ERAS protocol (developed by Henrik Kehlet) is a multimodal, evidence-based perioperative care pathway that has become standard in colorectal surgery. ERAS reduces hospital stay by 2–3 days, decreases complication rates by 30–50%, and improves patient satisf...","sourceLabel":"Section in Colorectal Surgery"},"1818":{"title":"Bowel Preparation & Antibiotic Prophylaxis","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s32","snippet":"Bowel Preparation & Antibiotic Prophylaxis Mechanical Bowel Preparation (MBP) MBP clears fecal content from the colon prior to surgery. Options: PEG-based lavage (GoLYTELY — 4 liters; or low-volume split-dose MiraLAX + Gatorade — 238 g PEG 3350 in 64 oz), sodium phosphate (OsmoPrep — oral tablets; h...","sourceLabel":"Section in Colorectal Surgery"},"1819":{"title":"IBD Medications","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s33","snippet":"IBD Medications Drug Class Examples Mechanism Surgical Implications 5-Aminosalicylates (5-ASA) Mesalamine (Asacol, Pentasa, Lialda), sulfasalazine Topical anti-inflammatory (inhibits prostaglandin/leukotriene synthesis) Safe perioperatively; no need to discontinue Corticosteroids Prednisone, budeson...","sourceLabel":"Section in Colorectal Surgery"},"1820":{"title":"Chemotherapy & Targeted Therapy for CRC","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s34","snippet":"Chemotherapy & Targeted Therapy for CRC Chemotherapy Backbone Regimen Components Indication Key Toxicity FOLFOX 5-FU + leucovorin + oxaliplatin Adjuvant stage III colon; neoadjuvant rectal (TNT); metastatic 1st line Peripheral neuropathy (cumulative, dose-limiting — cold-triggered in early cycles, p...","sourceLabel":"Section in Colorectal Surgery"},"1821":{"title":"Classification Systems (All)","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s35","snippet":"Classification Systems (All) TNM Staging — AJCC 8th Edition See Section 07 for complete TNM staging tables. Dukes Classification (Historical) Stage Description TNM Equivalent A Tumor confined to bowel wall (not through muscularis propria) T1–T2 N0 B Tumor extends through bowel wall T3–T4 N0 C Lymph ...","sourceLabel":"Section in Colorectal Surgery"},"1822":{"title":"Complications Master Table","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s36","snippet":"Complications Master Table Complication Incidence Risk Factors Presentation Management Anastomotic leak 3–15% (higher for low rectal) Low anastomosis, male, obesity, steroids, radiation, tension, poor blood supply, smoking Fever, tachycardia, peritonitis, feculent/purulent drain output; may be insid...","sourceLabel":"Section in Colorectal Surgery"},"1823":{"title":"Medications Master Table","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s37","snippet":"Medications Master Table Drug Class Dose Key Notes Cefazolin Surgical prophylaxis 2g IV (>120 kg: 3g); re-dose q3–4h Standard prophylaxis for colorectal surgery (+ metronidazole) Metronidazole (IV) Surgical prophylaxis 500 mg IV x1 Anaerobic coverage; combine with cefazolin Neomycin + Metronidazole ...","sourceLabel":"Section in Colorectal Surgery"},"1824":{"title":"Abbreviations Master List","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s38","snippet":"Abbreviations Master List Abbreviation Meaning APR Abdominoperineal resection ATZ Anal transition zone CME Complete mesocolic excision CRC Colorectal cancer CRLM Colorectal liver metastases CRM Circumferential resection margin CRT Chemoradiation therapy DRE Digital rectal exam EAS External anal sphi...","sourceLabel":"Section in Colorectal Surgery"},"1825":{"title":"Key Trials, Guidelines & References","pageTitle":"Colorectal Surgery","pageUrl":"/surgical/colorectal-surgery","url":"/surgical/colorectal-surgery#s39","snippet":"Key Trials, Guidelines & References Figures Figure Description Source Figure 1 Large Intestine Anatomy Wikimedia Commons , BruceBlaus, CC BY 3.0 Figure 2 Anal Canal Anatomy Wikimedia Commons , Public domain Key Trials & Guidelines Trial / Guideline Year Key Finding PMID COST (laparoscopic vs open co...","sourceLabel":"Section in Colorectal Surgery"},"1826":{"title":"Bariatric / Metabolic Surgery","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery","snippet":"Specialty Reference Bariatric & Metabolic Surgery Complete Specialty Reference Every diagnosis, procedure, classification, complication, medication, metabolic outcome, nutritional guideline, and management algorithm across the full scope of bariatric and metabolic surgery in one place."},"1827":{"title":"GI Anatomy & Hormonal Physiology","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s1","snippet":"GI Anatomy & Hormonal Physiology Gastric Anatomy The stomach is a J-shaped organ divided into four regions: the cardia (immediately distal to the GEJ), the fundus (dome-shaped area superior to the cardia, primary reservoir for ghrelin-secreting cells), the body/corpus (largest portion, contains pari...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1828":{"title":"Obesity Physiology & Metabolic Syndrome","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s2","snippet":"Obesity Physiology & Metabolic Syndrome BMI Classification Category BMI (kg/m&sup2;) WHO Class Underweight < 18.5 — Normal weight 18.5 – 24.9 — Overweight 25.0 – 29.9 Pre-obese Obesity Class I 30.0 – 34.9 Class I Obesity Class II 35.0 – 39.9 Class II Obesity Class III (severe/morbid) 40.0 – 49.9 Cla...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1829":{"title":"The Bariatric Exam & Preoperative Assessment","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s3","snippet":"The Bariatric Exam & Preoperative Assessment History & Physical Examination The bariatric-specific history should assess: weight history (onset of obesity, maximum lifetime weight, prior weight loss attempts and methods, rate of weight gain), dietary history (eating patterns — structured meals vs gr...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1830":{"title":"Patient Selection Criteria","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s4","snippet":"Patient Selection Criteria NIH 1991 Consensus Criteria (Traditional) The landmark 1991 NIH Consensus Conference established criteria that remained the standard for three decades: BMI &ge; 40 kg/m&sup2; without comorbidities, OR BMI &ge; 35 kg/m&sup2; with at least one obesity-related comorbidity (T2...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1831":{"title":"Metabolic Outcomes & T2DM Remission","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s5","snippet":"Metabolic Outcomes & T2DM Remission T2DM Remission by Procedure Type 2 diabetes remission is the most dramatic metabolic outcome of bariatric surgery. Remission is defined as HbA1c < 6.0% (complete) or < 6.5% (partial) without diabetes medications for &ge; 1 year. Procedure T2DM Remission at 1 yr T2...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1832":{"title":"Obesity-Related Comorbidities","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s6","snippet":"Obesity-Related Comorbidities NAFLD / NASH Non-alcoholic fatty liver disease affects > 90% of bariatric surgery candidates. NAFLD encompasses a spectrum: simple steatosis (&ge; 5% hepatocyte fat content) &rarr; NASH (steatosis with inflammation and hepatocyte ballooning) &rarr; fibrosis &rarr; cirrh...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1833":{"title":"Nutritional Deficiencies & Supplementation","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s7","snippet":"Nutritional Deficiencies & Supplementation Deficiency Risk by Procedure Nutrient LAGB LSG RYGB BPD/DS Mechanism Iron Low Moderate High (20-55%) Very high (25-70%) Bypassed duodenum (primary absorption site); reduced gastric acid impairs Fe3+ &rarr; Fe2+ conversion Vitamin B12 Low Low-Mod High (15-35...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1834":{"title":"Roux-en-Y Gastric Bypass (RYGB)","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s8","snippet":"Roux-en-Y Gastric Bypass (RYGB) Surgical Technique The Roux-en-Y gastric bypass is a combined restrictive and malabsorptive procedure; it is considered the \"gold standard\" bariatric operation. The key steps of the laparoscopic technique: Gastric pouch creation: A small (15-30 mL) gastric pouch is cr...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1835":{"title":"Sleeve Gastrectomy (LSG)","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s9","snippet":"Sleeve Gastrectomy (LSG) Surgical Technique Laparoscopic sleeve gastrectomy (LSG) is a purely restrictive procedure (though hormonal changes contribute significantly). It has become the most commonly performed bariatric procedure worldwide (~60% of all bariatric procedures globally as of 2023). Grea...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1836":{"title":"One Anastomosis Gastric Bypass (OAGB/MGB)","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s10","snippet":"One Anastomosis Gastric Bypass (OAGB/MGB) Surgical Technique The One Anastomosis Gastric Bypass (also known as Mini Gastric Bypass, MGB) is a simplified bypass with a single anastomosis. Key steps: Long gastric pouch: A narrow, tubular pouch is created along the lesser curvature, approximately 15-18...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1837":{"title":"BPD/DS & SADI-S","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s11","snippet":"BPD/DS & SADI-S Classic Biliopancreatic Diversion with Duodenal Switch (BPD/DS) The BPD/DS is the most powerful bariatric procedure for weight loss and metabolic improvement but carries the highest nutritional risk. Originally described by Scopinaro (BPD) and modified by Hess and Marceau (DS). Sleev...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1838":{"title":"Adjustable Gastric Banding (LAGB)","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s12","snippet":"Adjustable Gastric Banding (LAGB) Overview The laparoscopic adjustable gastric band (LAGB) — marketed as the Lap-Band or Realize band — was one of the most popular bariatric procedures from 2000-2010 but has declined dramatically (< 1% of bariatric procedures in 2023 in the US and Europe). The proce...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1839":{"title":"Revisional & Conversion Surgery","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s13","snippet":"Revisional & Conversion Surgery Indications for Revisional Surgery Revisional bariatric surgery is performed for: inadequate weight loss (< 50% EWL or < 20% TWL), significant weight regain (regain of > 25% of lost weight), complications of the index procedure (chronic leak, stricture, refractory GER...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1840":{"title":"Endoscopic Bariatric Therapies","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s14","snippet":"Endoscopic Bariatric Therapies Intragastric Balloons (IGB) Orbera (single fluid-filled balloon, 400-700 mL saline; placed for 6 months), Obalon (swallowable gas-filled capsules, up to 3 balloons), and Spatz (adjustable balloon, 12-month duration). Average %TWL: 10-15% at 6 months. Complications: nau...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1841":{"title":"Early Postoperative Complications","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s15","snippet":"Early Postoperative Complications Postoperative Day 1 Management Protocol Standard postoperative management on the first day after bariatric surgery: System Assessment/Intervention Red Flags Cardiovascular Heart rate monitoring q4h; target HR < 100 bpm; assess for orthostatic hypotension Persistent ...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1842":{"title":"Late Complications","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s16","snippet":"Late Complications Marginal Ulcer Marginal ulcers occur at or near the gastrojejunal (GJ) anastomosis after RYGB in 1-16% of patients. Risk factors: smoking (most significant modifiable risk factor — 3-5x increased risk), NSAID use, large pouch with parietal cells, H. pylori infection, ischemia at t...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1843":{"title":"Dumping Syndrome","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s17","snippet":"Dumping Syndrome Early Dumping Early dumping syndrome occurs 10-30 minutes after eating, primarily after RYGB (10-40% of patients). Pathophysiology: rapid emptying of hyperosmolar food from the gastric pouch into the jejunum causes fluid shifts into the intestinal lumen (osmotic effect) and release ...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1844":{"title":"Nutritional Emergencies","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s18","snippet":"Nutritional Emergencies Wernicke Encephalopathy (Thiamine/B1 Deficiency) Wernicke encephalopathy is the most dangerous nutritional emergency after bariatric surgery. Incidence: 0.5-1% but likely underdiagnosed. Typically occurs weeks to months postoperatively, especially in patients with prolonged v...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1845":{"title":"Enhanced Recovery & Perioperative Protocols","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s19","snippet":"Enhanced Recovery & Perioperative Protocols ERAS Protocol for Bariatric Surgery Enhanced Recovery After Surgery (ERAS) protocols have been widely adopted in bariatric surgery, reducing length of stay from 3-5 days to 1-2 days (many centers now perform LSG as same-day surgery). Key elements: Phase In...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1846":{"title":"Long-Term Follow-Up & Surveillance","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s20","snippet":"Long-Term Follow-Up & Surveillance Follow-Up Schedule Timepoint Assessments 2 weeks postop Wound check; diet advancement (full liquids to pureed); weight; review medications (adjust diabetes meds) 6 weeks postop Weight; diet advancement (soft to regular foods); labs (CMP, CBC); exercise counseling 3...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1847":{"title":"Classification Systems & Staging","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s21","snippet":"Classification Systems & Staging Edmonton Obesity Staging System (EOSS) Stage Description Clinical Features 0 No apparent risk factors No obesity-related risk factors, no physical symptoms, no functional limitations 1 Subclinical risk factors Borderline hypertension, impaired fasting glucose, elevat...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1848":{"title":"Medications Master Table","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s22","snippet":"Medications Master Table Anti-Obesity Medications (Pharmacotherapy) Medication Mechanism Dose Expected %TWL Key Side Effects / Notes Semaglutide (Wegovy) GLP-1 receptor agonist 2.4 mg SQ weekly (titrate over 16 weeks) 12-17% Nausea, vomiting, diarrhea, pancreatitis risk, contraindicated in MTC/MEN2 ...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1849":{"title":"Imaging & Diagnostics","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s23","snippet":"Imaging & Diagnostics Leak Detection Algorithm A systematic approach to suspected anastomotic/staple-line leak: Clinical suspicion: Persistent tachycardia (> 120 bpm), fever (> 38.5&deg;C), tachypnea, left shoulder pain (diaphragmatic irritation), oliguria, peritonitis, or elevated inflammatory mark...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1850":{"title":"Abbreviations Master List","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s24","snippet":"Abbreviations Master List Abbreviation Full Term ASMBS American Society for Metabolic and Bariatric Surgery BAT Brown adipose tissue BMI Body mass index (kg/m&sup2;) BP limb Biliopancreatic limb BPD/DS Biliopancreatic diversion with duodenal switch CCK Cholecystokinin CPAP Continuous positive airway...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1851":{"title":"Landmark Trials & Evidence","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/surgical/bariatric-surgery","url":"/surgical/bariatric-surgery#s25","snippet":"Landmark Trials & Evidence Swedish Obese Subjects (SOS) Study The SOS Study is the largest and longest prospective controlled study of bariatric surgery (Sj&ouml;str&ouml;m et al., PMID: 17715408 ). Design: prospective, matched, non-randomized; 2,010 surgical patients vs 2,037 matched obese controls...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"1852":{"title":"Plastic & Reconstructive Surgery","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery","snippet":"Specialty Reference Plastic & Reconstructive Surgery Complete Specialty Reference Every diagnosis, procedure, flap, graft, classification, complication, medication, and management algorithm across the full scope of plastic and reconstructive surgery in one place."},"1853":{"title":"Skin & Soft-Tissue Anatomy","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s1","snippet":"Skin & Soft-Tissue Anatomy Skin Layers The skin is the largest organ of the body, comprising approximately 15% of total body weight. It consists of two primary layers: the epidermis (stratified squamous epithelium, 0.04-1.5 mm thick) and the dermis (connective tissue, 0.5-5 mm thick). Beneath lies t...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1854":{"title":"Wound Healing Physiology","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s2","snippet":"Wound Healing Physiology Phases of Wound Healing Wound healing proceeds through four overlapping phases: hemostasis (minutes), inflammation (hours to days), proliferation (days to weeks), and remodelling (weeks to years). Hemostasis (0-minutes): Vasoconstriction, platelet adhesion via exposed collag...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1855":{"title":"The Reconstructive Exam & Tissue Assessment","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s3","snippet":"The Reconstructive Exam & Tissue Assessment History & Physical Examination The plastic surgery consultation begins with a thorough assessment of the wound or defect, patient comorbidities, and reconstructive goals. Key history points: mechanism of injury, time since injury, prior radiation or surger...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1856":{"title":"The Reconstructive Ladder & Elevator","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s4","snippet":"The Reconstructive Ladder & Elevator The Reconstructive Ladder is a conceptual framework for wound closure, progressing from simple to complex. The Reconstructive Elevator (Gottlieb & Krieger) modernises this concept by allowing the surgeon to skip rungs and proceed directly to the optimal reconstru...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1857":{"title":"Skin Grafts","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s5","snippet":"Skin Grafts Split-Thickness vs. Full-Thickness Skin Grafts Feature STSG (Split-Thickness) FTSG (Full-Thickness) Components Epidermis + partial dermis (0.008-0.018 in) Epidermis + entire dermis Donor site healing Re-epithelialises from adnexal structures (7-14 days) Requires primary closure or grafti...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1858":{"title":"Local Flaps","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s6","snippet":"Local Flaps Flap Design Principles Local flaps transfer tissue adjacent to the defect with its own blood supply. Key principles: plan in reverse (design the flap first, then create the defect), maintain adequate length-to-width ratios for random-pattern flaps (generally &le; 3:1 on the body, up to 5...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1859":{"title":"Regional & Pedicled Flaps","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s7","snippet":"Regional & Pedicled Flaps Common Pedicled Muscle & Musculocutaneous Flaps Flap Type (M-N) Pedicle Arc of Rotation Common Uses Pectoralis major V Thoracoacromial artery (dominant); internal mammary perforators (segmental) Head & neck, sternum, chest wall Head & neck reconstruction, sternal wound cove...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1860":{"title":"Free Tissue Transfer (Microsurgery)","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s8","snippet":"Free Tissue Transfer (Microsurgery) Principles of Microsurgery Free tissue transfer involves detaching a flap from its donor site, transferring it to a distant recipient site, and re-establishing blood flow via microvascular anastomosis. Requires an operating microscope (6-40&times; magnification), ...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1861":{"title":"Breast Reconstruction","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s9","snippet":"Breast Reconstruction Timing Immediate reconstruction is performed at the time of mastectomy. Advantages: preserved breast skin envelope, superior aesthetic outcome, single anaesthesia. Delayed reconstruction is performed weeks to months later - chosen when postmastectomy radiation is planned (radia...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1862":{"title":"Head & Neck Reconstruction","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s10","snippet":"Head & Neck Reconstruction Principles Head and neck reconstruction aims to restore form and function after ablative surgery for cancer, trauma, or congenital deformity. Critical functional goals: oral competence, speech, swallowing, airway patency, and eye protection. The \"like with like\" principle ...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1863":{"title":"Lower Extremity Reconstruction","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s11","snippet":"Lower Extremity Reconstruction Gustilo-Anderson Classification of Open Fractures Type Wound Size Soft-Tissue Injury Contamination Treatment Approach I < 1 cm Minimal Clean I&D, primary closure II 1-10 cm Moderate, no flap needed Moderate I&D, wound care &plusmn; skin graft IIIA > 10 cm Severe, but a...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1864":{"title":"Trunk & Abdominal Wall Reconstruction","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s12","snippet":"Trunk & Abdominal Wall Reconstruction Component Separation Technique Anterior component separation (Ramirez, 1990): Release of the external oblique aponeurosis 1-2 cm lateral to the rectus sheath from costal margin to inguinal ligament. This allows medial advancement of the rectus complex: up to 10 ...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1865":{"title":"Pressure Injuries (Decubitus Ulcers)","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s13","snippet":"Pressure Injuries (Decubitus Ulcers) NPUAP Staging Stage Description Tissue Involved I Non-blanchable erythema of intact skin Epidermis intact II Partial-thickness skin loss (blister or shallow ulcer) Epidermis & partial dermis III Full-thickness skin loss; fat visible; no bone/tendon/muscle exposur...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1866":{"title":"Burns","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s14","snippet":"Burns Burn Depth Classification Depth Old Term Clinical Findings Healing Superficial 1st degree Erythema, pain, dry; no blisters (sunburn) 3-5 days; no scarring Superficial partial-thickness 2nd degree (superficial) Blisters, weeping, painful, brisk capillary refill, blanches 7-14 days from adnexal ...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1867":{"title":"Cleft Lip & Palate","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s15","snippet":"Cleft Lip & Palate Embryology & Epidemiology Cleft lip results from failure of fusion of the medial nasal prominence with the maxillary prominence during weeks 4-7 of gestation. Cleft palate results from failure of fusion of the palatal shelves during weeks 8-12. Cleft lip &plusmn; palate (CL/P) occ...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1868":{"title":"Craniofacial Surgery","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s16","snippet":"Craniofacial Surgery Craniosynostosis Craniosynostosis is premature fusion of one or more cranial sutures, resulting in restricted growth perpendicular to the fused suture and compensatory growth parallel to it ( Virchow's law ). Incidence: ~1:2,000-2,500 live births. 80-90% are non-syndromic (singl...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1869":{"title":"Congenital Hand Anomalies","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s17","snippet":"Congenital Hand Anomalies Swanson Classification (Modified by IFSSH) Category Description Examples I Failure of formation (arrest of development) Radial club hand (radial longitudinal deficiency), phocomelia, transverse deficiency (congenital amputation) II Failure of differentiation (separation) Sy...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1870":{"title":"Lymphedema","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s18","snippet":"Lymphedema Classification Primary lymphedema: Congenital absence or dysfunction of lymphatics. Milroy disease (congenital, at birth; VEGFR3 mutation); lymphedema praecox (onset at puberty, most common form of primary lymphedema, predominantly female); lymphedema tarda (onset > 35 years). Secondary l...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1871":{"title":"Gender-Affirming Surgery","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s19","snippet":"Gender-Affirming Surgery Overview Gender-affirming surgical procedures are performed as part of a multidisciplinary approach following WPATH (World Professional Association for Transgender Health) Standards of Care. Referral requirements typically include persistent, well-documented gender dysphoria...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1872":{"title":"Rhinoplasty","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s20","snippet":"Rhinoplasty Approaches Open (external) rhinoplasty: Transcolumellar incision connected to bilateral marginal incisions. Provides direct visualisation of the nasal framework. Preferred for complex revision rhinoplasty, tip work, and cases requiring precise graft placement. Disadvantage: columellar sc...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1873":{"title":"Blepharoplasty & Facelift","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s21","snippet":"Blepharoplasty & Facelift Upper Blepharoplasty Removes excess skin (dermatochalasis) and protruding orbital fat from the upper eyelids. Functional indication: visual field obstruction (> 30% superior field loss on formal visual field testing). The incision is placed in the supratarsal crease (8-10 m...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1874":{"title":"Abdominoplasty & Body Contouring","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s22","snippet":"Abdominoplasty & Body Contouring Abdominoplasty Full abdominoplasty: Low transverse incision (hip to hip), umbilical transposition, undermining of abdominal skin flap to the costal margins, rectus diastasis repair (plication of the anterior rectus sheath in the midline), and excision of redundant sk...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1875":{"title":"Breast Augmentation & Mastopexy","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s23","snippet":"Breast Augmentation & Mastopexy Implant Types Silicone gel implants: Cohesive silicone gel (\"gummy bear\" = form-stable, highly cohesive). More natural feel than saline. If ruptured, gel may remain within the capsule (\"silent rupture\") - FDA recommends MRI screening at 5-6 years post-implantation, th...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1876":{"title":"Injectables & Non-Surgical Aesthetics","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s24","snippet":"Injectables & Non-Surgical Aesthetics Neurotoxins (Botulinum Toxin) Botulinum toxin type A (Botox/onabotulinumtoxinA, Dysport/abobotulinumtoxinA, Xeomin/incobotulinumtoxinA) inhibits acetylcholine release at the neuromuscular junction, causing temporary muscle paralysis. Onset: 2-5 days; peak effect...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1877":{"title":"Microsurgical Complications","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s25","snippet":"Microsurgical Complications Flap Failure & Salvage Overall free flap success rate at experienced centres: 95-98% . Flap compromise is most common in the first 24-48 hours. The most common cause of free flap failure is venous thrombosis (~80% of thrombotic events), followed by arterial thrombosis (~2...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1878":{"title":"Wound Complications","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s26","snippet":"Wound Complications Hematoma Incidence varies by procedure: rhytidectomy 1-4% (most common complication of facelift; risk higher in males, hypertension), breast surgery 1-3%, abdominoplasty 1-2%. Expanding hematomas after neck/face surgery can cause airway compromise and require immediate evacuation...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1879":{"title":"Post-operative Monitoring","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s27","snippet":"Post-operative Monitoring Free Flap Monitoring Free flaps require intensive monitoring in the immediate postoperative period to detect vascular compromise early and allow timely re-exploration. Standard protocol: Parameter Method Frequency Clinical assessment Colour, turgor, capillary refill, temper...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1880":{"title":"Classification Systems","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s28","snippet":"Classification Systems Mathes-Nahai Muscle Flap Classification Type Pattern Examples I One vascular pedicle Tensor fasciae latae, gastrocnemius, abductor digiti minimi II Dominant + minor pedicle(s) Gracilis, soleus, sternocleidomastoid, vastus lateralis, platysma III Two dominant pedicles Rectus ab...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1881":{"title":"Medications Master Table","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s29","snippet":"Medications Master Table Category Drug Dose/Route Key Notes Antibiotics (Perioperative) Cefazolin 2 g IV (3 g if > 120 kg) First-line prophylaxis for clean cases with implants; re-dose every 3-4 hours intraoperatively Ampicillin-sulbactam 3 g IV Head & neck cases with intraoral incisions (covers ora...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1882":{"title":"Imaging & Diagnostics","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s30","snippet":"Imaging & Diagnostics CT Angiography (CTA) Preoperative CTA for perforator mapping is the gold standard for planning DIEP and other perforator flaps. Identifies the location, calibre, and intramuscular course of perforators from the deep inferior epigastric artery. Reduces operative time, improves f...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1883":{"title":"Abbreviations Master List","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s31","snippet":"Abbreviations Master List Abbreviation Full Term ADM Acellular dermal matrix ALT Anterolateral thigh (flap) BIA-ALCL Breast implant-associated anaplastic large cell lymphoma CaHA Calcium hydroxylapatite CDT Complete decongestive therapy CL/P Cleft lip and/or palate CP Cleft palate CS Component separ...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1884":{"title":"Landmark Studies & Guidelines","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/surgical/plastic-reconstructive-surgery","url":"/surgical/plastic-reconstructive-surgery#s32","snippet":"Landmark Studies & Guidelines Study/Guideline Year Key Finding Reference Godina - Early Microsurgical Reconstruction of Complex Trauma 1986 Free flap coverage within 72 hours of injury has lowest failure rate (0.75%), lowest infection rate (1.5%), and shortest hospitalisation PMID: 3514036 LEAP Tria...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"1885":{"title":"Pediatric Surgery","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery","snippet":"Specialty Reference Pediatric Surgery Complete Specialty Reference Every diagnosis, classification, procedure, technique, medication, complication, and management algorithm across the full scope of pediatric surgery in one place."},"1886":{"title":"Pediatric Surgical Anatomy","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s1","snippet":"Pediatric Surgical Anatomy Children are not small adults. The pediatric surgical patient has unique anatomical features at every stage of development, from the premature neonate through the adolescent. Understanding these differences is essential for safe operative planning. Airway The neonatal airw...","sourceLabel":"Section in Pediatric Surgery"},"1887":{"title":"Pediatric Physiology & Fluid Management","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s2","snippet":"Pediatric Physiology & Fluid Management Fluid Requirements — The 4-2-1 Rule (Holliday-Segar) Maintenance intravenous fluid calculation for children by weight: Body Weight Rate Example First 10 kg 4 mL/kg/hr 10 kg child = 40 mL/hr Next 10 kg (11-20 kg) 2 mL/kg/hr 20 kg child = 40 + 20 = 60 mL/hr Each...","sourceLabel":"Section in Pediatric Surgery"},"1888":{"title":"Neonatal Assessment & Prematurity","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s3","snippet":"Neonatal Assessment & Prematurity Apgar Score Parameter 0 1 2 A ppearance (color) Blue/pale all over Acrocyanosis (blue extremities) Completely pink P ulse (heart rate) Absent <100 bpm &ge;100 bpm G rimace (reflex) No response Grimace Cry/cough/sneeze A ctivity (muscle tone) Limp Some flexion Active...","sourceLabel":"Section in Pediatric Surgery"},"1889":{"title":"Pediatric Surgical Principles","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s4","snippet":"Pediatric Surgical Principles Several principles distinguish pediatric from adult surgical practice and must guide every operative decision. Minimally Invasive Surgery Figure 16 - Pediatric Minimally Invasive Surgery. Thoracoscopic approach for pediatric chest wall repair demonstrating port placemen...","sourceLabel":"Section in Pediatric Surgery"},"1890":{"title":"Esophageal Atresia & Tracheoesophageal Fistula","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s5","snippet":"Esophageal Atresia & Tracheoesophageal Fistula Esophageal atresia (EA) occurs in approximately 1 in 3,000-4,500 live births. The esophagus ends in a blind pouch, with or without a fistulous connection to the trachea (tracheoesophageal fistula, TEF). Gross Classification Type Description Frequency Ty...","sourceLabel":"Section in Pediatric Surgery"},"1891":{"title":"Congenital Diaphragmatic Hernia","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s6","snippet":"Congenital Diaphragmatic Hernia Congenital diaphragmatic hernia (CDH) involves herniation of abdominal viscera into the chest through a diaphragmatic defect, causing pulmonary hypoplasia and pulmonary hypertension. Incidence: 1 in 2,500-5,000 live births. Mortality: 20-50% depending on severity. Typ...","sourceLabel":"Section in Pediatric Surgery"},"1892":{"title":"Intestinal Atresia","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s7","snippet":"Intestinal Atresia Duodenal Atresia Incidence: 1 in 5,000-10,000 live births. 30% associated with Down syndrome (trisomy 21) . Other associations: annular pancreas, malrotation, cardiac defects. Embryology: failure of recanalization of the duodenal lumen (weeks 8-10). Classic finding: \"Double bubble...","sourceLabel":"Section in Pediatric Surgery"},"1893":{"title":"Malrotation & Midgut Volvulus","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s8","snippet":"Malrotation & Midgut Volvulus SURGICAL EMERGENCY: Bilious Emesis in a Neonate Bilious (green) emesis in a neonate is malrotation with midgut volvulus until proven otherwise. This is a true surgical emergency — delay in diagnosis leads to midgut necrosis, short bowel syndrome, and death. An emergent ...","sourceLabel":"Section in Pediatric Surgery"},"1894":{"title":"Meconium Ileus & Abdominal Wall Defects","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s9","snippet":"Meconium Ileus & Abdominal Wall Defects Meconium Ileus Meconium ileus is intestinal obstruction caused by inspissated (abnormally thick and sticky) meconium in the terminal ileum. Almost pathognomonic for cystic fibrosis (CF) — 80-90% of neonates with meconium ileus have CF, and 15-20% of CF patient...","sourceLabel":"Section in Pediatric Surgery"},"1895":{"title":"Anorectal Malformations & Hirschsprung Disease","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s10","snippet":"Anorectal Malformations & Hirschsprung Disease Anorectal Malformations (ARM) Spectrum of congenital anomalies affecting the anus and rectum, ranging from simple perineal fistula to complex cloacal malformations. Incidence: 1 in 4,000-5,000 live births. Males and females are equally affected, but the...","sourceLabel":"Section in Pediatric Surgery"},"1896":{"title":"Pyloric Stenosis","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s11","snippet":"Pyloric Stenosis Hypertrophic pyloric stenosis (HPS) results from hypertrophy and hyperplasia of the pyloric muscle, causing gastric outlet obstruction. Incidence: 2-5 per 1,000 live births. M:F = 4-5:1. Typically presents at 3-6 weeks of age (rarely before 1 week or after 12 weeks). Risk factors: f...","sourceLabel":"Section in Pediatric Surgery"},"1897":{"title":"Intussusception","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s12","snippet":"Intussusception Intussusception is the telescoping of a proximal segment of bowel (intussusceptum) into the distal segment (intussuscipiens). It is the most common cause of intestinal obstruction in children aged 6 months to 3 years (peak incidence 5-10 months). The most common type is ileocolic (te...","sourceLabel":"Section in Pediatric Surgery"},"1898":{"title":"Inguinal Hernia, Umbilical Hernia & Meckel Diverticulum","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s13","snippet":"Inguinal Hernia, Umbilical Hernia & Meckel Diverticulum Inguinal Hernia Figure 18 - Patent Processus Vaginalis and Pediatric Inguinal Hernia. Illustration demonstrating the spectrum of processus vaginalis patency from normal obliteration to complete patency producing an indirect inguinal hernia. Nea...","sourceLabel":"Section in Pediatric Surgery"},"1899":{"title":"Necrotizing Enterocolitis","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s14","snippet":"Necrotizing Enterocolitis Necrotizing enterocolitis (NEC) is the most common surgical emergency in premature neonates. It primarily affects premature infants (90% of cases), with peak incidence at 30-32 weeks gestational age. The pathogenesis involves an immature intestinal barrier, bacterial transl...","sourceLabel":"Section in Pediatric Surgery"},"1900":{"title":"Appendicitis in Children","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s15","snippet":"Appendicitis in Children Appendicitis is the most common surgical emergency in children overall (NEC is the most common in neonates). Peak incidence: 10-12 years of age. The diagnosis is more challenging in children than adults — perforation rates are higher at presentation (30-40% in children <5 ye...","sourceLabel":"Section in Pediatric Surgery"},"1901":{"title":"Biliary Atresia & Choledochal Cyst","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s16","snippet":"Biliary Atresia & Choledochal Cyst Biliary Atresia Progressive fibro-obliterative disease of the extrahepatic biliary tree, leading to cholestasis, biliary cirrhosis, and death if untreated. Incidence: 1 in 8,000-18,000 live births (higher in East Asia). It is the most common indication for liver tr...","sourceLabel":"Section in Pediatric Surgery"},"1902":{"title":"Short Bowel Syndrome & Intestinal Duplications","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s17","snippet":"Short Bowel Syndrome & Intestinal Duplications Short Bowel Syndrome (SBS) SBS results from massive intestinal resection or congenital short bowel, leaving insufficient absorptive surface to maintain nutrition via the enteral route alone. In neonates, the most common causes are NEC (massive bowel nec...","sourceLabel":"Section in Pediatric Surgery"},"1903":{"title":"Congenital Lung Lesions","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s18","snippet":"Congenital Lung Lesions Congenital Pulmonary Airway Malformation (CPAM/CCAM) Figure 24 - Congenital Pulmonary Airway Malformation (CPAM) Imaging. CT imaging demonstrating a congenital lung lesion with its vascular anatomy. CPAM presents as cystic and/or solid components resulting from abnormal bronc...","sourceLabel":"Section in Pediatric Surgery"},"1904":{"title":"Chest Wall Deformities & Mediastinal Masses","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s19","snippet":"Chest Wall Deformities & Mediastinal Masses Pectus Excavatum Figure 25 - Pectus Excavatum - Nuss Procedure. CT cross-section and clinical images demonstrating pectus excavatum repair using the minimally invasive Nuss technique. The curved steel bar is inserted behind the sternum under thoracoscopic ...","sourceLabel":"Section in Pediatric Surgery"},"1905":{"title":"Neuroblastoma","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s20","snippet":"Neuroblastoma Neuroblastoma is the most common extracranial solid tumor in children, arising from neural crest cells. Median age at diagnosis: 17 months. Most common locations: adrenal gland (40%), paraspinal sympathetic chain (25%), posterior mediastinum (15%). Can occur anywhere along the sympathe...","sourceLabel":"Section in Pediatric Surgery"},"1906":{"title":"Wilms Tumor (Nephroblastoma)","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s21","snippet":"Wilms Tumor (Nephroblastoma) Wilms tumor is the most common renal malignancy in children. Peak incidence: 3-4 years. Incidence: 1 in 10,000 children. Bilateral in 5-7%. Associated with syndromes: WAGR (Wilms, Aniridia, GU anomalies, intellectual disability — 11p13 deletion including WT1), Beckwith-W...","sourceLabel":"Section in Pediatric Surgery"},"1907":{"title":"Hepatoblastoma, Rhabdomyosarcoma & Sacrococcygeal Teratoma","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s22","snippet":"Hepatoblastoma, Rhabdomyosarcoma & Sacrococcygeal Teratoma Hepatoblastoma Most common primary liver malignancy in children. Peak incidence: <3 years. Associated with Beckwith-Wiedemann syndrome, familial adenomatous polyposis (FAP), and extreme prematurity. Tumor marker: alpha-fetoprotein (AFP) — ma...","sourceLabel":"Section in Pediatric Surgery"},"1908":{"title":"Ovarian Tumors in Children","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s23","snippet":"Ovarian Tumors in Children Ovarian masses in children differ from adults — the majority are benign. The most common ovarian tumor in children is mature cystic teratoma (dermoid cyst) , followed by functional/physiologic cysts. Classification Category Types Key Features Germ cell tumors (60-70%) Matu...","sourceLabel":"Section in Pediatric Surgery"},"1909":{"title":"Undescended Testis & Testicular Torsion","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s24","snippet":"Undescended Testis & Testicular Torsion Undescended Testis (Cryptorchidism) The most common genitourinary anomaly in boys. Incidence: 3% of term males at birth (30% in premature males), decreasing to 1% by 6 months (spontaneous descent). Bilateral in 10-20%. Right side more common. A truly undescend...","sourceLabel":"Section in Pediatric Surgery"},"1910":{"title":"Hydrocele, Hypospadias & Vesicoureteral Reflux","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s25","snippet":"Hydrocele, Hypospadias & Vesicoureteral Reflux Hydrocele Fluid collection within the tunica vaginalis around the testis. Two types: Type Mechanism Transillumination Management Communicating Patent processus vaginalis allowing peritoneal fluid to flow in and out; fluctuates in size (larger when uprig...","sourceLabel":"Section in Pediatric Surgery"},"1911":{"title":"Posterior Urethral Valves & Ovarian Torsion","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s26","snippet":"Posterior Urethral Valves & Ovarian Torsion Posterior Urethral Valves (PUV) The most common cause of congenital lower urinary tract obstruction in males. Incidence: 1 in 5,000-8,000 male births. Obstructing mucosal folds in the posterior urethra (between the verumontanum and the external sphincter) ...","sourceLabel":"Section in Pediatric Surgery"},"1912":{"title":"Pediatric Trauma Assessment","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s27","snippet":"Pediatric Trauma Assessment Trauma is the leading cause of death in children >1 year old. Key anatomic and physiologic differences from adults that affect trauma management: Feature Pediatric Difference Clinical Implication Head Proportionally larger, thinner calvarium Higher incidence of head injur...","sourceLabel":"Section in Pediatric Surgery"},"1913":{"title":"Solid Organ Injury, Non-Accidental Trauma & Burns","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s28","snippet":"Solid Organ Injury, Non-Accidental Trauma & Burns Nonoperative Management of Solid Organ Injuries Children have a higher success rate of nonoperative management (NOM) of solid organ injuries than adults — >95% of splenic injuries and >90% of liver injuries in hemodynamically stable children are mana...","sourceLabel":"Section in Pediatric Surgery"},"1914":{"title":"Key Procedures & Techniques","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s29","snippet":"Key Procedures & Techniques Laparoscopic Pediatric Surgery Port sizes: 3 mm or 5 mm (vs 5-12 mm in adults). Insufflation pressure: 8-12 mmHg for infants and young children (vs 15 mmHg in adults). CO2 absorption is proportionally higher in children — monitor ETCO2 closely. Veress needle insertion tec...","sourceLabel":"Section in Pediatric Surgery"},"1915":{"title":"Medications & Therapeutics","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s30","snippet":"Medications & Therapeutics Pediatric Anesthesia Considerations All anesthetic agents must be weight-based. Sevoflurane is the most commonly used inhalational induction agent in children (pleasant smell, rapid onset). Rapid sequence induction: succinylcholine 2 mg/kg IV (higher dose than adults due t...","sourceLabel":"Section in Pediatric Surgery"},"1916":{"title":"Classification Systems","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s31","snippet":"Classification Systems Master Classification Reference Table System Condition Key Points Gross classification EA/TEF Types A-E; Type C (EA + distal TEF) = 85% Spitz classification EA/TEF prognosis Based on birth weight and cardiac defect Bell staging (modified) NEC Stages I-III; pneumatosis = Stage ...","sourceLabel":"Section in Pediatric Surgery"},"1917":{"title":"Complications & Management","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s32","snippet":"Complications & Management Complication Associated Conditions Management Anastomotic stricture EA/TEF repair, pull-through, intestinal anastomosis Serial dilations (balloon or Savary); resection if refractory Anastomotic leak Any intestinal/esophageal anastomosis Drainage, NPO, antibiotics; reoperat...","sourceLabel":"Section in Pediatric Surgery"},"1918":{"title":"Medications Master Table","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s33","snippet":"Medications Master Table Drug Class Pediatric Dose Key Notes Acetaminophen Analgesic/antipyretic 15 mg/kg PO/PR q4-6h; 12.5-15 mg/kg IV q6h Max 75 mg/kg/day; hepatotoxicity in overdose Ibuprofen NSAID 10 mg/kg PO q6-8h Avoid <6 months; renal/GI risks Morphine Opioid 0.05-0.1 mg/kg IV q2-4h Reduce do...","sourceLabel":"Section in Pediatric Surgery"},"1919":{"title":"Abbreviations Master List","pageTitle":"Pediatric Surgery","pageUrl":"/surgical/pediatric-surgery","url":"/surgical/pediatric-surgery#s34","snippet":"Abbreviations Master List Weight-Based Quick Reference (Emergency Doses) Medication Dose Route Epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000) IV/IO Atropine 0.02 mg/kg (min 0.1 mg) IV/IO Amiodarone 5 mg/kg IV/IO Adenosine 0.1 mg/kg (max 6 mg), then 0.2 mg/kg (max 12 mg) Rapid IV push Succinylcholine...","sourceLabel":"Section in Pediatric Surgery"},"1920":{"title":"Transplant Surgery","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery","snippet":"Specialty Reference Transplant Surgery Complete Specialty Reference Every organ system, donor evaluation, immunosuppression protocol, rejection classification, surgical technique, complication, and management algorithm across the full scope of transplant surgery in one place."},"1921":{"title":"Transplant Immunology","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s1","snippet":"Transplant Immunology The MHC / HLA System The major histocompatibility complex (MHC) is encoded on the short arm of chromosome 6 (6p21.3) and is the most polymorphic region in the human genome. In humans, MHC molecules are termed human leukocyte antigens (HLA) . Two classes are critical for transpl...","sourceLabel":"Section in Transplant Surgery"},"1922":{"title":"Donor Evaluation & Organ Procurement","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s2","snippet":"Donor Evaluation & Organ Procurement Brain Death Criteria Brain death is defined as the irreversible cessation of all functions of the entire brain, including the brainstem. Determination requires: (1) known cause of coma; (2) exclusion of confounders (hypothermia < 36&deg;C, drug intoxication, seve...","sourceLabel":"Section in Transplant Surgery"},"1923":{"title":"Recipient Evaluation & Listing","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s3","snippet":"Recipient Evaluation & Listing UNOS Organ Allocation System The United Network for Organ Sharing (UNOS) , operating as the Organ Procurement and Transplantation Network (OPTN) , manages organ allocation in the United States. Key principles: medical urgency, waiting time, geographic proximity (since ...","sourceLabel":"Section in Transplant Surgery"},"1924":{"title":"Histocompatibility & Crossmatching","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s4","snippet":"Histocompatibility & Crossmatching ABO Compatibility ABO-compatible transplantation follows standard blood group rules (identical or compatible). ABO-incompatible (ABOi) kidney transplantation is performed at experienced centers using desensitization: target anti-A or anti-B isoagglutinin titers &le...","sourceLabel":"Section in Transplant Surgery"},"1925":{"title":"Kidney Transplant — Surgical Technique","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s5","snippet":"Kidney Transplant — Surgical Technique Living Donor Nephrectomy Laparoscopic donor nephrectomy is the standard approach (left kidney preferred due to longer renal vein). Technique: lateral decubitus position, 3-4 ports, transperitoneal approach; identify ureter (preserve periureteral blood supply — ...","sourceLabel":"Section in Transplant Surgery"},"1926":{"title":"Kidney Transplant — Rejection","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s6","snippet":"Kidney Transplant — Rejection Hyperacute Rejection Occurs within minutes to hours of reperfusion. Caused by preformed antibodies (anti-donor HLA or anti-ABO) that bind graft endothelium &rarr; complement activation &rarr; diffuse thrombotic microangiopathy &rarr; graft thrombosis. The kidney turns b...","sourceLabel":"Section in Transplant Surgery"},"1927":{"title":"Delayed Graft Function","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s7","snippet":"Delayed Graft Function Definition & Epidemiology Delayed graft function (DGF) is defined as the need for dialysis within the first 7 days post-transplant. Incidence: ~25% in DBD kidneys, ~50% in DCD kidneys, < 5% in living donor kidneys. DGF is associated with increased acute rejection risk (OR ~1.4...","sourceLabel":"Section in Transplant Surgery"},"1928":{"title":"Post-Kidney Transplant Complications","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s8","snippet":"Post-Kidney Transplant Complications Urologic Complications Urine leak / urinoma: Usually at the ureteroneocystostomy (1-5% incidence); presents with pain, swelling, rising creatinine with stable serum BUN, perinephric fluid on imaging. Diagnosis: high creatinine in drain fluid (drain fluid Cr >> se...","sourceLabel":"Section in Transplant Surgery"},"1929":{"title":"Living Donor Kidney Transplantation","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s9","snippet":"Living Donor Kidney Transplantation Living Donor Evaluation Comprehensive assessment per OPTN policy: medical history & physical exam, psychosocial evaluation by independent living donor advocate (ILDA), ABO/HLA typing, crossmatch. Medical workup: GFR (must be > 80 mL/min by nuclear GFR or iothalama...","sourceLabel":"Section in Transplant Surgery"},"1930":{"title":"Liver Transplant — Indications & Listing","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s10","snippet":"Liver Transplant — Indications & Listing Indications Decompensated cirrhosis (most common indication — ~60%): variceal hemorrhage, ascites, hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome. Etiologies: alcohol-associated liver disease (now #1 cause in the US), NASH/MASLD (risin...","sourceLabel":"Section in Transplant Surgery"},"1931":{"title":"Liver Transplant — Surgical Technique","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s11","snippet":"Liver Transplant — Surgical Technique Recipient Hepatectomy The most challenging phase — extensive portal hypertension, coagulopathy, and adhesions (in redo cases). The operation has three phases: dissection, anhepatic, and neohepatic. Dissection phase: Bilateral subcostal incision with midline exte...","sourceLabel":"Section in Transplant Surgery"},"1932":{"title":"Post-Liver Transplant Complications","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s12","snippet":"Post-Liver Transplant Complications Primary Non-Function (PNF) Defined as graft failure within 7 days requiring retransplantation or causing death. Incidence: 2-6%. Characterized by severe coagulopathy (rising INR), metabolic acidosis, hypoglycemia, encephalopathy, minimal bile production, markedly ...","sourceLabel":"Section in Transplant Surgery"},"1933":{"title":"Liver Transplant — Rejection & Recurrent Disease","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s13","snippet":"Liver Transplant — Rejection & Recurrent Disease Acute Cellular Rejection (ACR) — Banff RAI Score Incidence: 15-30% in the first year. Diagnosed on biopsy using the Rejection Activity Index (RAI) , which scores three histologic components: Component Score 0 Score 1 Score 2 Score 3 Portal inflammatio...","sourceLabel":"Section in Transplant Surgery"},"1934":{"title":"HCC & Liver Transplantation","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s14","snippet":"HCC & Liver Transplantation Milan Criteria The gold standard for HCC transplant eligibility, proposed by Mazzaferro et al. (1996) PMID: 8632270 : Parameter Milan Criteria Single tumor &le; 5 cm diameter Multiple tumors &le; 3 nodules, each &le; 3 cm Macrovascular invasion Absent Extrahepatic spread ...","sourceLabel":"Section in Transplant Surgery"},"1935":{"title":"Pancreas Transplantation","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s15","snippet":"Pancreas Transplantation Categories Type Definition % of Pancreas Tx 1-Year Graft Survival SPK (Simultaneous Pancreas-Kidney) Pancreas + kidney from same donor, performed simultaneously ~75% ~87-90% PAK (Pancreas After Kidney) Pancreas transplant in patient with prior functioning kidney transplant ~...","sourceLabel":"Section in Transplant Surgery"},"1936":{"title":"Islet Cell Transplantation","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s16","snippet":"Islet Cell Transplantation Islet Isolation The pancreas is digested with collagenase (Liberase or collagenase blend) via intraductal infusion, followed by mechanical dissociation and density gradient purification (COBE 2991 cell processor). Goal: obtain &ge; 5,000 islet equivalents (IEQ) per kg reci...","sourceLabel":"Section in Transplant Surgery"},"1937":{"title":"Heart Transplantation","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s17","snippet":"Heart Transplantation Indications & Evaluation Primary indication: advanced/end-stage heart failure (NYHA Class III-IV) refractory to maximal medical therapy. Most common etiologies: dilated cardiomyopathy (~50%), ischemic cardiomyopathy (~40%), other (restrictive, congenital, valvular, retransplant...","sourceLabel":"Section in Transplant Surgery"},"1938":{"title":"Lung Transplantation","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s18","snippet":"Lung Transplantation Indications Disease % of Lung Tx Type of Tx Key Notes COPD/emphysema ~25% Single or bilateral Bilateral preferred (better survival); native hyperinflation with single lung (contralateral mediastinal shift) Idiopathic pulmonary fibrosis (IPF) ~25% Single or bilateral Bilateral in...","sourceLabel":"Section in Transplant Surgery"},"1939":{"title":"Intestinal & Multivisceral Transplantation","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s19","snippet":"Intestinal & Multivisceral Transplantation Indications Primary indication: irreversible intestinal failure with life-threatening complications of total parenteral nutrition (TPN). Specific criteria for transplant listing: (1) loss of &ge; 2 central venous access sites; (2) recurrent line sepsis (&ge...","sourceLabel":"Section in Transplant Surgery"},"1940":{"title":"Induction Therapy","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s20","snippet":"Induction Therapy Overview Induction therapy provides intense immunosuppression at the time of transplant — the period of highest immunologic risk. Used in > 80% of kidney transplants, less commonly in liver transplants (lower immunologic risk). Two categories: depleting and non-depleting agents. Ag...","sourceLabel":"Section in Transplant Surgery"},"1941":{"title":"Maintenance Immunosuppression","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s21","snippet":"Maintenance Immunosuppression Triple Therapy — Standard Regimen The cornerstone of transplant immunosuppression is triple therapy : calcineurin inhibitor (CNI) + antimetabolite + corticosteroids. Drug Mechanism Target Trough Level Key Side Effects Tacrolimus (FK506) Binds FKBP-12 &rarr; inhibits cal...","sourceLabel":"Section in Transplant Surgery"},"1942":{"title":"Rejection Treatment Protocols","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s22","snippet":"Rejection Treatment Protocols Acute Cellular Rejection (ACR) Treatment Severity First-Line Second-Line (Steroid-Resistant) Borderline / Banff IA Pulse methylprednisolone 250-500 mg IV daily &times; 3 days; optimize maintenance IS rATG 1.5 mg/kg/day &times; 5-7 days Banff IB-IIA Pulse methylprednisol...","sourceLabel":"Section in Transplant Surgery"},"1943":{"title":"Post-Transplant Infections","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s23","snippet":"Post-Transplant Infections Timeline of Post-Transplant Infections Period Type Common Pathogens 0-1 month Nosocomial / surgical site / donor-derived Wound infections (S. aureus, enterococcus), UTI (E. coli, Klebsiella), pneumonia (hospital flora), C. difficile, line infections, donor-derived (HSV, Ca...","sourceLabel":"Section in Transplant Surgery"},"1944":{"title":"Post-Transplant Malignancy","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s24","snippet":"Post-Transplant Malignancy Overall Risk Transplant recipients have a 3-5 fold increased overall cancer risk compared to the general population; for certain cancers, the increase is dramatic: non-melanoma skin cancer (~65-250x), PTLD/lymphoma (~8-12x), Kaposi sarcoma (~200-500x), lip cancer (~20x), r...","sourceLabel":"Section in Transplant Surgery"},"1945":{"title":"Classification Systems","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s25","snippet":"Classification Systems Banff Classification — Kidney Allograft Rejection (2022) Category Criteria 1. Normal No significant histologic changes 2. Antibody-mediated changes Active AMR: microvascular inflammation (g + ptc &ge; 2) OR v > 0 OR TMA; + C4d or molecular AMR markers; + DSA. Chronic active AM...","sourceLabel":"Section in Transplant Surgery"},"1946":{"title":"Medications Master Table","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s26","snippet":"Medications Master Table Drug Class Mechanism Dose / Target Level Key Side Effects Drug Interactions Tacrolimus CNI FKBP-12 &rarr; calcineurin inhibition &rarr; blocks IL-2 0.05-0.1 mg/kg BID; trough 5-12 ng/mL (time-dependent) Nephrotoxicity, PTDM, tremor, hyperkalemia, hypomagnesemia, alopecia, PR...","sourceLabel":"Section in Transplant Surgery"},"1947":{"title":"Imaging & Diagnostics","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s27","snippet":"Imaging & Diagnostics Doppler Ultrasound — Graft Assessment Renal allograft ultrasound: First-line imaging for transplant kidney dysfunction. Assess: (1) graft size (normal transplant kidney slightly larger than native); (2) hydronephrosis (ureteral obstruction); (3) perigraft collections (lymphocel...","sourceLabel":"Section in Transplant Surgery"},"1948":{"title":"Abbreviations Master List","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s28","snippet":"Abbreviations Master List Abbreviation Full Term ACR Acute cellular rejection AMR Antibody-mediated rejection APC Antigen-presenting cell ATG / rATG Anti-thymocyte globulin / rabbit ATG BOS Bronchiolitis obliterans syndrome CAV Cardiac allograft vasculopathy CDC Complement-dependent cytotoxicity CIT...","sourceLabel":"Section in Transplant Surgery"},"1949":{"title":"Landmark Trials","pageTitle":"Transplant Surgery","pageUrl":"/surgical/transplant-surgery","url":"/surgical/transplant-surgery#s29","snippet":"Landmark Trials Trial Year Key Finding PMID BENEFIT 2010 (7-yr: 2016) Belatacept vs. cyclosporine in kidney Tx: belatacept achieved superior 7-year GFR (+16 mL/min), comparable graft/patient survival despite higher early rejection rate PMID: 26816011 ELITE-Symphony 2007 Low-dose tacrolimus + MMF + c...","sourceLabel":"Section in Transplant Surgery"},"1950":{"title":"Hand Surgery","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery","snippet":"Specialty Reference Hand Surgery Complete Specialty Reference Every diagnosis, fracture pattern, tendon injury, nerve compression, reconstruction, classification, complication, medication, and management algorithm across the full scope of hand and upper extremity surgery in one place."},"1951":{"title":"Hand & Wrist Skeletal Anatomy","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s1","snippet":"Hand & Wrist Skeletal Anatomy Bony Architecture The hand and wrist skeleton comprises 27 bones : 8 carpal bones, 5 metacarpals, and 14 phalanges (2 in the thumb, 3 in each finger). The carpal bones are arranged in two rows. The classic mnemonic for the proximal-to-distal, radial-to-ulnar arrangement...","sourceLabel":"Section in Hand Surgery"},"1952":{"title":"Tendon Anatomy & Zones of Injury","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s2","snippet":"Tendon Anatomy & Zones of Injury Extensor Compartments of the Wrist There are six dorsal compartments at the wrist, each containing specific extensor tendons beneath the extensor retinaculum: Figure 2 - Extensor Tendon Apparatus of the Finger. Diagram illustrating the extensor mechanism over the dor...","sourceLabel":"Section in Hand Surgery"},"1953":{"title":"Neurovascular Anatomy","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s3","snippet":"Neurovascular Anatomy Median Nerve The median nerve (C5-T1) enters the hand through the carpal tunnel deep to the transverse carpal ligament (flexor retinaculum). The carpal tunnel contains: the median nerve, 4 FDP tendons, 4 FDS tendons, and the FPL tendon (9 tendons + 1 nerve). The recurrent motor...","sourceLabel":"Section in Hand Surgery"},"1954":{"title":"Hand Examination & Provocative Tests","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s4","snippet":"Hand Examination & Provocative Tests Motor Testing Intrinsic muscle testing: Interossei (finger abduction - dorsal interossei, finger adduction - palmar interossei; both ulnar nerve). Test adductor pollicis with Froment's sign : ask patient to pinch paper between thumb and index finger; compensation...","sourceLabel":"Section in Hand Surgery"},"1955":{"title":"Distal Radius Fractures","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s5","snippet":"Distal Radius Fractures Fracture Patterns Distal radius fractures are the most common fractures of the upper extremity, with a bimodal distribution (young males - high energy; postmenopausal women - low energy/osteoporotic). Key patterns: Fracture Mechanism Deformity Key Feature Colles fracture Fall...","sourceLabel":"Section in Hand Surgery"},"1956":{"title":"Scaphoid Fractures","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s6","snippet":"Scaphoid Fractures Blood Supply & AVN Risk Figure 9 - Scaphoid Fracture and Nonunion. Posteroanterior radiograph demonstrating scaphoid waist fracture with established nonunion. The retrograde blood supply from the dorsal branch of the radial artery makes proximal pole fractures highly susceptible t...","sourceLabel":"Section in Hand Surgery"},"1957":{"title":"Metacarpal Fractures","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s7","snippet":"Metacarpal Fractures Boxer's Fracture (5th Metacarpal Neck) Figure 20 - Metacarpal Anatomy and Fracture Assessment. Clinical photograph illustrating the dorsal anatomy of the hand and metacarpal region. Assessment of the knuckle cascade and rotational alignment are critical in the clinical evaluatio...","sourceLabel":"Section in Hand Surgery"},"1958":{"title":"Phalangeal Fractures & Dislocations","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s8","snippet":"Phalangeal Fractures & Dislocations PIP Joint Dislocations Figure 21 - Fingertip Amputation Zones and Digital Anatomy. Classification diagram of the fingertip showing the zones of injury relative to the nail anatomy. Understanding the digital vascular anatomy at each level guides treatment decisions...","sourceLabel":"Section in Hand Surgery"},"1959":{"title":"Carpal Instability & Perilunate Injuries","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s9","snippet":"Carpal Instability & Perilunate Injuries Scapholunate Dissociation Figure 10 - Scapholunate Dissociation - Terry Thomas Sign. PA radiograph demonstrating widened scapholunate interval (>3 mm), the hallmark of scapholunate ligament disruption. This finding initiates the cascade toward SLAC wrist arth...","sourceLabel":"Section in Hand Surgery"},"1960":{"title":"Wrist Arthritis - SNAC & SLAC","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s10","snippet":"Wrist Arthritis - SNAC & SLAC SLAC Wrist (Scapholunate Advanced Collapse) The most common pattern of wrist arthritis, resulting from chronic scapholunate ligament incompetence. Predictable progression: Figure 11 - SLAC Wrist Radiographic Appearance. PA radiograph showing scapholunate advanced collap...","sourceLabel":"Section in Hand Surgery"},"1961":{"title":"DRUJ Injuries & TFCC Tears","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s11","snippet":"DRUJ Injuries & TFCC Tears TFCC Anatomy & Palmer Classification Figure 13 - TFCC Anatomy. Illustration of the pronated left wrist showing the triangular fibrocartilage complex components: the articular disc (TFC proper), dorsal and volar radioulnar ligaments, meniscus homologue, and ulnocarpal ligam...","sourceLabel":"Section in Hand Surgery"},"1962":{"title":"Flexor Tendon Injuries","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s12","snippet":"Flexor Tendon Injuries Zone II - \"No Man's Land\" Figure 15 - Verdan Zones for Flexor Tendon Injuries. Detailed diagram of the flexor tendon zones highlighting Zone II (\"no man's land\"), where both FDP and FDS travel within the tight fibro-osseous sheath, making primary repair most technically demand...","sourceLabel":"Section in Hand Surgery"},"1963":{"title":"Extensor Tendon Injuries","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s13","snippet":"Extensor Tendon Injuries Mallet Finger (Zone I) Terminal extensor tendon disruption at the DIP joint. Tendinous mallet: continuous DIP extension splinting (Stack splint) for 6-8 weeks; full-time followed by 4-6 weeks night splinting. Success rate 80-90% with compliant splinting. If the DIP is allowe...","sourceLabel":"Section in Hand Surgery"},"1964":{"title":"Tendon Transfers","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s14","snippet":"Tendon Transfers Principles Figure 22 - Intraoperative Tendon Anatomy. Intraoperative photograph demonstrating the flexor tendon and associated pulley structures as seen during open hand surgery. Understanding of tendon gliding and mechanical properties is fundamental to tendon transfer planning and...","sourceLabel":"Section in Hand Surgery"},"1965":{"title":"Trigger Finger & De Quervain Tenosynovitis","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s15","snippet":"Trigger Finger & De Quervain Tenosynovitis Trigger Finger (Stenosing Tenosynovitis) Figure 23 - Trigger Finger Pathomechanism. Schematic diagram illustrating the A1 pulley and its relationship to the flexor tendon sheath. In trigger finger, stenosis of the A1 pulley creates a size mismatch with the ...","sourceLabel":"Section in Hand Surgery"},"1966":{"title":"Tendon Reconstruction & Tenolysis","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s16","snippet":"Tendon Reconstruction & Tenolysis Staged Flexor Tendon Reconstruction Indicated when primary repair has failed or is not possible (delayed presentation, scarred tendon bed, absent pulley system). The Hunter rod technique (two-stage reconstruction): Stage 1: Insert a silicone (Hunter) rod through the...","sourceLabel":"Section in Hand Surgery"},"1967":{"title":"Carpal Tunnel Syndrome","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s17","snippet":"Carpal Tunnel Syndrome Clinical Presentation & Diagnosis The most common peripheral nerve compression. Median nerve entrapment beneath the transverse carpal ligament. Classic presentation: nocturnal paresthesias in the thumb, index, long, and radial half of ring finger; thenar atrophy (late); decrea...","sourceLabel":"Section in Hand Surgery"},"1968":{"title":"Cubital Tunnel Syndrome","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s18","snippet":"Cubital Tunnel Syndrome Anatomy & Sites of Compression The second most common upper extremity compression neuropathy. The ulnar nerve passes posterior to the medial epicondyle in the cubital tunnel , whose roof is formed by Osborne's ligament (arcuate ligament of the cubital tunnel - the fascial ban...","sourceLabel":"Section in Hand Surgery"},"1969":{"title":"Radial Tunnel & PIN Syndrome","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s19","snippet":"Radial Tunnel & PIN Syndrome Radial Tunnel Syndrome Pain syndrome (without motor deficit) caused by compression of the posterior interosseous nerve within the radial tunnel. The radial tunnel extends from the radial head to the distal edge of the supinator. Five sites of compression: (1) fibrous ban...","sourceLabel":"Section in Hand Surgery"},"1970":{"title":"Peripheral Nerve Injury & Repair","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s20","snippet":"Peripheral Nerve Injury & Repair Seddon Classification Type Pathology Recovery Neurapraxia Focal demyelination; axon intact; no Wallerian degeneration Complete recovery in days to 12 weeks Axonotmesis Axon disrupted; endoneurium intact; Wallerian degeneration occurs Spontaneous recovery at ~1 mm/day...","sourceLabel":"Section in Hand Surgery"},"1971":{"title":"Brachial Plexus Injuries","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s21","snippet":"Brachial Plexus Injuries Anatomy The brachial plexus is formed from the ventral rami of C5-T1 , organized as: Roots &rarr; Trunks &rarr; Divisions &rarr; Cords &rarr; Branches (mnemonic: \"Robert Taylor Drinks Cold Beer\"). Three trunks: upper (C5-C6), middle (C7), lower (C8-T1). Each trunk divides in...","sourceLabel":"Section in Hand Surgery"},"1972":{"title":"Digital Nerve Injuries","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s22","snippet":"Digital Nerve Injuries Repair Technique Digital nerves are mixed nerves (predominantly sensory in the digits) with a diameter of ~1.5-2 mm. Repair is indicated for all clean lacerations. Technique: identify the nerve ends under loupe magnification (3.5&times; or 4.5&times;), trim the ends back to he...","sourceLabel":"Section in Hand Surgery"},"1973":{"title":"Dupuytren Disease","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s23","snippet":"Dupuytren Disease Pathology & Epidemiology Dupuytren disease is a fibroproliferative disorder of the palmar fascia leading to progressive flexion contracture of the fingers. It arises from myofibroblast proliferation within the palmar and digital fascia. Most commonly affects the ring and small fing...","sourceLabel":"Section in Hand Surgery"},"1974":{"title":"Hand Infections","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s24","snippet":"Hand Infections Felon Closed-space infection of the fingertip pulp . The septae of the pulp create a confined compartment - infection causes intense pressure and pain, risking osteomyelitis of the distal phalanx. Treatment: incision and drainage (unilateral longitudinal approach or \"fish-mouth\" inci...","sourceLabel":"Section in Hand Surgery"},"1975":{"title":"Replantation & Ring Avulsion","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s25","snippet":"Replantation & Ring Avulsion Indications for Replantation General indications (absolute): thumb (most important digit for hand function), multiple digits , pediatric patients (excellent regenerative capacity), sharp amputation (clean injury, best success), wrist/forearm level . Relative indications:...","sourceLabel":"Section in Hand Surgery"},"1976":{"title":"Vascular Conditions of the Hand","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s26","snippet":"Vascular Conditions of the Hand Hypothenar Hammer Syndrome Thrombosis or aneurysm of the ulnar artery at the hook of hamate due to repetitive blunt trauma to the hypothenar eminence (mechanics, carpenters, cyclists). The ulnar artery is vulnerable as it crosses superficial to the hook of hamate. Pre...","sourceLabel":"Section in Hand Surgery"},"1977":{"title":"Hand Tumors","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s27","snippet":"Hand Tumors Ganglion Cyst The most common mass in the hand (60-70% of all hand tumors). Mucin-filled cyst arising from a joint capsule or tendon sheath. Most common location: dorsal wrist (60-70%, arising from the scapholunate ligament). Second most common: volar wrist (18-20%, arising from the radi...","sourceLabel":"Section in Hand Surgery"},"1978":{"title":"Congenital Hand Differences","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s28","snippet":"Congenital Hand Differences Swanson Classification (Modified IFSSH) Category Examples I. Failure of formation Radial longitudinal deficiency (radial club hand), transverse deficiency (congenital amputation), phocomelia II. Failure of differentiation Syndactyly, symphalangism, radioulnar synostosis, ...","sourceLabel":"Section in Hand Surgery"},"1979":{"title":"Classification Systems","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s29","snippet":"Classification Systems Fracture & Injury Classifications Classification Condition Key Feature Frykman (I-VIII) Distal radius fractures Joint involvement (radiocarpal, DRUJ) &plusmn; ulnar styloid fracture AO/OTA (A, B, C) Distal radius fractures A = extra-articular, B = partial articular, C = comple...","sourceLabel":"Section in Hand Surgery"},"1980":{"title":"Medications Master Table","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s30","snippet":"Medications Master Table Antibiotics for Hand Infections Indication First-Line Alternative Notes Simple skin infection (felon, paronychia) Cephalexin 500 mg PO QID Dicloxacillin 500 mg PO QID Cover staphylococci; add TMP-SMX for MRSA risk Flexor tenosynovitis Ampicillin-sulbactam 3 g IV q6h Cefazoli...","sourceLabel":"Section in Hand Surgery"},"1981":{"title":"Imaging & Diagnostics","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s31","snippet":"Imaging & Diagnostics Radiographic Views View Technique Best For PA (posteroanterior) Standard; shoulder abducted 90&deg;, elbow flexed 90&deg; SL interval, Gilula's arcs, carpal alignment, ulnar variance Lateral True lateral with ulna and radius superimposed Volar/dorsal tilt (distal radius), SL an...","sourceLabel":"Section in Hand Surgery"},"1982":{"title":"Abbreviations Master List","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s32","snippet":"Abbreviations Master List Abbreviation Full Term ADM Abductor digiti minimi AIN Anterior interosseous nerve APB Abductor pollicis brevis APL Abductor pollicis longus AVN Avascular necrosis CMC Carpometacarpal CRPS Complex regional pain syndrome CTR Carpal tunnel release CTS Carpal tunnel syndrome DI...","sourceLabel":"Section in Hand Surgery"},"1983":{"title":"Key Rehabilitation Protocols","pageTitle":"Hand Surgery","pageUrl":"/surgical/hand-surgery","url":"/surgical/hand-surgery#s33","snippet":"Key Rehabilitation Protocols Flexor Tendon Repair (Zone II) Rehabilitation Phase Timeline Protocol Key Points Protective 0-4 weeks Dorsal blocking splint (wrist 20-30&deg; flexion, MCP 50-70&deg;, IP joints extended). Early active motion: place-and-hold exercises within splint, tendon gliding exerci...","sourceLabel":"Section in Hand Surgery"},"1984":{"title":"Oral & Maxillofacial Surgery","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery","snippet":"Specialty Reference Oral & Maxillofacial Surgery Complete Specialty Reference Every diagnosis, fracture pattern, surgical technique, pathology, implant procedure, classification, complication, medication, and management algorithm across the full scope of oral and maxillofacial surgery in one place."},"1985":{"title":"Facial & Oral Anatomy","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s1","snippet":"Facial & Oral Anatomy Facial Skeleton The facial skeleton (viscerocranium) is composed of 14 bones that form the structural framework for the orbits, nasal cavity, and oral cavity. The key bones in OMS practice include: Mandible: The only mobile bone of the facial skeleton. A U-shaped bone consistin...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"1986":{"title":"Neurovascular Anatomy","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s2","snippet":"Neurovascular Anatomy Trigeminal Nerve (CN V) The trigeminal nerve is the dominant sensory nerve of the face and the motor nerve to the muscles of mastication. It has three divisions: V1 — Ophthalmic Division: Purely sensory. Exits the skull via the superior orbital fissure. Branches: supraorbital n...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"1987":{"title":"The OMS Examination","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s3","snippet":"The OMS Examination Cranial Nerve Examination A focused cranial nerve exam is essential in facial trauma and pathology. Key elements: CN V — test light touch and pinprick in V1 (forehead), V2 (cheek), and V3 (chin/lower lip) distributions bilaterally; CN VII — assess frontalis (eyebrow raise), orbic...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"1988":{"title":"Anesthesia & Sedation in OMS","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s4","snippet":"Anesthesia & Sedation in OMS Local Anesthetic Techniques OMS practitioners use a wide range of local anesthetic injections. The most common agents are 2% lidocaine with 1:100,000 epinephrine (maximum dose 7 mg/kg with epi, 4.4 mg/kg without) and 4% articaine with 1:100,000 epinephrine (maximum dose ...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"1989":{"title":"Mandibular Fractures","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s5","snippet":"Mandibular Fractures Figure 9 - Mandibular Fracture Frequency by Location. Schematic representation of the mandible showing the relative frequency of fractures at each anatomic site. The condyle/subcondylar region is the most commonly fractured site (25-35%), followed by the angle (20-25%) and body ...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"1990":{"title":"Midface Fractures","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s6","snippet":"Midface Fractures Figure 11 - Le Fort Fracture Classification. Classic Le Fort fracture pattern classifications showing Type I (horizontal, floating palate), Type II (pyramidal, floating maxilla), and Type III (craniofacial dysjunction, floating face). All three types involve fracture of the pterygo...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"1991":{"title":"Orbital Fractures","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s7","snippet":"Orbital Fractures Figure 14 - Orbital Floor Blowout Fracture on CT. Coronal CT demonstrating an orbital floor fracture with herniation of periorbital fat and the inferior rectus muscle into the maxillary sinus. CT with thin cuts is the gold standard imaging modality for evaluating orbital fractures ...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"1992":{"title":"Nasal & Frontal Sinus Fractures","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s8","snippet":"Nasal & Frontal Sinus Fractures Nasal Fractures The nasal bones are the most commonly fractured facial bones. Diagnosis is primarily clinical — palpation of crepitus, deviation, epistaxis, periorbital ecchymosis. CT is not required for isolated nasal fractures but should be obtained if more extensiv...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"1993":{"title":"Dentoalveolar Trauma","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s9","snippet":"Dentoalveolar Trauma Tooth Avulsion — Reimplantation Protocol Tooth avulsion (complete displacement of the tooth from the socket) is a true dental emergency. Successful reimplantation depends critically on extraoral dry time and PDL cell viability : Replant immediately if possible (< 5 min extraoral...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"1994":{"title":"Cephalometric Analysis","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s10","snippet":"Cephalometric Analysis Key Landmarks Landmark Abbreviation Definition Sella S Center of the sella turcica (pituitary fossa) Nasion N Most anterior point of the frontonasal suture A-point (Subspinale) A Deepest concavity on the anterior maxilla between ANS and alveolar crest — represents maxillary AP...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"1995":{"title":"Orthognathic Procedures","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s11","snippet":"Orthognathic Procedures Le Fort I Osteotomy The workhorse maxillary osteotomy. The osteotomy line follows the Le Fort I fracture pattern — horizontal cut above the tooth apices through the lateral maxillary wall, lateral nasal wall, and nasal septum. The maxilla is then downfractured and mobilized. ...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"1996":{"title":"Distraction Osteogenesis","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s12","snippet":"Distraction Osteogenesis Principles Distraction osteogenesis (DO) generates new bone by gradually separating two osteotomized bone segments. First described by Ilizarov (1950s, orthopedics) , adapted for the craniofacial skeleton by McCarthy (1992) . The process has three phases: Phase Duration Desc...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"1997":{"title":"Obstructive Sleep Apnea Surgery","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s13","snippet":"Obstructive Sleep Apnea Surgery MMA — Maxillomandibular Advancement MMA is the most effective skeletal surgical treatment for moderate-to-severe obstructive sleep apnea (OSA). It combines a Le Fort I maxillary advancement with a BSSO mandibular advancement (typically 10-12 mm each), expanding the en...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"1998":{"title":"Odontogenic Cysts","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s14","snippet":"Odontogenic Cysts Figure 21 - Odontogenic Keratocyst Imaging. Panoramic radiograph demonstrating mandibular odontogenic keratocysts presenting as well-defined unilocular and multilocular radiolucencies. OKCs characteristically grow along the medullary cavity with minimal buccal-lingual expansion, di...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"1999":{"title":"Odontogenic Tumors","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s15","snippet":"Odontogenic Tumors Figure 23 - Ameloblastoma — Multilocular Pattern. Panoramic radiograph and CT imaging demonstrating a multilocular ameloblastoma of the posterior mandible with the characteristic soap bubble or honeycomb pattern. CT provides superior assessment of cortical integrity and tumor exte...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"2000":{"title":"Oral Mucosal Pathology & Premalignancy","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s16","snippet":"Oral Mucosal Pathology & Premalignancy Potentially Malignant Disorders Leukoplakia: A white plaque that cannot be characterized clinically or pathologically as any other disease (diagnosis of exclusion). Prevalence: 1-5% of adults. Malignant transformation rate: 1-9% overall (higher for nonhomogeneo...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"2001":{"title":"Oral Squamous Cell Carcinoma","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s17","snippet":"Oral Squamous Cell Carcinoma Risk Factors Tobacco (smoking and smokeless — 5-10× increased risk), alcohol (synergistic with tobacco — combined use increases risk 15-30×), betel quid/areca nut chewing, HPV (types 16/18 — primarily oropharyngeal, less commonly oral cavity), chronic trauma (controversi...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"2002":{"title":"Salivary Gland Disease","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s18","snippet":"Salivary Gland Disease Obstructive Conditions Sialolithiasis: Calcified stones in the salivary duct or gland. 80-90% occur in the submandibular gland (Wharton's duct) — the submandibular gland produces mucous (thicker) saliva that must flow uphill against gravity, and the duct has a tortuous course ...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"2003":{"title":"Medication-Related Osteonecrosis of the Jaw (MRONJ)","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s19","snippet":"Medication-Related Osteonecrosis of the Jaw (MRONJ) Definition & Risk Factors MRONJ is defined by the AAOMS as exposed bone or bone that can be probed through an intraoral or extraoral fistula in the maxillofacial region, persisting for > 8 weeks, in a patient with current or previous exposure to an...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"2004":{"title":"Surgical Extractions & Impacted Third Molars","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s20","snippet":"Surgical Extractions & Impacted Third Molars Classification of Impacted Third Molars Pell-Gregory Classification (Depth & Ramus Relationship): Depth (Relative to Occlusal Plane of 2nd Molar) Ramus Relationship (Space Available) Position A Highest point of tooth is at or above the occlusal plane of t...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"2005":{"title":"Dental Implants & Osseointegration","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s21","snippet":"Dental Implants & Osseointegration Osseointegration Principles Per-Ingvar Br&aring;nemark (1969) defined osseointegration as a direct structural and functional connection between ordered, living bone and the surface of a load-carrying implant. Modern dental implants are made of commercially pure tit...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"2006":{"title":"Bone Grafting & Augmentation","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s22","snippet":"Bone Grafting & Augmentation Graft Types & Properties Graft Type Source Properties Examples Autogenous (autograft) Patient's own bone Gold standard — only graft with all three properties: osteogenesis (living cells), osteoinduction (BMPs), osteoconduction (scaffold). Disadvantage: donor site morbidi...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"2007":{"title":"Preprosthetic Surgery & TMJ Surgery","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s23","snippet":"Preprosthetic Surgery & TMJ Surgery Preprosthetic Surgery Alveolar ridge augmentation: See bone grafting section. Onlay block grafts (from ramus or chin), GBR with particulate graft, or ridge split technique with expansion and graft for horizontally deficient ridges. Vertical augmentation is more ch...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"2008":{"title":"Classification Systems","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s24","snippet":"Classification Systems Fracture Classifications Classification Application Categories Le Fort I/II/III Midface fractures I: horizontal (floating palate); II: pyramidal (floating maxilla); III: craniofacial dysjunction (floating face). All involve pterygoid plates. Zingg (ZMC) Zygomatic complex fract...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"2009":{"title":"Medications Master Table","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s25","snippet":"Medications Master Table Antibiotics Drug Dose (Adult) Spectrum/Indication Notes Amoxicillin 500 mg PO TID or 875 mg PO BID First-line for odontogenic infections; covers oral streptococci and anaerobes Most common OMS antibiotic; add clavulanate (Augmentin 875/125 BID) if resistant organisms suspect...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"2010":{"title":"Imaging & Diagnostics","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s26","snippet":"Imaging & Diagnostics Modality Indications in OMS Advantages Limitations Panoramic Radiograph (OPG) Screening for impacted teeth, mandibular fractures, cysts/tumors, TMJ condylar morphology; preoperative planning for third molar surgery Single image of entire mandible, maxilla, teeth, TMJs, and sinu...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"2011":{"title":"Abbreviations Master List","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s27","snippet":"Abbreviations Master List Abbreviation Full Term OMS Oral and Maxillofacial Surgery TMJ Temporomandibular Joint TMD Temporomandibular Disorder IAN Inferior Alveolar Nerve IMA Internal Maxillary Artery ZMC Zygomaticomaxillary Complex NOE Naso-Orbito-Ethmoid MCT Medial Canthal Tendon ICD Intercanthal ...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"2012":{"title":"Key Guidelines & Landmark Studies","pageTitle":"Oral & Maxillofacial Surgery","pageUrl":"/surgical/oral-maxillofacial-surgery","url":"/surgical/oral-maxillofacial-surgery#s28","snippet":"Key Guidelines & Landmark Studies Study/Guideline Year Key Finding/Recommendation Reference Champy et al. — Ideal Lines of Osteosynthesis 1978 Defined the zones of tension and compression in the mandible; established monocortical miniplate fixation along the external oblique ridge for angle fracture...","sourceLabel":"Section in Oral & Maxillofacial Surgery"},"2013":{"title":"OB/GYN","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn","snippet":"Specialty Reference Obstetrics & Gynecology Complete Specialty Reference Every diagnosis, procedure, surgical technique, classification, complication, medication, and management algorithm across the full scope of obstetrics and gynecology in one place."},"2014":{"title":"Pelvic Anatomy","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s1","snippet":"Pelvic Anatomy Uterus, Cervix & Vagina The uterus is a thick-walled, pear-shaped muscular organ measuring approximately 7-8 cm in length, 4-5 cm in width, and 2-3 cm in anteroposterior diameter in the nulliparous adult. It is divided into the fundus (superior dome above the tubal ostia), corpus (bod...","sourceLabel":"Section in OB/GYN"},"2015":{"title":"Reproductive Physiology","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s2","snippet":"Reproductive Physiology Hypothalamic-Pituitary-Ovarian (HPO) Axis The hypothalamus secretes gonadotropin-releasing hormone (GnRH) in a pulsatile fashion from the arcuate nucleus. The pulsatile pattern is critical: high-frequency GnRH pulses favor LH secretion, while low-frequency pulses favor FSH se...","sourceLabel":"Section in OB/GYN"},"2016":{"title":"The OB/GYN Examination","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s3","snippet":"The OB/GYN Examination Speculum Examination The speculum exam is fundamental for visualizing the vagina and cervix. A Graves speculum (most common, wider blades) or Pedersen speculum (narrower blades, for nulliparous or atrophic patients) is used. The cervix is inspected for lesions, discharge, cerv...","sourceLabel":"Section in OB/GYN"},"2017":{"title":"Normal Pregnancy & Prenatal Care","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s4","snippet":"Normal Pregnancy & Prenatal Care Prenatal Visit Schedule Standard visit frequency: every 4 weeks until 28 weeks, every 2 weeks from 28-36 weeks, and weekly from 36 weeks until delivery. The first visit (ideally 6-10 weeks) includes comprehensive history, physical exam, dating ultrasound (if uncertai...","sourceLabel":"Section in OB/GYN"},"2018":{"title":"Hypertensive Disorders of Pregnancy","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s5","snippet":"Hypertensive Disorders of Pregnancy Classification Hypertensive disorders complicate 5-10% of all pregnancies and are a leading cause of maternal morbidity and mortality. The classification includes: Hypertensive Disorders - Definitions Chronic hypertension: BP &ge; 140/90 mmHg present before pregna...","sourceLabel":"Section in OB/GYN"},"2019":{"title":"Gestational Diabetes","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s6","snippet":"Gestational Diabetes Screening Universal screening at 24-28 weeks is recommended. Two approaches exist: Two-step approach (most common in the US): Step 1 - 50 g oral glucose challenge test (GCT), non-fasting. Threshold: &ge; 130 or &ge; 140 mg/dL at 1 hour (institution-dependent). If positive, proce...","sourceLabel":"Section in OB/GYN"},"2020":{"title":"Placental Abnormalities","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s7","snippet":"Placental Abnormalities Placenta Previa Placenta previa is defined as placental tissue covering or adjacent to the internal cervical os. Previously classified as complete, partial, marginal, and low-lying; current terminology distinguishes placenta previa (covering the os) from low-lying placenta (w...","sourceLabel":"Section in OB/GYN"},"2021":{"title":"Preterm Labor & Cervical Insufficiency","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s8","snippet":"Preterm Labor & Cervical Insufficiency Preterm Labor Preterm labor is defined as regular uterine contractions with cervical change between 20 0/7 and 36 6/7 weeks. Preterm birth is the leading cause of neonatal morbidity and mortality worldwide. Risk factors: prior preterm birth (strongest predictor...","sourceLabel":"Section in OB/GYN"},"2022":{"title":"Labor & Delivery","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s9","snippet":"Labor & Delivery Stages of Labor The Three Stages of Labor First stage: Onset of regular contractions to complete cervical dilation (10 cm). Divided into: Latent phase (0-6 cm, slow irregular progress, may last hours to days) and Active phase (6-10 cm, more rapid dilation, expected rate &ge; 1 cm/hr...","sourceLabel":"Section in OB/GYN"},"2023":{"title":"Postpartum Hemorrhage","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s10","snippet":"Postpartum Hemorrhage Definition & Epidemiology Postpartum hemorrhage (PPH) is defined as cumulative blood loss &ge; 1000 mL or blood loss accompanied by signs/symptoms of hypovolemia within 24 hours of delivery (ACOG revised definition). PPH complicates 1-5% of deliveries and is the leading cause o...","sourceLabel":"Section in OB/GYN"},"2024":{"title":"Ectopic Pregnancy","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s11","snippet":"Ectopic Pregnancy Epidemiology & Risk Factors Ectopic pregnancy occurs when a fertilized ovum implants outside the endometrial cavity. Incidence ~2% of all pregnancies. It is the leading cause of first-trimester maternal death. Sites: tubal (~95% - ampulla 70%, isthmus 12%, fimbrial 11%, interstitia...","sourceLabel":"Section in OB/GYN"},"2025":{"title":"Fetal Monitoring & Rh Isoimmunization","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s12","snippet":"Fetal Monitoring & Rh Isoimmunization NICHD Nomenclature for Fetal Heart Rate Interpretation FHR Components Baseline FHR: Mean FHR during a 10-minute segment, rounded to increments of 5 bpm. Normal: 110-160 bpm. Tachycardia: > 160 bpm (fever, chorioamnionitis, fetal anemia, maternal medications). Br...","sourceLabel":"Section in OB/GYN"},"2026":{"title":"Cervical Cancer","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s13","snippet":"Cervical Cancer HPV & Cervical Carcinogenesis Human papillomavirus (HPV) is the causative agent in > 99% of cervical cancers. High-risk types: HPV 16 (causes ~50% of cervical cancers) and HPV 18 (causes ~20%). Other high-risk types: 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68. Low-risk types (6, 11) ...","sourceLabel":"Section in OB/GYN"},"2027":{"title":"Endometrial Cancer","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s14","snippet":"Endometrial Cancer Epidemiology & Risk Factors Endometrial cancer is the most common gynecologic malignancy in the United States. Mean age at diagnosis: 63 years. The primary risk factor is unopposed estrogen exposure : obesity (adipose tissue aromatization of androgens to estrogens), early menarche...","sourceLabel":"Section in OB/GYN"},"2028":{"title":"Ovarian Cancer","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s15","snippet":"Ovarian Cancer Epithelial Ovarian Cancer - Histologic Subtypes Ovarian cancer is the most lethal gynecologic malignancy due to late-stage presentation (~70% diagnosed at stage III-IV). Epithelial ovarian cancer accounts for ~90% of cases. Epithelial Ovarian Cancer Subtypes High-grade serous carcinom...","sourceLabel":"Section in OB/GYN"},"2029":{"title":"Vulvar & Vaginal Cancer","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s16","snippet":"Vulvar & Vaginal Cancer Vulvar Cancer Vulvar cancer accounts for ~5% of gynecologic malignancies. Two pathways: (1) HPV-related (younger patients, associated with VIN/HSIL, warty/basaloid histology, better prognosis) and (2) HPV-independent (older patients, associated with lichen sclerosus and diffe...","sourceLabel":"Section in OB/GYN"},"2030":{"title":"Gestational Trophoblastic Disease","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s17","snippet":"Gestational Trophoblastic Disease Hydatidiform Mole Complete vs Partial Mole Complete mole: 46,XX or 46,XY (entirely paternal origin - empty ovum fertilized by one sperm that duplicates, or two sperm). No fetal tissue. \"Snowstorm\" pattern on ultrasound. Markedly elevated &beta;-hCG (> 100,000 mIU/mL...","sourceLabel":"Section in OB/GYN"},"2031":{"title":"Uterine Fibroids","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s18","snippet":"Uterine Fibroids Overview & Classification Uterine leiomyomas (fibroids) are the most common pelvic tumors in women, affecting up to 70-80% of women by age 50. They are benign smooth muscle tumors of the myometrium, estrogen- and progesterone-dependent (grow during reproductive years, shrink after m...","sourceLabel":"Section in OB/GYN"},"2032":{"title":"Endometriosis","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s19","snippet":"Endometriosis Pathogenesis & Clinical Features Endometriosis is defined as the presence of endometrial-like tissue (glands and stroma) outside the uterine cavity. Affects ~10% of reproductive-age women. The leading theory is retrograde menstruation (Sampson theory) - reflux of menstrual tissue throu...","sourceLabel":"Section in OB/GYN"},"2033":{"title":"Abnormal Uterine Bleeding","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s20","snippet":"Abnormal Uterine Bleeding PALM-COEIN Classification The FIGO PALM-COEIN system classifies causes of abnormal uterine bleeding (AUB) in non-pregnant reproductive-age women: PALM-COEIN Classification Structural causes (PALM): P olyp - endometrial or endocervical. A denomyosis - endometrial glands with...","sourceLabel":"Section in OB/GYN"},"2034":{"title":"Ovarian Cysts & Adnexal Masses","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s21","snippet":"Ovarian Cysts & Adnexal Masses Functional Cysts Follicular cysts arise from unruptured dominant follicles, typically < 8 cm, thin-walled, unilocular, simple on US. Usually resolve spontaneously in 1-3 cycles. Corpus luteum cysts form from the hemorrhagic corpus luteum, may contain internal echoes (h...","sourceLabel":"Section in OB/GYN"},"2035":{"title":"Pelvic Inflammatory Disease & STIs","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s22","snippet":"Pelvic Inflammatory Disease & STIs Pelvic Inflammatory Disease (PID) PID is an ascending infection of the upper genital tract (endometritis, salpingitis, tubo-ovarian abscess, peritonitis). Most commonly caused by Neisseria gonorrhoeae and Chlamydia trachomatis , but often polymicrobial (anaerobes, ...","sourceLabel":"Section in OB/GYN"},"2036":{"title":"Menopause & Hormone Replacement Therapy","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s23","snippet":"Menopause & Hormone Replacement Therapy Definitions & Physiology Menopause is defined retrospectively as 12 consecutive months of amenorrhea in a woman &ge; 45 years (without other pathologic cause), reflecting permanent cessation of ovarian follicular activity. Mean age in the US: 51 years. Perimen...","sourceLabel":"Section in OB/GYN"},"2037":{"title":"Pelvic Organ Prolapse","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s24","snippet":"Pelvic Organ Prolapse Types & Pathophysiology Pelvic organ prolapse (POP) is the descent of pelvic organs through the vagina due to loss of support. Affects up to 50% of parous women to some degree. Types: cystocele (anterior vaginal wall prolapse, most common), rectocele (posterior vaginal wall), u...","sourceLabel":"Section in OB/GYN"},"2038":{"title":"Urinary Incontinence","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s25","snippet":"Urinary Incontinence Types Stress urinary incontinence (SUI): Involuntary urine leakage with increased abdominal pressure (coughing, sneezing, laughing, exercise). Due to urethral hypermobility or intrinsic sphincter deficiency. Most common type in younger women. Urgency urinary incontinence (UUI): ...","sourceLabel":"Section in OB/GYN"},"2039":{"title":"Gynecologic Procedures","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s26","snippet":"Gynecologic Procedures Hysteroscopy Hysteroscopy is the direct visualization of the uterine cavity using a hysteroscope inserted through the cervix. Diagnostic hysteroscopy : Office-based, using a small-diameter scope (3-4 mm), saline distension. For evaluation of AUB, polyps, submucosal fibroids, i...","sourceLabel":"Section in OB/GYN"},"2040":{"title":"Classification Systems","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s27","snippet":"Classification Systems FIGO Staging - Cervical Cancer (2018) Stage IA: microscopic invasion (&le; 5 mm depth). IB: clinically visible or > 5 mm (IB1 &le; 2 cm, IB2 2-4 cm, IB3 > 4 cm). IIA: upper 2/3 vagina (IIA1 &le; 4 cm, IIA2 > 4 cm). IIB: parametrial invasion. IIIA: lower 1/3 vagina. IIIB: pelvi...","sourceLabel":"Section in OB/GYN"},"2041":{"title":"Medications Master Table","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s28","snippet":"Medications Master Table Uterotonics Drug Dose/Route Mechanism Key Contraindications Oxytocin (Pitocin) 10-40 units IV infusion Oxytocin receptor agonist &rarr; myometrial contraction Hypersensitivity (very few absolute CIs) Methylergonovine (Methergine) 0.2 mg IM Ergot alkaloid &rarr; sustained ute...","sourceLabel":"Section in OB/GYN"},"2042":{"title":"Imaging & Diagnostics","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s29","snippet":"Imaging & Diagnostics Pelvic Ultrasound Transvaginal ultrasound (TVUS) is the primary imaging modality in gynecology and early pregnancy. Higher resolution than transabdominal US for pelvic structures. Key measurements and findings: Key Ultrasound Measurements & Findings Endometrial thickness: Postm...","sourceLabel":"Section in OB/GYN"},"2043":{"title":"Abbreviations Master List","pageTitle":"OB/GYN","pageUrl":"/procedural/obgyn","url":"/procedural/obgyn#s30","snippet":"Abbreviations Master List Abbreviation Full Term AIS Adenocarcinoma in situ AMA Advanced maternal age (&ge; 35 at delivery) AMH Anti-M&uuml;llerian hormone ART Assisted reproductive technology ASC-H Atypical squamous cells, cannot exclude HSIL ASC-US Atypical squamous cells of undetermined significa...","sourceLabel":"Section in OB/GYN"},"2044":{"title":"Urology","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology","snippet":"Specialty Reference Urology Complete Specialty Reference Every diagnosis, procedure, surgical technique, classification, complication, medication, and management algorithm across the full scope of urology in one place."},"2045":{"title":"Upper Urinary Tract Anatomy","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s1","snippet":"Upper Urinary Tract Anatomy Kidneys The kidneys are paired retroperitoneal organs lying at the T12-L3 vertebral level. The right kidney sits slightly lower than the left due to the liver. Each kidney measures approximately 10-12 cm in length, 5-7 cm in width, and 3 cm in anteroposterior diameter, we...","sourceLabel":"Section in Urology"},"2046":{"title":"Lower Urinary Tract & Male Genital Anatomy","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s2","snippet":"Lower Urinary Tract & Male Genital Anatomy Urinary Bladder The bladder is a hollow muscular organ with a capacity of 400-600 mL. It lies in the retropubic space (space of Retzius) when empty. The bladder wall consists of: mucosa (transitional epithelium/urothelium), lamina propria, detrusor muscle (...","sourceLabel":"Section in Urology"},"2047":{"title":"Renal Physiology & Fluid/Electrolyte Basics","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s3","snippet":"Renal Physiology & Fluid/Electrolyte Basics Glomerular Filtration The glomerular filtration rate (GFR) is approximately 120 mL/min (180 L/day) in a healthy adult. Filtration is driven by net filtration pressure — the balance of hydrostatic and oncotic pressures across the glomerular capillary. The G...","sourceLabel":"Section in Urology"},"2048":{"title":"The Urologic Exam & Assessment","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s4","snippet":"The Urologic Exam & Assessment History & Physical Examination The urologic history should address: voiding symptoms (LUTS — frequency, urgency, nocturia, hesitancy, weak stream, straining, incomplete emptying, terminal dribbling), storage symptoms (urgency, incontinence, frequency), hematuria (gross...","sourceLabel":"Section in Urology"},"2049":{"title":"Prostate Cancer","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s5","snippet":"Prostate Cancer Epidemiology & Risk Factors Prostate cancer is the most commonly diagnosed non-cutaneous malignancy in men and the second leading cause of cancer death in American men. Risk factors: age (rare before 50; median age at diagnosis ~66), race (African American men have ~60% higher incide...","sourceLabel":"Section in Urology"},"2050":{"title":"Bladder Cancer","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s6","snippet":"Bladder Cancer Epidemiology & Risk Factors Bladder cancer is the 6th most common cancer overall and the most common malignancy of the urinary tract. Approximately 90% of bladder cancers in the Western world are urothelial carcinoma (transitional cell carcinoma, TCC) . Other histologies: squamous cel...","sourceLabel":"Section in Urology"},"2051":{"title":"Renal Cell Carcinoma","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s7","snippet":"Renal Cell Carcinoma Epidemiology & Subtypes Renal cell carcinoma (RCC) accounts for ~90% of renal malignancies and ~3% of all adult cancers. Peak incidence age 60-70; M:F ratio 2:1. Risk factors: smoking, obesity, hypertension, acquired cystic kidney disease (dialysis patients), von Hippel-Lindau (...","sourceLabel":"Section in Urology"},"2052":{"title":"Testicular Cancer","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s8","snippet":"Testicular Cancer Epidemiology & Risk Factors Testicular cancer is the most common solid malignancy in men aged 15-35. Incidence has been increasing over recent decades. Risk factors: cryptorchidism (3-8&times; increased risk; orchiopexy before puberty may reduce risk but does not eliminate it), pri...","sourceLabel":"Section in Urology"},"2053":{"title":"Upper Tract Urothelial Carcinoma","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s9","snippet":"Upper Tract Urothelial Carcinoma Overview Upper tract urothelial carcinoma (UTUC) accounts for 5-10% of urothelial cancers. It involves the renal pelvis (~60%) or ureter (~40%). Risk factors mirror those of bladder cancer (smoking, aromatic amines) with additional associations: aristolochic acid (Ba...","sourceLabel":"Section in Urology"},"2054":{"title":"Penile Cancer","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s10","snippet":"Penile Cancer Overview Penile cancer is rare in developed countries (< 1% of male cancers) but more common in developing nations. The vast majority (~95%) are squamous cell carcinoma . Risk factors: lack of circumcision (phimosis and chronic balanitis), poor hygiene, HPV infection (types 16 and 18 —...","sourceLabel":"Section in Urology"},"2055":{"title":"Nephrolithiasis — Evaluation & Medical Management","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s11","snippet":"Nephrolithiasis — Evaluation & Medical Management Epidemiology & Stone Types Nephrolithiasis affects ~10% of the population, with a recurrence rate of ~50% within 5-10 years. Peak incidence age 30-60; M:F ratio ~2:1 (narrowing with rising female obesity rates). Stone composition: Stone Type Frequenc...","sourceLabel":"Section in Urology"},"2056":{"title":"Surgical Stone Management","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s12","snippet":"Surgical Stone Management Indications for Surgical Intervention Surgery is indicated when: stone fails to pass with MET after 4-6 weeks, stone > 10 mm (unlikely to pass spontaneously), intractable pain, persistent obstruction with infection ( — sepsis risk), bilateral obstruction, solitary kidney wi...","sourceLabel":"Section in Urology"},"2057":{"title":"Ureteral Obstruction & Stenting","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s13","snippet":"Ureteral Obstruction & Stenting Acute Ureteral Obstruction Causes: nephrolithiasis (most common), malignant extrinsic compression (cervical, colorectal, ovarian cancer, retroperitoneal lymphadenopathy), retroperitoneal fibrosis (idiopathic/Ormond disease or drug-induced — methysergide, ergotamine), ...","sourceLabel":"Section in Urology"},"2058":{"title":"Benign Prostatic Hyperplasia (BPH)","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s14","snippet":"Benign Prostatic Hyperplasia (BPH) Pathophysiology BPH is a histologic diagnosis characterized by proliferation of stromal and epithelial cells in the prostatic transition zone , leading to glandular enlargement and potential bladder outlet obstruction (BOO). BPH affects ~50% of men aged 50-60 and ~...","sourceLabel":"Section in Urology"},"2059":{"title":"Overactive Bladder & Urinary Incontinence","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s15","snippet":"Overactive Bladder & Urinary Incontinence Types of Urinary Incontinence Type Mechanism Key Features Stress urinary incontinence (SUI) Urethral hypermobility or intrinsic sphincter deficiency (ISD) Leakage with cough, sneeze, lifting, exertion; more common in women (after childbirth, menopause) and p...","sourceLabel":"Section in Urology"},"2060":{"title":"Neurogenic Bladder","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s16","snippet":"Neurogenic Bladder Overview Neurogenic bladder refers to bladder dysfunction caused by neurologic disease or injury. The clinical presentation depends on the level of the neurologic lesion: Lesion Level Type Bladder Behavior Examples Suprapontine (above pons) Upper motor neuron Detrusor overactivity...","sourceLabel":"Section in Urology"},"2061":{"title":"Urethral Stricture Disease","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s17","snippet":"Urethral Stricture Disease Etiology Urethral stricture is fibrotic narrowing of the urethra caused by spongiofibrosis (scar tissue in the corpus spongiosum). Etiologies: iatrogenic (most common in developed countries — urethral catheterization, instrumentation, hypospadias repair, TURP), idiopathic ...","sourceLabel":"Section in Urology"},"2062":{"title":"Testicular Torsion & Scrotal Emergencies","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s18","snippet":"Testicular Torsion & Scrotal Emergencies Testicular Torsion Testicular torsion is a surgical emergency caused by twisting of the spermatic cord with resultant ischemia of the testis. Peak incidence: bimodal — neonates and adolescents (12-18 years). The underlying anomaly is the \"bell clapper\" deform...","sourceLabel":"Section in Urology"},"2063":{"title":"Cryptorchidism & Inguinal Disorders","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s19","snippet":"Cryptorchidism & Inguinal Disorders Cryptorchidism Cryptorchidism (undescended testis) is the most common congenital anomaly of the male genitalia, affecting ~3% of full-term and ~30% of premature male neonates. By 6 months of age, most undescended testes will spontaneously descend — prevalence stab...","sourceLabel":"Section in Urology"},"2064":{"title":"Vesicoureteral Reflux","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s20","snippet":"Vesicoureteral Reflux Overview Vesicoureteral reflux (VUR) is the retrograde flow of urine from the bladder into the ureter and renal collecting system. It is the most common urologic abnormality in children, affecting ~1% of the general pediatric population and ~30-40% of children who present with ...","sourceLabel":"Section in Urology"},"2065":{"title":"Hypospadias & Congenital Anomalies","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s21","snippet":"Hypospadias & Congenital Anomalies Hypospadias Hypospadias is a congenital anomaly in which the urethral meatus opens on the ventral surface of the penis, proximal to the normal glanular position. Incidence: ~1 in 200-300 live male births — one of the most common congenital anomalies. Classification...","sourceLabel":"Section in Urology"},"2066":{"title":"Fournier Gangrene, Priapism & Paraphimosis","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s22","snippet":"Fournier Gangrene, Priapism & Paraphimosis Fournier Gangrene Fournier gangrene is a life-threatening necrotizing fasciitis of the perineum and external genitalia. It is a polymicrobial infection (aerobic + anaerobic organisms: E. coli, Bacteroides, Streptococcus, Staphylococcus, Clostridium) involvi...","sourceLabel":"Section in Urology"},"2067":{"title":"Classification Systems","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s23","snippet":"Classification Systems Gleason / ISUP Grading (Prostate Cancer) ISUP Grade Group Gleason Score Pattern Description 1 3+3 = 6 Well-formed individual glands 2 3+4 = 7 Predominantly well-formed glands with a lesser component of poorly formed/fused/cribriform glands 3 4+3 = 7 Predominantly poorly formed...","sourceLabel":"Section in Urology"},"2068":{"title":"Medications Master Table","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s24","snippet":"Medications Master Table Alpha-Adrenergic Blockers (BPH / MET) Drug Selectivity Dose Key Notes Tamsulosin Alpha-1A selective 0.4 mg daily Most commonly prescribed; less orthostatic hypotension; IFIS risk; also used for MET Alfuzosin Alpha-1 (uroselective) 10 mg daily (ER) Once daily; contraindicated...","sourceLabel":"Section in Urology"},"2069":{"title":"Imaging & Diagnostics","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s25","snippet":"Imaging & Diagnostics CT Urogram The CT urogram is the gold standard for evaluating hematuria and the upper urinary tract. It consists of three phases: non-contrast (detects stones, calcifications), nephrographic (enhancing renal masses), and delayed/excretory (opacifies the collecting system, urete...","sourceLabel":"Section in Urology"},"2070":{"title":"Abbreviations Master List","pageTitle":"Urology","pageUrl":"/procedural/urology","url":"/procedural/urology#s26","snippet":"Abbreviations Master List Abbreviation Meaning ADT Androgen deprivation therapy AFP Alpha-fetoprotein AR Androgen receptor AUA American Urological Association AUS Artificial urinary sphincter BCG Bacillus Calmette-Gu&eacute;rin BEP Bleomycin, etoposide, cisplatin BMG Buccal mucosal graft BOO Bladder...","sourceLabel":"Section in Urology"},"2071":{"title":"Otolaryngology (ENT)","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent","snippet":"Specialty Reference Otolaryngology (ENT) Complete Specialty Reference Every diagnosis, procedure, surgical technique, classification, complication, medication, and management algorithm across the full scope of otolaryngology — head and neck surgery in one place."},"2072":{"title":"Head & Neck Anatomy","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s1","snippet":"Head & Neck Anatomy Temporal Bone The temporal bone is one of the most complex bones in the body, housing the organs of hearing and balance. It consists of five parts: squamous (forms the lateral skull wall), mastoid (contains air cells communicating with the middle ear via the aditus ad antrum), pe...","sourceLabel":"Section in Otolaryngology (ENT)"},"2073":{"title":"Neurovascular Anatomy","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s2","snippet":"Neurovascular Anatomy Facial Nerve (CN VII) The facial nerve has the longest intraosseous course of any cranial nerve. It exits the brainstem at the cerebellopontine angle (CPA), enters the internal auditory canal (IAC) in the anterosuperior quadrant, then courses through the temporal bone in three ...","sourceLabel":"Section in Otolaryngology (ENT)"},"2074":{"title":"The ENT Examination","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s3","snippet":"The ENT Examination Otoscopy The otoscopic examination begins with inspection of the auricle and periauricular region (pre-auricular pits, post-auricular swelling in mastoiditis). The external auditory canal is examined for cerumen, otorrhea, masses, and exostoses. Pull the pinna posterosuperiorly i...","sourceLabel":"Section in Otolaryngology (ENT)"},"2075":{"title":"Audiology Basics","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s4","snippet":"Audiology Basics Audiogram Interpretation The pure tone audiogram measures hearing thresholds (in dB HL) at frequencies 250-8000 Hz. Air conduction (AC) is tested with headphones or insert earphones; bone conduction (BC) is tested with a bone oscillator on the mastoid. The air-bone gap (difference b...","sourceLabel":"Section in Otolaryngology (ENT)"},"2076":{"title":"Hearing Loss","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s5","snippet":"Hearing Loss Conductive vs Sensorineural Conductive hearing loss (CHL) results from impaired sound transmission through the external or middle ear (cerumen impaction, TM perforation, ossicular discontinuity, otosclerosis, middle ear effusion, cholesteatoma). On audiogram: air-bone gap &ge; 10 dB wit...","sourceLabel":"Section in Otolaryngology (ENT)"},"2077":{"title":"Otitis Media & Cholesteatoma","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s6","snippet":"Otitis Media & Cholesteatoma Acute Otitis Media (AOM) AOM is an acute infection of the middle ear, most common in children aged 6-24 months. Risk factors: Eustachian tube dysfunction, daycare attendance, lack of breastfeeding, cleft palate. Most common pathogens: Streptococcus pneumoniae , Haemophil...","sourceLabel":"Section in Otolaryngology (ENT)"},"2078":{"title":"Otosclerosis","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s7","snippet":"Otosclerosis Otosclerosis is an autosomal dominant disorder with variable penetrance affecting the otic capsule. Abnormal remodeling of the bony labyrinth leads to fixation of the stapes footplate at the oval window, causing progressive conductive hearing loss . It is the most common cause of CHL in...","sourceLabel":"Section in Otolaryngology (ENT)"},"2079":{"title":"Vestibular Disorders","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s8","snippet":"Vestibular Disorders Benign Paroxysmal Positional Vertigo (BPPV) BPPV is the most common cause of vertigo. Caused by free-floating otoconia (calcium carbonate crystals) displaced from the utricle into a semicircular canal — most commonly the posterior canal (~80-90%). Patients experience brief episo...","sourceLabel":"Section in Otolaryngology (ENT)"},"2080":{"title":"Temporal Bone Fractures","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s9","snippet":"Temporal Bone Fractures Temporal bone fractures occur in ~18-22% of skull fractures, usually from high-energy blunt trauma. Two classification systems are used: Traditional Classification (Relative to Petrous Ridge) Type Frequency Fracture Line Key Features Longitudinal 70-80% Parallel to long axis ...","sourceLabel":"Section in Otolaryngology (ENT)"},"2081":{"title":"Cochlear Implants & Hearing Rehabilitation","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s10","snippet":"Cochlear Implants & Hearing Rehabilitation Cochlear Implant Candidacy Cochlear implants (CI) bypass damaged hair cells and directly stimulate the spiral ganglion neurons of the auditory nerve. FDA-approved candidacy criteria have expanded over time. General adult criteria: bilateral severe-to-profou...","sourceLabel":"Section in Otolaryngology (ENT)"},"2082":{"title":"Rhinosinusitis","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s11","snippet":"Rhinosinusitis Acute Rhinosinusitis (ARS) ARS is inflammation of the nasal cavity and paranasal sinuses lasting < 4 weeks. Most cases are viral (common cold) — symptoms include nasal congestion, purulent rhinorrhea, facial pressure/pain, and hyposmia. Acute bacterial rhinosinusitis (ABRS) should be ...","sourceLabel":"Section in Otolaryngology (ENT)"},"2083":{"title":"Functional Endoscopic Sinus Surgery (FESS)","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s12","snippet":"Functional Endoscopic Sinus Surgery (FESS) Indications FESS is indicated for CRS refractory to maximal medical therapy, recurrent acute sinusitis, complications of sinusitis, mucoceles, fungal sinusitis, sinonasal tumors (biopsy and select resections), CSF leak repair, and orbital decompression. The...","sourceLabel":"Section in Otolaryngology (ENT)"},"2084":{"title":"Nasal Obstruction","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s13","snippet":"Nasal Obstruction Septal Deviation & Septoplasty Nasal septal deviation is the most common structural cause of nasal obstruction. The septum consists of cartilage (quadrangular cartilage anteriorly) and bone (perpendicular plate of the ethmoid superiorly, vomer posteroinferiorly). Septoplasty involv...","sourceLabel":"Section in Otolaryngology (ENT)"},"2085":{"title":"Epistaxis","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s14","snippet":"Epistaxis Anterior Epistaxis Anterior epistaxis accounts for ~90% of nosebleeds and arises from Kiesselbach's plexus (Little's area) on the anterior nasal septum — an anastomotic network of the anterior ethmoidal artery, sphenopalatine artery, greater palatine artery, and superior labial artery (fro...","sourceLabel":"Section in Otolaryngology (ENT)"},"2086":{"title":"Sinonasal Tumors","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s15","snippet":"Sinonasal Tumors Inverted Papilloma Inverted papilloma is the most common benign sinonasal tumor. It arises from the lateral nasal wall (most commonly at the middle meatus/ethmoid region) and has a characteristic endophytic growth pattern (Schneiderian epithelium inverts into the underlying stroma)....","sourceLabel":"Section in Otolaryngology (ENT)"},"2087":{"title":"Voice Disorders & Vocal Fold Paralysis","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s16","snippet":"Voice Disorders & Vocal Fold Paralysis Vocal Fold Paralysis Unilateral vocal fold paralysis (UVFP) results from injury to the recurrent laryngeal nerve. Most common causes: iatrogenic (thyroidectomy — most common surgical cause, followed by anterior cervical spine surgery, carotid endarterectomy, ca...","sourceLabel":"Section in Otolaryngology (ENT)"},"2088":{"title":"Laryngeal Cancer","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s17","snippet":"Laryngeal Cancer Epidemiology & Risk Factors Laryngeal squamous cell carcinoma accounts for ~1% of all malignancies. Major risk factors: tobacco smoking (most important), alcohol (synergistic with tobacco), HPV (less significant than in oropharynx). Male predominance (4:1). Three subsites with disti...","sourceLabel":"Section in Otolaryngology (ENT)"},"2089":{"title":"Airway Management & Subglottic Stenosis","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s18","snippet":"Airway Management & Subglottic Stenosis Tracheotomy Tracheotomy is the creation of a surgical opening in the anterior tracheal wall for insertion of a tracheostomy tube. Indications: prolonged mechanical ventilation, upper airway obstruction, secretion management, pulmonary toilet, and as part of he...","sourceLabel":"Section in Otolaryngology (ENT)"},"2090":{"title":"Dysphagia & Esophageal Disorders","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s19","snippet":"Dysphagia & Esophageal Disorders Evaluation of Dysphagia Fiberoptic Endoscopic Evaluation of Swallowing (FEES): Flexible laryngoscopy performed during swallowing of dyed food/liquid boluses. Assesses laryngeal sensation, pharyngeal residue, penetration, and aspiration. Advantages: portable (bedside)...","sourceLabel":"Section in Otolaryngology (ENT)"},"2091":{"title":"Pediatric Airway","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s20","snippet":"Pediatric Airway Laryngomalacia Laryngomalacia is the most common cause of stridor in neonates. Caused by collapse of supraglottic structures (omega-shaped/tubular epiglottis, shortened aryepiglottic folds, redundant arytenoid mucosa) during inspiration. Presents with inspiratory stridor that worsen...","sourceLabel":"Section in Otolaryngology (ENT)"},"2092":{"title":"Thyroid Surgery","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s21","snippet":"Thyroid Surgery Indications for Thyroidectomy Indications for thyroid surgery include: malignancy or suspicious cytology (Bethesda V-VI), indeterminate cytology (Bethesda III-IV) for definitive diagnosis, compressive goiter (dyspnea, dysphagia), substernal goiter, hyperthyroidism refractory to medic...","sourceLabel":"Section in Otolaryngology (ENT)"},"2093":{"title":"Parathyroid Surgery","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s22","snippet":"Parathyroid Surgery Primary Hyperparathyroidism (PHPT) PHPT is the most common cause of hypercalcemia in the outpatient setting. Caused by a single adenoma (~85%), multigland hyperplasia (~10-15%), double adenoma (~4%), or rarely carcinoma (< 1%). Biochemistry: elevated serum calcium with inappropri...","sourceLabel":"Section in Otolaryngology (ENT)"},"2094":{"title":"Head & Neck Squamous Cell Carcinoma","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s23","snippet":"Head & Neck Squamous Cell Carcinoma Risk Factors & HPV-Positive Oropharyngeal Cancer Head and neck SCC (HNSCC) arises from the mucosal epithelium of the upper aerodigestive tract. Traditional risk factors: tobacco and alcohol (synergistic — 15-fold increase). HPV-positive oropharyngeal SCC (p16+) is...","sourceLabel":"Section in Otolaryngology (ENT)"},"2095":{"title":"Salivary Gland Surgery","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s24","snippet":"Salivary Gland Surgery Salivary Gland Tumors The parotid gland accounts for ~80% of salivary gland tumors, of which ~80% are benign. The submandibular gland has a roughly 50:50 benign-to-malignant ratio. Minor salivary glands (palate is the most common site) have a higher proportion of malignancy (~...","sourceLabel":"Section in Otolaryngology (ENT)"},"2096":{"title":"Facial Plastics & Reconstruction","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s25","snippet":"Facial Plastics & Reconstruction Rhinoplasty Overview Figure 28 - External Nasal Anatomy. The layered structure of the external nose showing the bony vault (nasal bones), cartilaginous middle vault (upper lateral cartilages), and tip (lower lateral cartilages with medial and lateral crura). Source: ...","sourceLabel":"Section in Otolaryngology (ENT)"},"2097":{"title":"Pediatric ENT","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s26","snippet":"Pediatric ENT Tonsillectomy & Adenoidectomy Tonsillectomy is one of the most commonly performed surgical procedures in children. Indications: (1) Obstructive sleep apnea (OSA) — the most common indication in children (adenotonsillar hypertrophy is the primary cause of pediatric OSA; polysomnography ...","sourceLabel":"Section in Otolaryngology (ENT)"},"2098":{"title":"Classification Systems","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s27","snippet":"Classification Systems House-Brackmann Facial Nerve Grading System Grade Description Characteristics I Normal Normal facial function in all areas II Mild dysfunction Slight weakness on close inspection; complete eye closure with minimal effort; slight mouth asymmetry III Moderate dysfunction Obvious...","sourceLabel":"Section in Otolaryngology (ENT)"},"2099":{"title":"Medications Master Table","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s28","snippet":"Medications Master Table Antibiotics Drug Indication Dose (Adult) Key Notes Amoxicillin AOM (first-line), ABRS 875 mg BID or 80-90 mg/kg/day (pediatric) High-dose for resistant S. pneumoniae Amoxicillin-clavulanate ABRS (first-line), AOM (second-line/treatment failure) 875/125 mg BID or 2 g/125 mg B...","sourceLabel":"Section in Otolaryngology (ENT)"},"2100":{"title":"Imaging & Diagnostics","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s29","snippet":"Imaging & Diagnostics CT Temporal Bone High-resolution CT temporal bone (0.5-0.625 mm axial cuts, bone algorithm) is the primary imaging modality for: cholesteatoma (soft tissue in the middle ear/mastoid with bony erosion), temporal bone fractures (otic capsule-sparing vs -violating), otosclerosis (...","sourceLabel":"Section in Otolaryngology (ENT)"},"2101":{"title":"Abbreviations Master List","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s30","snippet":"Abbreviations Master List Abbreviation Meaning ABR Auditory brainstem response ABRS Acute bacterial rhinosinusitis AC Air conduction AERD Aspirin-exacerbated respiratory disease AFRS Allergic fungal rhinosinusitis AIFS Acute invasive fungal sinusitis ALT Anterolateral thigh (flap) ANSD Auditory neur...","sourceLabel":"Section in Otolaryngology (ENT)"},"2102":{"title":"Landmark Guidelines & Trials","pageTitle":"Otolaryngology (ENT)","pageUrl":"/procedural/ent","url":"/procedural/ent#s31","snippet":"Landmark Guidelines & Trials Trial / Guideline Year Key Finding / Recommendation VA Laryngeal Cancer Study 1991 Induction chemotherapy (cisplatin + 5-FU) followed by radiation achieved laryngeal preservation in 64% of patients with advanced laryngeal cancer, with equivalent survival to total larynge...","sourceLabel":"Section in Otolaryngology (ENT)"},"2103":{"title":"Ophthalmology","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology","snippet":"Specialty Reference Ophthalmology Complete Specialty Reference Every diagnosis, procedure, surgical technique, classification, complication, medication, and management algorithm across the full scope of ophthalmology in one place."},"2104":{"title":"Ocular Anatomy","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s1","snippet":"Ocular Anatomy Globe Layers The eye is a ~24 mm sphere composed of three concentric coats. The outer fibrous coat consists of the sclera (opaque, collagen-rich posterior five-sixths) and the cornea (transparent anterior one-sixth). The cornea provides approximately two-thirds (~43 D) of the eye's to...","sourceLabel":"Section in Ophthalmology"},"2105":{"title":"Optics & Refraction","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s2","snippet":"Optics & Refraction Refractive Errors Emmetropia is the state in which parallel light rays focus precisely on the retina without accommodation. Refractive errors (ametropia) are the most common cause of correctable visual impairment worldwide. Myopia (nearsightedness): The eye is too long or the cor...","sourceLabel":"Section in Ophthalmology"},"2106":{"title":"The Ophthalmic Examination","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s3","snippet":"The Ophthalmic Examination Visual Acuity Visual acuity (VA) is the most important single measurement in ophthalmology. Measured using a Snellen chart at 20 feet (6 meters) or an ETDRS chart at 4 meters (preferred in clinical trials for its logarithmic design). Notation: 20/20 means the patient reads...","sourceLabel":"Section in Ophthalmology"},"2107":{"title":"Cataracts & Lens Surgery","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s4","snippet":"Cataracts & Lens Surgery Cataract Types & Pathophysiology A cataract is any opacity of the crystalline lens. Cataracts are the leading cause of reversible blindness worldwide. Risk factors include age (most common), UV exposure, diabetes, corticosteroid use, smoking, trauma, and radiation. Nuclear s...","sourceLabel":"Section in Ophthalmology"},"2108":{"title":"Corneal Diseases & Transplantation","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s5","snippet":"Corneal Diseases & Transplantation Keratoconus Figure 12 - Corneal Topography in Keratoconus. Corneal topography color map demonstrating the hallmark inferior or paracentral steepening of keratoconus. Red/orange colors represent steeper areas (higher dioptric power) and blue/purple represent flatter...","sourceLabel":"Section in Ophthalmology"},"2109":{"title":"Refractive Surgery","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s6","snippet":"Refractive Surgery LASIK Laser in situ keratomileusis (LASIK) is the most commonly performed refractive surgery worldwide. A flap (typically 90-120 &mu;m) is created with a femtosecond laser (or microkeratome), reflected, and the excimer laser (193 nm, argon fluoride) ablates the exposed stromal bed...","sourceLabel":"Section in Ophthalmology"},"2110":{"title":"Anterior Uveitis","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s7","snippet":"Anterior Uveitis Classification & Etiology Figure 14 - Keratic Precipitates in Anterior Uveitis. Slit lamp photograph demonstrating keratic precipitates (KPs) deposited on the corneal endothelium. Fine, small KPs suggest non-granulomatous uveitis (HLA-B27, idiopathic), while large mutton-fat KPs ind...","sourceLabel":"Section in Ophthalmology"},"2111":{"title":"Dry Eye Disease & Ocular Surface","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s8","snippet":"Dry Eye Disease & Ocular Surface Pathophysiology & Classification Dry eye disease (DED) is a multifactorial disease of the ocular surface characterized by loss of homeostasis of the tear film, causing ocular symptoms and visual disturbance, with tear film instability, hyperosmolarity, inflammation, ...","sourceLabel":"Section in Ophthalmology"},"2112":{"title":"Ocular Surface Tumors","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s9","snippet":"Ocular Surface Tumors Allergic Eye Disease Seasonal/perennial allergic conjunctivitis: The most common form — IgE-mediated type I hypersensitivity. Bilateral itching (hallmark symptom), watery discharge, chemosis, papillary reaction. Treatment: avoidance of allergens, artificial tears, topical antih...","sourceLabel":"Section in Ophthalmology"},"2113":{"title":"Open-Angle Glaucoma","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s10","snippet":"Open-Angle Glaucoma Pathophysiology & Diagnosis Figure 16 - Glaucomatous vs. Non-Glaucomatous Optic Disc Cupping. Comparison demonstrating the characteristics that distinguish glaucomatous cupping (progressive rim thinning, vertical elongation of the cup, disc hemorrhages, nerve fiber layer loss) fr...","sourceLabel":"Section in Ophthalmology"},"2114":{"title":"Angle-Closure Glaucoma","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s11","snippet":"Angle-Closure Glaucoma Acute Angle-Closure Attack (EMERGENCY) Figure 19 - Narrow Angle on Anterior Segment OCT. AS-OCT demonstrating a narrow iridocorneal angle with the peripheral iris in close proximity to the trabecular meshwork. In acute angle closure, complete appositional closure blocks aqueou...","sourceLabel":"Section in Ophthalmology"},"2115":{"title":"Secondary & Pediatric Glaucomas","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s12","snippet":"Secondary & Pediatric Glaucomas Neovascular Glaucoma (NVG) Neovascular glaucoma results from retinal ischemia driving VEGF-mediated neovascularization of the iris (rubeosis iridis) and angle, forming a fibrovascular membrane that obstructs the trabecular meshwork. Causes: proliferative diabetic reti...","sourceLabel":"Section in Ophthalmology"},"2116":{"title":"Diabetic Retinopathy","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s13","snippet":"Diabetic Retinopathy Pathophysiology & Staging Figure 22 - Diabetic Retinopathy Pathophysiology. Schematic illustrating the progression of diabetic retinal microangiopathy: chronic hyperglycemia leads to pericyte loss, basement membrane thickening, endothelial dysfunction, microaneurysm formation, c...","sourceLabel":"Section in Ophthalmology"},"2117":{"title":"Age-Related Macular Degeneration","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s14","snippet":"Age-Related Macular Degeneration Classification & Pathogenesis Figure 25 - Large Drusen in Age-Related Macular Degeneration. Spectral-domain OCT and corresponding fundus image demonstrating large drusen (greater than 125 micrometers) appearing as RPE elevations on OCT. The presence of large drusen c...","sourceLabel":"Section in Ophthalmology"},"2118":{"title":"Retinal Detachment","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s15","snippet":"Retinal Detachment Types Figure 26 - Types of Retinal Detachment. Schematic comparing rhegmatogenous (retinal break allows vitreous fluid into subretinal space), tractional (fibrovascular membranes mechanically pull retina from RPE), and exudative (fluid accumulation without break or traction) retin...","sourceLabel":"Section in Ophthalmology"},"2119":{"title":"Retinal Vascular Disease","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s16","snippet":"Retinal Vascular Disease Central Retinal Vein Occlusion (CRVO) CRVO is occlusion of the central retinal vein at or posterior to the lamina cribrosa. Presents with sudden painless monocular vision loss. Fundus: widespread retinal hemorrhages in all four quadrants (\"blood and thunder\" appearance), dil...","sourceLabel":"Section in Ophthalmology"},"2120":{"title":"Vitreoretinal Surgery","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s17","snippet":"Vitreoretinal Surgery Pars Plana Vitrectomy (PPV) — Technique & Indications Figure 29 - Multimodal Imaging in Proliferative Diabetic Retinopathy. Combined imaging demonstrating neovascularization of the disc (NVD) and neovascularization elsewhere (NVE) visible on fundus photography with correspondin...","sourceLabel":"Section in Ophthalmology"},"2121":{"title":"Posterior Uveitis & Endophthalmitis","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s18","snippet":"Posterior Uveitis & Endophthalmitis Infectious Posterior Uveitis Toxoplasma retinochoroiditis: The most common cause of infectious posterior uveitis worldwide. Caused by Toxoplasma gondii . Classic presentation: focal necrotizing retinitis appearing as a white lesion adjacent to an old, pigmented ch...","sourceLabel":"Section in Ophthalmology"},"2122":{"title":"Optic Neuritis & Papilledema","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s19","snippet":"Optic Neuritis & Papilledema Optic Neuritis Figure 30 - Ischemic Optic Neuropathy: AAION vs. NAION. Fundus photographs comparing arteritic (GCA-related) and non-arteritic anterior ischemic optic neuropathy. AAION typically shows chalky-white, pale disc swelling with more severe vision loss, while NA...","sourceLabel":"Section in Ophthalmology"},"2123":{"title":"Cranial Nerve Palsies","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s20","snippet":"Cranial Nerve Palsies Third Nerve Palsy (CN III) CN III innervates the medial rectus, superior rectus, inferior rectus, inferior oblique, and levator palpebrae superioris, and carries parasympathetic fibers to the pupillary sphincter (constriction) and ciliary muscle (accommodation). Complete CN III...","sourceLabel":"Section in Ophthalmology"},"2124":{"title":"Thyroid Eye Disease","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s21","snippet":"Thyroid Eye Disease Pathophysiology & Clinical Features Figure 31 - Clinical Features of Graves Ophthalmopathy. Clinical photographs demonstrating the hallmark features of thyroid eye disease: bilateral proptosis (exophthalmos), upper and lower lid retraction (Dalrymple sign), periorbital edema, and...","sourceLabel":"Section in Ophthalmology"},"2125":{"title":"Orbital Tumors & Trauma","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s22","snippet":"Orbital Tumors & Trauma Orbital Cellulitis Orbital infection is an ophthalmic emergency with risk of vision loss and life-threatening intracranial extension. Chandler Classification of Orbital Complications of Sinusitis Group I — Preseptal (periorbital) cellulitis: Infection anterior to the orbital ...","sourceLabel":"Section in Ophthalmology"},"2126":{"title":"Oculoplastics","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s23","snippet":"Oculoplastics Ptosis Ptosis (drooping of the upper eyelid) is classified by etiology: Aponeurotic (involutional): Most common type in adults. Due to dehiscence or disinsertion of the levator aponeurosis from the tarsal plate, often accelerated by contact lens wear, eye rubbing, or previous intraocul...","sourceLabel":"Section in Ophthalmology"},"2127":{"title":"Pediatric Ophthalmology & Strabismus","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s24","snippet":"Pediatric Ophthalmology & Strabismus Amblyopia Amblyopia (\"lazy eye\") is reduced best-corrected visual acuity in one or both eyes due to abnormal visual development during the critical period (birth to ~7-8 years, with some plasticity up to age 12-13). It is the most common cause of monocular vision...","sourceLabel":"Section in Ophthalmology"},"2128":{"title":"Classification Systems","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s25","snippet":"Classification Systems Cataract Grading — LOCS III Feature Grades Assessment Method Nuclear color (NC) NC1 (clear) — NC6 (brunescent) Slit-lamp comparison photographs Nuclear opalescence (NO) NO1 — NO6 Slit-lamp retroillumination Cortical cataract (C) C1 — C5 Retroillumination, percent area affected...","sourceLabel":"Section in Ophthalmology"},"2129":{"title":"Medications Master Table","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s26","snippet":"Medications Master Table Anti-VEGF Agents Agent Target Dose (Intravitreal) Key Indications Notes Bevacizumab (Avastin) VEGF-A 1.25 mg/0.05 mL Wet AMD, DME, RVO, NV Off-label; most cost-effective (~$50/dose) Ranibizumab (Lucentis) VEGF-A 0.5 mg (AMD), 0.3 mg (DME, RVO) Wet AMD, DME, DR, RVO Fab fragm...","sourceLabel":"Section in Ophthalmology"},"2130":{"title":"Imaging & Diagnostics","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s27","snippet":"Imaging & Diagnostics Optical Coherence Tomography (OCT) Figure 35 - Corneal Epithelium and Bowman Membrane. Histological detail of the anterior corneal layers showing the stratified squamous non-keratinized epithelium (5-7 cell layers thick) resting on the acellular Bowman layer. The epithelium pro...","sourceLabel":"Section in Ophthalmology"},"2131":{"title":"Abbreviations Master List","pageTitle":"Ophthalmology","pageUrl":"/procedural/ophthalmology","url":"/procedural/ophthalmology#s28","snippet":"Abbreviations Master List Abbreviation Definition AC Anterior chamber ACG Angle-closure glaucoma AMD Age-related macular degeneration AREDS Age-Related Eye Disease Study BCC Basal cell carcinoma BIO Binocular indirect ophthalmoscope BRVO Branch retinal vein occlusion CAI Carbonic anhydrase inhibitor...","sourceLabel":"Section in Ophthalmology"},"2132":{"title":"Maternal-Fetal Medicine","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine","snippet":"Specialty Reference Maternal-Fetal Medicine Complete Specialty Reference Every high-risk obstetric condition, fetal diagnosis, ultrasound finding, genetic screening, procedure, classification, complication, medication, and management algorithm across the full scope of maternal-fetal medicine in one ..."},"2133":{"title":"Placental & Fetal Physiology","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s1","snippet":"Placental & Fetal Physiology Placental Development The placenta develops from the trophoblast , which differentiates into the outer syncytiotrophoblast (multinucleated, hormone-producing, in direct contact with maternal blood) and the inner cytotrophoblast (proliferative stem cells). Placentation in...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2134":{"title":"Obstetric Ultrasound","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s2","snippet":"Obstetric Ultrasound First Trimester Ultrasound Dating: Crown-rump length (CRL) measured between 6-13+6 weeks is the most accurate parameter for determining gestational age (&plusmn;5-7 days). If the CRL-based dating differs from LMP dating by > 5 days (in the first trimester) or > 7 days (second tr...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2135":{"title":"Genetic Screening & Diagnosis","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s3","snippet":"Genetic Screening & Diagnosis Cell-Free DNA / Non-Invasive Prenatal Testing (NIPT) Cell-free DNA (cfDNA) screening analyzes placental-origin cell-free DNA fragments in the maternal circulation. Available from 10 weeks gestation. Performance characteristics: Condition Detection Rate False Positive Ra...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2136":{"title":"Risk Assessment & Antepartum Surveillance","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s4","snippet":"Risk Assessment & Antepartum Surveillance Biophysical Profile (BPP) The BPP is a composite assessment of fetal well-being that evaluates five parameters, each scored 0 or 2 (total 0-10): Component Normal (Score 2) Abnormal (Score 0) Fetal breathing movements &ge; 1 episode &ge; 30 seconds in 30 minu...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2137":{"title":"Hypertensive Disorders of Pregnancy","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s5","snippet":"Hypertensive Disorders of Pregnancy Classification Hypertensive disorders complicate 5-10% of pregnancies and are a leading cause of maternal morbidity and mortality. The ACOG classification divides them into four categories: ACOG Classification of Hypertensive Disorders Chronic hypertension: HTN pr...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2138":{"title":"Diabetes in Pregnancy","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s6","snippet":"Diabetes in Pregnancy Pregestational Diabetes (Type 1 & Type 2) Pregestational diabetes complicates ~1% of pregnancies and is associated with significantly increased risks of congenital anomalies (3-5&times; baseline, especially cardiac — VSD, transposition; NTDs; caudal regression syndrome), macros...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2139":{"title":"Cardiac Disease in Pregnancy","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s7","snippet":"Cardiac Disease in Pregnancy Physiologic Cardiovascular Changes in Pregnancy Normal pregnancy produces dramatic hemodynamic changes: blood volume increases by 40-50% (peaking at 32-34 weeks), cardiac output increases by 30-50% (increased HR by 10-20 bpm and increased stroke volume), systemic vascula...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2140":{"title":"Renal Disease in Pregnancy","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s8","snippet":"Renal Disease in Pregnancy Chronic Kidney Disease (CKD) in Pregnancy Normal pregnancy increases GFR by ~50% — serum creatinine normally decreases to 0.4-0.6 mg/dL (a \"normal\" non-pregnant creatinine of 1.0 mg/dL represents significant renal impairment in pregnancy). The degree of baseline renal dysf...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2141":{"title":"Thrombophilia & Venous Thromboembolism","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s9","snippet":"Thrombophilia & Venous Thromboembolism Inherited Thrombophilias Pregnancy is a hypercoagulable state due to increased clotting factors (I, VII, VIII, X, vWF), decreased protein S, increased PAI-1 and PAI-2, and venous stasis. The risk of VTE is 4-5&times; higher in pregnancy and 20-80&times; higher ...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2142":{"title":"Autoimmune Disease in Pregnancy","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s10","snippet":"Autoimmune Disease in Pregnancy Systemic Lupus Erythematosus (SLE) SLE flares occur in ~40-60% of pregnancies (risk higher if disease is active at conception — ideally defer pregnancy until 6 months of quiescence). Key complications: preeclampsia (20-30%), fetal growth restriction, preterm delivery,...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2143":{"title":"Hematologic Disorders","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s11","snippet":"Hematologic Disorders Sickle Cell Disease Sickle cell disease (HbSS, HbSC, HbS-&beta;-thalassemia) in pregnancy is associated with increased risk of pain crises, acute chest syndrome, preeclampsia (2-4&times;), FGR, preterm delivery, VTE, and maternal mortality (0.5-2%). Management: continued folic ...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2144":{"title":"Infections in Pregnancy","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s12","snippet":"Infections in Pregnancy TORCH Infections The TORCH acronym encompasses the major perinatal infections: T oxoplasmosis, O ther (syphilis, varicella, parvovirus B19), R ubella, C ytomegalovirus, H erpes simplex virus. Shared clinical features of congenital TORCH infection include: IUGR, hepatosplenome...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2145":{"title":"Fetal Growth Abnormalities","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s13","snippet":"Fetal Growth Abnormalities Fetal Growth Restriction (FGR) Fetal growth restriction is defined as estimated fetal weight (EFW) < 10th percentile for gestational age. It affects 5-10% of pregnancies and is a leading cause of perinatal morbidity and mortality. Distinction from constitutionally small fe...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2146":{"title":"Fetal Structural Anomalies","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s14","snippet":"Fetal Structural Anomalies Central Nervous System Anomalies Anencephaly: Failure of closure of the rostral neural tube. Absence of the cranial vault and cerebral hemispheres. Universally lethal. Diagnosed by first trimester (absent calvarium). Elevated MSAFP. Folic acid supplementation (0.4-4 mg/day...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2147":{"title":"Fetal Chromosomal & Genetic Conditions","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s15","snippet":"Fetal Chromosomal & Genetic Conditions Trisomy 21 (Down Syndrome) Most common viable autosomal trisomy (1 in 700 live births). Risk increases with maternal age (1 in 1,250 at age 25; 1 in 350 at age 35; 1 in 100 at age 40). US markers: increased NT, absent or hypoplastic nasal bone, shortened humeru...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2148":{"title":"Multiple Gestations","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s16","snippet":"Multiple Gestations Chorionicity Determination Determining chorionicity is the single most important step in managing twin pregnancies, ideally in the first trimester. Dichorionic-diamniotic (DCDA): \"Lambda sign\" (twin peak sign) — triangular projection of placental tissue extending between the memb...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2149":{"title":"Hydrops Fetalis","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s17","snippet":"Hydrops Fetalis Definition & Classification Hydrops fetalis is the pathologic accumulation of fluid in &ge; 2 fetal body compartments (ascites, pleural effusion, pericardial effusion, skin edema > 5 mm). Immune hydrops (10-15% of cases): caused by maternal red cell alloimmunization (anti-D, anti-Kel...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2150":{"title":"Fetal Demise","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s18","snippet":"Fetal Demise Definition & Evaluation Intrauterine fetal demise (IUFD) is defined as fetal death at &ge; 20 weeks gestation (or birth weight &ge; 350 g if gestational age is unknown). Incidence: ~6 per 1,000 births. Diagnosis: absent fetal cardiac activity on ultrasound. Common causes: placental insu...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2151":{"title":"Preterm Birth & Cervical Insufficiency","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s19","snippet":"Preterm Birth & Cervical Insufficiency Preterm Birth — Epidemiology & Risk Factors Preterm birth (< 37 weeks) complicates ~10% of pregnancies and is the leading cause of neonatal morbidity and mortality. Risk factors: prior spontaneous preterm birth (strongest predictor — recurrence risk 15-50%), sh...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2152":{"title":"Preterm Premature Rupture of Membranes","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s20","snippet":"Preterm Premature Rupture of Membranes Definition & Epidemiology PPROM occurs in ~3% of pregnancies and accounts for approximately 30-40% of all preterm births. It is distinct from preterm labor (which presents with contractions and cervical change with intact membranes). Risk factors: prior PPROM (...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2153":{"title":"Placenta Accreta Spectrum","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s21","snippet":"Placenta Accreta Spectrum Classification Placenta accreta spectrum (PAS) describes abnormally adherent or invasive placentation resulting from defective decidua basalis. Risk increases dramatically with the number of prior cesarean deliveries, particularly with concurrent placenta previa. PAS Classi...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2154":{"title":"Obstetric Hemorrhage","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s22","snippet":"Obstetric Hemorrhage Antepartum Hemorrhage Placental abruption: Premature separation of a normally implanted placenta from the uterine wall. Risk factors: chronic HTN (most important), prior abruption (recurrence 5-17%), cocaine use, trauma, PPROM, advanced maternal age, smoking. Presentation: vagin...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2155":{"title":"Alloimmunization","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s23","snippet":"Alloimmunization Rh Alloimmunization Rh(D) alloimmunization occurs when an Rh-negative mother produces anti-D antibodies after exposure to Rh-positive fetal red blood cells (via fetomaternal hemorrhage at delivery, trauma, procedures, or spontaneous events). Anti-D antibodies cross the placenta and ...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2156":{"title":"Amniocentesis & Chorionic Villus Sampling","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s24","snippet":"Amniocentesis & Chorionic Villus Sampling Amniocentesis — Technique & Indications Timing: &ge; 15 weeks (early amniocentesis at < 15 weeks is associated with increased talipes equinovarus and is not recommended). Technique: Under continuous ultrasound guidance, a 20-22 gauge spinal needle is inserte...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2157":{"title":"Fetal Procedures & Surgery","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s25","snippet":"Fetal Procedures & Surgery Intrauterine Transfusion (IUT) Detailed in Section 23 (Alloimmunization). Key points: intravascular approach (umbilical vein at cord insertion) under US guidance; peritoneal approach as backup if intravascular access is not possible. Type O, Rh-negative, Kell-negative, CMV...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2158":{"title":"Cervical Ripening & Induction in High-Risk Pregnancy","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s26","snippet":"Cervical Ripening & Induction in High-Risk Pregnancy Cervical Ripening Methods Prostaglandins: Misoprostol (PGE1 analog) — 25 &mu;g intravaginally q3-6h (most effective ripening agent; contraindicated with prior uterine scar due to uterine rupture risk ~1-5%). Dinoprostone (PGE2) — 10 mg vaginal ins...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2159":{"title":"Antenatal Corticosteroids & Magnesium Neuroprotection","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s27","snippet":"Antenatal Corticosteroids & Magnesium Neuroprotection Antenatal Corticosteroids Indication: Women at risk of preterm delivery within 7 days between 24+0 and 33+6 weeks of gestation (some centers extend to 23 weeks). Regimen: Betamethasone 12 mg IM q24h &times; 2 doses (preferred — shown in the 1994 ...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2160":{"title":"Classification Systems","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s28","snippet":"Classification Systems ACOG Preeclampsia Criteria See Section 5 for complete diagnostic criteria. Key threshold: BP &ge; 140/90 + proteinuria (&ge; 300 mg/24h or P:C &ge; 0.3) or BP &ge; 140/90 + any severe feature (without proteinuria). Severe features: SBP &ge; 160/DBP &ge; 110, platelets < 100K, ...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2161":{"title":"Medications Master Table","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s29","snippet":"Medications Master Table Antihypertensives Drug Class Dose Route Notes Labetalol &alpha;/&beta;-blocker Acute: 20-80 mg IV; Chronic: 200-2400 mg/day PO IV/PO First-line for acute severe HTN. Avoid in asthma, heart block. Hydralazine Vasodilator 5-10 mg IV q20 min IV Second-line acute. Reflex tachyca...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2162":{"title":"Imaging & Diagnostics Reference","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s30","snippet":"Imaging & Diagnostics Reference Ultrasound Parameters by Gestational Age GA (weeks) BPD (mm) HC (mm) AC (mm) FL (mm) EFW (g) 20 47 175 149 33 300 24 59 219 195 44 600 28 72 262 240 54 1,100 32 82 296 281 63 1,800 36 89 322 316 70 2,600 40 94 341 350 76 3,400 Doppler Indices — Normal Values Vessel Pa...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2163":{"title":"Abbreviations Master List","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s31","snippet":"Abbreviations Master List Abbreviations A-F AC — Abdominal circumference AEDF — Absent end-diastolic flow AFE — Amniotic fluid embolism AFI — Amniotic fluid index AFLP — Acute fatty liver of pregnancy aHUS — Atypical hemolytic uremic syndrome APS — Antiphospholipid syndrome BPD — Biparietal diameter...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2164":{"title":"Landmark Trials","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/procedural/maternal-fetal-medicine","url":"/procedural/maternal-fetal-medicine#s32","snippet":"Landmark Trials Landmark Trials in Maternal-Fetal Medicine MAGPIE Trial (Lancet 2002) — Magnesium sulphate for preeclampsia. 10,141 women with preeclampsia. MgSO4 reduced eclampsia by 58% (RR 0.42, 95% CI 0.29-0.60) with no significant effect on maternal mortality. Established MgSO4 as the standard ...","sourceLabel":"Section in Maternal-Fetal Medicine"},"2165":{"title":"Reproductive Endocrinology","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology","snippet":"Specialty Reference Reproductive Endocrinology Complete Specialty Reference Every diagnosis, hormonal pathway, fertility treatment, assisted reproduction technique, classification, complication, medication, and management algorithm across the full scope of reproductive endocrinology and infertility ..."},"2166":{"title":"Reproductive Anatomy & Physiology","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s1","snippet":"Reproductive Anatomy & Physiology Hypothalamic-Pituitary-Ovarian (HPO) Axis The HPO axis is the master regulatory circuit for female reproduction. The hypothalamus releases gonadotropin-releasing hormone (GnRH) in a pulsatile fashion from the arcuate nucleus into the hypophyseal portal system. GnRH ...","sourceLabel":"Section in Reproductive Endocrinology"},"2167":{"title":"Reproductive Hormones & Assays","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s2","snippet":"Reproductive Hormones & Assays Estradiol (E2) Estradiol is the principal circulating estrogen in premenopausal women, produced primarily by the dominant follicle's granulosa cells. Early follicular phase levels: 20-60 pg/mL. Each mature follicle contributes approximately 200-300 pg/mL in stimulated ...","sourceLabel":"Section in Reproductive Endocrinology"},"2168":{"title":"Ovarian Reserve Assessment","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s3","snippet":"Ovarian Reserve Assessment Anti-M&uuml;llerian Hormone (AMH) - Clinical Application AMH is the single best endocrine marker of ovarian reserve, offering several clinical advantages: (1) Can be drawn on any cycle day (minimal intra-cycle variation - though small fluctuations exist, they are not clini...","sourceLabel":"Section in Reproductive Endocrinology"},"2169":{"title":"The REI Evaluation","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s4","snippet":"The REI Evaluation Hysterosalpingography (HSG) HSG is a first-line radiographic test for simultaneous assessment of tubal patency and uterine cavity morphology. Under fluoroscopy, radiopaque contrast is injected through the cervix via a cannula while serial spot images are obtained. Two types of con...","sourceLabel":"Section in Reproductive Endocrinology"},"2170":{"title":"Ovulatory Disorders","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s5","snippet":"Ovulatory Disorders WHO Group I - Hypogonadotropic Hypogonadism WHO Group I anovulation is characterized by low FSH, low LH, and low estradiol (<20 pg/mL) - reflecting hypothalamic or pituitary failure. This accounts for ~5-10% of anovulatory infertility. Kallmann syndrome: Congenital GnRH deficienc...","sourceLabel":"Section in Reproductive Endocrinology"},"2171":{"title":"Tubal Factor Infertility","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s6","snippet":"Tubal Factor Infertility Etiology & Prevalence Tubal factor accounts for ~25-35% of female infertility. The most common cause is pelvic inflammatory disease (PID) from ascending Chlamydia trachomatis or Neisseria gonorrhoeae infection. Risk of tubal infertility by number of PID episodes: 1 episode =...","sourceLabel":"Section in Reproductive Endocrinology"},"2172":{"title":"Uterine Factors","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s7","snippet":"Uterine Factors Fibroids (Leiomyomas) Uterine fibroids (leiomyomas) affect ~70-80% of women by age 50, with higher prevalence in Black women (earlier onset, larger size, more symptomatic). Most fibroids are asymptomatic and do not impair fertility. The impact on reproduction depends primarily on loc...","sourceLabel":"Section in Reproductive Endocrinology"},"2173":{"title":"Endometriosis & Infertility","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s8","snippet":"Endometriosis & Infertility Pathophysiology of Endometriosis-Associated Infertility Endometriosis - the presence of endometrial-like tissue outside the uterine cavity - affects ~6-10% of reproductive-age women and is found in up to 25-50% of infertile women. The leading theories of pathogenesis incl...","sourceLabel":"Section in Reproductive Endocrinology"},"2174":{"title":"Unexplained Infertility","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s9","snippet":"Unexplained Infertility Definition & Prevalence Unexplained infertility is a diagnosis of exclusion, made when standard evaluation reveals no identifiable cause: (1) documented regular ovulation (regular cycles, mid-luteal progesterone >3 ng/mL, or positive ovulation predictor kit); (2) patent fallo...","sourceLabel":"Section in Reproductive Endocrinology"},"2175":{"title":"Recurrent Pregnancy Loss","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s10","snippet":"Recurrent Pregnancy Loss Definition & Epidemiology Recurrent pregnancy loss (RPL) is defined by ASRM as two or more clinical pregnancy losses (documented by ultrasound or histopathology - this includes missed abortions and documented gestational sacs, not chemical pregnancies). ESHRE defines RPL as ...","sourceLabel":"Section in Reproductive Endocrinology"},"2176":{"title":"Semen Analysis & Interpretation","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s11","snippet":"Semen Analysis & Interpretation Collection & Processing Semen specimens should be collected by masturbation into a sterile, non-toxic, wide-mouthed container after 2-5 days of abstinence. Longer abstinence (>5 days) increases volume and concentration but decreases motility and increases DNA fragment...","sourceLabel":"Section in Reproductive Endocrinology"},"2177":{"title":"Male Factor Conditions","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s12","snippet":"Male Factor Conditions Varicocele Varicocele (dilation of the pampiniform plexus of the spermatic cord veins) is found in ~15% of the general male population, ~35-40% of men with primary infertility, and ~75-80% of men with secondary infertility. Left-sided predominance (~80-90%) due to the left tes...","sourceLabel":"Section in Reproductive Endocrinology"},"2178":{"title":"Male Hormonal Evaluation & Treatment","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s13","snippet":"Male Hormonal Evaluation & Treatment Hormonal Assessment Initial male hormonal panel (drawn in the morning, 8-10 AM, fasting - testosterone exhibits diurnal variation with peak in early morning): total testosterone (low if <264 ng/dL per AUA 2018 guidelines; must be confirmed on two separate morning...","sourceLabel":"Section in Reproductive Endocrinology"},"2179":{"title":"Surgical Sperm Retrieval","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s14","snippet":"Surgical Sperm Retrieval Techniques & Indications TESA (Testicular Sperm Aspiration): Percutaneous needle aspiration of testicular tissue. Simple, office-based. Best for obstructive azoospermia. Sperm yield may be limited. TESE (Testicular Sperm Extraction): Open biopsy with extraction of testicular...","sourceLabel":"Section in Reproductive Endocrinology"},"2180":{"title":"Ovarian Stimulation Protocols","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s15","snippet":"Ovarian Stimulation Protocols GnRH Agonist Long Protocol The traditional \"long protocol\" was the gold standard for IVF for decades and remains widely used: GnRH agonist (leuprolide acetate 0.5-1.0 mg SC daily, or nafarelin nasal spray 200 &mu;g BID) is started in the mid-luteal phase of the precedin...","sourceLabel":"Section in Reproductive Endocrinology"},"2181":{"title":"Oocyte Retrieval & IVF Laboratory","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s16","snippet":"Oocyte Retrieval & IVF Laboratory Transvaginal Oocyte Retrieval Performed 34-36 hours after trigger under IV sedation (propofol &plusmn; fentanyl) or less commonly under general anesthesia. The timing is critical: retrieval must occur before spontaneous ovulation (which occurs ~38-40 hours after tri...","sourceLabel":"Section in Reproductive Endocrinology"},"2182":{"title":"Preimplantation Genetic Testing","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s17","snippet":"Preimplantation Genetic Testing PGT-A (Aneuploidy) PGT-A screens embryos for whole chromosome aneuploidy (monosomy, trisomy, segmental gains/losses). The evolution of PGT: first generation used FISH on single blastomeres (PGS 1.0 - limited chromosomes tested, now obsolete); second generation used aC...","sourceLabel":"Section in Reproductive Endocrinology"},"2183":{"title":"Embryo Transfer & Luteal Support","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s18","snippet":"Embryo Transfer & Luteal Support Fresh vs. Frozen Embryo Transfer The trend in ART has shifted toward freeze-all strategies (vitrifying all embryos, performing FET in a subsequent cycle). Advantages: avoids transfer in a supraphysiologic hormonal environment, mandatory when using GnRH agonist trigge...","sourceLabel":"Section in Reproductive Endocrinology"},"2184":{"title":"Cryopreservation & IVF Outcomes","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s19","snippet":"Cryopreservation & IVF Outcomes Vitrification Vitrification is an ultrarapid freezing technique (>15,000&deg;C/min cooling rate) that prevents intracellular ice crystal formation by transitioning the cell directly from liquid to a glass-like (vitreous) solid state. The process requires high concentr...","sourceLabel":"Section in Reproductive Endocrinology"},"2185":{"title":"ART Complications","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s20","snippet":"ART Complications Ovarian Hyperstimulation Syndrome (OHSS) OHSS is the most serious iatrogenic complication of ovarian stimulation. Pathophysiology: hCG triggers massive vascular endothelial growth factor (VEGF) release from hyperstimulated ovarian granulosa-lutein cells, causing increased capillary...","sourceLabel":"Section in Reproductive Endocrinology"},"2186":{"title":"Polycystic Ovary Syndrome (PCOS)","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s21","snippet":"Polycystic Ovary Syndrome (PCOS) Rotterdam Criteria (2003) PCOS is diagnosed when two of three criteria are met (after exclusion of other etiologies): (1) Oligo-anovulation (cycles >35 days, <8 cycles/year, or amenorrhea); (2) Clinical and/or biochemical hyperandrogenism (hirsutism by modified Ferri...","sourceLabel":"Section in Reproductive Endocrinology"},"2187":{"title":"Amenorrhea & Hyperprolactinemia","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s22","snippet":"Amenorrhea & Hyperprolactinemia Primary Amenorrhea Defined as absence of menarche by age 15 with normal secondary sexual characteristics (breast development present, indicating estrogen production), or by age 13 without any secondary sexual characteristics. Prevalence: ~0.1%. Workup algorithm: (1) P...","sourceLabel":"Section in Reproductive Endocrinology"},"2188":{"title":"M&uuml;llerian Anomalies","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s23","snippet":"M&uuml;llerian Anomalies Embryology The M&uuml;llerian (paramesonephric) ducts develop at ~6 weeks of gestation alongside the mesonephric (Wolffian) ducts. In the female fetus (absence of AMH from Sertoli cells and absence of testosterone from Leydig cells), the Wolffian ducts regress and the M&uuml...","sourceLabel":"Section in Reproductive Endocrinology"},"2189":{"title":"Menopause, POI & Perimenopause","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s24","snippet":"Menopause, POI & Perimenopause STRAW+10 Staging System The Stages of Reproductive Aging Workshop +10 (STRAW+10) classification divides reproductive aging into stages: Reproductive (early, peak, late - characterized by regular cycles, variable AMH); Menopausal transition (early - cycle length variabi...","sourceLabel":"Section in Reproductive Endocrinology"},"2190":{"title":"Disorders of Sexual Development","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s25","snippet":"Disorders of Sexual Development 46,XX DSD Congenital adrenal hyperplasia (CAH): The most common cause of 46,XX DSD and the most common autosomal recessive disorder affecting fertility. 21-hydroxylase deficiency (CYP21A2 mutations) accounts for ~95% of CAH. The enzyme block prevents cortisol synthesi...","sourceLabel":"Section in Reproductive Endocrinology"},"2191":{"title":"Oncofertility & Fertility Preservation","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s26","snippet":"Oncofertility & Fertility Preservation Oocyte & Embryo Cryopreservation Oocyte vitrification is the standard for fertility preservation in post-pubertal females facing gonadotoxic therapy (chemotherapy, pelvic radiation) or elective social fertility preservation. A standard ovarian stimulation cycle...","sourceLabel":"Section in Reproductive Endocrinology"},"2192":{"title":"Third-Party Reproduction","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s27","snippet":"Third-Party Reproduction Donor Oocytes Indications: POI/premature menopause, diminished ovarian reserve with poor IVF prognosis after multiple cycles, repeated IVF failure with own oocytes, genetic disease in the female (when PGT-M is not desired or feasible), gonadal dysgenesis (Turner syndrome, Sw...","sourceLabel":"Section in Reproductive Endocrinology"},"2193":{"title":"Classification Systems","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s28","snippet":"Classification Systems WHO Classification of Anovulation WHO Anovulation Groups Group I - Hypogonadotropic Hypogonadism: Low FSH, low LH, low estrogen. Hypothalamic/pituitary failure (Kallmann, FHA, Sheehan). ~5-10% of anovulation. Group II - Normogonadotropic Anovulation: Normal FSH/LH, normal estr...","sourceLabel":"Section in Reproductive Endocrinology"},"2194":{"title":"Medications Master Table","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s29","snippet":"Medications Master Table GnRH Agonists GnRH Agonists Leuprolide acetate (Lupron): SC injection. IVF long protocol: 0.5-1.0 mg daily (downregulation); reduced to 0.25 mg during stimulation. Microdose flare: 20-40 &mu;g BID. Trigger: 1-4 mg single dose (antagonist protocol only). Depot: 3.75 mg IM mon...","sourceLabel":"Section in Reproductive Endocrinology"},"2195":{"title":"Abbreviations Master List","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s30","snippet":"Abbreviations Master List Abbreviations AFC - Antral Follicle Count AFS - American Fertility Society (now ASRM) AIS - Androgen Insensitivity Syndrome AMH - Anti-M&uuml;llerian Hormone APS - Antiphospholipid Syndrome ART - Assisted Reproductive Technology ASRM - American Society for Reproductive Medi...","sourceLabel":"Section in Reproductive Endocrinology"},"2196":{"title":"Landmark Trials","pageTitle":"Reproductive Endocrinology","pageUrl":"/procedural/reproductive-endocrinology","url":"/procedural/reproductive-endocrinology#s31","snippet":"Landmark Trials Landmark Clinical Trials in Reproductive Endocrinology PPCOS II (Legro et al., NEJM 2014): Letrozole vs. clomiphene for ovulation induction in PCOS. Letrozole: higher live birth rate (27.5% vs. 19.1%, p = 0.007), higher ovulation rate, lower multiple pregnancy rate. Established letro...","sourceLabel":"Section in Reproductive Endocrinology"},"2197":{"title":"Interventional Radiology","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology","snippet":"Specialty Reference Interventional Radiology Complete Specialty Reference Every procedure, access technique, device, embolization agent, drainage protocol, classification, complication, medication, and management algorithm across the full scope of interventional radiology in one place."},"2198":{"title":"Vascular Anatomy for IR","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s1","snippet":"Vascular Anatomy for IR Aorta & Major Branches The abdominal aorta enters the abdomen through the aortic hiatus of the diaphragm at T12 and bifurcates into the common iliac arteries at the level of L4. Major anterior visceral branches (in descending order): celiac trunk (T12) - left gastric, splenic...","sourceLabel":"Section in Interventional Radiology"},"2199":{"title":"Image Guidance & Radiation Safety","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s2","snippet":"Image Guidance & Radiation Safety Fluoroscopy Figure 5 - C-Arm Fluoroscopy System. Modern flat-panel detector C-arm in an interventional radiology suite. The X-ray tube is positioned beneath the table, while the image receptor (flat-panel detector) is above the patient, reducing scatter radiation ex...","sourceLabel":"Section in Interventional Radiology"},"2200":{"title":"Access, Wires, Catheters & Closure Devices","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s3","snippet":"Access, Wires, Catheters & Closure Devices The Seldinger Technique Figure 6 - The Seldinger Technique. Sequential steps of percutaneous vascular access: (1) needle puncture of the target vessel, (2) guidewire advancement through the needle, (3) needle removal over the wire, and (4) catheter/dilator ...","sourceLabel":"Section in Interventional Radiology"},"2201":{"title":"Contrast Agents & Procedural Sedation","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s4","snippet":"Contrast Agents & Procedural Sedation Iodinated Contrast Media Iodinated contrast agents are classified by osmolality and ionicity . High-osmolar contrast media (HOCM): Ionic monomers (e.g., diatrizoate/Hypaque) - osmolality ~1,500-2,000 mOsm/kg, highest rate of adverse reactions. Rarely used today....","sourceLabel":"Section in Interventional Radiology"},"2202":{"title":"Angioplasty & Stenting","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s5","snippet":"Angioplasty & Stenting Percutaneous Transluminal Angioplasty (PTA) Figure 9 - Stent and Balloon Catheter Designs. Comparison of different vascular stent designs used in peripheral interventions, including self-expanding nitinol stents, balloon-expandable stents, and covered stent grafts with their r...","sourceLabel":"Section in Interventional Radiology"},"2203":{"title":"Thrombolysis & Thrombectomy","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s6","snippet":"Thrombolysis & Thrombectomy Catheter-Directed Thrombolysis (CDT) Figure 10 - Catheter-Directed Thrombolysis and Thrombectomy Techniques. Schematic illustration of standard endovascular thrombectomy approaches including stent retriever deployment, direct aspiration (ADAPT), and combined techniques fo...","sourceLabel":"Section in Interventional Radiology"},"2204":{"title":"Venous Disease & IVC Filters","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s7","snippet":"Venous Disease & IVC Filters IVC Filter Indications Absolute indication: Acute VTE (DVT or PE) with an absolute contraindication to anticoagulation (active hemorrhage, recent major surgery or trauma, hemorrhagic stroke). Relative indications: Failure of anticoagulation (recurrent PE despite therapeu...","sourceLabel":"Section in Interventional Radiology"},"2205":{"title":"Dialysis Access Interventions","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s8","snippet":"Dialysis Access Interventions Fistulogram & Diagnostic Assessment Figure 12 - Dialysis Access Fistulogram. Angiographic evaluation of a brachiocephalic arteriovenous fistula showing the arterial anastomosis, body of the fistula, and draining veins. Fistulography identifies hemodynamically significan...","sourceLabel":"Section in Interventional Radiology"},"2206":{"title":"Aortic Interventions (EVAR & TEVAR)","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s9","snippet":"Aortic Interventions (EVAR & TEVAR) Endovascular Aneurysm Repair (EVAR) Figure 15 - EVAR Stent-Graft Components. Diagram of a bifurcated modular aortic stent-graft showing the main body with suprarenal fixation, infrarenal seal zone, and bilateral iliac limb extensions used for endovascular exclusio...","sourceLabel":"Section in Interventional Radiology"},"2207":{"title":"Hemorrhage Control & Embolization","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s10","snippet":"Hemorrhage Control & Embolization Principles of Embolization Transcatheter embolization is the deliberate occlusion of a blood vessel to stop hemorrhage, devascularize a tumor, or eliminate a vascular malformation. Catheter position determines the level of occlusion: proximal embolization (occludes ...","sourceLabel":"Section in Interventional Radiology"},"2208":{"title":"Venous Access - PICC, CVC & Ports","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s11","snippet":"Venous Access - PICC, CVC & Ports Peripherally Inserted Central Catheters (PICC) A PICC is a central venous catheter inserted through a peripheral arm vein (basilic or brachial vein preferred - the basilic vein is larger and has a straighter course to the central veins than the cephalic vein, which ...","sourceLabel":"Section in Interventional Radiology"},"2209":{"title":"Image-Guided Biopsy","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s12","snippet":"Image-Guided Biopsy Principles Image-guided percutaneous biopsy provides tissue diagnosis while minimizing surgical morbidity. The choice of imaging modality depends on target location and visibility: ultrasound for superficial structures (liver, kidney, thyroid, lymph nodes - advantages: real-time ...","sourceLabel":"Section in Interventional Radiology"},"2210":{"title":"Abscess & Fluid Drainage","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s13","snippet":"Abscess & Fluid Drainage Principles of Percutaneous Drainage Figure 21 - Percutaneous Catheter Drainage. Illustrations of catheter drainage technique demonstrating proper pigtail catheter positioning within a fluid collection, as well as potential complications including catheter malposition and ina...","sourceLabel":"Section in Interventional Radiology"},"2211":{"title":"Urinary Interventions","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s14","snippet":"Urinary Interventions Percutaneous Nephrostomy (PCN) Figure 23 - Percutaneous Nephrostomy Technique. Single-stick nephrostomy approach demonstrating needle access into a posterior lower pole calyx, guidewire advancement, tract dilation, and pigtail catheter deployment in the renal pelvis for urinary...","sourceLabel":"Section in Interventional Radiology"},"2212":{"title":"Musculoskeletal Interventions","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s15","snippet":"Musculoskeletal Interventions Vertebroplasty & Kyphoplasty Figure 25 - Vertebroplasty Transpedicular Approach. CT image demonstrating the transpedicular route for vertebral augmentation, with the needle traversing the pedicle into the anterior two-thirds of the vertebral body. Cement injection is pe...","sourceLabel":"Section in Interventional Radiology"},"2213":{"title":"Thoracic Interventions","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s16","snippet":"Thoracic Interventions Image-Guided Chest Tube Placement IR-guided chest tube placement (pigtail catheter, 8-14 Fr) is performed for pleural effusion, empyema, or pneumothorax when standard bedside thoracostomy is not feasible or has failed. Advantages of image guidance: precise catheter positioning...","sourceLabel":"Section in Interventional Radiology"},"2214":{"title":"GI & Hepatobiliary Interventions","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s17","snippet":"GI & Hepatobiliary Interventions Percutaneous Cholecystostomy Percutaneous cholecystostomy is the placement of a drainage catheter into the gallbladder for acute cholecystitis in patients who are poor surgical candidates (critically ill, septic, high surgical risk). The Tokyo Guidelines (TG18/TG13) ...","sourceLabel":"Section in Interventional Radiology"},"2215":{"title":"Transarterial Chemoembolization (TACE)","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s18","snippet":"Transarterial Chemoembolization (TACE) Principles & Indications TACE exploits the dual blood supply of the liver: hepatocellular carcinoma (HCC) derives > 90% of its blood supply from the hepatic artery, while normal hepatocytes receive ~75% from the portal vein. By selectively delivering chemothera...","sourceLabel":"Section in Interventional Radiology"},"2216":{"title":"Transarterial Radioembolization (TARE / Y-90)","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s19","snippet":"Transarterial Radioembolization (TARE / Y-90) Mechanism & Microsphere Types Figure 28 - Y-90 TheraSphere Microspheres. Glass microspheres containing Yttrium-90 (TheraSphere) used for transarterial radioembolization. These microspheres deliver targeted beta radiation with a mean tissue penetration of...","sourceLabel":"Section in Interventional Radiology"},"2217":{"title":"Thermal Ablation (RFA, MWA, Cryoablation)","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s20","snippet":"Thermal Ablation (RFA, MWA, Cryoablation) General Principles of Thermal Ablation Thermal ablation destroys tumor tissue through temperature-mediated cell death. Hyperthermic ablation (RFA, MWA) achieves cell death at temperatures > 60&deg;C (instantaneous coagulative necrosis) through protein denatu...","sourceLabel":"Section in Interventional Radiology"},"2218":{"title":"Portal Vein Embolization","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s21","snippet":"Portal Vein Embolization Rationale & Indications Portal vein embolization (PVE) is performed before major hepatectomy to induce hypertrophy of the future liver remnant (FLR). By occluding portal venous flow to the liver segments planned for resection, hepatotrophic factors are redirected to the FLR,...","sourceLabel":"Section in Interventional Radiology"},"2219":{"title":"Stroke Thrombectomy & Cerebrovascular Interventions","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s22","snippet":"Stroke Thrombectomy & Cerebrovascular Interventions Mechanical Thrombectomy for Acute Ischemic Stroke Figure 34 - Stroke Thrombectomy Techniques. Schematic illustration of advanced mechanical thrombectomy techniques for large vessel occlusion stroke, including combined stent retriever plus aspiratio...","sourceLabel":"Section in Interventional Radiology"},"2220":{"title":"Vascular & Access Complications","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s23","snippet":"Vascular & Access Complications Access-Site Complications Hematoma: Most common access complication (~3-5% for diagnostic, up to 10% for interventional). Management: manual compression, bed rest, serial hemoglobin monitoring. Large or expanding hematomas may require surgical evacuation or covered st...","sourceLabel":"Section in Interventional Radiology"},"2221":{"title":"Procedure-Specific Complications","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s24","snippet":"Procedure-Specific Complications Post-Embolization Syndrome Post-embolization syndrome (PES) occurs after virtually all embolization procedures (TACE, UAE, splenic embolization, renal embolization) and is the expected physiologic response to tissue ischemia and necrosis. The classic triad: pain (at ...","sourceLabel":"Section in Interventional Radiology"},"2222":{"title":"Post-Procedure Management","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s25","snippet":"Post-Procedure Management Anticoagulation Bridging for IR Procedures The SIR classifies procedures by bleeding risk for anticoagulation management: Category Examples INR Target Platelet Target Category 1 (low risk) Venous access (PICC, port, tunneled CVC), IVC filter, thoracentesis, paracentesis, su...","sourceLabel":"Section in Interventional Radiology"},"2223":{"title":"Classification Systems","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s26","snippet":"Classification Systems SIR Adverse Event Classification SIR Complication Severity (Society of Interventional Radiology) Minor Complications: A: No therapy, no consequence. B: Nominal therapy, no consequence; includes overnight admission for observation only. Major Complications: C: Requires therapy,...","sourceLabel":"Section in Interventional Radiology"},"2224":{"title":"Medications Master Table","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s27","snippet":"Medications Master Table Contrast Agents Agent Type Osmolality Common Use Iohexol (Omnipaque) Non-ionic monomer (LOCM) ~670-840 mOsm/kg Standard IR angiography Iopamidol (Isovue) Non-ionic monomer (LOCM) ~616-796 mOsm/kg Angiography, CT enhancement Iodixanol (Visipaque) Non-ionic dimer (IOCM) ~290 m...","sourceLabel":"Section in Interventional Radiology"},"2225":{"title":"Imaging Protocols","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s28","snippet":"Imaging Protocols CT Angiography (CTA) CTA of the aorta and runoff: Multidetector CT with iodinated contrast (100-120 mL at 4-5 mL/s), bolus tracking with ROI in the abdominal aorta (trigger at 150-200 HU). Arterial phase acquisition from the diaphragm to the feet (1-2 mm slice thickness). Delayed p...","sourceLabel":"Section in Interventional Radiology"},"2226":{"title":"Abbreviations Master List","pageTitle":"Interventional Radiology","pageUrl":"/procedural/interventional-radiology","url":"/procedural/interventional-radiology#s29","snippet":"Abbreviations Master List Common Abbreviations in Interventional Radiology Abbreviation Meaning AAA Abdominal aortic aneurysm AVF Arteriovenous fistula AVG Arteriovenous graft AVM Arteriovenous malformation BAE Bronchial artery embolization BCLC Barcelona Clinic Liver Cancer BMS Bare metal stent BSA...","sourceLabel":"Section in Interventional Radiology"},"2227":{"title":"Interventional Cardiology","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology","snippet":"Specialty Reference Interventional Cardiology Complete Specialty Reference Every procedure, device, access technique, hemodynamic assessment, classification, complication, medication, and management algorithm across the full scope of interventional cardiology in one place."},"2228":{"title":"Coronary Anatomy & Variants","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s1","snippet":"Coronary Anatomy & Variants Coronary Arterial System The coronary circulation arises from two ostia in the sinuses of Valsalva of the aortic root. The left main coronary artery (LMCA) arises from the left coronary sinus and typically courses 1-2 cm before bifurcating into the left anterior descendin...","sourceLabel":"Section in Interventional Cardiology"},"2229":{"title":"The Cardiac Catheterization Lab","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s2","snippet":"The Cardiac Catheterization Lab Radiation Safety The cath lab uses fluoroscopy and cineangiography (digital acquisition) to visualize coronary arteries and cardiac structures. Radiation exposure is measured in air kerma (Gy) — cumulative dose at the interventional reference point — and dose-area pro...","sourceLabel":"Section in Interventional Cardiology"},"2230":{"title":"Hemodynamic Assessment & Right Heart Catheterization","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s3","snippet":"Hemodynamic Assessment & Right Heart Catheterization Right Heart Catheterization (Swan-Ganz) A balloon-tipped pulmonary artery catheter (PAC) is advanced from venous access (internal jugular or femoral vein) through the RA &rarr; RV &rarr; PA and into the wedge position. Continuous monitoring provid...","sourceLabel":"Section in Interventional Cardiology"},"2231":{"title":"Diagnostic Coronary Angiography","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s4","snippet":"Diagnostic Coronary Angiography Standard Angiographic Views View Angulation Best Visualizes RAO caudal RAO 20-30&deg;, caudal 20-30&deg; Left main bifurcation, proximal LAD/LCx RAO cranial RAO 20-30&deg;, cranial 20-30&deg; Mid/distal LAD, diagonal branches LAO cranial (spider view) LAO 40-60&deg;, ...","sourceLabel":"Section in Interventional Cardiology"},"2232":{"title":"Percutaneous Coronary Intervention (PCI)","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s5","snippet":"Percutaneous Coronary Intervention (PCI) Evolution of Coronary Stents Generation Examples Drug / Polymer Key Features POBA Plain old balloon angioplasty None 30-40% restenosis rate; acute vessel closure risk BMS Palmaz-Schatz, Liberté None / bare metal Reduced acute closure vs POBA; 20-30% ISR 1st g...","sourceLabel":"Section in Interventional Cardiology"},"2233":{"title":"STEMI Intervention & Cardiogenic Shock","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s6","snippet":"STEMI Intervention & Cardiogenic Shock Primary PCI for STEMI Primary PCI is the preferred reperfusion strategy for STEMI when it can be performed within 120 minutes of first medical contact (door-to-balloon time target <90 minutes at PCI-capable hospitals; <120 minutes with transfer). Primary PCI ac...","sourceLabel":"Section in Interventional Cardiology"},"2234":{"title":"Complex PCI — CTO, Bifurcation & Left Main","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s7","snippet":"Complex PCI — CTO, Bifurcation & Left Main Chronic Total Occlusion (CTO) PCI A CTO is defined as a coronary occlusion with TIMI 0 flow for &ge;3 months . CTO PCI is among the most technically demanding coronary interventions. The hybrid algorithm guides strategy selection based on four angiographic ...","sourceLabel":"Section in Interventional Cardiology"},"2235":{"title":"Intravascular Imaging & Coronary Physiology","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s8","snippet":"Intravascular Imaging & Coronary Physiology Intravascular Ultrasound (IVUS) IVUS uses a miniaturized ultrasound transducer (20-60 MHz) on a catheter to produce cross-sectional images of the vessel wall. Resolution: axial ~100 &mu;m, lateral ~200 &mu;m. IVUS penetrates through calcium (unlike OCT) an...","sourceLabel":"Section in Interventional Cardiology"},"2236":{"title":"Acute Coronary Syndromes — Antithrombotic Management","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s9","snippet":"Acute Coronary Syndromes — Antithrombotic Management NSTEMI — Timing of Catheterization Risk stratification guides timing: Immediate (<2 hours) — hemodynamic instability, ongoing chest pain despite medical therapy, life-threatening arrhythmias, mechanical complications. Early (<24 hours) — GRACE sco...","sourceLabel":"Section in Interventional Cardiology"},"2237":{"title":"Stent Complications & No-Reflow","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s10","snippet":"Stent Complications & No-Reflow In-Stent Restenosis (ISR) ISR is defined as &ge;50% diameter stenosis within the stent or within 5 mm of the stent edges. It is caused by neointimal hyperplasia (smooth muscle cell proliferation and extracellular matrix deposition) and, in late ISR, neoatherosclerosis...","sourceLabel":"Section in Interventional Cardiology"},"2238":{"title":"Transcatheter Aortic Valve Replacement (TAVR)","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s11","snippet":"Transcatheter Aortic Valve Replacement (TAVR) Indications & Evidence TAVR is approved for symptomatic severe aortic stenosis across the surgical risk spectrum. Landmark trials by risk category: Risk Category Key Trials Findings Inoperable / extreme risk PARTNER 1B (Edwards SAPIEN) TAVR reduced morta...","sourceLabel":"Section in Interventional Cardiology"},"2239":{"title":"Mitral & Tricuspid Interventions","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s12","snippet":"Mitral & Tricuspid Interventions Transcatheter Edge-to-Edge Repair (TEER) — MitraClip / PASCAL TEER creates a tissue bridge between the anterior and posterior mitral leaflets, mimicking the surgical Alfieri edge-to-edge repair. The MitraClip (Abbott) is delivered via transseptal puncture from the fe...","sourceLabel":"Section in Interventional Cardiology"},"2240":{"title":"Left Atrial Appendage Closure","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s13","snippet":"Left Atrial Appendage Closure Rationale The left atrial appendage (LAA) is the source of >90% of thrombi in non-valvular atrial fibrillation. LAA closure (LAAC) provides an alternative to long-term oral anticoagulation (OAC) for stroke prevention in patients with AF who have contraindications to OAC...","sourceLabel":"Section in Interventional Cardiology"},"2241":{"title":"ASD/PFO Closure & Septal Ablation","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s14","snippet":"ASD/PFO Closure & Septal Ablation Patent Foramen Ovale (PFO) Closure PFO is present in ~25% of the general population. The association between PFO and cryptogenic stroke led to pivotal closure trials: Trial Device Key Finding RESPECT (extended follow-up) Amplatzer PFO Occluder 45% relative risk redu...","sourceLabel":"Section in Interventional Cardiology"},"2242":{"title":"Peripheral Vascular Interventions","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s15","snippet":"Peripheral Vascular Interventions Carotid Artery Stenting (CAS) & TCAR CAS is an alternative to carotid endarterectomy (CEA) for significant carotid stenosis. Indications: symptomatic carotid stenosis &ge;50% or asymptomatic stenosis &ge;70% with high surgical risk. Embolic protection devices (EPDs)...","sourceLabel":"Section in Interventional Cardiology"},"2243":{"title":"Mechanical Circulatory Support","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s16","snippet":"Mechanical Circulatory Support Intra-Aortic Balloon Pump (IABP) The IABP is a counterpulsation device inserted via the femoral artery and positioned in the descending aorta just distal to the left subclavian artery. Inflation during diastole augments coronary perfusion pressure and diastolic blood p...","sourceLabel":"Section in Interventional Cardiology"},"2244":{"title":"Advanced Hemodynamic Profiles & Waveforms","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s17","snippet":"Advanced Hemodynamic Profiles & Waveforms Hemodynamic Profiles in Shock Condition RA PCWP CO/CI SVR Distinguishing Feature LV cardiogenic shock &uarr; &uarr;&uarr; &darr;&darr; &uarr;&uarr; PCWP > 18; CI < 1.8; RA < PCWP RV failure / RV infarct &uarr;&uarr; Normal/&darr; &darr; &uarr; RA &ge; PCWP; ...","sourceLabel":"Section in Interventional Cardiology"},"2245":{"title":"Access Site Complications","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s18","snippet":"Access Site Complications Femoral Access Complications Retroperitoneal hemorrhage: Occurs with high femoral arterial puncture (above the inguinal ligament) or through-and-through puncture. Presents with hemodynamic instability, back/flank pain, ipsilateral abdominal distension, and unexplained Hgb d...","sourceLabel":"Section in Interventional Cardiology"},"2246":{"title":"Procedural Complications","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s19","snippet":"Procedural Complications Contrast-Induced Nephropathy (CIN) CIN is defined as a rise in serum creatinine of &ge;0.5 mg/dL or &ge;25% from baseline within 48-72 hours of contrast exposure. Risk factors: pre-existing CKD (eGFR <60), diabetes, volume depletion, contrast volume, hemodynamic instability,...","sourceLabel":"Section in Interventional Cardiology"},"2247":{"title":"Antithrombotic Protocols & Bleeding Management","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s20","snippet":"Antithrombotic Protocols & Bleeding Management DAPT Protocols by Indication Indication Standard DAPT Duration Preferred P2Y12 Notes ACS + DES 12 months Ticagrelor or prasugrel Consider extended (>12 mo) if high ischemic risk, low bleed risk Stable CAD + DES 6 months (may shorten to 3 mo) Clopidogrel...","sourceLabel":"Section in Interventional Cardiology"},"2248":{"title":"Classification Systems","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s21","snippet":"Classification Systems SYNTAX Score Angiographic scoring system for coronary disease complexity. Low (&le;22) : PCI equivalent to CABG; Intermediate (23-32) : Heart Team discussion; High (&ge;33) : CABG preferred. Variables: number of lesions, segments involved, total occlusions, trifurcation/bifurc...","sourceLabel":"Section in Interventional Cardiology"},"2249":{"title":"Medications Master Table","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s22","snippet":"Medications Master Table Antiplatelet Agents Drug Mechanism Dose Key Considerations Aspirin Irreversible COX-1 inhibitor Load 325 mg; maintenance 81 mg daily Lifelong after ACS/PCI; GI protection with PPI Clopidogrel Irreversible P2Y12 (prodrug, CYP2C19) Load 600 mg; maintenance 75 mg daily 3-15% po...","sourceLabel":"Section in Interventional Cardiology"},"2250":{"title":"Imaging & Diagnostics Reference","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s23","snippet":"Imaging & Diagnostics Reference Coronary Angiography Views — Quick Reference Vessel / Segment Optimal Views Left main AP caudal, LAO cranial (spider), RAO caudal Proximal/mid LAD RAO cranial, AP cranial, LAO cranial Distal LAD RAO cranial, lateral Diagonal branches RAO cranial, AP cranial, LAO crani...","sourceLabel":"Section in Interventional Cardiology"},"2251":{"title":"Abbreviations Master List","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s24","snippet":"Abbreviations Master List Abbreviation Full Term ACT Activated clotting time ADR Antegrade dissection re-entry ARC Academic Research Consortium ASD Atrial septal defect ASA Alcohol septal ablation (or atrial septal aneurysm, per context) AVA Aortic valve area AWE Antegrade wire escalation BARC Bleed...","sourceLabel":"Section in Interventional Cardiology"},"2252":{"title":"Landmark Trials","pageTitle":"Interventional Cardiology","pageUrl":"/procedural/interventional-cardiology","url":"/procedural/interventional-cardiology#s25","snippet":"Landmark Trials Coronary Revascularization Strategy Trial Year Key Finding Reference COURAGE 2007 PCI + OMT did not reduce death or MI vs OMT alone in stable CAD PMID 17387127 ISCHEMIA 2020 Invasive strategy did not reduce death or MI vs conservative strategy in stable CAD with moderate-severe ische...","sourceLabel":"Section in Interventional Cardiology"},"2253":{"title":"Electrophysiology","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology","snippet":"Specialty Reference Cardiac Electrophysiology Complete Specialty Reference Every arrhythmia, device, ablation technique, classification, complication, medication, and management algorithm across the full scope of cardiac electrophysiology in one place."},"2254":{"title":"Cardiac Conduction Anatomy","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s1","snippet":"Cardiac Conduction Anatomy Sinoatrial (SA) Node The SA node is the primary cardiac pacemaker, located at the junction of the superior vena cava (SVC) and the right atrium, in the sulcus terminalis. It is a crescent-shaped structure approximately 13-20 mm long. The SA node is supplied by the SA nodal...","sourceLabel":"Section in Electrophysiology"},"2255":{"title":"Cellular Electrophysiology","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s2","snippet":"Cellular Electrophysiology Cardiac Action Potential — Working Myocytes The cardiac action potential in ventricular and atrial myocytes has five phases: Figure 5 - Ventricular Myocyte Action Potential Phases. The five phases of the cardiac action potential: Phase 0 (rapid Na+ influx upstroke), Phase ...","sourceLabel":"Section in Electrophysiology"},"2256":{"title":"ECG Interpretation for EP","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s3","snippet":"ECG Interpretation for EP Key Intervals Interval Normal Value Clinical Significance PR interval 120-200 ms Short PR (< 120 ms): pre-excitation (WPW), enhanced AV conduction, ectopic atrial rhythm. Long PR (> 200 ms): first-degree AV block QRS duration < 120 ms 120-149 ms: incomplete BBB or IVCD. &ge...","sourceLabel":"Section in Electrophysiology"},"2257":{"title":"The Electrophysiology Study","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s4","snippet":"The Electrophysiology Study Intracardiac Catheters Standard diagnostic EP study uses four multipolar catheters placed via the femoral veins (and sometimes the internal jugular vein): Figure 8 - Standard EP Study Catheter Positions. Fluoroscopic and anatomical depiction of the four standard EP study ...","sourceLabel":"Section in Electrophysiology"},"2258":{"title":"Atrial Fibrillation","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s5","snippet":"Atrial Fibrillation Figure 10 - Pulmonary Vein Triggers in Atrial Fibrillation. Illustration of the landmark Haïssaguerre (1998) discovery: ectopic foci in the pulmonary veins (especially left superior PV) fire rapid, repetitive impulses that trigger AF initiation. The left superior PV is the most c...","sourceLabel":"Section in Electrophysiology"},"2259":{"title":"Atrial Flutter","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s6","snippet":"Atrial Flutter Typical (CTI-Dependent) Atrial Flutter Typical atrial flutter is a macro-reentrant circuit that travels around the tricuspid valve annulus, with the cavotricuspid isthmus (CTI) — the region between the IVC, Eustachian ridge, and tricuspid annulus — as the critical isthmus. In counterc...","sourceLabel":"Section in Electrophysiology"},"2260":{"title":"AVNRT","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s7","snippet":"AVNRT Figure 13 - AVNRT Circuit and Koch Triangle Anatomy. The triangle of Koch showing the substrate for AVNRT: the slow pathway (inferoposterior AV nodal inputs, near the CS ostium) and the fast pathway (superior AV nodal inputs). In typical (slow-fast) AVNRT, antegrade conduction through the slow...","sourceLabel":"Section in Electrophysiology"},"2261":{"title":"AVRT & Wolff-Parkinson-White Syndrome","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s8","snippet":"AVRT & Wolff-Parkinson-White Syndrome Definitions WPW pattern: Pre-excitation on ECG (delta wave, short PR, wide QRS) without symptoms. WPW syndrome: Pre-excitation plus symptomatic tachyarrhythmias. AVRT: A reentrant tachycardia using the AV node as one limb and an accessory pathway as the other li...","sourceLabel":"Section in Electrophysiology"},"2262":{"title":"Atrial Tachycardia","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s9","snippet":"Atrial Tachycardia Focal Atrial Tachycardia Arises from a single atrial focus with centrifugal spread of activation. Mechanism can be automaticity (most common — warm-up/cool-down behavior), triggered activity (DAD-mediated, sensitive to adenosine), or micro-reentry . Common sites of origin: crista ...","sourceLabel":"Section in Electrophysiology"},"2263":{"title":"SVT Differential & Management Algorithm","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s10","snippet":"SVT Differential & Management Algorithm Regular Narrow-Complex Tachycardia Algorithm When confronted with a regular narrow-complex tachycardia (QRS < 120 ms, rate > 100 bpm) , the differential diagnosis and approach are: Step 1 — Determine the Atrial Rate and AV Relationship Is the atrial rate faste...","sourceLabel":"Section in Electrophysiology"},"2264":{"title":"Ventricular Tachycardia","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s11","snippet":"Ventricular Tachycardia Figure 14 - Action Potential Morphology in Arrhythmia Channelopathies. Comparison of normal action potential with pathological variants: prolonged phase 2/3 in LQTS (predisposing to early afterdepolarizations and torsades de pointes), the phase 1 notch exaggeration in Brugada...","sourceLabel":"Section in Electrophysiology"},"2265":{"title":"Ventricular Fibrillation & Cardiac Arrest","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s12","snippet":"Ventricular Fibrillation & Cardiac Arrest Ventricular Fibrillation VF is chaotic, disorganized electrical activity without coordinated ventricular contraction, producing hemodynamic collapse and cardiac arrest. Primary VF occurs in the setting of acute MI (most commonly in the first hour) and is not...","sourceLabel":"Section in Electrophysiology"},"2266":{"title":"Channelopathies","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s13","snippet":"Channelopathies Long QT Syndrome (LQTS) A group of inherited (or acquired) disorders characterized by prolonged ventricular repolarization (QTc prolongation) and risk of torsades de pointes and SCD. Prevalence ~1:2,000. Diagnosed when QTc &ge; 480 ms (or &ge; 460 ms with unexplained syncope), or whe...","sourceLabel":"Section in Electrophysiology"},"2267":{"title":"Inherited Cardiomyopathies & Arrhythmia","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s14","snippet":"Inherited Cardiomyopathies & Arrhythmia Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) ARVC is characterized by fibrofatty replacement of the RV myocardium, predisposing to VT (typically with LBBB morphology — arising from the RV) and SCD, particularly during exercise. Prevalence: ~1:2,000-5...","sourceLabel":"Section in Electrophysiology"},"2268":{"title":"Sudden Cardiac Death Risk Stratification","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s15","snippet":"Sudden Cardiac Death Risk Stratification Primary Prevention ICD Criteria Primary prevention ICDs are implanted in patients who have not yet had a sustained VT/VF episode but are at elevated risk: Key Landmark Trials MADIT II (2002): ICD reduced all-cause mortality by 31% in patients with prior MI an...","sourceLabel":"Section in Electrophysiology"},"2269":{"title":"Sinus Node Dysfunction","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s16","snippet":"Sinus Node Dysfunction Sick Sinus Syndrome Sick sinus syndrome (SSS) encompasses a spectrum of SA node dysfunction: sinus bradycardia (inappropriate for physiologic needs), sinus arrest/pauses (failure of impulse generation — pauses > 3 seconds are significant), sinoatrial exit block (impulse genera...","sourceLabel":"Section in Electrophysiology"},"2270":{"title":"Atrioventricular Block","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s17","snippet":"Atrioventricular Block Classification Type ECG Features Level of Block Prognosis & Treatment First degree PR > 200 ms, all P waves conducted Usually AV nodal Benign; no treatment unless markedly prolonged (PR > 300 ms with symptoms — \"pacemaker syndrome\" from AV dyssynchrony) Second degree — Mobitz ...","sourceLabel":"Section in Electrophysiology"},"2271":{"title":"Bundle Branch Block & Fascicular Block","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s18","snippet":"Bundle Branch Block & Fascicular Block Left Bundle Branch Block (LBBB) LBBB (QRS &ge; 120 ms, broad monophasic R in I, aVL, V5-V6; QS or rS in V1-V2) represents delayed activation of the left ventricle. LBBB is rarely a normal variant — it usually indicates underlying cardiac disease (hypertension, ...","sourceLabel":"Section in Electrophysiology"},"2272":{"title":"Neurocardiogenic Syncope","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s19","snippet":"Neurocardiogenic Syncope Vasovagal Syncope Vasovagal syncope (VVS) is the most common cause of syncope (~60% of cases). It results from an inappropriate reflex causing vasodilation (hypotension) and/or bradycardia (cardioinhibition) in response to a trigger (prolonged standing, emotional stress, pai...","sourceLabel":"Section in Electrophysiology"},"2273":{"title":"Permanent Pacemakers","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s20","snippet":"Permanent Pacemakers Indications (ACC/AHA/HRS Guidelines) Class I indications for permanent pacing include: symptomatic sinus bradycardia (symptom-rhythm correlation), Mobitz II second-degree AV block, high-grade AV block, third-degree (complete) AV block, alternating BBB, symptomatic chronotropic i...","sourceLabel":"Section in Electrophysiology"},"2274":{"title":"Implantable Cardioverter-Defibrillators (ICDs)","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s21","snippet":"Implantable Cardioverter-Defibrillators (ICDs) Primary vs Secondary Prevention Secondary prevention: ICD for survivors of cardiac arrest due to VF or hemodynamically significant VT, or sustained VT with structural heart disease (Class I). Primary prevention: ICD for patients at elevated risk of SCD ...","sourceLabel":"Section in Electrophysiology"},"2275":{"title":"Cardiac Resynchronization Therapy (CRT)","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s22","snippet":"Cardiac Resynchronization Therapy (CRT) Indications Class I indication: LVEF &le; 35%, NYHA II-IV (ambulatory) on GDMT, sinus rhythm, LBBB with QRS &ge; 150 ms . This group has the strongest evidence and highest response rate (~70%). Class IIa: LBBB with QRS 120-149 ms; non-LBBB with QRS &ge; 150 ms...","sourceLabel":"Section in Electrophysiology"},"2276":{"title":"Lead Management & Extraction","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s23","snippet":"Lead Management & Extraction Lead Complications Lead dislodgement: Most common early complication (~2-3% of leads). Presents with failure to pace/sense, diaphragmatic stimulation (RV lead near the diaphragm), or intercostal muscle stimulation. Diagnosed by CXR (lead tip position change) and device i...","sourceLabel":"Section in Electrophysiology"},"2277":{"title":"Device Complications","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s24","snippet":"Device Complications Device Infection Pocket infection: Presents with erythema, warmth, swelling, pain, and/or erosion of the generator through the skin. Most commonly caused by Staphylococcus aureus or coagulase-negative staphylococci (S. epidermidis) . CIED-associated infective endocarditis (CIED-...","sourceLabel":"Section in Electrophysiology"},"2278":{"title":"Remote Monitoring","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s25","snippet":"Remote Monitoring Alert-Based Follow-Up Remote monitoring (RM) allows CIEDs to transmit data wirelessly to a secure server for review by the EP team, without the patient visiting the clinic. All major manufacturers have RM platforms (Medtronic CareLink, Abbott Merlin.net, Boston Scientific Latitude,...","sourceLabel":"Section in Electrophysiology"},"2279":{"title":"Ablation Technology","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s26","snippet":"Ablation Technology Radiofrequency (RF) Ablation RF ablation uses alternating current (300-750 kHz) delivered via a catheter electrode to create thermal lesions in the myocardium. Tissue is heated to > 50&deg;C to cause irreversible cell death. Modern RF ablation uses irrigated-tip catheters — salin...","sourceLabel":"Section in Electrophysiology"},"2280":{"title":"AF Ablation — Detailed","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s27","snippet":"AF Ablation — Detailed PVI Strategies The goal of PVI is to electrically disconnect all four pulmonary veins from the left atrium. Wide-area circumferential ablation (WACA): RF lesions delivered 1-2 cm outside the PV ostia in a circumferential fashion, typically isolating the PVs in ipsilateral pair...","sourceLabel":"Section in Electrophysiology"},"2281":{"title":"VT Ablation","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s28","snippet":"VT Ablation Substrate-Based Approach Most scar-related VT ablation is performed using a substrate-based approach rather than relying solely on activation mapping during VT (which may be hemodynamically unstable). The procedure involves: (1) creating a detailed 3D voltage map of the LV (or RV) in sin...","sourceLabel":"Section in Electrophysiology"},"2282":{"title":"Classification Systems","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s29","snippet":"Classification Systems Vaughan-Williams Antiarrhythmic Classification Class Mechanism Subclass Agents Key Uses Class I Sodium channel blockers Ia — moderate Na+ block, prolong AP Procainamide, quinidine, disopyramide Procainamide: WCT, Brugada provocation. Quinidine: Brugada (I to block) Ib — weak N...","sourceLabel":"Section in Electrophysiology"},"2283":{"title":"Medications Master Table","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s30","snippet":"Medications Master Table Antiarrhythmic Drugs Drug Class Route Key Indications Major Side Effects / Monitoring Amiodarone III (also I, II, IV) IV / PO VT/VF (ACLS), AF (rate + rhythm), VT storm Pulmonary toxicity (fibrosis), thyroid (hypo/hyper — contains iodine), hepatotoxicity, corneal microdeposi...","sourceLabel":"Section in Electrophysiology"},"2284":{"title":"Abbreviations Master List","pageTitle":"Electrophysiology","pageUrl":"/procedural/electrophysiology","url":"/procedural/electrophysiology#s31","snippet":"Abbreviations Master List Abbreviation Meaning AAD Antiarrhythmic drug ACT Activated clotting time AF Atrial fibrillation AFL Atrial flutter AHRE Atrial high-rate episode AP Accessory pathway ARVC Arrhythmogenic right ventricular cardiomyopathy AT Atrial tachycardia ATP Anti-tachycardia pacing AV At...","sourceLabel":"Section in Electrophysiology"},"2285":{"title":"Psychiatry","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main","snippet":"Specialty Reference Psychiatry Complete Specialty Reference Mood disorders, psychotic disorders, anxiety, trauma, psychopharmacology, neuromodulation, risk assessment, and every classification system, diagnostic threshold, and management algorithm across the full scope of adult psychiatry."},"2286":{"title":"Neuroanatomy & Neurophysiology for Psychiatry","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s1","snippet":"Neuroanatomy & Neurophysiology for Psychiatry Psychiatric illness arises from dysfunction in specific neural circuits rather than single brain regions. Understanding the anatomy and neurochemistry of these circuits is essential for rational psychopharmacology and for interpreting neuroimaging findin...","sourceLabel":"Section in Psychiatry"},"2287":{"title":"Psychiatric Assessment & Mental Status Examination","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s2","snippet":"Psychiatric Assessment & Mental Status Examination The psychiatric interview combines history-taking with systematic behavioral observation. The Mental Status Examination (MSE) is the psychiatric equivalent of the physical exam-it documents the patient's psychological state at the time of assessment...","sourceLabel":"Section in Psychiatry"},"2288":{"title":"Diagnostic Frameworks - DSM-5-TR & ICD-11","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s3","snippet":"Diagnostic Frameworks - DSM-5-TR & ICD-11 The DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision, 2022) is the primary classification system for psychiatric diagnosis in the United States. The ICD-11 (International Classification of Diseases, 11th revision, W...","sourceLabel":"Section in Psychiatry"},"2289":{"title":"Key Terminology & Abbreviations","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s4","snippet":"Key Terminology & Abbreviations Term Definition Euthymic Normal, non-depressed, non-manic mood state Anhedonia Inability to experience pleasure-cardinal symptom of MDD Avolition Lack of motivation/initiative-negative symptom of schizophrenia Alogia Poverty of speech-negative symptom of schizophrenia...","sourceLabel":"Section in Psychiatry"},"2290":{"title":"Major Depressive Disorder","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s5","snippet":"Major Depressive Disorder DSM-5-TR Diagnostic Criteria Five or more of the following symptoms present during the same 2-week period, with at least one being (1) depressed mood or (2) anhedonia, representing a change from previous functioning: SIG E CAPS Mnemonic S leep disturbance (insomnia or hyper...","sourceLabel":"Section in Psychiatry"},"2291":{"title":"Bipolar I & II Disorder","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s6","snippet":"Bipolar I & II Disorder Bipolar I Disorder Defined by the occurrence of at least one manic episode . A manic episode requires a distinct period of abnormally and persistently elevated, expansive, or irritable mood AND increased goal-directed activity or energy, lasting &ge;7 days (or any duration if...","sourceLabel":"Section in Psychiatry"},"2292":{"title":"Persistent Depressive Disorder & Cyclothymia","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s7","snippet":"Persistent Depressive Disorder & Cyclothymia Peripartum & Seasonal Specifiers With peripartum onset - mood episode (depressive or manic) with onset during pregnancy or within 4 weeks postpartum (clinically, symptoms may begin anytime in the first year). Peripartum depression affects ~10-15% of women...","sourceLabel":"Section in Psychiatry"},"2293":{"title":"Suicide Risk Assessment & Management","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s8","snippet":"Suicide Risk Assessment & Management Suicide is the 10th leading cause of death in the US (~48,000 deaths/year) and the 2nd leading cause in ages 10-34. Approximately 90% of completed suicides have a diagnosable psychiatric disorder at the time of death. Risk assessment is a core psychiatric compete...","sourceLabel":"Section in Psychiatry"},"2294":{"title":"Schizophrenia","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s9","snippet":"Schizophrenia Schizophrenia is a chronic psychotic disorder with a lifetime prevalence of ~1%, equal across sexes. Onset typically late adolescence to early adulthood (males 18-25, females 25-35, with a second peak in women at ~45). Heritability is ~80%; concordance in monozygotic twins is ~48% (not...","sourceLabel":"Section in Psychiatry"},"2295":{"title":"Schizoaffective, Brief Psychotic & Delusional Disorder","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s10","snippet":"Schizoaffective, Brief Psychotic & Delusional Disorder Schizoaffective Disorder An uninterrupted period of illness during which there is a major mood episode (depressive or manic) concurrent with Criterion A symptoms of schizophrenia. Key distinguishing criterion: Delusions or hallucinations must be...","sourceLabel":"Section in Psychiatry"},"2296":{"title":"First-Episode Psychosis - Workup & Management","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s11","snippet":"First-Episode Psychosis - Workup & Management First-episode psychosis (FEP) warrants a thorough medical workup to rule out organic causes before attributing symptoms to a primary psychotic disorder. Duration of untreated psychosis (DUP) is the single strongest predictor of long-term outcome-every ef...","sourceLabel":"Section in Psychiatry"},"2297":{"title":"Generalized Anxiety Disorder","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s12","snippet":"Generalized Anxiety Disorder Generalized Anxiety Disorder (GAD) is characterized by excessive anxiety and worry (apprehensive expectation) about a number of events or activities, occurring more days than not for &ge;6 months. The individual finds it difficult to control the worry. Three or more of (...","sourceLabel":"Section in Psychiatry"},"2298":{"title":"Panic Disorder & Agoraphobia","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s13","snippet":"Panic Disorder & Agoraphobia Panic Attack Criteria An abrupt surge of intense fear or discomfort reaching a peak within minutes, with four or more of 13 symptoms: (1) Palpitations or accelerated heart rate, (2) Sweating, (3) Trembling or shaking, (4) Shortness of breath or smothering, (5) Feelings o...","sourceLabel":"Section in Psychiatry"},"2299":{"title":"PTSD & Acute Stress Disorder","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s14","snippet":"PTSD & Acute Stress Disorder DSM-5 PTSD Criteria Exposure to actual or threatened death, serious injury, or sexual violence via: direct experience, witnessing in person, learning it occurred to a close family member/friend (must be violent or accidental), or repeated/extreme exposure to aversive det...","sourceLabel":"Section in Psychiatry"},"2300":{"title":"OCD & Related Disorders","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s15","snippet":"OCD & Related Disorders Obsessive-Compulsive Disorder Presence of obsessions (recurrent, persistent, intrusive, unwanted thoughts, urges, or images causing marked anxiety) and/or compulsions (repetitive behaviors or mental acts performed to reduce anxiety or prevent a dreaded event). Time-consuming ...","sourceLabel":"Section in Psychiatry"},"2301":{"title":"Personality Disorders - Clusters A, B, C","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s16","snippet":"Personality Disorders - Clusters A, B, C Personality disorders are enduring, pervasive patterns of inner experience and behavior that deviate markedly from cultural expectations, are inflexible, onset in adolescence/early adulthood, are stable over time, and lead to distress or impairment. They mani...","sourceLabel":"Section in Psychiatry"},"2302":{"title":"Somatic Symptom & Related Disorders","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s17","snippet":"Somatic Symptom & Related Disorders Somatic Symptom Disorder One or more somatic symptoms that are distressing or result in significant disruption of daily life. Excessive thoughts, feelings, or behaviors related to the symptoms: (1) disproportionate and persistent thoughts about severity, (2) persi...","sourceLabel":"Section in Psychiatry"},"2303":{"title":"Dissociative Disorders","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s18","snippet":"Dissociative Disorders Dissociative Identity Disorder (DID) Disruption of identity characterized by two or more distinct personality states (in some cultures described as an experience of possession). Marked discontinuity in sense of self and agency, accompanied by alterations in affect, behavior, c...","sourceLabel":"Section in Psychiatry"},"2304":{"title":"Antidepressants - Complete Drug Tables","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s19","snippet":"Antidepressants - Complete Drug Tables Selective Serotonin Reuptake Inhibitors (SSRIs) Drug Brand Start Dose Target Dose Key Pearls Fluoxetine Prozac 20 mg 20-80 mg Longest half-life (2-6 days; norfluoxetine 4-16 days)-self-tapering, least discontinuation syndrome; CYP2D6 inhibitor; FDA-approved for...","sourceLabel":"Section in Psychiatry"},"2305":{"title":"Antipsychotics - FGAs & SGAs","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s20","snippet":"Antipsychotics - FGAs & SGAs First-Generation Antipsychotics (FGAs / Typicals) Drug Potency Dose Range EPS Risk Sedation Key Pearls Haloperidol (Haldol) High 2-20 mg High Low IM/IV available; QTc prolongation (especially IV); most commonly used FGA; decanoate (LAI) available q4wk Fluphenazine High 2...","sourceLabel":"Section in Psychiatry"},"2306":{"title":"Mood Stabilizers","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s21","snippet":"Mood Stabilizers Lithium The oldest and best-studied mood stabilizer. Mechanism: inhibits inositol monophosphatase (depleting IP3 signaling), inhibits GSK-3beta, enhances serotonergic transmission, neuroprotective (increases gray matter volume). Uniquely reduces suicide risk. Lithium Management Ther...","sourceLabel":"Section in Psychiatry"},"2307":{"title":"Anxiolytics, Hypnotics & Stimulants","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s22","snippet":"Anxiolytics, Hypnotics & Stimulants Benzodiazepine Equivalency Table Drug Equivalent Dose Half-Life Onset Primary Use Alprazolam (Xanax) 0.5 mg 6-12 hr Fast Panic, GAD Lorazepam (Ativan) 1 mg 10-20 hr Intermediate Anxiety, catatonia, status epilepticus, alcohol withdrawal Clonazepam (Klonopin) 0.25-...","sourceLabel":"Section in Psychiatry"},"2308":{"title":"Psychopharmacology in Pregnancy & Lactation","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s23","snippet":"Psychopharmacology in Pregnancy & Lactation The FDA replaced pregnancy letter categories (A/B/C/D/X) with the Pregnancy and Lactation Labeling Rule (PLLR) in 2015, requiring descriptive summaries of human and animal data. Clinical decisions require balancing teratogenic risk against the risk of untr...","sourceLabel":"Section in Psychiatry"},"2309":{"title":"ECT, TMS & Other Neuromodulation","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s24","snippet":"ECT, TMS & Other Neuromodulation Electroconvulsive Therapy (ECT) Indications: Treatment-resistant depression (failed &ge;2 adequate medication trials), psychotic depression (remission rate ~90%), catatonia (when lorazepam fails), severe suicidality requiring rapid response, bipolar depression/mania ...","sourceLabel":"Section in Psychiatry"},"2310":{"title":"Psychiatric Emergencies - Agitation, Catatonia, NMS, Serotonin Syndrome","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s25","snippet":"Psychiatric Emergencies - Agitation, Catatonia, NMS, Serotonin Syndrome Acute Agitation Management De-escalation first: Verbal techniques-calm tone, non-threatening posture, offer choices (\"Would you like to sit down?\"), identify and address needs (pain, hunger, fear), maintain safe distance, avoid ...","sourceLabel":"Section in Psychiatry"},"2311":{"title":"Forensic Psychiatry & Involuntary Commitment","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s26","snippet":"Forensic Psychiatry & Involuntary Commitment Capacity vs. Competency Capacity is a clinical determination made by any physician at the bedside. A patient has decision-making capacity if they can: (1) Understand the relevant information about the proposed treatment, (2) Appreciate how the information...","sourceLabel":"Section in Psychiatry"},"2312":{"title":"Sleep Disorders in Psychiatry","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s27","snippet":"Sleep Disorders in Psychiatry Insomnia Disorder Difficulty initiating sleep, maintaining sleep, or early morning awakening with inability to return to sleep, despite adequate opportunity. &ge;3 nights/week for &ge;3 months, causing daytime impairment. Prevalence 6-10% (chronic insomnia). Comorbid wi...","sourceLabel":"Section in Psychiatry"},"2313":{"title":"Comorbid Medical & Psychiatric Conditions","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s28","snippet":"Comorbid Medical & Psychiatric Conditions Delirium vs. Dementia vs. Depression Feature Delirium Dementia Depression (\"Pseudodementia\") Onset Acute (hours to days) Insidious (months to years) Weeks to months Course Fluctuating (worse at night-\"sundowning\") Progressive, stable day-to-day Diurnal varia...","sourceLabel":"Section in Psychiatry"},"2314":{"title":"Classification Systems & Rating Scales","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s29","snippet":"Classification Systems & Rating Scales PHQ-9 (Patient Health Questionnaire-9) 9 items each scored 0-3 (not at all, several days, more than half the days, nearly every day) over the past 2 weeks. Items correspond to DSM-5 MDD criteria: (1) little interest/pleasure, (2) feeling down/depressed/hopeless...","sourceLabel":"Section in Psychiatry"},"2315":{"title":"Medications Master Table","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s30","snippet":"Medications Master Table Class Drug Typical Dose Mechanism Key Indication Major Side Effects / Pearls SSRIs Fluoxetine 20-80 mg SERT inhibitor MDD, OCD, bulimia, panic Longest t1/2; CYP2D6 inhibitor Sertraline 50-200 mg SERT inhibitor MDD, PTSD, OCD, panic, SAD Safest in cardiac; mild DRI Paroxetine...","sourceLabel":"Section in Psychiatry"},"2316":{"title":"Laboratory Monitoring Guide","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s31","snippet":"Laboratory Monitoring Guide Drug Class / Agent Baseline Labs Ongoing Monitoring Frequency Lithium BMP (Cr, BUN, electrolytes), TSH, calcium, CBC, urinalysis, ECG, pregnancy test Lithium level (trough, 12hr post-dose), Cr, TSH, calcium Level: 5-7 days after dose change until stable, then q3-6 months....","sourceLabel":"Section in Psychiatry"},"2317":{"title":"Abbreviations Master List","pageTitle":"Psychiatry","pageUrl":"/psychiatry/psychiatry-main","url":"/psychiatry/psychiatry-main#s32","snippet":"Abbreviations Master List General Psychiatry Abbreviation Meaning MDD Major depressive disorder GAD Generalized anxiety disorder OCD Obsessive-compulsive disorder PTSD Post-traumatic stress disorder ASD Acute stress disorder (or autism spectrum disorder-context dependent) BPD Borderline personality ...","sourceLabel":"Section in Psychiatry"},"2318":{"title":"Child & Adolescent Psychiatry","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry","snippet":"Specialty Reference Child & Adolescent Psychiatry Complete Specialty Reference Neurodevelopmental disorders, pediatric mood and anxiety disorders, ADHD, autism spectrum, eating disorders, psychopharmacology in youth, evidence-based therapies, and every screening tool, dosing guideline, and developme..."},"2319":{"title":"Neurodevelopment & Brain Maturation","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s1","snippet":"Neurodevelopment & Brain Maturation The developing brain undergoes a predictable sequence of structural and functional changes from gestation through early adulthood. Understanding these trajectories is essential for recognizing deviation from typical development and for appreciating why psychiatric...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2320":{"title":"Developmental Milestones & Assessment","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s2","snippet":"Developmental Milestones & Assessment Developmental surveillance is a core competency in child psychiatry. Milestones represent median ages of acquisition; significant delay in any domain warrants formal evaluation. The four primary developmental domains are gross motor , fine motor , language (rece...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2321":{"title":"Psychiatric Assessment in Children & Adolescents","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s3","snippet":"Psychiatric Assessment in Children & Adolescents Psychiatric evaluation of children and adolescents differs fundamentally from adult assessment. Children are brought to evaluation by others (parents, teachers, courts), may lack insight into their symptoms, and present differently at varying developm...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2322":{"title":"Key Terminology & Abbreviations","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s4","snippet":"Key Terminology & Abbreviations Core terms and abbreviations encountered throughout child and adolescent psychiatry. A comprehensive abbreviation reference is in Section 30. Essential Terminology Neurodevelopmental disorder - A condition with onset in the developmental period that produces deficits ...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2323":{"title":"Attention-Deficit/Hyperactivity Disorder (ADHD)","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s5","snippet":"Attention-Deficit/Hyperactivity Disorder (ADHD) ADHD is the most common neurodevelopmental disorder, affecting 5-7% of children worldwide and 9.4% in the United States (2016 NSCH data). It is characterized by developmentally inappropriate levels of inattention, hyperactivity, and impulsivity that ca...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2324":{"title":"Autism Spectrum Disorder (ASD)","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s6","snippet":"Autism Spectrum Disorder (ASD) ASD is a neurodevelopmental disorder characterized by persistent deficits in social communication and social interaction across contexts, combined with restricted, repetitive patterns of behavior. DSM-5 collapsed the previous DSM-IV categories (autistic disorder, Asper...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2325":{"title":"Intellectual Disability & Global Developmental Delay","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s7","snippet":"Intellectual Disability & Global Developmental Delay Intellectual disability (ID) is characterized by deficits in both intellectual functioning (IQ approximately 2 SDs below the mean, ~70 or below) and adaptive functioning (conceptual, social, and practical domains) with onset during the development...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2326":{"title":"Specific Learning Disorders & Communication Disorders","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s8","snippet":"Specific Learning Disorders & Communication Disorders Specific Learning Disorder (SLD) involves persistent difficulties in learning and using academic skills, with onset during school years, that are not explained by ID, sensory impairment, or inadequate instruction. Prevalence is 5-15% of school-ag...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2327":{"title":"Tic Disorders & Tourette Syndrome","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s9","snippet":"Tic Disorders & Tourette Syndrome Tic disorders exist on a spectrum defined by tic type (motor and/or vocal) and duration. Tourette syndrome (TS) is the most severe, requiring both motor and vocal tics for more than one year. Prevalence of TS is 0.3-1% of school-age children, with a male-to-female r...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2328":{"title":"Pediatric Depression","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s10","snippet":"Pediatric Depression Major depressive disorder (MDD) affects approximately 2% of prepubertal children and 4-8% of adolescents, with a lifetime prevalence by age 18 of 11-14%. Before puberty, the sex ratio is approximately equal; after puberty, females are affected 2-3 times more often than males. Pe...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2329":{"title":"Pediatric Bipolar Disorder & DMDD","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s11","snippet":"Pediatric Bipolar Disorder & DMDD Pediatric bipolar disorder is among the most controversial diagnoses in child psychiatry. The core debate centers on whether chronic, non-episodic irritability in children represents bipolar disorder or a different condition. DSM-5 addressed this by introducing Disr...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2330":{"title":"Anxiety Disorders in Children","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s12","snippet":"Anxiety Disorders in Children Anxiety disorders are the most common psychiatric conditions in childhood, affecting 15-20% of children and adolescents. Unlike typical developmental fears (stranger anxiety at 8-12 months, fear of the dark at 3-5 years), pathological anxiety is excessive, persistent, a...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2331":{"title":"OCD in Children & Adolescents","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s13","snippet":"OCD in Children & Adolescents Obsessive-compulsive disorder affects 1-3% of children and adolescents, with bimodal onset: early childhood (mean age 10, more common in males) and late adolescence/early adulthood. Pediatric OCD is strongly familial, with a 4-8 times increased risk in first-degree rela...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2332":{"title":"Disruptive Behavior Disorders - ODD & Conduct Disorder","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s14","snippet":"Disruptive Behavior Disorders - ODD & Conduct Disorder Oppositional defiant disorder (ODD) and conduct disorder (CD) are the disruptive, impulse-control, and conduct disorders most frequently encountered in child psychiatry. ODD affects 3-6% of children; CD affects 2-10%. Both are more common in mal...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2333":{"title":"PTSD & Trauma in Children","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s15","snippet":"PTSD & Trauma in Children Approximately two-thirds of children experience at least one traumatic event by age 16. Traumatic events include physical, sexual, or emotional abuse; neglect; witnessing domestic violence; community violence; natural disasters; motor vehicle accidents; sudden loss of a lov...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2334":{"title":"Attachment Disorders - RAD & DSED","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s16","snippet":"Attachment Disorders - RAD & DSED Attachment disorders arise from severely inadequate caregiving in early childhood (before age 5). Both DSM-5 diagnoses - Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) - require a history of social neglect, frequent changes in ...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2335":{"title":"Anorexia Nervosa & Bulimia in Adolescents","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s17","snippet":"Anorexia Nervosa & Bulimia in Adolescents Eating disorders have the highest mortality rate of any psychiatric illness. Anorexia nervosa (AN) has a lifetime prevalence of 0.5-2% in females and a mortality rate of 5-10% per decade (from medical complications and suicide). Bulimia nervosa (BN) affects ...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2336":{"title":"ARFID & Other Feeding Disorders","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s18","snippet":"ARFID & Other Feeding Disorders Avoidant/Restrictive Food Intake Disorder (ARFID) is a DSM-5 diagnosis characterized by persistent failure to meet nutritional/energy needs (not due to body image disturbance or lack of food availability), manifested by significant weight loss or growth failure, nutri...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2337":{"title":"Self-Harm & Suicidality in Youth","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s19","snippet":"Self-Harm & Suicidality in Youth Suicide is the second leading cause of death among individuals aged 10-24 in the United States. Rates have increased approximately 60% since 2007. In the 2021 Youth Risk Behavior Survey (YRBS), 22% of high school students seriously considered suicide, 18% made a plan...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2338":{"title":"Stimulants & ADHD Medications - Complete Drug Table","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s20","snippet":"Stimulants & ADHD Medications - Complete Drug Table Stimulant medications are the most effective pharmacological treatment for ADHD, with effect sizes of 0.8-1.0 (large). They act by blocking the dopamine transporter (DAT) and norepinephrine transporter (NET) in the prefrontal cortex and striatum. T...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2339":{"title":"SSRIs & Antidepressants in Pediatrics","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s21","snippet":"SSRIs & Antidepressants in Pediatrics SSRIs are the first-line pharmacotherapy for pediatric depression, anxiety disorders, and OCD. They work by selectively blocking the serotonin transporter (SERT), increasing serotonin availability in the synaptic cleft. Onset of therapeutic effect is typically 2...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2340":{"title":"Antipsychotics in Children","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s22","snippet":"Antipsychotics in Children Antipsychotic use in children and adolescents has increased dramatically (5-7-fold since the 1990s), primarily second-generation (atypical) antipsychotics. FDA-approved pediatric indications include ASD-associated irritability, bipolar mania, schizophrenia (age 13+), and T...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2341":{"title":"Other Agents - Mood Stabilizers, Alpha-Agonists, Melatonin","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s23","snippet":"Other Agents - Mood Stabilizers, Alpha-Agonists, Melatonin Lithium in Adolescents Lithium is FDA-approved for bipolar I disorder in children aged 7+ (mania and maintenance). Mechanism: multifactorial - inhibits inositol monophosphatase, modulates GSK-3beta, neuroprotective effects. Starting dose: 30...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2342":{"title":"Evidence-Based Psychotherapies","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s24","snippet":"Evidence-Based Psychotherapies Psychotherapy is a first-line or co-first-line treatment for most pediatric psychiatric disorders. The choice of modality depends on the diagnosis, child's age and cognitive development, family resources, and available providers. The following modalities have the stron...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2343":{"title":"School-Based Interventions & IEP/504 Plans","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s25","snippet":"School-Based Interventions & IEP/504 Plans Schools are the primary setting where child psychiatric conditions affect functioning. Understanding the educational framework for supporting students with psychiatric disabilities is essential for child psychiatrists, who frequently write letters supportin...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2344":{"title":"Gender Diversity & Gender-Affirming Care","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s26","snippet":"Gender Diversity & Gender-Affirming Care Gender dysphoria in children and adolescents refers to marked incongruence between experienced/expressed gender and assigned gender, associated with clinically significant distress or impairment. Gender diverse youth experience higher rates of depression (2-3...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2345":{"title":"Legal & Ethical Issues in Child Psychiatry","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s27","snippet":"Legal & Ethical Issues in Child Psychiatry Child and adolescent psychiatry operates at the intersection of clinical care, family dynamics, and legal systems. The child psychiatrist must navigate complex ethical terrain involving children who cannot legally consent, families who may disagree with tre...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2346":{"title":"Rating Scales & Screening Tools","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s28","snippet":"Rating Scales & Screening Tools A compilation of the most commonly used assessment instruments in child and adolescent psychiatry, with age ranges, administration details, scoring guidelines, and clinical interpretation. Selection of instruments should be guided by the clinical question, the child's...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2347":{"title":"Medications Master Table","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s29","snippet":"Medications Master Table Comprehensive pediatric psychopharmacology reference organized by drug class. All doses are for children and adolescents unless otherwise specified. Always verify current prescribing information. General principles of pediatric psychopharmacology: (1) Start low, go slow, but...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2348":{"title":"Abbreviations Master List","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/psychiatry/child-psychiatry","url":"/psychiatry/child-psychiatry#s30","snippet":"Abbreviations Master List Abbreviation Full Term AACAP American Academy of Child and Adolescent Psychiatry AAP American Academy of Pediatrics ABA Applied Behavior Analysis ACE Adverse Childhood Experience ADHD Attention-Deficit/Hyperactivity Disorder ADI-R Autism Diagnostic Interview - Revised ADOS-...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"2349":{"title":"Addiction Medicine","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine","snippet":"Specialty Reference Addiction Medicine Complete Specialty Reference Alcohol, opioid, stimulant, sedative, cannabis, and tobacco use disorders, withdrawal syndromes, medication-assisted treatment, motivational interviewing, harm reduction, drug screening, and every pharmacotherapy protocol, scoring s..."},"2350":{"title":"Neurobiology of Addiction","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s1","snippet":"Neurobiology of Addiction Addiction is a chronic, relapsing brain disorder characterized by compulsive substance seeking and use despite harmful consequences. The neurobiology centers on the mesolimbic dopamine pathway - a circuit linking the ventral tegmental area (VTA) in the midbrain to the nucle...","sourceLabel":"Section in Addiction Medicine"},"2351":{"title":"Screening & Assessment","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s2","snippet":"Screening & Assessment Universal screening for substance use disorders is recommended by USPSTF (Grade B for alcohol in adults; Grade I for drugs). The SBIRT framework (Screening, Brief Intervention, Referral to Treatment) is the evidence-based model for integrating screening into primary care, emer...","sourceLabel":"Section in Addiction Medicine"},"2352":{"title":"Motivational Interviewing & Stages of Change","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s3","snippet":"Motivational Interviewing & Stages of Change Transtheoretical Model (Prochaska & DiClemente) The Stages of Change model describes readiness for behavior change as a dynamic, non-linear process. Patients may cycle through stages multiple times before achieving sustained change. Relapse is considered ...","sourceLabel":"Section in Addiction Medicine"},"2353":{"title":"Key Terminology & Abbreviations","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s4","snippet":"Key Terminology & Abbreviations Core definitions used throughout addiction medicine. These terms have specific clinical meanings that differ from colloquial usage. Term Definition Addiction Chronic brain disorder characterized by compulsive substance use despite harm, loss of control, and craving; p...","sourceLabel":"Section in Addiction Medicine"},"2354":{"title":"AUD - Diagnosis & Medical Complications","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s5","snippet":"AUD - Diagnosis & Medical Complications Alcohol use disorder affects approximately 29 million Americans (10.5% of adults). It is the third leading preventable cause of death in the United States (~95,000 deaths/year). The DSM-5 SUD criteria (Section 2) are applied specifically to alcohol. Standard d...","sourceLabel":"Section in Addiction Medicine"},"2355":{"title":"Alcohol Withdrawal - CIWA Protocol & Management","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s6","snippet":"Alcohol Withdrawal - CIWA Protocol & Management Alcohol withdrawal results from abrupt cessation or reduction of heavy, prolonged alcohol use. Chronic alcohol exposure upregulates excitatory NMDA glutamate receptors and downregulates inhibitory GABA-A receptors. Upon cessation, unopposed glutamaterg...","sourceLabel":"Section in Addiction Medicine"},"2356":{"title":"Pharmacotherapy for AUD","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s7","snippet":"Pharmacotherapy for AUD Three medications have FDA approval for AUD: naltrexone, acamprosate, and disulfiram. Several off-label agents have supporting evidence. Despite strong efficacy data, fewer than 10% of patients with AUD receive any pharmacotherapy. Medication Mechanism Dosing Key Evidence Con...","sourceLabel":"Section in Addiction Medicine"},"2357":{"title":"Alcohol-Related Emergencies","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s8","snippet":"Alcohol-Related Emergencies Figure 19 - Brain Regions Affected by Alcohol. Location of key brain regions impacted by alcohol, including the mesolimbic dopamine system (VTA and nucleus accumbens), prefrontal cortex, cerebellum, and hypothalamus. Alcohol's broad pharmacological actions affect multiple...","sourceLabel":"Section in Addiction Medicine"},"2358":{"title":"OUD - Epidemiology, Pharmacology & Diagnosis","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s9","snippet":"OUD - Epidemiology, Pharmacology & Diagnosis Opioid use disorder (OUD) affects approximately 2.7 million Americans. Opioid-involved overdose deaths reached ~82,000 in 2022, driven primarily by illicitly manufactured fentanyl. The opioid epidemic evolved through three waves: (1) prescription opioid d...","sourceLabel":"Section in Addiction Medicine"},"2359":{"title":"Opioid Withdrawal - COWS Protocol","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s10","snippet":"Opioid Withdrawal - COWS Protocol Figure 26 - Descending Opioid Pain Modulation Pathways. Opioid receptors in the periaqueductal gray and rostral ventromedial medulla activate descending inhibitory pathways to the spinal cord dorsal horn. Chronic opioid use disrupts these endogenous pain modulation ...","sourceLabel":"Section in Addiction Medicine"},"2360":{"title":"Buprenorphine - Induction, Stabilization & Maintenance","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s11","snippet":"Buprenorphine - Induction, Stabilization & Maintenance Buprenorphine is a partial mu-opioid agonist with very high receptor binding affinity (Ki ~1 nM, higher than morphine, methadone, or fentanyl). Its partial agonism produces a ceiling effect on respiratory depression (maximal at ~24-32 mg SL), ma...","sourceLabel":"Section in Addiction Medicine"},"2361":{"title":"Methadone Maintenance","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s12","snippet":"Methadone Maintenance Methadone is a full mu-opioid agonist with additional NMDA receptor antagonist activity and serotonin/norepinephrine reuptake inhibition. It has strong evidence for reducing illicit opioid use, criminal activity, HIV transmission, and all-cause mortality. However, its unique ph...","sourceLabel":"Section in Addiction Medicine"},"2362":{"title":"Naloxone & Overdose Reversal","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s13","snippet":"Naloxone & Overdose Reversal Naloxone is a competitive mu-opioid receptor antagonist that rapidly reverses opioid-induced respiratory depression. It is the cornerstone of opioid overdose emergency response and has been designated an over-the-counter (OTC) medication (Narcan nasal spray) since 2023. ...","sourceLabel":"Section in Addiction Medicine"},"2363":{"title":"Stimulant Use Disorder - Cocaine & Methamphetamine","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s14","snippet":"Stimulant Use Disorder - Cocaine & Methamphetamine Stimulant use disorder encompasses cocaine and amphetamine-type stimulants (methamphetamine, prescription amphetamines). There are no FDA-approved pharmacotherapies for stimulant use disorder; contingency management is the most effective evidence-ba...","sourceLabel":"Section in Addiction Medicine"},"2364":{"title":"Cannabis Use Disorder","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s15","snippet":"Cannabis Use Disorder Figure 32 - CB1 Receptor Distribution. CB1 cannabinoid receptors are densely expressed in the hippocampus (memory), cerebellum (coordination), basal ganglia (movement), and cortex (cognition), explaining the effects of THC on short-term memory, motor coordination, and executive...","sourceLabel":"Section in Addiction Medicine"},"2365":{"title":"Sedative-Hypnotic Use Disorder - Benzodiazepines & Z-drugs","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s16","snippet":"Sedative-Hypnotic Use Disorder - Benzodiazepines & Z-drugs Benzodiazepines and Z-drugs (zolpidem, zaleplon, eszopiclone) act on the GABA-A receptor complex. Benzodiazepines bind the alpha subunit at the benzodiazepine binding site, increasing the frequency of chloride channel opening (requiring endo...","sourceLabel":"Section in Addiction Medicine"},"2366":{"title":"Tobacco Use Disorder","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s17","snippet":"Tobacco Use Disorder Tobacco use is the leading preventable cause of death in the United States (~480,000 deaths/year, including ~41,000 from secondhand smoke). Nicotine acts on nicotinic acetylcholine receptors (nAChRs) , particularly the alpha-4-beta-2 subtype in the VTA, stimulating dopamine rele...","sourceLabel":"Section in Addiction Medicine"},"2367":{"title":"Hallucinogens, Inhalants & Novel Psychoactive Substances","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s18","snippet":"Hallucinogens, Inhalants & Novel Psychoactive Substances Classic Serotonergic Hallucinogens LSD (lysergic acid diethylamide) and psilocybin (from Psilocybe mushrooms) are 5-HT2A receptor agonists that produce altered perception, visual hallucinations, synesthesia, mystical experiences, and altered s...","sourceLabel":"Section in Addiction Medicine"},"2368":{"title":"Harm Reduction Principles & Programs","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s19","snippet":"Harm Reduction Principles & Programs Harm reduction is a public health approach that aims to minimize the negative health, social, and economic consequences of substance use without necessarily requiring abstinence. It is grounded in the pragmatic recognition that some people cannot or will not stop...","sourceLabel":"Section in Addiction Medicine"},"2369":{"title":"Co-Occurring Disorders - Dual Diagnosis","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s20","snippet":"Co-Occurring Disorders - Dual Diagnosis Approximately 50% of individuals with a severe mental illness and 30-40% with any mental illness also have a substance use disorder. Conversely, people with SUD have high rates of comorbid depression (20-40%), anxiety disorders (20-30%), PTSD (30-60% in women ...","sourceLabel":"Section in Addiction Medicine"},"2370":{"title":"Special Populations","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s21","snippet":"Special Populations Pregnancy - Opioid Use Disorder MOUD is the standard of care for pregnant patients with OUD. Both methadone and buprenorphine are safe and recommended; medically supervised withdrawal (detoxification) during pregnancy is associated with high relapse rates and increased risk of fe...","sourceLabel":"Section in Addiction Medicine"},"2371":{"title":"Urine Drug Screens & Confirmatory Testing","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s22","snippet":"Urine Drug Screens & Confirmatory Testing Immunoassay (Screening) vs. Confirmatory Testing Standard urine drug screens (UDS) use immunoassay technology: antibodies recognize drug class metabolites. Advantages: rapid (results in minutes), inexpensive, broad panels available. Limitations: cross-reacti...","sourceLabel":"Section in Addiction Medicine"},"2372":{"title":"Prescription Drug Monitoring & Safe Prescribing","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s23","snippet":"Prescription Drug Monitoring & Safe Prescribing Prescription Drug Monitoring Programs (PDMPs) PDMPs are state-run electronic databases that track controlled substance prescriptions. All 50 US states have operational PDMPs. Most states mandate PDMP check before prescribing opioids or benzodiazepines....","sourceLabel":"Section in Addiction Medicine"},"2373":{"title":"Levels of Care - ASAM Criteria","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s24","snippet":"Levels of Care - ASAM Criteria The ASAM Criteria (American Society of Addiction Medicine), formerly known as the \"ASAM Patient Placement Criteria,\" is the most widely used and comprehensive set of guidelines for matching patients to appropriate levels and types of addiction treatment. Placement deci...","sourceLabel":"Section in Addiction Medicine"},"2374":{"title":"Evidence-Based Psychotherapies","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s25","snippet":"Evidence-Based Psychotherapies Therapy Approach Key Evidence Best For Cognitive Behavioral Therapy (CBT) Identifies and modifies maladaptive thought patterns and behaviors; teaches coping skills, trigger management, refusal skills Strong evidence across all substances; effects maintained after treat...","sourceLabel":"Section in Addiction Medicine"},"2375":{"title":"Classification Systems & Scoring Tools","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s26","snippet":"Classification Systems & Scoring Tools This section consolidates all clinical scoring instruments referenced throughout the page with scoring thresholds and clinical application. Each tool is validated for specific populations and clinical contexts; using the correct tool in the correct setting impr...","sourceLabel":"Section in Addiction Medicine"},"2376":{"title":"Medications Master Table","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s27","snippet":"Medications Master Table Medications for Alcohol Use Disorder Drug Class Mechanism Dose Key Side Effects Monitoring Naltrexone PO Opioid antagonist Mu-opioid receptor blockade 50 mg daily Nausea, headache, dizziness, hepatotoxicity (rare) LFTs at baseline and periodically; ensure opioid-free &ge;7 d...","sourceLabel":"Section in Addiction Medicine"},"2377":{"title":"MME Conversion Table","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s28","snippet":"MME Conversion Table The morphine milligram equivalent (MME) is a standardized measure used to compare potency across different opioid medications. It represents the dose of a given opioid that is approximately equivalent to 1 mg of oral morphine. The 2022 CDC guideline uses MME thresholds for risk ...","sourceLabel":"Section in Addiction Medicine"},"2378":{"title":"Drug Interaction Reference","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s29","snippet":"Drug Interaction Reference Methadone Drug Interactions Interacting Drug Effect on Methadone Clinical Consequence Management Rifampin Potent CYP3A4 induction; reduces methadone levels by >50% Precipitated withdrawal within days Increase methadone dose; consider split dosing; monitor closely during an...","sourceLabel":"Section in Addiction Medicine"},"2379":{"title":"Abbreviations Master List","pageTitle":"Addiction Medicine","pageUrl":"/psychiatry/addiction-medicine","url":"/psychiatry/addiction-medicine#s30","snippet":"Abbreviations Master List Abbreviation Meaning AA Alcoholics Anonymous ADH Alcohol dehydrogenase ALDH Aldehyde dehydrogenase ASAM American Society of Addiction Medicine AUD Alcohol use disorder AUDIT Alcohol Use Disorders Identification Test BAC Blood alcohol concentration BBB Blood-brain barrier BI...","sourceLabel":"Section in Addiction Medicine"},"2380":{"title":"Behavioral Science","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science","snippet":"Specialty Reference Behavioral Science Complete Specialty Reference Health behavior models, doctor-patient communication, biopsychosocial framework, defense mechanisms, learning theory, psychological development, ethics of behavior change, cultural competency, and every major theory, classification,..."},"2381":{"title":"Biopsychosocial Model & Systems Theory","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s1","snippet":"Biopsychosocial Model & Systems Theory In 1977, internist and psychiatrist George Engel published a landmark paper in Science proposing the biopsychosocial (BPS) model as an alternative to the prevailing biomedical model . Engel argued that understanding illness requires simultaneous attention to bi...","sourceLabel":"Section in Behavioral Science"},"2382":{"title":"Behavioral Neuroscience Foundations","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s2","snippet":"Behavioral Neuroscience Foundations Behavioral science rests on neurobiological substrates. Understanding the key brain regions, circuits, and neurotransmitter systems that govern emotion, motivation, stress, and executive control provides the mechanistic basis for health behavior, defense mechanism...","sourceLabel":"Section in Behavioral Science"},"2383":{"title":"Key Terminology & Abbreviations","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s3","snippet":"Key Terminology & Abbreviations Behavioral science draws on multiple disciplines - psychology, sociology, public health, neuroscience, and ethics - each with specialized terminology. Mastering these terms is essential for understanding the literature and clinical communication. The following table d...","sourceLabel":"Section in Behavioral Science"},"2384":{"title":"Health Belief Model","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s4","snippet":"Health Belief Model The Health Belief Model (HBM) was developed in the 1950s by social psychologists Irwin Rosenstock, Godfrey Hochbaum, Stephen Kegeles, and Howard Leventhal at the U.S. Public Health Service to explain why people failed to participate in free tuberculosis screening programs. It is ...","sourceLabel":"Section in Behavioral Science"},"2385":{"title":"Transtheoretical Model - Stages of Change","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s5","snippet":"Transtheoretical Model - Stages of Change The Transtheoretical Model (TTM) , developed by James Prochaska and Carlo DiClemente beginning in 1977, emerged from a comparative analysis of 18 different psychotherapy systems. It conceptualizes behavior change as a process that unfolds through a series of...","sourceLabel":"Section in Behavioral Science"},"2386":{"title":"Social Cognitive Theory & Self-Efficacy","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s6","snippet":"Social Cognitive Theory & Self-Efficacy Social Cognitive Theory (SCT) , developed by Albert Bandura (1986), is one of the most comprehensive theories of human behavior. It evolved from Social Learning Theory (1960s-70s) and introduced the concept of reciprocal determinism - the idea that behavior, p...","sourceLabel":"Section in Behavioral Science"},"2387":{"title":"Theory of Planned Behavior & Reasoned Action","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s7","snippet":"Theory of Planned Behavior & Reasoned Action The Theory of Reasoned Action (TRA) was proposed by Martin Fishbein and Icek Ajzen in 1975 and later expanded into the Theory of Planned Behavior (TPB) by Ajzen in 1991. These models focus on the cognitive determinants of behavioral intention, which is vi...","sourceLabel":"Section in Behavioral Science"},"2388":{"title":"Ecological Model & Social Determinants of Health","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s8","snippet":"Ecological Model & Social Determinants of Health The Ecological Model (socioecological model), adapted from Urie Bronfenbrenner's ecological systems theory (1979), recognizes that health behavior is influenced by multiple levels of the social environment, not just individual cognition. Effective pub...","sourceLabel":"Section in Behavioral Science"},"2389":{"title":"Communication Models & Skills","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s9","snippet":"Communication Models & Skills Effective clinician-patient communication is associated with improved diagnostic accuracy, better adherence, fewer malpractice claims, higher patient satisfaction, and improved clinical outcomes. Communication is a skill that can be systematically taught and assessed. C...","sourceLabel":"Section in Behavioral Science"},"2390":{"title":"Motivational Interviewing in Clinical Practice","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s10","snippet":"Motivational Interviewing in Clinical Practice Motivational interviewing (MI) is a patient-centered, directive counseling method developed by William Miller and Stephen Rollnick (1991) to enhance intrinsic motivation to change by exploring and resolving ambivalence. MI was originally developed for a...","sourceLabel":"Section in Behavioral Science"},"2391":{"title":"Breaking Bad News - SPIKES Protocol","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s11","snippet":"Breaking Bad News - SPIKES Protocol Delivering bad news is among the most difficult communication tasks in medicine. The SPIKES protocol (Buckman, 2000) provides a six-step framework used worldwide for disclosing unfavorable medical information - cancer diagnoses, terminal prognosis, treatment failu...","sourceLabel":"Section in Behavioral Science"},"2392":{"title":"Informed Consent & Health Literacy","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s12","snippet":"Informed Consent & Health Literacy Elements of Valid Informed Consent Informed consent is both an ethical obligation and a legal requirement. For consent to be valid, five elements must be present: (1) Disclosure - the clinician provides adequate information about the diagnosis, proposed treatment, ...","sourceLabel":"Section in Behavioral Science"},"2393":{"title":"Psychosexual Development - Freud","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s13","snippet":"Psychosexual Development - Freud Sigmund Freud's psychosexual theory of development (1905) proposes that personality develops through a series of stages in which the libido (psychic energy) focuses on different erogenous zones. Failure to adequately resolve the conflict at each stage results in fixa...","sourceLabel":"Section in Behavioral Science"},"2394":{"title":"Psychosocial Development - Erikson","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s14","snippet":"Psychosocial Development - Erikson Erik Erikson's psychosocial theory (1950, 1963) extends developmental theory across the entire lifespan and emphasizes social and cultural influences rather than biological drives. Erikson proposed eight stages, each characterized by a psychosocial crisis (a turnin...","sourceLabel":"Section in Behavioral Science"},"2395":{"title":"Cognitive Development - Piaget","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s15","snippet":"Cognitive Development - Piaget Jean Piaget's theory of cognitive development (1936, refined through the 1970s) describes how children actively construct understanding of the world through a series of qualitatively different stages. Each stage represents a fundamentally different way of thinking. Pia...","sourceLabel":"Section in Behavioral Science"},"2396":{"title":"Moral Development - Kohlberg","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s16","snippet":"Moral Development - Kohlberg Figure 23 - Kohlberg's Stages of Moral Development. Three levels (preconventional, conventional, postconventional) encompass six stages of progressively more sophisticated moral reasoning. Most adults operate at the conventional level (stages 3 to 4); postconventional re...","sourceLabel":"Section in Behavioral Science"},"2397":{"title":"Mature Defense Mechanisms","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s17","snippet":"Mature Defense Mechanisms Defense mechanisms are unconscious psychological strategies used by the ego to manage anxiety arising from conflicts among the id, superego, and external reality. George Vaillant (1977) classified defense mechanisms into a hierarchy from immature/psychotic to mature. Mature...","sourceLabel":"Section in Behavioral Science"},"2398":{"title":"Neurotic & Immature Defense Mechanisms","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s18","snippet":"Neurotic & Immature Defense Mechanisms Neurotic defenses are common in everyday life and in neurotic disorders (anxiety, OCD, depression). They distort internal feelings or external reality but generally maintain some connection to reality. Immature defenses are characteristic of personality disorde...","sourceLabel":"Section in Behavioral Science"},"2399":{"title":"Coping Strategies & Stress Response","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s19","snippet":"Coping Strategies & Stress Response While defense mechanisms operate unconsciously, coping strategies are conscious, deliberate efforts to manage stressful situations. The dominant framework is Lazarus and Folkman's transactional model of stress and coping (1984), which views stress as resulting fro...","sourceLabel":"Section in Behavioral Science"},"2400":{"title":"K&uuml;bler-Ross Model & Normal Grief","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s20","snippet":"K&uuml;bler-Ross Model & Normal Grief Elisabeth K&uuml;bler-Ross introduced the five stages of grief in On Death and Dying (1969), based on her interviews with terminally ill patients. Originally describing the emotional journey of the dying person, the model has been broadly (and sometimes imprecis...","sourceLabel":"Section in Behavioral Science"},"2401":{"title":"Complicated / Prolonged Grief","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s21","snippet":"Complicated / Prolonged Grief Prolonged Grief Disorder (PGD) was introduced in the DSM-5-TR (2022) as a new diagnostic entity, distinct from both MDD and PTSD. It affects approximately 7-10% of bereaved individuals (higher rates after sudden, violent, or unexpected deaths). DSM-5-TR Diagnostic Crite...","sourceLabel":"Section in Behavioral Science"},"2402":{"title":"End-of-Life Communication & Palliative Perspectives","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s22","snippet":"End-of-Life Communication & Palliative Perspectives Advance Directives Advance directives are legal documents that allow competent adults to specify their healthcare preferences in case they lose decisional capacity. Two main types: (1) Living will - a written statement specifying which medical inte...","sourceLabel":"Section in Behavioral Science"},"2403":{"title":"Classical Conditioning","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s23","snippet":"Classical Conditioning Classical (Pavlovian) conditioning , discovered by Ivan Pavlov in the 1890s through his research on canine salivation, is a form of associative learning in which a neutral stimulus acquires the ability to elicit a response after being repeatedly paired with an unconditioned st...","sourceLabel":"Section in Behavioral Science"},"2404":{"title":"Operant Conditioning","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s24","snippet":"Operant Conditioning Operant (instrumental) conditioning , systematized by B.F. Skinner (1938), is learning in which behavior is shaped by its consequences. Behaviors followed by favorable consequences are strengthened (more likely to recur); behaviors followed by unfavorable consequences are weaken...","sourceLabel":"Section in Behavioral Science"},"2405":{"title":"Cognitive-Behavioral Theory & Applications","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s25","snippet":"Cognitive-Behavioral Theory & Applications Cognitive-behavioral therapy (CBT) is based on the principle that psychological distress results from dysfunctional cognitions (thoughts) that can be identified, evaluated, and modified to improve emotional and behavioral functioning. CBT integrates Aaron B...","sourceLabel":"Section in Behavioral Science"},"2406":{"title":"Cultural Competency & Health Equity","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s26","snippet":"Cultural Competency & Health Equity Cultural Competency vs. Cultural Humility Cultural competency is the ability to effectively interact with people of different cultures, encompassing awareness of one's own cultural worldview, knowledge of different cultural practices and health beliefs, and cross-...","sourceLabel":"Section in Behavioral Science"},"2407":{"title":"Adherence & Behavior Change in Chronic Disease","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s27","snippet":"Adherence & Behavior Change in Chronic Disease Scope of the Adherence Problem The World Health Organization (2003) estimated that ~50% of patients with chronic diseases in developed countries do not take medications as prescribed. Non-adherence is responsible for an estimated 125,000 deaths and $100...","sourceLabel":"Section in Behavioral Science"},"2408":{"title":"Classification of Defense Mechanisms","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s28","snippet":"Classification of Defense Mechanisms The following table classifies defense mechanisms according to Vaillant's hierarchy, from most mature (healthiest) to most immature (most pathological). All defense mechanisms are unconscious except suppression (semi-conscious). Each mechanism functions to reduce...","sourceLabel":"Section in Behavioral Science"},"2409":{"title":"Developmental Stages Master Table","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s29","snippet":"Developmental Stages Master Table This master reference aligns the four major developmental theories by age, allowing rapid comparison of what each theorist predicts for a given developmental period. Each column represents a different theoretical lens through which the same child can be understood s...","sourceLabel":"Section in Behavioral Science"},"2410":{"title":"Abbreviations Master List","pageTitle":"Behavioral Science","pageUrl":"/psychiatry/behavioral-science","url":"/psychiatry/behavioral-science#s30","snippet":"Abbreviations Master List Abbreviation Full Term ACE Adverse childhood experience ACTH Adrenocorticotropic hormone AD Advance directive ANS Autonomic nervous system BA Behavioral activation BATHE Background, Affect, Trouble, Handling, Empathy BPD Borderline personality disorder BPS Biopsychosocial C...","sourceLabel":"Section in Behavioral Science"},"2411":{"title":"Radiology","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology","snippet":"Specialty Reference Diagnostic Radiology Complete Specialty Reference Chest X-ray, CT, MRI, ultrasound, fluoroscopy, contrast agents, radiation safety, structured reporting, and every imaging protocol, classification system, critical finding, and interpretive framework across the full scope of diagn..."},"2412":{"title":"Physics of Medical Imaging","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s1","snippet":"Physics of Medical Imaging All diagnostic imaging begins with the interaction between energy and tissue. Understanding the physics of image formation — from X-ray production to digital detection — is fundamental to selecting appropriate protocols, recognizing artifacts, and optimizing image quality ...","sourceLabel":"Section in Radiology"},"2413":{"title":"Radiation Safety & ALARA","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s2","snippet":"Radiation Safety & ALARA Ionizing radiation carries both deterministic and stochastic risks. The principle of ALARA (As Low As Reasonably Achievable) mandates that every imaging study using ionizing radiation must be justified (the benefit outweighs the risk) and optimized (the lowest dose consisten...","sourceLabel":"Section in Radiology"},"2414":{"title":"Contrast Agents — Iodinated & Gadolinium","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s3","snippet":"Contrast Agents — Iodinated & Gadolinium Iodinated Contrast Media Iodinated contrast agents are used in CT, fluoroscopy, and conventional angiography. Iodine attenuates X-rays by the photoelectric effect (Z=53). Agents are classified by osmolality and ionicity : Class Osmolality Examples Clinical No...","sourceLabel":"Section in Radiology"},"2415":{"title":"Key Terminology & Abbreviations","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s4","snippet":"Key Terminology & Abbreviations Radiographic Descriptors Radiolucent : allows X-rays to pass through, appearing dark/black on radiographs (air, fat). Radiopaque : absorbs X-rays, appearing white/bright (bone, metal, barium). Opacity : any white/bright area on radiograph — a general term avoiding pre...","sourceLabel":"Section in Radiology"},"2416":{"title":"Chest X-Ray — Systematic Approach","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s5","snippet":"Chest X-Ray — Systematic Approach Projections & Technical Adequacy The standard chest radiograph is a PA (posteroanterior) upright projection taken at 72 inches (6 feet) source-to-image distance, with the anterior chest against the detector. The AP (anteroposterior) projection (portable/bedside) pos...","sourceLabel":"Section in Radiology"},"2417":{"title":"Chest X-Ray Pathology","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s6","snippet":"Chest X-Ray Pathology Figure 5 - Pneumoperitoneum on Upright Chest Radiograph. Normal versus abnormal upright chest X-ray demonstrating subdiaphragmatic free air (pneumoperitoneum) seen as a lucent crescent beneath the hemidiaphragm, indicating bowel perforation until proven otherwise. Pneumonia Pat...","sourceLabel":"Section in Radiology"},"2418":{"title":"Chest CT — Protocols & Interpretation","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s7","snippet":"Chest CT — Protocols & Interpretation CT Chest Protocols Non-contrast CT chest : screening for lung nodules (low-dose CT — LDCT), evaluation of interstitial lung disease, assessment of emphysema severity, characterization of calcified structures. CT chest with IV contrast (standard) : soft tissue en...","sourceLabel":"Section in Radiology"},"2419":{"title":"Thoracic MRI & Special Applications","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s8","snippet":"Thoracic MRI & Special Applications Indications for Thoracic MRI MRI of the chest is reserved for specific clinical scenarios where its superior soft tissue contrast and multiplanar capability provide information beyond CT: superior sulcus (Pancoast) tumors — assessment of brachial plexus invasion, ...","sourceLabel":"Section in Radiology"},"2420":{"title":"Abdominal CT — Protocols","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s9","snippet":"Abdominal CT — Protocols CT Abdomen/Pelvis — Contrast Phases The timing of IV contrast injection relative to image acquisition is the central concept in abdominal CT protocol design. The CT abdomen/pelvis with IV contrast in the portal venous phase is the workhorse examination for most abdominal pat...","sourceLabel":"Section in Radiology"},"2421":{"title":"Hepatobiliary Imaging","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s10","snippet":"Hepatobiliary Imaging Liver Lesion Characterization — Enhancement Patterns The key to liver lesion diagnosis is the enhancement pattern across multiple contrast phases: Lesion Non-contrast Arterial Phase Portal Venous Phase Delayed Phase Key Features Hemangioma Hypodense Peripheral, discontinuous no...","sourceLabel":"Section in Radiology"},"2422":{"title":"GI & Mesenteric Imaging","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s11","snippet":"GI & Mesenteric Imaging Pancreatitis Imaging Acute pancreatitis : CT is not needed for diagnosis (clinical + lipase), but is indicated for assessing severity, complications, and alternative diagnoses. Initial CT is best performed at 72-96 hours after onset (earlier CT may underestimate necrosis). Th...","sourceLabel":"Section in Radiology"},"2423":{"title":"Renal & Urologic Imaging","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s12","snippet":"Renal & Urologic Imaging CT Urogram The CT urogram is a multiphase study for evaluation of hematuria: non-contrast phase (stones, baseline density), nephrographic phase (renal mass detection), and excretory/delayed phase (urothelial lesions, collecting system filling defects). It has replaced IV pye...","sourceLabel":"Section in Radiology"},"2424":{"title":"Pelvic Imaging — Male & Female","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s13","snippet":"Pelvic Imaging — Male & Female Ovarian Mass — O-RADS (Ovarian-Adnexal Reporting & Data System) O-RADS for MRI standardizes risk stratification of adnexal masses detected on ultrasound that require further characterization: O-RADS MRI Score Description Risk of Malignancy Management 1 Normal ovaries, ...","sourceLabel":"Section in Radiology"},"2425":{"title":"Brain CT & Emergencies","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s14","snippet":"Brain CT & Emergencies Acute Stroke — CT Findings Non-contrast CT head is the initial study in acute stroke to exclude hemorrhage before thrombolysis. Early ischemic signs (within 6 hours): hyperdense MCA sign (thrombus in the MCA appearing bright white — 30-40% sensitivity), insular ribbon sign (lo...","sourceLabel":"Section in Radiology"},"2426":{"title":"Brain MRI — Sequences & Pathology","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s15","snippet":"Brain MRI — Sequences & Pathology MRI Sequences — What Each Shows Sequence Key Principle Bright Signal (Hyperintense) Dark Signal (Hypointense) Primary Use T1-weighted Short TR, short TE; reflects T1 relaxation Fat, subacute blood (methemoglobin), gadolinium, melanin, proteinaceous fluid Water/CSF, ...","sourceLabel":"Section in Radiology"},"2427":{"title":"Spine Imaging","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s16","snippet":"Spine Imaging Figure 30 - Lumbar Disc Herniation on MRI. Sagittal T2-weighted MRI demonstrating lumbar disc herniation with disc height assessment, comparing normal disc height versus decreased height at the level of herniation. Loss of T2 signal (disc desiccation) indicates degenerative change. Dis...","sourceLabel":"Section in Radiology"},"2428":{"title":"Head & Neck Imaging","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s17","snippet":"Head & Neck Imaging Vascular Imaging of the Head & Neck CTA head and neck is the primary modality for evaluating the intracranial and extracranial vasculature in the acute setting. Indications: acute stroke (identify large vessel occlusion for thrombectomy), carotid stenosis (NASCET criteria: % sten...","sourceLabel":"Section in Radiology"},"2429":{"title":"Fracture Imaging & Classifications","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s18","snippet":"Fracture Imaging & Classifications Radiography is the primary imaging study for suspected fractures. Key principles: obtain at least two orthogonal views (AP and lateral); include the joint above and below the fracture site; describe fracture location (diaphysis, metaphysis, epiphysis), type (transv...","sourceLabel":"Section in Radiology"},"2430":{"title":"Joint & Soft Tissue Imaging","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s19","snippet":"Joint & Soft Tissue Imaging MRI is the primary modality for evaluating internal derangement of joints, soft tissue masses, and inflammatory arthropathies. The combination of multiplanar capability, superior soft tissue contrast, and absence of ionizing radiation makes MRI indispensable in musculoske...","sourceLabel":"Section in Radiology"},"2431":{"title":"Bone Tumors & Metabolic Bone Disease","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s20","snippet":"Bone Tumors & Metabolic Bone Disease Bone Tumors — Age-Location Matrix The combination of patient age and tumor location within bone narrows the differential diagnosis significantly: Tumor Age Peak Location in Bone Preferred Bone Key Imaging Feature Osteosarcoma 10-20 (primary); >60 (Paget-associate...","sourceLabel":"Section in Radiology"},"2432":{"title":"Mammography & Screening","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s21","snippet":"Mammography & Screening BI-RADS (Breast Imaging Reporting & Data System) The ACR BI-RADS system standardizes mammographic reporting and provides management recommendations: BI-RADS Categories — Complete Enumeration BI-RADS 0 (Incomplete): Additional imaging needed — spot compression, magnification v...","sourceLabel":"Section in Radiology"},"2433":{"title":"Breast MRI & Interventional","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s22","snippet":"Breast MRI & Interventional Breast MRI Indications ACR-recommended indications for breast MRI: high-risk screening (&ge;20% lifetime risk — BRCA carriers, first-degree relatives of BRCA carriers, prior chest radiation ages 10-30, Li-Fraumeni syndrome); extent of disease assessment in newly diagnosed...","sourceLabel":"Section in Radiology"},"2434":{"title":"Pediatric-Specific Imaging","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s23","snippet":"Pediatric-Specific Imaging Image Gently — Principles Children are more radiosensitive than adults (rapidly dividing cells, longer remaining life expectancy for stochastic effects to manifest). Pediatric CT dose should be reduced by 25-50% compared to adult protocols. The four pillars: child-size the...","sourceLabel":"Section in Radiology"},"2435":{"title":"Pediatric Chest & Airway","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s24","snippet":"Pediatric Chest & Airway Croup (Laryngotracheobronchitis) AP neck radiograph shows the steeple sign — symmetric subglottic narrowing of the trachea creating a pointed configuration (normally the subglottis has squared-off \"shoulders\" due to the cricoid cartilage). The lateral view shows a distended ...","sourceLabel":"Section in Radiology"},"2436":{"title":"Radiology Report Structure","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s25","snippet":"Radiology Report Structure Structured Reporting — Essential Components The radiology report is the primary product of the radiologist. ACR Practice Parameters specify the following components: Radiology Report Components Clinical Information: Relevant history, indication for the study, and specific ...","sourceLabel":"Section in Radiology"},"2437":{"title":"Image-Guided Procedures","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s26","snippet":"Image-Guided Procedures Fluoroscopic Procedures Upper GI series : barium swallow evaluates the esophagus (strictures, webs, Schatzki ring, achalasia — \"bird beak\" tapering, Zenker diverticulum) and stomach (ulcers, masses, hiatal hernia). Small bowel follow-through : serial images of barium transit ...","sourceLabel":"Section in Radiology"},"2438":{"title":"Classification Systems Master Table","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s27","snippet":"How to Use Classification Systems Effectively Standardized reporting systems accomplish three goals: they ensure consistent language across radiologists, provide evidence-based risk stratification, and include built-in management recommendations. Always include the system name and version (e.g., \"BI...","sourceLabel":"Section in Radiology"},"2439":{"title":"CT Protocols Quick Reference","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s28","snippet":"CT Protocols Quick Reference Clinical Indication Protocol Contrast Phase / Timing Key Notes Pulmonary embolism CTPA IV — bolus tracking in PA Pulmonary arterial (~15-20 s) ECG gating not required; look for filling defects + RV strain Aortic dissection / traumatic aortic injury CTA chest IV — bolus t...","sourceLabel":"Section in Radiology"},"2440":{"title":"Normal Measurements & Values","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s29","snippet":"Normal Measurements & Values Knowledge of normal measurements and thresholds is essential for identifying pathology on imaging. The following tables provide reference values for the most commonly measured structures. Measurements should be made using standardized techniques (e.g., outer wall to oute...","sourceLabel":"Section in Radiology"},"2441":{"title":"Abbreviations Master List","pageTitle":"Radiology","pageUrl":"/diagnostic/radiology","url":"/diagnostic/radiology#s30","snippet":"Abbreviations Master List Abbreviation Full Term AAA Abdominal aortic aneurysm ACR American College of Radiology ADC Apparent diffusion coefficient ALARA As low as reasonably achievable AML Angiomyolipoma AP Anteroposterior APHE Arterial phase hyperenhancement ASPECTS Alberta Stroke Program Early CT...","sourceLabel":"Section in Radiology"},"2442":{"title":"Pathology","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology","snippet":"Specialty Reference Pathology Complete Specialty Reference Surgical pathology, cytopathology, hematopathology, molecular diagnostics, autopsy, clinical chemistry, immunohistochemistry, frozen sections, and every grading system, staining technique, diagnostic criterion, and laboratory method across t..."},"2443":{"title":"Tissue Processing & Histology","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s1","snippet":"Tissue Processing & Histology Specimen Fixation The first and most critical step in histologic processing is fixation , which preserves tissue morphology by cross-linking proteins and preventing autolysis. The universal standard fixative is 10% neutral buffered formalin (NBF) , a 4% aqueous solution...","sourceLabel":"Section in Pathology"},"2444":{"title":"Special Stains & Their Targets","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s2","snippet":"Special Stains & Their Targets Special stains exploit the chemical properties of tissue components to highlight structures not visible on routine H&E. Each stain has specific targets, characteristic colors, and defined clinical applications. Figure 3 - Masson Trichrome Stain - Hepatic Fibrosis. Dens...","sourceLabel":"Section in Pathology"},"2445":{"title":"Immunohistochemistry — Principles & Key Markers","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s3","snippet":"Immunohistochemistry — Principles & Key Markers IHC Technique Immunohistochemistry (IHC) uses antibodies to detect specific protein antigens in tissue sections. The basic steps are: (1) antigen retrieval — heat-induced epitope retrieval (HIER) using citrate buffer (pH 6) or EDTA buffer (pH 9), or en...","sourceLabel":"Section in Pathology"},"2446":{"title":"Key Terminology & Abbreviations","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s4","snippet":"Key Terminology & Abbreviations Fundamental Pathology Terms Hyperplasia — increase in cell number (reversible). Hypertrophy — increase in cell size. Atrophy — decrease in cell size or number. Metaplasia — reversible replacement of one differentiated cell type by another (e.g., squamous metaplasia in...","sourceLabel":"Section in Pathology"},"2447":{"title":"Specimen Handling & Grossing","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s5","snippet":"Specimen Handling & Grossing Specimen Orientation & Inking Proper orientation of surgical specimens is essential for accurate margin assessment. Surgeons mark specimens with sutures, clips, or designated inks: a common convention is short suture = superior, long suture = lateral. The pathology assis...","sourceLabel":"Section in Pathology"},"2448":{"title":"Breast Pathology","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s6","snippet":"Breast Pathology Ductal Carcinoma In Situ (DCIS) DCIS is a neoplastic proliferation of malignant epithelial cells confined to the ductal system without invasion through the basement membrane. Architectural patterns include: comedo (central necrosis with calcification), cribriform (punched-out spaces...","sourceLabel":"Section in Pathology"},"2449":{"title":"GI Pathology","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s7","snippet":"GI Pathology Gynecologic Pathology — Endometrial & Ovarian Endometrial carcinoma is classified by the dualistic model: Type I (endometrioid) — 80% of cases, grade 1-3 by FIGO (grade 1: &le;5% solid, grade 2: 6-50% solid, grade 3: >50% solid); ER/PR positive, associated with estrogen excess, obesity,...","sourceLabel":"Section in Pathology"},"2450":{"title":"Pulmonary Pathology","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s8","snippet":"Pulmonary Pathology Lung Carcinoma — WHO Classification Adenocarcinoma (40% of lung cancers) — the most common histologic type, typically peripheral. Classified by predominant pattern: lepidic (growth along alveolar walls without invasion — formerly BAC), acinar (gland-forming), papillary , micropap...","sourceLabel":"Section in Pathology"},"2451":{"title":"Dermatopathology","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s9","snippet":"Dermatopathology Melanoma Figure 29 - Cutaneous Melanoma - Gross Appearance. An asymmetric, irregularly bordered pigmented lesion with color variation (the ABCDE criteria: Asymmetry, Border irregularity, Color variation, Diameter greater than 6 mm, Evolving). Breslow thickness measured on histologic...","sourceLabel":"Section in Pathology"},"2452":{"title":"Cervical Cytology — Pap Smear (Bethesda System)","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s10","snippet":"Cervical Cytology — Pap Smear (Bethesda System) The Bethesda System for Reporting Cervical Cytology (TBS, 3rd edition 2014) standardizes cervical Pap smear reporting into the following categories: Figure 30 - Cervical Dysplasia (CIN) vs. Normal Epithelium (H&E). High-power comparison of dysplastic c...","sourceLabel":"Section in Pathology"},"2453":{"title":"Fine Needle Aspiration — Thyroid (Bethesda System)","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s11","snippet":"Fine Needle Aspiration — Thyroid (Bethesda System) The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) , 3rd edition (2023), classifies thyroid FNA results into six diagnostic categories, each with an implied risk of malignancy (ROM) and recommended management: Bethesda System for Thyro...","sourceLabel":"Section in Pathology"},"2454":{"title":"Non-Gynecologic Cytology","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s12","snippet":"Non-Gynecologic Cytology Figure 31 - Psammoma Bodies in Ovarian Serous Carcinoma (H&E). Concentric laminated calcified structures (psammoma bodies) within papillary architecture of ovarian serous carcinoma. Psammoma bodies are also found in papillary thyroid carcinoma, meningiomas, and mesotheliomas...","sourceLabel":"Section in Pathology"},"2455":{"title":"Peripheral Blood Smear & CBC","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s13","snippet":"Peripheral Blood Smear & CBC Figure 32 - Schistocytes (Fragmented RBCs) on Peripheral Blood Smear. Multiple helmet cells and triangular red cell fragments (schistocytes) indicating mechanical hemolysis. Greater than 1% schistocytes is clinically significant and raises suspicion for TTP/HUS, DIC, mec...","sourceLabel":"Section in Pathology"},"2456":{"title":"Bone Marrow Evaluation","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s14","snippet":"Bone Marrow Evaluation Aspiration vs. Biopsy The bone marrow aspirate provides material for: morphologic assessment on smear (cell counts, blast percentage, dysplasia), flow cytometry (immunophenotyping), cytogenetics (karyotype), molecular studies (PCR, NGS), and iron stain. The bone marrow trephin...","sourceLabel":"Section in Pathology"},"2457":{"title":"Lymphoma Classification — WHO","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s15","snippet":"Lymphoma Classification — WHO Hodgkin Lymphoma (HL) Figure 37 - Reed-Sternberg Cells in Hodgkin Lymphoma (H&E). Large binucleated Reed-Sternberg cells with prominent eosinophilic nucleoli giving the classic owl-eye appearance, surrounded by a mixed inflammatory background of lymphocytes, eosinophils...","sourceLabel":"Section in Pathology"},"2458":{"title":"Leukemia Classification","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s16","snippet":"Leukemia Classification Acute Myeloid Leukemia (AML) — WHO 5th Edition AML is defined by &ge;20% myeloid blasts in blood or marrow, except for AML with defining genetic abnormalities (which can be diagnosed regardless of blast count). Major categories: AML with Defining Genetic Abnormalities Genetic...","sourceLabel":"Section in Pathology"},"2459":{"title":"PCR & Sequencing","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s17","snippet":"PCR & Sequencing Polymerase Chain Reaction (PCR) Conventional PCR amplifies a specific DNA target using primers flanking the region of interest, Taq polymerase, and thermal cycling (denaturation 95&deg;C, annealing 50-65&deg;C, extension 72&deg;C). Product is visualized by gel electrophoresis. Used ...","sourceLabel":"Section in Pathology"},"2460":{"title":"FISH & Cytogenetics","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s18","snippet":"FISH & Cytogenetics Fluorescence In Situ Hybridization (FISH) FISH uses fluorescently labeled DNA probes that hybridize to complementary sequences on chromosomes or tissue sections. Probe types: break-apart probes (two differently colored probes flank a gene; separation indicates rearrangement — use...","sourceLabel":"Section in Pathology"},"2461":{"title":"Companion Diagnostics & Precision Medicine","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s19","snippet":"Companion Diagnostics & Precision Medicine PD-L1 Scoring PD-L1 (programmed death-ligand 1) expression by IHC guides immune checkpoint inhibitor therapy. Two major scoring methods: Tumor Proportion Score (TPS) — percentage of viable tumor cells with partial or complete membrane PD-L1 staining (used i...","sourceLabel":"Section in Pathology"},"2462":{"title":"Clinical Chemistry","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s20","snippet":"Clinical Chemistry Comprehensive Metabolic Panel (CMP) Interpretation Sodium (Na+) — 136-145 mEq/L; hyponatremia (<135): SIADH, heart failure, cirrhosis, thiazide diuretics, adrenal insufficiency; hypernatremia (>145): diabetes insipidus, dehydration, osmotic diuresis. Potassium (K+) — 3.5-5.0 mEq/L...","sourceLabel":"Section in Pathology"},"2463":{"title":"Coagulation & Transfusion Medicine","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s21","snippet":"Coagulation & Transfusion Medicine Coagulation Cascade — Laboratory Correlates PT (prothrombin time) / INR — measures the extrinsic pathway (factor VII) and the common pathway (factors X, V, II/prothrombin, fibrinogen). Normal PT 11-13.5 seconds; INR 0.8-1.1. Prolonged by: warfarin (targets vitamin ...","sourceLabel":"Section in Pathology"},"2464":{"title":"Microbiology & Point-of-Care","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s22","snippet":"Microbiology & Point-of-Care Gram Stain Interpretation The Gram stain is the most important rapid diagnostic tool in microbiology. Gram-positive organisms (thick peptidoglycan wall retains crystal violet) appear purple/blue : cocci in clusters (Staphylococcus), cocci in chains (Streptococcus), cocci...","sourceLabel":"Section in Pathology"},"2465":{"title":"Autopsy Pathology","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s23","snippet":"Autopsy Pathology Renal Pathology — Overview Renal biopsies require a coordinated approach: tissue is divided for light microscopy (H&E, PAS, trichrome, silver stain — Jones methenamine silver highlights basement membranes), immunofluorescence (IF) (fresh/frozen tissue stained with fluorescent antib...","sourceLabel":"Section in Pathology"},"2466":{"title":"Quality Assurance & Laboratory Accreditation","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s24","snippet":"Quality Assurance & Laboratory Accreditation CAP Accreditation & CLIA The College of American Pathologists (CAP) laboratory accreditation program is the gold standard, accepted by CMS as equivalent to CLIA inspection. CLIA (Clinical Laboratory Improvement Amendments, 1988) regulates all clinical lab...","sourceLabel":"Section in Pathology"},"2467":{"title":"Grading & Staging Systems","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s25","snippet":"Grading & Staging Systems Nottingham Histologic Grade — Breast See section 6 for full enumeration. Summary: 3 components (tubule formation, nuclear pleomorphism, mitotic count) scored 1-3 each. Total 3-5 = Grade 1; 6-7 = Grade 2; 8-9 = Grade 3. Gleason Grading — Prostate The Gleason grading system a...","sourceLabel":"Section in Pathology"},"2468":{"title":"IHC Marker Reference Table","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s26","snippet":"IHC Marker Reference Table Tumor Type / Category Positive Markers Negative Markers Lung adenocarcinoma TTF-1, Napsin A, CK7 CK20, p40, CK5/6 Lung squamous cell carcinoma p40, p63, CK5/6 TTF-1, Napsin A Small cell lung carcinoma Synaptophysin, chromogranin, CD56, TTF-1, Ki-67 >80% CK5/6, p40 Breast —...","sourceLabel":"Section in Pathology"},"2469":{"title":"Normal Laboratory Values","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s27","snippet":"Normal Laboratory Values Complete Blood Count (CBC) Analyte Reference Range (Adult) Units WBC 4,500-11,000 /&micro;L RBC (male) 4.5-5.5 &times;10&sup6;/&micro;L RBC (female) 4.0-5.0 &times;10&sup6;/&micro;L Hemoglobin (male) 13.5-17.5 g/dL Hemoglobin (female) 12.0-16.0 g/dL Hematocrit (male) 38.3-48...","sourceLabel":"Section in Pathology"},"2470":{"title":"Abbreviations Master List","pageTitle":"Pathology","pageUrl":"/diagnostic/pathology","url":"/diagnostic/pathology#s28","snippet":"Abbreviations Master List Abbreviation Meaning AFB Acid-fast bacilli AGC Atypical glandular cells AIS Adenocarcinoma in situ ALCL Anaplastic large cell lymphoma ALL Acute lymphoblastic leukemia AML Acute myeloid leukemia APL Acute promyelocytic leukemia aPTT Activated partial thromboplastin time ASC...","sourceLabel":"Section in Pathology"},"2471":{"title":"Anesthesiology","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology","snippet":"Specialty Reference Anesthesiology Complete Specialty Reference Pre-operative evaluation, airway management, general and regional anesthesia, pharmacology of anesthetic agents, hemodynamic monitoring, pain management, and every classification system, drug dosing protocol, and management algorithm ac..."},"2472":{"title":"Airway Anatomy & Physiology","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s1","snippet":"Airway Anatomy & Physiology Upper Airway Anatomy The upper airway extends from the nares and oral cavity to the laryngeal inlet. The nasal cavity is lined with highly vascular mucosa (Kiesselbach plexus on the anterior septum is the most common site of epistaxis) and warms, humidifies, and filters i...","sourceLabel":"Section in Anesthesiology"},"2473":{"title":"Cardiovascular Physiology for Anesthesia","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s2","snippet":"Cardiovascular Physiology for Anesthesia Frank-Starling Mechanism The Frank-Starling law states that the force of ventricular contraction increases with increasing preload (end-diastolic volume) up to a physiologic limit, because stretching sarcomeres to optimal length improves actin-myosin overlap....","sourceLabel":"Section in Anesthesiology"},"2474":{"title":"Pharmacokinetics & Pharmacodynamics","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s3","snippet":"Pharmacokinetics & Pharmacodynamics Compartment Models Anesthetic drug distribution is modeled using multi-compartment pharmacokinetics. In a one-compartment model , the drug distributes instantaneously throughout a single homogeneous volume; elimination follows first-order kinetics with a single ha...","sourceLabel":"Section in Anesthesiology"},"2475":{"title":"Key Terminology & Abbreviations","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s4","snippet":"Key Terminology & Abbreviations Term Definition General anesthesia Drug-induced loss of consciousness with loss of protective reflexes, including inability to maintain airway independently MAC (monitored anesthesia care) Anesthesia team provides sedation, analgesia, and monitoring while patient brea...","sourceLabel":"Section in Anesthesiology"},"2476":{"title":"ASA Physical Status Classification","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s5","snippet":"ASA Physical Status Classification The ASA Physical Status Classification System , developed by the American Society of Anesthesiologists, is a subjective assessment of a patient's overall health status before surgery. It is the single most widely used preoperative risk stratification tool and is do...","sourceLabel":"Section in Anesthesiology"},"2477":{"title":"Preoperative Assessment","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s6","snippet":"Preoperative Assessment Cardiovascular Risk Assessment - ACC/AHA Stepwise Approach The 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management provides a stepwise algorithm for non-cardiac surgery: ACC/AHA Stepwise Approach Step 1: Is the surgery emergent? If yes &rarr; proc...","sourceLabel":"Section in Anesthesiology"},"2478":{"title":"Airway Assessment","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s7","snippet":"Airway Assessment Mallampati Classification The modified Mallampati classification is assessed with the patient sitting upright, mouth open maximally, tongue protruded, without phonation. It predicts the relative size of the tongue to the pharynx and correlates with difficulty of laryngoscopy. Class...","sourceLabel":"Section in Anesthesiology"},"2479":{"title":"Medication Management - Perioperative","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s8","snippet":"Medication Management - Perioperative Anticoagulants - Hold Times & Bridging Drug Hold Before Surgery Bridging Consideration Warfarin 5 days (target INR &le;1.5) Bridge with LMWH if high thrombotic risk (mechanical mitral valve, recent VTE <3 months, CHA₂DS₂-VASc &ge;7); no bridging for low risk (AF...","sourceLabel":"Section in Anesthesiology"},"2480":{"title":"Induction Agents","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s9","snippet":"Induction Agents Agent Mechanism Induction Dose (IV) Onset Duration Advantages Adverse Effects / Pearls Propofol GABA A receptor potentiation 1.5-2.5 mg/kg 30-40 sec 5-10 min Rapid, smooth induction; antiemetic properties; decreases ICP; pleasant emergence Hypotension (decreased SVR and myocardial d...","sourceLabel":"Section in Anesthesiology"},"2481":{"title":"Volatile Anesthetics","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s10","snippet":"Volatile Anesthetics Volatile (inhaled) anesthetics are halogenated ethers (except N₂O) that provide all components of general anesthesia: amnesia, unconsciousness, immobility, and some analgesia. They are administered via calibrated vaporizers (except desflurane, which requires a heated pressurized...","sourceLabel":"Section in Anesthesiology"},"2482":{"title":"Neuromuscular Blocking Agents","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s11","snippet":"Neuromuscular Blocking Agents Figure 10 - Neuromuscular Junction Physiology. The mechanism of neuromuscular transmission: acetylcholine is synthesized and stored in vesicles at the motor nerve terminal, released into the synaptic cleft upon nerve depolarization, and binds to nicotinic receptors on t...","sourceLabel":"Section in Anesthesiology"},"2483":{"title":"Opioids in Anesthesia","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s12","snippet":"Opioids in Anesthesia Opioids are the primary analgesic agents in anesthesia, acting at mu (&mu;), kappa (&kappa;), and delta (&delta;) receptors in the CNS and periphery. Mu-receptor activation produces analgesia, euphoria, respiratory depression, miosis, decreased GI motility, and physical depende...","sourceLabel":"Section in Anesthesiology"},"2484":{"title":"Airway Management Techniques","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s13","snippet":"Airway Management Techniques Mask Ventilation Bag-mask ventilation (BMV) is the foundational airway skill. The jaw thrust (bilateral mandibular angles lifted anteriorly) and chin lift displace the tongue from the posterior pharynx. Oral airways (Guedel) are sized from the corner of the mouth to the ...","sourceLabel":"Section in Anesthesiology"},"2485":{"title":"Local Anesthetics","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s14","snippet":"Local Anesthetics Mechanism of Action Local anesthetics (LAs) reversibly block voltage-gated sodium channels from the intracellular side, preventing sodium influx, depolarization, and action potential propagation. They preferentially block small, myelinated (A&delta; - pain, temperature) and unmyeli...","sourceLabel":"Section in Anesthesiology"},"2486":{"title":"Neuraxial Anesthesia - Spinal & Epidural","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s15","snippet":"Neuraxial Anesthesia - Spinal & Epidural Figure 13 - Vertebral Anatomy for Neuraxial Anesthesia. Cross-sectional view showing the layers traversed during neuraxial needle placement: skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space, dura mater...","sourceLabel":"Section in Anesthesiology"},"2487":{"title":"Peripheral Nerve Blocks - Upper Extremity","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s16","snippet":"Peripheral Nerve Blocks - Upper Extremity Brachial Plexus Anatomy The brachial plexus is formed by the ventral rami of C5-T1 and follows the mnemonic R obert T aylor D rinks C old B eer - Roots, Trunks, Divisions, Cords, Branches: Level Components Location Roots C5, C6, C7, C8, T1 Exit intervertebra...","sourceLabel":"Section in Anesthesiology"},"2488":{"title":"Peripheral Nerve Blocks - Lower Extremity & Truncal","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s17","snippet":"Peripheral Nerve Blocks - Lower Extremity & Truncal Lower Extremity Blocks Block Target Nerve(s) Indication Technique / Pearls Femoral nerve block Femoral nerve (L2-L4) Anterior thigh, knee (TKA, ACL repair), femur fracture Ultrasound: nerve is lateral to femoral artery below inguinal ligament. Prov...","sourceLabel":"Section in Anesthesiology"},"2489":{"title":"Standard ASA Monitors","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s18","snippet":"Standard ASA Monitors The ASA Standards for Basic Anesthetic Monitoring (last affirmed 2020) mandate monitoring of oxygenation , ventilation , circulation , and temperature during all anesthetics. A qualified anesthesia provider must be continuously present. Oxygenation Pulse oximetry (SpO₂) is mand...","sourceLabel":"Section in Anesthesiology"},"2490":{"title":"Invasive Monitoring","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s19","snippet":"Invasive Monitoring Goal-Directed Fluid Therapy (GDFT) Rather than relying on fixed formulas, goal-directed fluid therapy uses dynamic hemodynamic parameters to guide individual fluid administration. Static parameters (CVP, PCWP) are poor predictors of fluid responsiveness. Dynamic parameters includ...","sourceLabel":"Section in Anesthesiology"},"2491":{"title":"Fluid Management & Transfusion","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s20","snippet":"Fluid Management & Transfusion Crystalloids vs. Colloids Crystalloids are electrolyte solutions that distribute freely across the extracellular space. Approximately 25% of infused crystalloid remains intravascular after 30 minutes (the rest shifts to the interstitium). Balanced crystalloids - lactat...","sourceLabel":"Section in Anesthesiology"},"2492":{"title":"Malignant Hyperthermia","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s21","snippet":"Malignant Hyperthermia Pathophysiology Malignant hyperthermia (MH) is a pharmacogenetic syndrome triggered by exposure to volatile anesthetic agents (sevoflurane, desflurane, isoflurane, halothane) and/or succinylcholine in genetically susceptible individuals. The defect is most commonly an autosoma...","sourceLabel":"Section in Anesthesiology"},"2493":{"title":"Anaphylaxis in the OR","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s22","snippet":"Anaphylaxis in the OR Common Triggers Perioperative anaphylaxis occurs in approximately 1:10,000-1:20,000 anesthetics. The most common triggers are: neuromuscular blocking agents (~60% of cases - particularly rocuronium and succinylcholine, due to quaternary ammonium cross-reactivity), antibiotics (...","sourceLabel":"Section in Anesthesiology"},"2494":{"title":"Perioperative Cardiac Events","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s23","snippet":"Perioperative Cardiac Events Intraoperative Myocardial Ischemia / Infarction Intraoperative STEMI/NSTEMI may present as new ST elevation/depression &ge;1 mm on ECG monitor, new regional wall motion abnormality on TEE, hemodynamic instability (hypotension, new arrhythmia), or elevated troponin postop...","sourceLabel":"Section in Anesthesiology"},"2495":{"title":"Acute Postoperative Pain","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s24","snippet":"Acute Postoperative Pain Multimodal Analgesia Modern postoperative pain management uses a multimodal approach - combining agents with different mechanisms to optimize analgesia while minimizing opioid consumption and side effects. This is a core principle of Enhanced Recovery After Surgery (ERAS) pr...","sourceLabel":"Section in Anesthesiology"},"2496":{"title":"Chronic Pain Fundamentals","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s25","snippet":"Chronic Pain Fundamentals Pain Classification Nociceptive pain results from activation of peripheral nociceptors by tissue damage (somatic = well-localized, sharp/aching from skin, muscle, bone; visceral = diffuse, cramping from internal organs). Neuropathic pain arises from damage or dysfunction of...","sourceLabel":"Section in Anesthesiology"},"2497":{"title":"Interventional Pain Procedures","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s26","snippet":"Interventional Pain Procedures Anticoagulation & Neuraxial/Regional Anesthesia Timing The ASRA (American Society of Regional Anesthesia and Pain Medicine) guidelines provide evidence-based timing recommendations for neuraxial and deep peripheral blocks relative to anticoagulant administration: Antic...","sourceLabel":"Section in Anesthesiology"},"2498":{"title":"Obstetric Anesthesia","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s27","snippet":"Obstetric Anesthesia Physiologic Changes of Pregnancy Pregnancy produces profound physiologic changes relevant to anesthesia: System Change Anesthetic Implication Respiratory Decreased FRC (20%), increased oxygen consumption (20%), increased minute ventilation (50%), decreased PaCO₂ to 30 mmHg Rapid...","sourceLabel":"Section in Anesthesiology"},"2499":{"title":"Pediatric Anesthesia","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s28","snippet":"Pediatric Anesthesia Weight-Based Dosing & Equipment Sizing Pediatric drug dosing is universally weight-based (mg/kg or mcg/kg). ETT sizing: cuffed ETT (now preferred even in young children): internal diameter (mm) = (age in years / 4) + 3.5 for cuffed tubes. For uncuffed ETT (historically used in c...","sourceLabel":"Section in Anesthesiology"},"2500":{"title":"Geriatric & High-Risk Patients","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s29","snippet":"Geriatric & High-Risk Patients Pharmacokinetic Changes with Aging The elderly demonstrate decreased hepatic blood flow (by ~40%) and reduced Phase I metabolism (CYP450), leading to prolonged elimination of midazolam, fentanyl, and propofol. Decreased renal function (GFR declines ~1 mL/min/year after...","sourceLabel":"Section in Anesthesiology"},"2501":{"title":"Drug Dosing Master Table","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s30","snippet":"Drug Dosing Master Table Induction Agents Drug IV Induction Dose Onset Duration Propofol 1.5-2.5 mg/kg 30-40 sec 5-10 min Etomidate 0.2-0.3 mg/kg 30-60 sec 3-5 min Ketamine 1-2 mg/kg IV; 4-6 mg/kg IM 30-60 sec IV 10-20 min Midazolam (co-induction) 0.01-0.05 mg/kg 1-3 min 15-30 min Thiopental 3-5 mg/...","sourceLabel":"Section in Anesthesiology"},"2502":{"title":"Classification Systems","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s31","snippet":"Classification Systems ASA Physical Status Classification Class Definition ASA I Normal healthy patient ASA II Mild systemic disease, no functional limitation ASA III Severe systemic disease, substantive functional limitation ASA IV Severe systemic disease, constant threat to life ASA V Moribund, no...","sourceLabel":"Section in Anesthesiology"},"2503":{"title":"Abbreviations Master List","pageTitle":"Anesthesiology","pageUrl":"/diagnostic/anesthesiology","url":"/diagnostic/anesthesiology#s32","snippet":"Abbreviations Master List Abbreviation Meaning ABG Arterial blood gas ACLS Advanced cardiac life support AFOI Awake fiberoptic intubation AKI Acute kidney injury ARDS Acute respiratory distress syndrome ARISCAT Assess Respiratory Risk in Surgical Patients in Catalonia ASA American Society of Anesthe...","sourceLabel":"Section in Anesthesiology"},"2504":{"title":"Nuclear Medicine","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine","snippet":"Specialty Reference Nuclear Medicine Complete Specialty Reference PET/CT, SPECT, thyroid scintigraphy, cardiac stress testing, bone scans, radiopharmaceuticals, theranostics, radiation safety, and every imaging protocol, uptake pattern, radiopharmaceutical agent, and interpretive framework across th..."},"2505":{"title":"Nuclear Physics & Radioactive Decay","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s1","snippet":"Nuclear Physics & Radioactive Decay Nuclear medicine exploits the spontaneous transformation of unstable atomic nuclei to produce radiation that can be detected externally for imaging or deposited locally for therapy. Understanding the basic physics of radioactive decay, the properties of emitted pa...","sourceLabel":"Section in Nuclear Medicine"},"2506":{"title":"Radiation Detection & Imaging Systems","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s2","snippet":"Radiation Detection & Imaging Systems The Gamma Camera (Anger Camera) The gamma camera , invented by Hal Anger in 1958, remains the primary imaging device for single-photon emitting radionuclides. Its components, in order from patient to output, are: (1) collimator - a lead plate with holes that sel...","sourceLabel":"Section in Nuclear Medicine"},"2507":{"title":"Radiation Safety & Regulatory","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s3","snippet":"Radiation Safety & Regulatory Regulatory Framework In the United States, the Nuclear Regulatory Commission (NRC) regulates the medical use of byproduct material under 10 CFR Part 35. Individual states may become \"Agreement States\" and assume regulatory authority. The NRC defines categories of author...","sourceLabel":"Section in Nuclear Medicine"},"2508":{"title":"Key Terminology & Abbreviations","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s4","snippet":"Key Terminology & Abbreviations Nuclear medicine uses a specialized vocabulary drawn from physics, radiochemistry, and clinical medicine. This section provides the essential terms needed to navigate the discipline. Term Definition Activity Rate of nuclear disintegration; SI unit = becquerel (Bq, 1 d...","sourceLabel":"Section in Nuclear Medicine"},"2509":{"title":"F-18 FDG PET/CT - Physics & Protocol","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s5","snippet":"F-18 FDG PET/CT - Physics & Protocol FDG Mechanism F-18 fluorodeoxyglucose (FDG) is a glucose analog in which the 2&prime;-hydroxyl group is replaced by F-18. FDG enters cells via glucose transporters (GLUT-1, GLUT-3 - upregulated in most cancers) and is phosphorylated by hexokinase to FDG-6-phospha...","sourceLabel":"Section in Nuclear Medicine"},"2510":{"title":"FDG PET/CT - Oncologic Applications","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s6","snippet":"FDG PET/CT - Oncologic Applications Initial Staging & Restaging FDG PET/CT is a cornerstone of oncologic staging. It detects unsuspected distant metastases in 10-30% of patients with various cancers, upstaging disease and avoiding futile surgery. Its principal value lies in whole-body assessment in ...","sourceLabel":"Section in Nuclear Medicine"},"2511":{"title":"FDG PET/CT - Non-Oncologic Applications","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s7","snippet":"FDG PET/CT - Non-Oncologic Applications Figure 5 - Cardiac Viability Assessment with FDG PET. Comparison of myocardial perfusion (top) and FDG metabolism (bottom) images demonstrating various perfusion-metabolism patterns. A mismatch pattern (decreased perfusion with preserved FDG uptake) indicates ...","sourceLabel":"Section in Nuclear Medicine"},"2512":{"title":"Non-FDG PET Tracers","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s8","snippet":"Non-FDG PET Tracers F-18 Sodium Fluoride (NaF) F-18 NaF is a bone-seeking PET tracer that localizes to areas of active bone remodeling by exchanging with hydroxyl ions on the surface of hydroxyapatite crystals. It offers superior sensitivity and spatial resolution compared to Tc-99m MDP bone scan fo...","sourceLabel":"Section in Nuclear Medicine"},"2513":{"title":"Myocardial Perfusion Imaging - Stress Protocols","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s9","snippet":"Myocardial Perfusion Imaging - Stress Protocols Indications for Stress MPI The principal indications for myocardial perfusion imaging include: (1) diagnosis of obstructive CAD in patients with intermediate pretest probability and uninterpretable or equivocal ECG stress test; (2) risk stratification ...","sourceLabel":"Section in Nuclear Medicine"},"2514":{"title":"MPI - Radiopharmaceuticals & Acquisition","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s10","snippet":"MPI - Radiopharmaceuticals & Acquisition Tc-99m Sestamibi (Cardiolite) & Tc-99m Tetrofosmin (Myoview) Both are lipophilic cationic complexes that enter myocardial cells passively via the mitochondrial membrane potential gradient. Uptake is proportional to regional myocardial blood flow and cell viab...","sourceLabel":"Section in Nuclear Medicine"},"2515":{"title":"MPI - Interpretation & Reporting","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s11","snippet":"MPI - Interpretation & Reporting Figure 12 - Myocardial Perfusion SPECT (MPI). Stress and rest myocardial perfusion SPECT images displayed in short-axis, vertical long-axis, and horizontal long-axis views. Comparison of stress and rest images identifies reversible defects (ischemia) and fixed defect...","sourceLabel":"Section in Nuclear Medicine"},"2516":{"title":"MUGA Scan & Cardiac PET","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s12","snippet":"MUGA Scan & Cardiac PET MUGA (Multigated Acquisition) Scan The MUGA scan (radionuclide ventriculography, RVG) measures LVEF by labeling red blood cells with Tc-99m and acquiring gated images of the cardiac blood pool. The ECG-gated acquisition divides the cardiac cycle into 16-24 frames, producing a...","sourceLabel":"Section in Nuclear Medicine"},"2517":{"title":"Thyroid Scintigraphy & Uptake","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s13","snippet":"Thyroid Scintigraphy & Uptake Radiopharmaceuticals for Thyroid Imaging I-123 is the preferred agent for thyroid imaging: it is organified (trapped and incorporated into thyroglobulin like stable iodine), emits a 159-keV gamma ideal for gamma camera imaging, and has a 13.2-hour half-life limiting rad...","sourceLabel":"Section in Nuclear Medicine"},"2518":{"title":"Radioiodine Therapy - I-131","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s14","snippet":"Radioiodine Therapy - I-131 I-131 for Graves Disease Radioactive iodine (RAI) with I-131 is a definitive treatment for Graves disease. The typical dose is 10-15 mCi (370-555 MBq) administered as a single oral capsule. The I-131 is trapped and organified by the hyperactive thyroid, delivering a high ...","sourceLabel":"Section in Nuclear Medicine"},"2519":{"title":"Parathyroid Imaging & Other Endocrine","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s15","snippet":"Parathyroid Imaging & Other Endocrine Parathyroid Scintigraphy Tc-99m sestamibi is the primary agent for parathyroid adenoma localization. Sestamibi is taken up by both thyroid and parathyroid tissue, but it washes out of normal thyroid faster than from hyperfunctioning parathyroid tissue (which has...","sourceLabel":"Section in Nuclear Medicine"},"2520":{"title":"Bone Scintigraphy","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s16","snippet":"Bone Scintigraphy Tc-99m MDP Mechanism Tc-99m methylene diphosphonate (MDP) localizes to bone by chemisorption onto the surface of hydroxyapatite crystals in areas of active osteoblastic activity and increased regional blood flow. The degree of uptake is proportional to bone turnover and perfusion. ...","sourceLabel":"Section in Nuclear Medicine"},"2521":{"title":"Infection & Inflammation Imaging","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s17","snippet":"Infection & Inflammation Imaging Labeled WBC Scans In-111 oxine-labeled WBCs and Tc-99m HMPAO-labeled WBCs are used for localization of infection. Patient's own WBCs are drawn, labeled ex vivo with the radiotracer, and reinjected. Normal biodistribution includes liver, spleen (most intense), and bon...","sourceLabel":"Section in Nuclear Medicine"},"2522":{"title":"Pediatric Nuclear Medicine","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s18","snippet":"Pediatric Nuclear Medicine Renal Imaging Tc-99m DMSA cortical scintigraphy is the gold standard for detecting acute pyelonephritis (photopenic cortical defects) and renal scarring in children. Split renal function calculation (normal: each kidney within 45-55% of total) is essential for surgical dec...","sourceLabel":"Section in Nuclear Medicine"},"2523":{"title":"Renal Scintigraphy","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s19","snippet":"Renal Scintigraphy Tc-99m MAG3 (Mercaptoacetyltriglycine) Tc-99m MAG3 is cleared almost entirely by tubular secretion (effective renal plasma flow, ERPF) with minimal glomerular filtration, providing excellent images even in patients with impaired renal function. Applications: (1) diuretic renograph...","sourceLabel":"Section in Nuclear Medicine"},"2524":{"title":"Pulmonary Scintigraphy","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s20","snippet":"Pulmonary Scintigraphy V/Q Scan Protocol The ventilation/perfusion (V/Q) scan evaluates for pulmonary embolism by comparing the distribution of ventilation and perfusion in the lungs. Perfusion: Tc-99m macroaggregated albumin (MAA), 2-4 mCi IV, lodges in ~0.1% of pulmonary capillaries proportional t...","sourceLabel":"Section in Nuclear Medicine"},"2525":{"title":"GI & Hepatobiliary Scintigraphy","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s21","snippet":"GI & Hepatobiliary Scintigraphy Hepatobiliary (HIDA) Scan Tc-99m mebrofenin (Choletec) or Tc-99m disofenin (Hepatolite) are IDA (iminodiacetic acid) analogs cleared by hepatocytes into bile, following the bilirubin pathway. The study evaluates biliary patency, gallbladder function, and bile leaks. N...","sourceLabel":"Section in Nuclear Medicine"},"2526":{"title":"Brain & CSF Imaging","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s22","snippet":"Brain & CSF Imaging Brain Death Study A nuclear medicine brain perfusion study confirms brain death when clinical examination is equivocal or confounded (sedation, hypothermia, metabolic derangement). Tc-99m HMPAO (Ceretec) or Tc-99m ECD (Neurolite) are lipophilic agents that cross the intact blood-...","sourceLabel":"Section in Nuclear Medicine"},"2527":{"title":"Theranostics Concept & PSMA","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s23","snippet":"Theranostics Concept & PSMA The Theranostic Paradigm Theranostics pairs a diagnostic imaging agent with a therapeutic counterpart targeting the same molecular pathway. The diagnostic scan identifies patients whose tumors express the target (patient selection), and the therapeutic agent delivers targ...","sourceLabel":"Section in Nuclear Medicine"},"2528":{"title":"Peptide Receptor Radionuclide Therapy","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s24","snippet":"Peptide Receptor Radionuclide Therapy Lu-177 DOTATATE (Lutathera) Lu-177 DOTATATE (Lutathera) is FDA-approved for SSTR-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs). Approval was based on the NETTER-1 trial (2017), which showed: 65.2% estimated progression-free survival at 20 mont...","sourceLabel":"Section in Nuclear Medicine"},"2529":{"title":"Other Radionuclide Therapies","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s25","snippet":"Other Radionuclide Therapies Ra-223 Dichloride (Xofigo) Ra-223 is an alpha-emitting calcium mimetic that targets areas of increased bone turnover in osteoblastic metastases. FDA-approved for symptomatic bone metastases in metastatic castration-resistant prostate cancer (mCRPC) without known visceral...","sourceLabel":"Section in Nuclear Medicine"},"2530":{"title":"Radiopharmaceutical Master Table","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s26","snippet":"Radiopharmaceutical Master Table Agent Mechanism T&frac12; Energy Key Organ Dose Primary Clinical Use Tc-99m pertechnetate Trapped by NIS (thyroid, salivary, gastric) 6.02 hr 140 keV &gamma; Thyroid, GI Thyroid imaging, Meckel scan, salivary gland Tc-99m MDP Chemisorption to hydroxyapatite 6.02 hr 1...","sourceLabel":"Section in Nuclear Medicine"},"2531":{"title":"Classification & Scoring Systems","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s27","snippet":"Classification & Scoring Systems Deauville 5-Point Scale (Lymphoma) See section 6 for complete description. In summary: Scores 1-3 at end-of-treatment = complete metabolic response for most lymphoma subtypes. Score 4-5 = residual metabolically active disease. The reference structures are the mediast...","sourceLabel":"Section in Nuclear Medicine"},"2532":{"title":"Patient Preparation Protocols","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s28","snippet":"Patient Preparation Protocols Study Preparation FDG PET/CT (oncology) Fast 4-6 hr; blood glucose <200 mg/dL; avoid strenuous exercise 24 hr; IV hydration; void before scan; warm/quiet uptake room 60 min FDG PET/CT (cardiac viability) Glucose load (50 g PO) + insulin as needed to shift metabolism to ...","sourceLabel":"Section in Nuclear Medicine"},"2533":{"title":"Normal Biodistribution Patterns","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s29","snippet":"Normal Biodistribution Patterns Radiopharmaceutical Normal Biodistribution F-18 FDG Brain (intense, most avid organ), liver (moderate, reference structure), myocardium (variable - depends on fasting/insulin state), GI (mild variable), kidneys/bladder (renal excretion), bone marrow (mild diffuse), to...","sourceLabel":"Section in Nuclear Medicine"},"2534":{"title":"Abbreviations Master List","pageTitle":"Nuclear Medicine","pageUrl":"/diagnostic/nuclear-medicine","url":"/diagnostic/nuclear-medicine#s30","snippet":"Abbreviations Master List Abbreviation Meaning AC Attenuation correction ACR American College of Radiology ALARA As Low As Reasonably Achievable ATA American Thyroid Association BBB Blood-brain barrier Bq Becquerel (SI unit of activity; 1 decay/sec) BSA Body surface area CCK Cholecystokinin (sincali...","sourceLabel":"Section in Nuclear Medicine"},"2535":{"title":"Forensic Medicine","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine","snippet":"Specialty Reference Forensic Medicine Complete Specialty Reference Cause and manner of death, medicolegal death investigation, autopsy techniques, forensic toxicology, injury pattern analysis, time-of-death estimation, mass disaster response, and every classification system, legal standard, and inve..."},"2536":{"title":"Medicolegal System & Death Investigation","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s1","snippet":"Medicolegal System & Death Investigation The medicolegal death investigation system determines the cause and manner of death in cases that fall under statutory jurisdiction. In the United States, two parallel systems exist: the medical examiner system and the coroner system . Approximately 20 states...","sourceLabel":"Section in Forensic Medicine"},"2537":{"title":"Cause & Manner of Death","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s2","snippet":"Cause & Manner of Death Precise determination of cause and manner of death is the central obligation of the forensic pathologist. These two concepts are distinct: cause of death identifies the disease, injury, or event that initiated the chain of pathophysiologic events leading to death, while manne...","sourceLabel":"Section in Forensic Medicine"},"2538":{"title":"Thanatology - Postmortem Changes & Time of Death","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s3","snippet":"Thanatology - Postmortem Changes & Time of Death Thanatology is the scientific study of death and the changes that occur after death. Estimating the postmortem interval (PMI) - the time elapsed since death - relies on a combination of physical, chemical, and biological markers. No single finding pro...","sourceLabel":"Section in Forensic Medicine"},"2539":{"title":"Key Terminology & Abbreviations","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s4","snippet":"Key Terminology & Abbreviations Forensic medicine spans pathology, toxicology, law enforcement, and the legal system, producing a dense specialized vocabulary. Mastering these terms is essential for report writing, courtroom communication, and interdisciplinary collaboration. The following tables co...","sourceLabel":"Section in Forensic Medicine"},"2540":{"title":"External Examination","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s5","snippet":"External Examination The external examination is conducted before any incision and is arguably the most important phase of the forensic autopsy. It documents the identity of the decedent, the condition of the body, all external injuries, evidence of medical intervention, and any trace evidence. Meti...","sourceLabel":"Section in Forensic Medicine"},"2541":{"title":"Internal Examination - Technique","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s6","snippet":"Internal Examination - Technique The internal examination provides direct visualization of organs, body cavities, and internal injuries. The choice of technique depends on the nature of the case, the pathologist's training, and institutional protocol. Regardless of method, the goal is systematic, th...","sourceLabel":"Section in Forensic Medicine"},"2542":{"title":"Histology & Ancillary Studies","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s7","snippet":"Histology & Ancillary Studies Microscopic examination and specialized ancillary tests complement gross autopsy findings. Histology can reveal subclinical disease processes, confirm suspected diagnoses, and provide crucial evidence of wound vitality and timing. Standard Histologic Blocks A routine fo...","sourceLabel":"Section in Forensic Medicine"},"2543":{"title":"Pediatric Autopsy & SIDS","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s8","snippet":"Pediatric Autopsy & SIDS Pediatric forensic autopsy requires specialized protocols because the spectrum of natural disease, the recognition of inflicted injury, and the normal anatomic variants differ significantly from adults. Every unexpected death in an infant or young child must be approached wi...","sourceLabel":"Section in Forensic Medicine"},"2544":{"title":"Blunt Force Injuries","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s9","snippet":"Blunt Force Injuries Blunt force injuries result from impact with or by a blunt object or surface. The tissue response depends on the force, velocity, surface area of impact, and tissue type (skin, fat, muscle, bone). Blunt force produces four principal injury types: abrasion, contusion, laceration,...","sourceLabel":"Section in Forensic Medicine"},"2545":{"title":"Sharp Force Injuries","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s10","snippet":"Sharp Force Injuries Sharp force injuries are produced by objects with a cutting edge, a pointed tip, or both. They are distinguished from blunt force injuries by their clean-cut wound margins, absence of bridging vessels, and sharp division of tissue planes. Three principal types exist: incised wou...","sourceLabel":"Section in Forensic Medicine"},"2546":{"title":"Gunshot Wounds","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s11","snippet":"Gunshot Wounds Gunshot wound interpretation is one of the most critical competencies in forensic pathology. Proper documentation of wound morphology allows determination of range of fire, entrance versus exit, bullet trajectory, and (with limitations) firearm type. The appearance of gunshot wounds v...","sourceLabel":"Section in Forensic Medicine"},"2547":{"title":"Asphyxia","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s12","snippet":"Asphyxia Asphyxia is the failure of cells to receive or utilize oxygen. In forensic practice, asphyxial deaths are classified by the mechanism of oxygen deprivation. Classic autopsy findings of asphyxia (petechiae, congestion, cyanosis, fluidity of blood) are nonspecific and may be absent; scene inv...","sourceLabel":"Section in Forensic Medicine"},"2548":{"title":"Thermal, Electrical & Chemical Injuries","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s13","snippet":"Thermal, Electrical & Chemical Injuries Injuries from thermal, electrical, and chemical agents present unique forensic challenges, particularly the distinction between antemortem and postmortem changes and the determination of whether death was caused by the environmental exposure or by an underlyin...","sourceLabel":"Section in Forensic Medicine"},"2549":{"title":"Specimen Collection & Analysis","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s14","snippet":"Specimen Collection & Analysis Forensic toxicology identifies and quantifies drugs, poisons, and metabolites in biological specimens collected at autopsy. Proper specimen collection, preservation, and chain-of-custody documentation are essential for the results to be admissible in court and scientif...","sourceLabel":"Section in Forensic Medicine"},"2550":{"title":"Common Toxicologic Findings","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s15","snippet":"Common Toxicologic Findings Interpretation of postmortem toxicology results requires understanding of pharmacokinetics, postmortem redistribution, tolerance, and the clinical significance of measured concentrations in the context of autopsy findings and circumstances. Ethanol Postmortem ethanol prod...","sourceLabel":"Section in Forensic Medicine"},"2551":{"title":"Drug-Related Deaths","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s16","snippet":"Drug-Related Deaths Drug-related deaths are among the most common cases in forensic pathology practice. The forensic pathologist must determine whether the drug caused, contributed to, or was incidental to the death, and whether the manner of death is accident, suicide, homicide, or undetermined. Op...","sourceLabel":"Section in Forensic Medicine"},"2552":{"title":"Forensic Identification","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s17","snippet":"Forensic Identification Positive identification of human remains is a legal requirement before a death certificate can be issued. In mass disasters, decomposed remains, or skeletonized cases, multiple identification modalities may be required. Methods are classified as positive (scientifically indiv...","sourceLabel":"Section in Forensic Medicine"},"2553":{"title":"Wound Ballistics & Forensic Engineering","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s18","snippet":"Wound Ballistics & Forensic Engineering Understanding the biomechanics of injury production is essential for interpreting wound patterns and reconstructing the events that caused them. Wound Ballistics When a projectile enters tissue, it creates two zones of injury: the permanent cavity (the wound t...","sourceLabel":"Section in Forensic Medicine"},"2554":{"title":"Mass Disaster Response","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s19","snippet":"Mass Disaster Response Mass disasters (airline crashes, earthquakes, tsunamis, terrorist attacks, building collapses) generate large numbers of casualties requiring systematic identification and processing. The forensic response must be organized, standardized, and scalable. Disaster Victim Identifi...","sourceLabel":"Section in Forensic Medicine"},"2555":{"title":"Child Abuse & Elder Abuse - Forensic Aspects","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s20","snippet":"Child Abuse & Elder Abuse - Forensic Aspects Non-accidental trauma (NAT) in children and abuse/neglect of the elderly require careful forensic evaluation to distinguish inflicted injury from accidental or natural causes. The forensic pathologist, clinician, and social worker each play critical roles...","sourceLabel":"Section in Forensic Medicine"},"2556":{"title":"Sexual Assault Examination","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s21","snippet":"Sexual Assault Examination The forensic examination of sexual assault victims requires a trauma-informed approach that prioritizes patient welfare while systematically collecting evidence that may be critical for prosecution. Sexual Assault Forensic Examiners (SAFEs) or Sexual Assault Nurse Examiner...","sourceLabel":"Section in Forensic Medicine"},"2557":{"title":"Expert Testimony & Legal Process","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s22","snippet":"Expert Testimony & Legal Process The forensic pathologist frequently serves as an expert witness in criminal and civil proceedings. Expert testimony requires not only technical knowledge but also an understanding of the legal framework, evidentiary standards, and the responsibilities of the expert. ...","sourceLabel":"Section in Forensic Medicine"},"2558":{"title":"Legal Standards in Death Investigation","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s23","snippet":"Legal Standards in Death Investigation The forensic pathologist must understand the legal framework within which death investigation operates, including the distinctions between legal and medical terminology and the standards of proof applied in various legal proceedings. Homicide vs Murder In foren...","sourceLabel":"Section in Forensic Medicine"},"2559":{"title":"Ethical Issues in Forensic Medicine","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s24","snippet":"Ethical Issues in Forensic Medicine Forensic medicine raises unique ethical challenges that distinguish it from clinical medicine. The forensic pathologist serves the public interest and the justice system rather than an individual patient, creating a fundamentally different physician relationship. ...","sourceLabel":"Section in Forensic Medicine"},"2560":{"title":"Postmortem Changes Timeline","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s25","snippet":"Postmortem Changes Timeline The following comprehensive table integrates all major postmortem changes with their approximate timelines under standard temperate conditions (~20&deg;C ambient temperature). All timelines are approximate ranges and are significantly affected by environmental conditions,...","sourceLabel":"Section in Forensic Medicine"},"2561":{"title":"Normal Organ Weights","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s26","snippet":"Normal Organ Weights Reference organ weights for autopsy. Values vary by sex, age, body habitus, and ethnicity. The following tables provide commonly used ranges for adults and pediatric age groups. These values are derived from the most commonly cited sources in forensic pathology (Ludwig 2002, Mol...","sourceLabel":"Section in Forensic Medicine"},"2562":{"title":"Toxicology Reference Ranges","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s27","snippet":"Toxicology Reference Ranges The following table provides approximate therapeutic, toxic, and potentially lethal blood concentrations for commonly encountered substances in forensic toxicology. All values are subject to individual variation, tolerance, postmortem redistribution, and analytical method...","sourceLabel":"Section in Forensic Medicine"},"2563":{"title":"Abbreviations Master List","pageTitle":"Forensic Medicine","pageUrl":"/diagnostic/forensic-medicine","url":"/diagnostic/forensic-medicine#s28","snippet":"Abbreviations Master List Comprehensive listing of abbreviations used throughout forensic medicine, organized alphabetically for rapid reference. This master list consolidates abbreviations from all sections and adds additional entries commonly encountered in forensic pathology reports, toxicology r...","sourceLabel":"Section in Forensic Medicine"},"2564":{"title":"Hospitalist Medicine","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine","snippet":"Specialty Reference Hospitalist Medicine Complete Specialty Reference Admission and discharge workflows, inpatient diabetes and anticoagulation management, DVT prophylaxis, hospital-acquired infections, transitions of care, observation status, and every protocol, scoring system, and management algor..."},"2565":{"title":"Admission & History Framework","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s1","snippet":"Admission & History Framework Hospital medicine (hospitalist medicine) is the specialty devoted to the care of acutely ill patients from the moment of admission through discharge. The hospitalist performs the initial history and physical examination, writes admission orders, coordinates specialist c...","sourceLabel":"Section in Hospitalist Medicine"},"2566":{"title":"Hospital Systems & Quality Metrics","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s2","snippet":"Hospital Systems & Quality Metrics Modern hospitalists operate within a complex quality and regulatory framework. Understanding these metrics is essential because they directly influence hospital reimbursement, public reporting, accreditation, and patient safety. CMS Core Measures The Centers for Me...","sourceLabel":"Section in Hospitalist Medicine"},"2567":{"title":"Key Terminology & Abbreviations","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s3","snippet":"Key Terminology & Abbreviations Hospital medicine uses abbreviations drawn from every medical and surgical subspecialty, plus administrative and regulatory terminology unique to the inpatient setting. Mastery of this vocabulary is essential for efficient chart review, order writing, and communicatio...","sourceLabel":"Section in Hospitalist Medicine"},"2568":{"title":"Admission Workflow & Order Sets","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s4","snippet":"Admission Workflow & Order Sets The admission process is a high-risk transition that demands a systematic approach. Errors in admission orders - missed VTE prophylaxis, incorrect medication doses, inappropriate diet - can cause preventable harm. A standardized workflow reduces variability and improv...","sourceLabel":"Section in Hospitalist Medicine"},"2569":{"title":"Discharge Planning & Transitions of Care","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s5","snippet":"Discharge Planning & Transitions of Care Discharge planning begins at admission. Effective transitions of care reduce 30-day readmission rates, prevent medication errors, and improve patient satisfaction. Approximately 20% of Medicare patients are readmitted within 30 days, costing the healthcare sy...","sourceLabel":"Section in Hospitalist Medicine"},"2570":{"title":"Handoff Communication - I-PASS & SBAR","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s6","snippet":"Handoff Communication - I-PASS & SBAR Communication failures during care transitions are the leading root cause of sentinel events. Standardized handoff tools reduce preventable adverse events by 23-30% (I-PASS study, NEJM 2014). Every patient handoff - shift change, service transfer, cross-cover - ...","sourceLabel":"Section in Hospitalist Medicine"},"2571":{"title":"Observation vs Inpatient Status","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s7","snippet":"Observation vs Inpatient Status The distinction between observation and inpatient status is one of the most consequential administrative decisions in hospital medicine. It affects hospital reimbursement, patient cost-sharing, and eligibility for post-acute care benefits. Hospitalists must understand...","sourceLabel":"Section in Hospitalist Medicine"},"2572":{"title":"Community-Acquired Pneumonia","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s8","snippet":"Community-Acquired Pneumonia Community-acquired pneumonia (CAP) is the most common infectious cause of hospitalization and the leading infectious cause of death in the United States, with approximately 1.5 million hospitalizations and 50,000 deaths annually. The hospitalist must rapidly assess sever...","sourceLabel":"Section in Hospitalist Medicine"},"2573":{"title":"Acute Heart Failure","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s9","snippet":"Acute Heart Failure Acute decompensated heart failure (ADHF) accounts for over 1 million hospitalizations annually in the US and is the leading cause of 30-day readmission. The hospitalist manages the acute episode, optimizes guideline-directed medical therapy (GDMT), and coordinates a transition de...","sourceLabel":"Section in Hospitalist Medicine"},"2574":{"title":"COPD Exacerbation","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s10","snippet":"COPD Exacerbation Acute exacerbations of COPD (AECOPD) are defined by worsening dyspnea, increased sputum volume, and/or increased sputum purulence beyond normal day-to-day variation. AECOPD accounts for ~700,000 hospitalizations per year in the US and carries in-hospital mortality of 2-4%, with 1-y...","sourceLabel":"Section in Hospitalist Medicine"},"2575":{"title":"Acute Kidney Injury","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s11","snippet":"Acute Kidney Injury Acute kidney injury (AKI) occurs in 10-15% of all hospitalized patients and up to 50% of ICU patients. AKI is independently associated with increased mortality, prolonged LOS, progression to CKD, and higher healthcare costs. The hospitalist must rapidly classify the injury, ident...","sourceLabel":"Section in Hospitalist Medicine"},"2576":{"title":"Cellulitis & Skin/Soft Tissue Infections","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s12","snippet":"Cellulitis & Skin/Soft Tissue Infections Skin and soft tissue infections (SSTIs) are among the most common reasons for hospitalization. The hospitalist must distinguish purulent from non-purulent infections, classify severity, identify necrotizing infections early, and select appropriate antibiotic ...","sourceLabel":"Section in Hospitalist Medicine"},"2577":{"title":"Venous Thromboembolism","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s13","snippet":"Venous Thromboembolism Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), is a leading cause of preventable hospital death. The hospitalist must be proficient in risk stratification, diagnosis, and anticoagulation management. Wells Score for DVT Criter...","sourceLabel":"Section in Hospitalist Medicine"},"2578":{"title":"Inpatient Diabetes Management","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s14","snippet":"Inpatient Diabetes Management Hyperglycemia (BG >140 mg/dL) occurs in up to 40% of hospitalized patients and is associated with increased infection rates, impaired wound healing, longer LOS, and higher mortality. Insulin is the preferred agent for inpatient glycemic management; oral hypoglycemics ar...","sourceLabel":"Section in Hospitalist Medicine"},"2579":{"title":"VTE Prophylaxis","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s15","snippet":"VTE Prophylaxis Venous thromboembolism is the most common preventable cause of hospital death. Every hospitalized patient should undergo VTE risk assessment on admission and receive appropriate prophylaxis. Failure to provide prophylaxis is a never event for surgical patients and a key CMS quality m...","sourceLabel":"Section in Hospitalist Medicine"},"2580":{"title":"Anticoagulation Management","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s16","snippet":"Anticoagulation Management Anticoagulation is one of the highest-risk medication classes in the hospital, accounting for a disproportionate share of adverse drug events. The hospitalist must master heparin dosing, warfarin management, DOAC selection, reversal strategies, and the recognition and mana...","sourceLabel":"Section in Hospitalist Medicine"},"2581":{"title":"Electrolyte Management","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s17","snippet":"Electrolyte Management Electrolyte disorders are ubiquitous in hospitalized patients and can cause life-threatening arrhythmias, seizures, and neuromuscular dysfunction. The hospitalist must know correction rates, treatment protocols, and the critical ECG changes that demand emergent intervention. H...","sourceLabel":"Section in Hospitalist Medicine"},"2582":{"title":"Pain Management in Hospitalized Patients","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s18","snippet":"Pain Management in Hospitalized Patients Effective pain management improves patient outcomes, mobility, and satisfaction while reducing complications. The hospitalist must employ multimodal analgesia, understand opioid equivalencies, and anticipate opioid side effects. Multimodal Analgesia Approach ...","sourceLabel":"Section in Hospitalist Medicine"},"2583":{"title":"Hospital-Acquired & Ventilator-Associated Pneumonia","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s19","snippet":"Hospital-Acquired & Ventilator-Associated Pneumonia Hospital-acquired pneumonia (HAP) develops &ge;48 hours after admission in non-intubated patients. Ventilator-associated pneumonia (VAP) develops &ge;48 hours after endotracheal intubation. Together they are the leading cause of death from hospital...","sourceLabel":"Section in Hospitalist Medicine"},"2584":{"title":"Clostridioides difficile Infection","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s20","snippet":"Clostridioides difficile Infection Clostridioides difficile (formerly Clostridium difficile) is the most common cause of healthcare-associated infectious diarrhea. CDI rates have increased dramatically, with approximately 500,000 infections and 29,000 deaths annually in the US. The hospitalist must ...","sourceLabel":"Section in Hospitalist Medicine"},"2585":{"title":"Catheter-Associated UTI & CLABSI","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s21","snippet":"Catheter-Associated UTI & CLABSI Catheter-associated urinary tract infections (CAUTI) and central line-associated bloodstream infections (CLABSI) are the two most common device-associated hospital-acquired infections and CMS-designated never events. Prevention is a core hospitalist responsibility. C...","sourceLabel":"Section in Hospitalist Medicine"},"2586":{"title":"Falls, Delirium & Pressure Injuries","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s22","snippet":"Falls, Delirium & Pressure Injuries Falls, delirium, and pressure injuries are the triad of preventable hospital-acquired conditions that disproportionately affect elderly and critically ill patients. All three are CMS-reportable quality measures and are tied to reimbursement penalties. Morse Fall S...","sourceLabel":"Section in Hospitalist Medicine"},"2587":{"title":"Bedside Procedures","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s23","snippet":"Bedside Procedures Hospitalists perform and interpret several core bedside procedures. Proficiency in these procedures allows rapid diagnosis and therapeutic intervention without waiting for subspecialty availability. Paracentesis Indicated for: new-onset ascites (diagnostic), suspected spontaneous ...","sourceLabel":"Section in Hospitalist Medicine"},"2588":{"title":"Consultation & Comanagement","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s24","snippet":"Consultation & Comanagement Effective consultation is a core hospitalist skill. Knowing when to consult, how to frame the clinical question, and how to comanage complex patients with other specialties improves outcomes and efficiency. When to Consult Consult when: the patient has a condition outside...","sourceLabel":"Section in Hospitalist Medicine"},"2589":{"title":"Geriatric Hospital Medicine","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s25","snippet":"Geriatric Hospital Medicine Patients aged &ge;65 account for over 35% of hospitalizations and are at disproportionate risk for medication adverse events, delirium, falls, functional decline, and iatrogenic complications. Geriatric-specific principles should guide every aspect of hospital care for th...","sourceLabel":"Section in Hospitalist Medicine"},"2590":{"title":"Palliative Care & Goals of Care","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s26","snippet":"Palliative Care & Goals of Care Palliative care focuses on relief of suffering and improvement of quality of life for patients with serious illness, regardless of prognosis. It is not synonymous with hospice or end-of-life care. Every hospitalist should be competent in primary palliative care skills...","sourceLabel":"Section in Hospitalist Medicine"},"2591":{"title":"Medical-Legal & Documentation","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s27","snippet":"Medical-Legal & Documentation Hospitalists carry substantial medicolegal risk due to the volume and acuity of patients they manage. Thorough documentation is the single most important defense against liability and ensures accurate coding, reimbursement, and quality reporting. Medical Necessity Docum...","sourceLabel":"Section in Hospitalist Medicine"},"2592":{"title":"Scoring Systems Master Table","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s28","snippet":"Scoring Systems Master Table This section consolidates every major scoring system referenced in hospital medicine. Each score is fully enumerated with thresholds and interpretation. CURB-65 (Pneumonia Severity) Score 30-Day Mortality Disposition 0 0.6% Outpatient 1 2.7% Outpatient or brief observati...","sourceLabel":"Section in Hospitalist Medicine"},"2593":{"title":"Medications Master Table","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s29","snippet":"Medications Master Table This table lists the most commonly used inpatient medications by class, with dosing, indications, and clinical pearls relevant to hospitalist practice. Antibiotics Drug Class / Mechanism Typical Dose Indication Pearls Ceftriaxone 3rd-gen cephalosporin; beta-lactam, PBP inhib...","sourceLabel":"Section in Hospitalist Medicine"},"2594":{"title":"Abbreviations Master List","pageTitle":"Hospitalist Medicine","pageUrl":"/clinical-settings/hospitalist-medicine","url":"/clinical-settings/hospitalist-medicine#s30","snippet":"Abbreviations Master List Comprehensive list of abbreviations used throughout hospital medicine documentation, orders, and communication. Abbreviation Meaning ABG Arterial blood gas ACLS Advanced cardiovascular life support ADL Activities of daily living ADHF Acute decompensated heart failure ADT Ad...","sourceLabel":"Section in Hospitalist Medicine"},"2595":{"title":"Urgent Care","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care","snippet":"Specialty Reference Urgent Care Complete Specialty Reference Walk-in acute care, laceration repair, fracture management, rapid diagnostic evaluation, point-of-care testing, and every protocol, disposition criteria, and management algorithm across the full scope of urgent care medicine."},"2596":{"title":"Urgent Care Scope & Triage","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s1","snippet":"Urgent Care Scope & Triage Urgent care occupies a critical niche between primary care and the emergency department, providing walk-in evaluation and management of acute, non-life-threatening conditions. The scope encompasses minor trauma, acute infections, exacerbations of chronic disease, occupatio...","sourceLabel":"Section in Urgent Care"},"2597":{"title":"Point-of-Care Testing & Diagnostics","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s2","snippet":"Point-of-Care Testing & Diagnostics Urgent care centers rely heavily on point-of-care testing (POCT) to provide rapid diagnostic results that guide same-visit clinical decisions. Unlike send-out laboratory testing that may take hours to days, POCT delivers results within minutes, enabling efficient ...","sourceLabel":"Section in Urgent Care"},"2598":{"title":"Terminology & Abbreviations","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s3","snippet":"Terminology & Abbreviations Familiarity with urgent care terminology is essential for efficient documentation and communication. The following terms appear frequently in urgent care clinical notes, triage records, and disposition documentation. Term / Abbreviation Definition ACS Acute coronary syndr...","sourceLabel":"Section in Urgent Care"},"2599":{"title":"Upper Respiratory Infections & Pharyngitis","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s4","snippet":"Upper Respiratory Infections & Pharyngitis Upper respiratory infections account for the single largest category of urgent care visits. The clinical challenge lies in distinguishing viral URI (the vast majority) from bacterial infections requiring antibiotics, and in identifying dangerous complicatio...","sourceLabel":"Section in Urgent Care"},"2600":{"title":"Otitis Media & Externa","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s5","snippet":"Otitis Media & Externa Acute Otitis Media (AOM) Diagnostic criteria (AAP 2013 guidelines) require ALL of the following: (1) moderate-to-severe bulging of the tympanic membrane (TM) , or new onset otorrhea not due to otitis externa, or mild bulging of the TM with recent onset of ear pain (<48 hours) ...","sourceLabel":"Section in Urgent Care"},"2601":{"title":"Sinusitis","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s6","snippet":"Sinusitis Acute rhinosinusitis is one of the most common diagnoses in urgent care. The vast majority (90-98%) of cases are viral and self-limited. The critical clinical skill is distinguishing viral from bacterial sinusitis to avoid unnecessary antibiotic prescribing. Viral vs. Bacterial Sinusitis C...","sourceLabel":"Section in Urgent Care"},"2602":{"title":"Lower Respiratory - Bronchitis, Asthma Exacerbation, Pneumonia","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s7","snippet":"Lower Respiratory - Bronchitis, Asthma Exacerbation, Pneumonia Acute Bronchitis An acute cough illness (typically 1-3 weeks) with or without sputum production, in the absence of pneumonia. Etiology is viral in >90% of cases (same pathogens as URI). Sputum color (yellow/green) does NOT distinguish ba...","sourceLabel":"Section in Urgent Care"},"2603":{"title":"Fracture Evaluation & Management","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s8","snippet":"Fracture Evaluation & Management Musculoskeletal injuries are among the most common urgent care presentations. Clinical decision rules help determine which patients need X-rays, and knowledge of splinting techniques allows definitive urgent care management for stable fractures. Ottawa Ankle Rules An...","sourceLabel":"Section in Urgent Care"},"2604":{"title":"Sprains & Strains","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s9","snippet":"Sprains & Strains Ankle Sprain Classification The lateral ankle ligament complex (anterior talofibular [ATFL], calcaneofibular [CFL], posterior talofibular [PTFL]) is involved in ~85% of ankle sprains, with ATFL most commonly injured (inversion mechanism). Grade Pathology Exam Findings Weight-Bearin...","sourceLabel":"Section in Urgent Care"},"2605":{"title":"Back Pain","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s10","snippet":"Back Pain Acute low back pain is an exceedingly common urgent care presentation. The vast majority (85-90%) is mechanical/non-specific and self-limited. The primary role of the urgent care clinician is to identify the rare but serious causes (\"red flags\") and provide appropriate symptomatic manageme...","sourceLabel":"Section in Urgent Care"},"2606":{"title":"Joint Complaints","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s11","snippet":"Joint Complaints Acute Monoarticular Arthritis The critical rule-out in any acute monoarticular joint presentation is septic arthritis , which is a medical emergency. Until proven otherwise, an acutely swollen, hot, painful joint with limited ROM should be considered septic. Risk factors: prosthetic...","sourceLabel":"Section in Urgent Care"},"2607":{"title":"Laceration Repair","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s12","snippet":"Laceration Repair Laceration repair is one of the most common and satisfying procedures in urgent care. A systematic approach to wound assessment, anesthesia, irrigation, closure technique, and follow-up ensures optimal outcomes and minimizes infection and scarring. Wound Assessment Before closure, ...","sourceLabel":"Section in Urgent Care"},"2608":{"title":"Wound Infections & Abscesses","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s13","snippet":"Wound Infections & Abscesses Cutaneous Abscess - Incision & Drainage (I&D) A fluctuant, tender, erythematous, often warm collection of pus within the skin/subcutaneous tissue. I&D is the definitive treatment and is the single most important intervention - antibiotics alone without drainage are inade...","sourceLabel":"Section in Urgent Care"},"2609":{"title":"Burns","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s14","snippet":"Burns Burn Degree Classification Degree Depth Appearance Sensation Healing Superficial (1st) Epidermis only Red, dry, no blisters (sunburn-like) Painful 3-5 days, no scarring Superficial partial (2nd) Epidermis + superficial dermis Red, moist, blisters, blanches with pressure Very painful (intact ne...","sourceLabel":"Section in Urgent Care"},"2610":{"title":"Common Dermatologic Conditions","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s15","snippet":"Common Dermatologic Conditions Cellulitis vs. Abscess Cellulitis is a non-purulent, spreading skin infection (erythema, warmth, tenderness, edema without a drainable collection) most commonly caused by beta-hemolytic streptococci (GAS) and Staphylococcus aureus . Treatment: cephalexin 500 mg QID or ...","sourceLabel":"Section in Urgent Care"},"2611":{"title":"Urinary Tract Infections","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s16","snippet":"Urinary Tract Infections Uncomplicated Cystitis Defined as UTI in a non-pregnant, premenopausal woman with no urologic abnormalities. Symptoms: dysuria, frequency, urgency, suprapubic pain. UA findings: positive leukocyte esterase, nitrites, pyuria (&ge;10 WBC/hpf). Urine culture is NOT required for...","sourceLabel":"Section in Urgent Care"},"2612":{"title":"STI Screening & Treatment","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s17","snippet":"STI Screening & Treatment Gonorrhea & Chlamydia Often co-transmitted; test for both simultaneously. NAAT (urine or swab) is the diagnostic test of choice. Typical presentation: dysuria, urethral/vaginal discharge, cervicitis. May be asymptomatic (especially chlamydia in women). Treatment (CDC 2021 g...","sourceLabel":"Section in Urgent Care"},"2613":{"title":"Acute Abdominal Pain","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s18","snippet":"Acute Abdominal Pain Abdominal pain is one of the highest-acuity presentations in urgent care, requiring careful assessment to identify surgical emergencies and conditions requiring ED transfer. Right Lower Quadrant - Appendicitis Classic presentation: periumbilical pain migrating to RLQ, anorexia, ...","sourceLabel":"Section in Urgent Care"},"2614":{"title":"Pediatric Fever & Common Infections","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s19","snippet":"Pediatric Fever & Common Infections Fever Definitions by Age Fever is defined as a rectal temperature &ge;38.0&deg;C (100.4&deg;F). In young infants, the management of fever varies dramatically by age group: Age-Based Fever Management in Pediatrics &le;28 days (0-4 weeks): ALL febrile neonates requi...","sourceLabel":"Section in Urgent Care"},"2615":{"title":"Pediatric Injuries & Foreign Bodies","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s20","snippet":"Pediatric Injuries & Foreign Bodies Nursemaid's Elbow (Radial Head Subluxation) Common in children 1-4 years. Mechanism: longitudinal traction on an extended, pronated forearm (lifting/swinging child by the hand). The annular ligament slips over the radial head and becomes interposed. The child hold...","sourceLabel":"Section in Urgent Care"},"2616":{"title":"Occupational Medicine in Urgent Care","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s21","snippet":"Occupational Medicine in Urgent Care Workers' Compensation Documentation Accurate documentation is critical in occupational injury cases as it has legal and financial implications. Every work injury note must include: (1) date and time of injury , (2) detailed mechanism (how, where, what task), (3) ...","sourceLabel":"Section in Urgent Care"},"2617":{"title":"Procedures & Minor Surgery","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s22","snippet":"Procedures & Minor Surgery Incision & Drainage (I&D) Detailed technique covered in Section 13. Key points: field block anesthesia (not into abscess cavity), #11 scalpel, full-length incision, break up loculations, irrigate, pack loosely. Document: size of abscess cavity, volume and character of drai...","sourceLabel":"Section in Urgent Care"},"2618":{"title":"Medication Management & Prescribing","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s23","snippet":"Medication Management & Prescribing Controlled Substance Prescribing Urgent care providers must balance adequate pain management with responsible opioid prescribing. General principles: (1) use multimodal analgesia first (NSAIDs + acetaminophen), (2) if opioids are necessary, prescribe the lowest ef...","sourceLabel":"Section in Urgent Care"},"2619":{"title":"Disposition Decision-Making","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s24","snippet":"Disposition Decision-Making Every urgent care visit concludes with a disposition decision: discharge home, transfer to the ED, direct admission (rare), or referral for follow-up. Documenting the reasoning for each disposition decision is essential for patient safety and medicolegal protection. ED Tr...","sourceLabel":"Section in Urgent Care"},"2620":{"title":"Documentation & Coding","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s25","snippet":"Documentation & Coding E&M Coding in Urgent Care Urgent care visits are coded using standard outpatient E&M codes. Under the 2021 E&M coding reforms, office/outpatient visits (99202-99215) are based on medical decision-making (MDM) complexity or total time spent on the encounter. Code Patient Status...","sourceLabel":"Section in Urgent Care"},"2621":{"title":"Scoring Systems","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s26","snippet":"Scoring Systems Ottawa Ankle Rules See Section 8 for complete criteria. Sensitivity 97-100% for clinically significant fractures. An ankle X-ray is indicated only if there is malleolar zone pain PLUS bone tenderness at the posterior edge/tip of either malleolus OR inability to bear weight (4 steps)....","sourceLabel":"Section in Urgent Care"},"2622":{"title":"Common Medications Quick Reference","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s27","snippet":"Common Medications Quick Reference Antibiotics Medication Common Indications Adult Dose Duration Key Notes Amoxicillin GAS pharyngitis, AOM, dental infections 500 mg BID or 1 g TID (CAP) 5-10 days First-line for strep; well tolerated Amoxicillin-clavulanate ABRS, AOM (2nd line), bites, UTI 875/125 m...","sourceLabel":"Section in Urgent Care"},"2623":{"title":"Abbreviations Master List","pageTitle":"Urgent Care","pageUrl":"/clinical-settings/urgent-care","url":"/clinical-settings/urgent-care#s28","snippet":"Abbreviations Master List Abbreviation Full Term ABRS Acute bacterial rhinosinusitis ACE-I Angiotensin-converting enzyme inhibitor ACLS Advanced cardiovascular life support ACS Acute coronary syndrome AOM Acute otitis media AOE Acute otitis externa ATFL Anterior talofibular ligament BID Twice daily ...","sourceLabel":"Section in Urgent Care"},"2624":{"title":"Critical Care / ICU","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care","snippet":"Specialty Reference Critical Care Medicine Complete Specialty Reference Mechanical ventilation, sepsis management, hemodynamic monitoring, vasopressor therapy, ARDS, multi-organ dysfunction, sedation protocols, and every scoring system, ventilator setting, and management algorithm across the full sc..."},"2625":{"title":"ICU Physiology","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s1","snippet":"ICU Physiology Critical care medicine is grounded in applied cardiopulmonary physiology. The intensivist must understand oxygen delivery, ventilation-perfusion relationships, and acid-base chemistry at a quantitative level to make rational decisions about ventilator settings, fluid resuscitation, an...","sourceLabel":"Section in Critical Care / ICU"},"2626":{"title":"ICU Monitoring","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s2","snippet":"ICU Monitoring Arterial Line & Waveform Analysis An arterial line provides continuous beat-to-beat blood pressure monitoring and facilitates frequent blood gas sampling. Preferred sites: radial (most common), femoral, dorsalis pedis, brachial (avoid - end-artery risk). The Allen test assesses collat...","sourceLabel":"Section in Critical Care / ICU"},"2627":{"title":"Terminology & Abbreviations","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s3","snippet":"Terminology & Abbreviations A working knowledge of ICU abbreviations is essential for reading notes, interpreting orders, and communicating efficiently during rounds. A comprehensive master list is provided in Section 30 . Key foundational terms: ARDS Acute Respiratory Distress Syndrome CI Cardiac I...","sourceLabel":"Section in Critical Care / ICU"},"2628":{"title":"Sepsis & Septic Shock","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s4","snippet":"Sepsis & Septic Shock Sepsis-3 Definitions (2016) Figure 10 - Sepsis-3 Clinical Criteria Algorithm. Operationalization of the Sepsis-3 definitions showing how qSOFA screening, SOFA score assessment, and lactate/vasopressor criteria are applied to identify patients with sepsis and septic shock. Sepsi...","sourceLabel":"Section in Critical Care / ICU"},"2629":{"title":"Vasopressors & Inotropes","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s5","snippet":"Vasopressors & Inotropes Vasoactive medications are the pharmacologic backbone of shock management. They are classified by receptor activity (&alpha; 1 = vasoconstriction, &beta; 1 = inotropy/chronotropy, &beta; 2 = vasodilation/bronchodilation, V 1 = vasoconstriction, D 1 = renal/splanchnic vasodil...","sourceLabel":"Section in Critical Care / ICU"},"2630":{"title":"Cardiogenic Shock","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s6","snippet":"Cardiogenic Shock Cardiogenic shock is defined hemodynamically as CI < 2.2 L/min/m 2 with an elevated PCWP > 15 mmHg (evidence of congestion) in the presence of adequate or elevated intravascular volume. It is the most lethal form of shock, with in-hospital mortality 40-60%. Etiology Acute MI (most ...","sourceLabel":"Section in Critical Care / ICU"},"2631":{"title":"Distributive, Obstructive & Hypovolemic Shock","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s7","snippet":"Distributive, Obstructive & Hypovolemic Shock Anaphylaxis Anaphylaxis is a severe, potentially fatal allergic reaction causing distributive shock via massive histamine-mediated vasodilation and capillary leak. Treatment: Epinephrine IM 0.3-0.5 mg (1:1000) into anterolateral thigh - repeat every 5-15...","sourceLabel":"Section in Critical Care / ICU"},"2632":{"title":"Ventilator Modes","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s8","snippet":"Ventilator Modes Understanding ventilator modes requires mastery of three concepts: the trigger (what initiates the breath - patient effort or time), the target/limit (what controls gas delivery during inspiration - volume or pressure), and the cycle (what terminates inspiration - volume delivered, ...","sourceLabel":"Section in Critical Care / ICU"},"2633":{"title":"ARDS","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s9","snippet":"ARDS Figure 16 - ARDS Chest Radiograph with Bilateral Opacities. Anteroposterior chest radiograph demonstrating diffuse bilateral pulmonary opacities consistent with ARDS, showing the characteristic pattern of non-cardiogenic pulmonary edema that is not fully explained by effusions, lobar collapse, ...","sourceLabel":"Section in Critical Care / ICU"},"2634":{"title":"Ventilator Management & Troubleshooting","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s10","snippet":"Ventilator Management & Troubleshooting Auto-PEEP (Intrinsic PEEP) Auto-PEEP occurs when expiratory flow does not reach zero before the next breath, causing gas trapping and increased end-expiratory pressure above the set PEEP. Common in obstructive disease (COPD, asthma) and when RR is too high or ...","sourceLabel":"Section in Critical Care / ICU"},"2635":{"title":"Liberation from Mechanical Ventilation","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s11","snippet":"Liberation from Mechanical Ventilation Readiness for SBT (Spontaneous Breathing Trial) Assess daily once the patient meets the following criteria: underlying cause of respiratory failure improving/resolved, adequate oxygenation (PaO 2 /FiO 2 &ge; 150 or SpO 2 &ge; 90% on FiO 2 &le; 0.4 and PEEP &le;...","sourceLabel":"Section in Critical Care / ICU"},"2636":{"title":"Non-Invasive Ventilation & High-Flow","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s12","snippet":"Non-Invasive Ventilation & High-Flow CPAP vs. BiPAP Modality Mechanism Settings Primary Indications CPAP (Continuous Positive Airway Pressure) Single level of positive pressure throughout respiratory cycle; splints open alveoli and airways, improves FRC, decreases preload/afterload CPAP 5-15 cmH 2 O...","sourceLabel":"Section in Critical Care / ICU"},"2637":{"title":"Acute Kidney Injury & RRT","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s13","snippet":"Acute Kidney Injury & RRT KDIGO Staging of AKI Stage Serum Creatinine Criteria Urine Output Criteria 1 1.5-1.9 &times; baseline OR increase &ge; 0.3 mg/dL within 48 h < 0.5 mL/kg/h for 6-12 h 2 2.0-2.9 &times; baseline < 0.5 mL/kg/h for &ge; 12 h 3 3.0 &times; baseline OR increase to &ge; 4.0 mg/dL ...","sourceLabel":"Section in Critical Care / ICU"},"2638":{"title":"Hepatic Failure & Encephalopathy","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s14","snippet":"Hepatic Failure & Encephalopathy Acute Liver Failure (ALF) Defined as coagulopathy (INR &ge; 1.5) and hepatic encephalopathy in a patient without preexisting liver disease, with illness duration < 26 weeks. Causes: acetaminophen (most common in US/UK), viral hepatitis (A, B, E), drug-induced liver i...","sourceLabel":"Section in Critical Care / ICU"},"2639":{"title":"GI Bleeding in the ICU","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s15","snippet":"GI Bleeding in the ICU Upper GI Bleeding Risk stratification: The Glasgow-Blatchford Score (GBS) identifies patients at very low risk (GBS = 0) who may not need endoscopy; components include BUN, hemoglobin, SBP, pulse, melena, syncope, hepatic disease, heart failure. The Rockall Score (pre-endoscop...","sourceLabel":"Section in Critical Care / ICU"},"2640":{"title":"Coagulopathy & DIC","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s16","snippet":"Coagulopathy & DIC ISTH DIC Score Parameter 0 Points 1 Point 2 Points 3 Points Platelet count (&times;10 9 /L) > 100 50-100 < 50 - D-dimer / FDP No increase Moderate increase Strong increase - Prolonged PT (seconds above normal) < 3 3-6 > 6 - Fibrinogen (g/L) > 1.0 &le; 1.0 - - Figure 26 - DIC Patho...","sourceLabel":"Section in Critical Care / ICU"},"2641":{"title":"Nutrition in the ICU","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s17","snippet":"Nutrition in the ICU Enteral Nutrition (EN) - Preferred Route Early enteral nutrition (within 24-48 hours of ICU admission) is recommended for all hemodynamically stable critically ill patients who cannot maintain voluntary intake. Enteral feeding maintains gut mucosal integrity, reduces bacterial t...","sourceLabel":"Section in Critical Care / ICU"},"2642":{"title":"Status Epilepticus","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s18","snippet":"Status Epilepticus Status epilepticus (SE) is defined as a seizure lasting > 5 minutes or two or more seizures without full recovery of consciousness between them. Convulsive SE has a mortality of 10-20%; the longer the seizure, the harder it is to terminate and the greater the risk of neuronal inju...","sourceLabel":"Section in Critical Care / ICU"},"2643":{"title":"Traumatic Brain Injury","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s19","snippet":"Traumatic Brain Injury Glasgow Coma Scale (GCS) Component Response Score Eye Opening (E) Spontaneous 4 To voice 3 To pain 2 None 1 Verbal (V) Oriented 5 Confused 4 Inappropriate words 3 Incomprehensible sounds 2 None 1 Motor (M) Obeys commands 6 Localizes pain 5 Withdraws from pain (flexion) 4 Abnor...","sourceLabel":"Section in Critical Care / ICU"},"2644":{"title":"Stroke in the ICU","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s20","snippet":"Stroke in the ICU Acute Ischemic Stroke (AIS) IV alteplase (tPA) : 0.9 mg/kg (max 90 mg), 10% as bolus then remainder over 60 min. Eligible within 4.5 hours of symptom onset (or last known well). Exclusions for 3-4.5 hour window: age > 80, NIHSS > 25, oral anticoagulant use, history of both DM and p...","sourceLabel":"Section in Critical Care / ICU"},"2645":{"title":"Sedation & Analgesia","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s21","snippet":"Sedation & Analgesia PADIS Guidelines 2018 (Pain, Agitation/sedation, Delirium, Immobility, Sleep) Key principles: Analgesia-first approach (treat pain before treating agitation), target light sedation (RASS 0 to &minus;2) unless deeper sedation required (ARDS prone positioning, NMB, ICP management)...","sourceLabel":"Section in Critical Care / ICU"},"2646":{"title":"Antibiotics in the ICU","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s22","snippet":"Antibiotics in the ICU Empiric Antibiotic Regimens by Suspected Source Suspected Source Empiric Regimen Duration Key Notes Community-acquired pneumonia (CAP), ICU admission &beta;-lactam (ceftriaxone 2 g or ampicillin-sulbactam 3 g) + azithromycin 500 mg IV; OR &beta;-lactam + respiratory FQ (levofl...","sourceLabel":"Section in Critical Care / ICU"},"2647":{"title":"Electrolyte & Acid-Base Emergencies","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s23","snippet":"Electrolyte & Acid-Base Emergencies Hyperkalemia Hyperkalemia Emergency Management ECG changes (in order of severity): peaked T waves &rarr; prolonged PR &rarr; wide QRS &rarr; sine wave &rarr; VF/asystole Step 1 - Cardiac membrane stabilization: Calcium gluconate 1-3 g IV over 2-5 min (or calcium c...","sourceLabel":"Section in Critical Care / ICU"},"2648":{"title":"Central Lines & Arterial Access","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s24","snippet":"Central Lines & Arterial Access Central Venous Catheter (CVC) Placement Site selection: Site Advantages Disadvantages Key Anatomy Internal Jugular (IJ) Most common; reliable US landmarks; compressible; lower PTX risk than subclavian Uncomfortable (neck); higher infection rate than subclavian; limits...","sourceLabel":"Section in Critical Care / ICU"},"2649":{"title":"Chest Tubes & Thoracic Procedures","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s25","snippet":"Chest Tubes & Thoracic Procedures Indications Pneumothorax: symptomatic, large (> 2 cm apex-to-cupola), tension, or requiring positive pressure ventilation. Hemothorax: initial output > 1500 mL (consider thoracotomy) or ongoing output > 200 mL/h for 2-4 h. Empyema: infected pleural fluid (pH < 7.2, ...","sourceLabel":"Section in Critical Care / ICU"},"2650":{"title":"ICU Bundles & Prevention","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s26","snippet":"ICU Bundles & Prevention VAP Prevention Bundle (1) Elevate head of bed 30-45&deg;; (2) Daily sedation interruption + assessment of readiness to extubate; (3) DVT prophylaxis; (4) Stress ulcer prophylaxis; (5) Oral care with chlorhexidine 0.12% q12h (some guidelines have moved away from CHG oral care...","sourceLabel":"Section in Critical Care / ICU"},"2651":{"title":"Withdrawal of Care & Brain Death","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s27","snippet":"Withdrawal of Care & Brain Death Brain Death Determination Brain death is the irreversible cessation of all functions of the entire brain, including the brainstem. It is a clinical diagnosis. Legal death is declared at the time of the brain death examination completion. Requirements vary by state/in...","sourceLabel":"Section in Critical Care / ICU"},"2652":{"title":"Prognostication & Family Communication","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s28","snippet":"Prognostication & Family Communication APACHE II Score The Acute Physiology and Chronic Health Evaluation II (APACHE II) score is calculated from 12 physiologic variables (worst values in first 24 hours of ICU admission: temperature, MAP, HR, RR, oxygenation, arterial pH, sodium, potassium, creatini...","sourceLabel":"Section in Critical Care / ICU"},"2653":{"title":"Scoring Systems Master Table","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s29","snippet":"Scoring Systems Master Table SOFA Score See Section 4 for the fully enumerated SOFA score table with all six organ systems and scoring criteria (0-4 points each, total 0-24). qSOFA Criterion Points Respiratory rate &ge; 22/min 1 Altered mentation (GCS < 15) 1 Systolic BP &le; 100 mmHg 1 Score &ge; 2...","sourceLabel":"Section in Critical Care / ICU"},"2654":{"title":"Abbreviations Master List","pageTitle":"Critical Care / ICU","pageUrl":"/clinical-settings/critical-care","url":"/clinical-settings/critical-care#s30","snippet":"Abbreviations Master List A-a gradient Alveolar-arterial oxygen gradient ABG Arterial blood gas ABCDEF ICU liberation bundle (Assess pain, Both SAT+SBT, Choice of sedation, Delirium, Early mobility, Family) AC Assist-Control ventilator mode ACS Acute coronary syndrome AG Anion gap AIS Acute ischemic...","sourceLabel":"Section in Critical Care / ICU"},"2655":{"title":"Neonatology","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology","snippet":"Specialty Reference Neonatology Complete Specialty Reference Neonatal resuscitation, respiratory distress, prematurity management, congenital anomalies, neonatal sepsis, hyperbilirubinemia, and every scoring system, ventilator protocol, and management algorithm across the full scope of neonatal-peri..."},"2656":{"title":"Neonatal Physiology & Transition","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s1","snippet":"Neonatal Physiology & Transition The transition from intrauterine to extrauterine life is the most complex physiologic adaptation that occurs in human biology. Within seconds to minutes of birth, the neonate must establish independent gas exchange, redirect circulatory pathways, maintain thermoregul...","sourceLabel":"Section in Neonatology"},"2657":{"title":"APGAR Score & Neonatal Assessment","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s2","snippet":"APGAR Score & Neonatal Assessment The APGAR score , introduced by Virginia Apgar in 1952, is the most widely used rapid assessment tool for neonatal transition. It is performed at 1 and 5 minutes of life (and at 5-minute intervals thereafter if the score remains <7). The APGAR does not determine the...","sourceLabel":"Section in Neonatology"},"2658":{"title":"Terminology & Abbreviations","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s3","snippet":"Terminology & Abbreviations Neonatology uses a specialized vocabulary for gestational age classification, birth weight categories, and clinical conditions. Mastery of these terms is essential for documentation, communication, and interpreting the neonatal literature. Term Definition Preterm Born <37...","sourceLabel":"Section in Neonatology"},"2659":{"title":"NRP Algorithm","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s4","snippet":"NRP Algorithm Approximately 10% of newborns require some assistance to begin breathing, and about 1% require extensive resuscitation. The Neonatal Resuscitation Program (NRP) , updated in the 8th edition (2020), provides an evidence-based, algorithmic approach. Every delivery should have at least on...","sourceLabel":"Section in Neonatology"},"2660":{"title":"Delivery Room Stabilization","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s5","snippet":"Delivery Room Stabilization Delayed Cord Clamping Delayed cord clamping (DCC) is recommended for all vigorous newborns who do not require immediate resuscitation: Term infants : Delay clamping for at least 30-60 seconds; improves iron stores, reduces iron deficiency anemia at 3-6 months Preterm infa...","sourceLabel":"Section in Neonatology"},"2661":{"title":"Perinatal Asphyxia & HIE","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s6","snippet":"Perinatal Asphyxia & HIE Hypoxic-ischemic encephalopathy (HIE) results from impaired cerebral blood flow and oxygen delivery around the time of birth, leading to a cascade of excitotoxicity, oxidative stress, inflammation, and apoptosis. It occurs in 1-3 per 1,000 term live births and remains a lead...","sourceLabel":"Section in Neonatology"},"2662":{"title":"Respiratory Distress Syndrome","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s7","snippet":"Respiratory Distress Syndrome Respiratory distress syndrome (RDS) , formerly known as hyaline membrane disease, is caused by deficiency of pulmonary surfactant , a complex mixture of phospholipids (primarily dipalmitoylphosphatidylcholine/DPPC) and surfactant proteins (SP-A, SP-B, SP-C, SP-D) produc...","sourceLabel":"Section in Neonatology"},"2663":{"title":"Transient Tachypnea & Meconium Aspiration","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s8","snippet":"Transient Tachypnea & Meconium Aspiration Transient Tachypnea of the Newborn (TTN) TTN (\"wet lung\") is the most common cause of respiratory distress in term and late preterm newborns, caused by delayed clearance of fetal lung fluid. Normally, labor triggers catecholamine-mediated activation of epith...","sourceLabel":"Section in Neonatology"},"2664":{"title":"Bronchopulmonary Dysplasia","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s9","snippet":"Bronchopulmonary Dysplasia Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease of infancy, resulting from arrested alveolar and vascular development in the immature lung, compounded by inflammation from mechanical ventilation, oxygen toxicity, and infection. Definition & Grading...","sourceLabel":"Section in Neonatology"},"2665":{"title":"Neonatal Ventilation","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s10","snippet":"Neonatal Ventilation Respiratory support in the NICU spans a spectrum from non-invasive strategies (CPAP, HFNC) to conventional mechanical ventilation and high-frequency oscillatory/jet ventilation. The principle of lung-protective ventilation - using the minimum support necessary to maintain accept...","sourceLabel":"Section in Neonatology"},"2666":{"title":"Neonatal Sepsis","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s11","snippet":"Neonatal Sepsis Neonatal sepsis is a clinical syndrome of systemic infection in the first 28 days of life. It is a leading cause of neonatal morbidity and mortality, particularly in preterm infants. Classification by timing of onset has critical implications for microbiology, evaluation, and empiric...","sourceLabel":"Section in Neonatology"},"2667":{"title":"TORCH Infections","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s12","snippet":"TORCH Infections TORCH is a mnemonic for congenital infections that share overlapping clinical features: intrauterine growth restriction, hepatosplenomegaly, jaundice, thrombocytopenia, rash, and central nervous system involvement. Each infection has unique characteristics that guide diagnosis and t...","sourceLabel":"Section in Neonatology"},"2668":{"title":"Necrotizing Enterocolitis","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s13","snippet":"Necrotizing Enterocolitis Necrotizing enterocolitis (NEC) is the most common life-threatening gastrointestinal emergency in neonates, affecting 5-10% of VLBW infants, with mortality of 20-30% (up to 50% in those requiring surgery). It is characterized by intestinal inflammation, mucosal necrosis, an...","sourceLabel":"Section in Neonatology"},"2669":{"title":"Neonatal Hyperbilirubinemia","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s14","snippet":"Neonatal Hyperbilirubinemia Jaundice is visible in ~60% of term and ~80% of preterm newborns in the first week of life. Most jaundice is benign ( physiologic ), but unchecked unconjugated hyperbilirubinemia can cause bilirubin encephalopathy and kernicterus , a devastating and preventable condition....","sourceLabel":"Section in Neonatology"},"2670":{"title":"Neonatal Hypoglycemia","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s15","snippet":"Neonatal Hypoglycemia Neonatal hypoglycemia is one of the most common metabolic problems in the nursery. While a precise definition remains debated, the AAP Committee on Fetus and Newborn uses an operational threshold of <45 mg/dL (2.5 mmol/L) as the level below which intervention is recommended in ...","sourceLabel":"Section in Neonatology"},"2671":{"title":"Fluid, Electrolytes & Nutrition","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s16","snippet":"Fluid, Electrolytes & Nutrition Daily Fluid Requirements Neonatal fluid management is guided by gestational age, postnatal age, body weight changes, urine output, and serum sodium. Insensible water loss (IWL) is highest in the most premature infants due to thin, permeable skin and high surface area-...","sourceLabel":"Section in Neonatology"},"2672":{"title":"Neonatal Hematology","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s17","snippet":"Neonatal Hematology Anemia of Prematurity Anemia of prematurity (AOP) is a normocytic, normochromic anemia that develops in preterm infants over the first weeks of life, caused by low erythropoietin (EPO) production, shortened RBC lifespan (40-60 days), rapid body growth, and iatrogenic blood loss f...","sourceLabel":"Section in Neonatology"},"2673":{"title":"Congenital Heart Disease","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s18","snippet":"Congenital Heart Disease Congenital heart disease (CHD) affects approximately 8-10 per 1,000 live births and is the leading cause of death from congenital anomalies. Classification into cyanotic vs. acyanotic lesions guides the initial clinical approach. Cyanotic CHD - The 5 T's Lesion Key Features ...","sourceLabel":"Section in Neonatology"},"2674":{"title":"Patent Ductus Arteriosus","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s19","snippet":"Patent Ductus Arteriosus The patent ductus arteriosus (PDA) occurs in up to 70% of infants born <28 weeks gestation and is a major contributor to morbidity in preterm infants. As PVR falls postnatally, the shunt direction becomes left-to-right, causing pulmonary overcirculation and systemic hypoperf...","sourceLabel":"Section in Neonatology"},"2675":{"title":"Neonatal Neurology","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s20","snippet":"Neonatal Neurology Intraventricular Hemorrhage (IVH) IVH occurs in ~25-30% of VLBW infants, originating from the fragile germinal matrix vasculature. The germinal matrix is a highly vascularized region in the subependymal zone that involutes by 34-36 weeks; its vessels lack smooth muscle support and...","sourceLabel":"Section in Neonatology"},"2676":{"title":"Prematurity & NICU Organization","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s21","snippet":"Prematurity & NICU Organization Classification of Preterm Birth Category Gestational Age Approximate Survival Extreme preterm <28 weeks 22 wk: 30-40%; 24 wk: 60-70%; 26 wk: 80-85% Very preterm 28-31 6/7 weeks >90-95% Moderate preterm 32-33 6/7 weeks >98% Late preterm 34-36 6/7 weeks >99% Periviabili...","sourceLabel":"Section in Neonatology"},"2677":{"title":"Congenital Anomalies","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s22","snippet":"Congenital Anomalies Tracheoesophageal Fistula / Esophageal Atresia Incidence ~1:3,500. The most common type (85%, Type C ) is esophageal atresia with a distal tracheoesophageal fistula (TEF). Presents with drooling, choking, cyanosis with first feed, inability to pass an orogastric tube (coils in p...","sourceLabel":"Section in Neonatology"},"2678":{"title":"Neonatal Abstinence Syndrome","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s23","snippet":"Neonatal Abstinence Syndrome Neonatal abstinence syndrome (NAS) , increasingly termed neonatal opioid withdrawal syndrome (NOWS), occurs in 55-94% of neonates exposed to opioids in utero. Incidence has risen dramatically with the opioid epidemic, from ~1.5 per 1,000 hospital births in 2004 to ~7 per...","sourceLabel":"Section in Neonatology"},"2679":{"title":"Discharge Planning","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s24","snippet":"Discharge Planning Discharge from the NICU represents a critical transition. The preterm infant must meet several physiologic milestones and the family must be prepared for home care, follow-up, and monitoring. Physiologic Criteria for Discharge Thermal stability : Maintain normal temperature in an ...","sourceLabel":"Section in Neonatology"},"2680":{"title":"Scoring Systems","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s25","snippet":"Scoring Systems APGAR Score Sign 0 1 2 Appearance Blue/pale Acrocyanosis Pink Pulse Absent <100 &ge;100 Grimace No response Grimace Cry/cough/sneeze Activity Limp Some flexion Active motion Respiration Absent Slow/irregular Good cry New Ballard Score Total score range: &minus;10 to 50. Score mapped ...","sourceLabel":"Section in Neonatology"},"2681":{"title":"Medications Master Table","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s26","snippet":"Medications Master Table Medication Category Neonatal Dose Key Notes Poractant alfa (Curosurf) Surfactant 200 mg/kg initial; 100 mg/kg repeat &times; 2 Natural porcine surfactant; intratracheal; fastest onset Beractant (Survanta) Surfactant 100 mg/kg/dose &times; 4 doses q6h PRN Natural bovine surfa...","sourceLabel":"Section in Neonatology"},"2682":{"title":"Normal Neonatal Values","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s27","snippet":"Normal Neonatal Values Vital Signs by Gestational Age Parameter 24-28 wk 28-32 wk 32-36 wk Term (&ge;37 wk) Heart rate (bpm) 140-180 130-170 120-160 120-160 Respiratory rate 40-70 40-60 30-60 30-60 Systolic BP (mmHg) 35-55 40-60 50-70 60-80 Mean BP (mmHg) 24-40 30-45 35-55 40-60 Temperature (&deg;C)...","sourceLabel":"Section in Neonatology"},"2683":{"title":"Abbreviations Master List","pageTitle":"Neonatology","pageUrl":"/clinical-settings/neonatology","url":"/clinical-settings/neonatology#s28","snippet":"Abbreviations Master List Abbreviation Meaning ABR Auditory brainstem response AC Assist/control (ventilator mode) aEEG Amplitude-integrated electroencephalography AGA Appropriate for gestational age AOP Apnea of prematurity AP-ROP Aggressive posterior retinopathy of prematurity BAT Brown adipose ti...","sourceLabel":"Section in Neonatology"},"2684":{"title":"Pain Management","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management","snippet":"Specialty Reference Pain Management Complete Specialty Reference Acute and chronic pain, nociceptive and neuropathic mechanisms, opioid pharmacology, interventional procedures, neuromodulation, multimodal analgesia, and every scoring tool, drug conversion, and treatment algorithm across the full sco..."},"2685":{"title":"Pain Neuroanatomy & Physiology","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s1","snippet":"Pain Neuroanatomy & Physiology Pain perception is a complex process involving peripheral transduction, spinal cord transmission, supraspinal processing, and descending modulation. Understanding these mechanisms is essential for selecting targeted interventions at every level of the pain pathway. Per...","sourceLabel":"Section in Pain Management"},"2686":{"title":"Pain Classification & Assessment","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s2","snippet":"Pain Classification & Assessment Mechanistic Classification Type Mechanism Character Examples Treatment Targets Nociceptive - Somatic Activation of nociceptors in skin, bone, muscle, joints Well-localized, sharp, aching, throbbing Fractures, OA, surgical incisions, muscle strain NSAIDs, acetaminophe...","sourceLabel":"Section in Pain Management"},"2687":{"title":"Terminology & Abbreviations","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s3","snippet":"Terminology & Abbreviations Term Definition Allodynia Pain from a stimulus that does not normally cause pain Hyperalgesia Increased pain from a normally painful stimulus Hyperpathia Exaggerated pain response, especially to repetitive stimuli, with increased threshold Dysesthesia Unpleasant abnormal ...","sourceLabel":"Section in Pain Management"},"2688":{"title":"Acetaminophen & NSAIDs","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s4","snippet":"Acetaminophen & NSAIDs Acetaminophen Mechanism : Centrally acting; proposed mechanisms include inhibition of COX-3 (a splice variant of COX-1 in the CNS), augmentation of descending serotonergic inhibition, and activation of the endocannabinoid system via AM404 metabolite acting on TRPV1 and CB1 rec...","sourceLabel":"Section in Pain Management"},"2689":{"title":"Neuropathic Pain Agents","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s5","snippet":"Neuropathic Pain Agents First-line agents for neuropathic pain include gabapentinoids, SNRIs, and TCAs. Selection is guided by pain type, comorbidities, side-effect profile, and cost. NNT for &ge;50% pain reduction ranges from 3.6 to 7.7 for first-line agents. Figure 11 - Neuropathic Pain Treatment ...","sourceLabel":"Section in Pain Management"},"2690":{"title":"Muscle Relaxants & Adjuvants","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s6","snippet":"Muscle Relaxants & Adjuvants Skeletal Muscle Relaxants Drug Mechanism Dose Key Notes Cyclobenzaprine Centrally acting; structurally related to TCAs; reduces tonic somatic motor activity at brainstem 5-10 mg PO TID (or 5 mg QHS for tolerability); ER 15-30 mg daily Most studied; efficacy best in acute...","sourceLabel":"Section in Pain Management"},"2691":{"title":"Corticosteroids & Anti-Inflammatory Agents","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s7","snippet":"Corticosteroids & Anti-Inflammatory Agents Systemic Corticosteroids Agent Relative Potency Half-life Dose / Protocol Indication Prednisone 1 (reference) 18-36 h Taper: 60 mg &times; 3d &rarr; 40 mg &times; 3d &rarr; 20 mg &times; 3d &rarr; 10 mg &times; 3d; or 1 mg/kg &times; 5d then taper over 1-2 ...","sourceLabel":"Section in Pain Management"},"2692":{"title":"Opioid Receptor Pharmacology","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s8","snippet":"Opioid Receptor Pharmacology Opioid Receptor Types & Effects Figure 13 - Opioid Receptor Sites of Action. Distribution of mu, kappa, and delta opioid receptors throughout the nervous system. Mu receptors are concentrated in the PAG, RVM, dorsal horn lamina II, and nucleus accumbens, mediating supras...","sourceLabel":"Section in Pain Management"},"2693":{"title":"Oral Opioids","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s9","snippet":"Oral Opioids Drug Starting Dose (Opioid-Naive) Onset / Duration Potency vs Morphine PO Metabolism Key Considerations Morphine IR 15 mg PO q4h (5-10 mg in elderly/renal) 30 min / 3-4 h 1 (reference) Hepatic glucuronidation: M3G (neuroexcitatory, no analgesia) + M6G (active, 10x potency, renally clear...","sourceLabel":"Section in Pain Management"},"2694":{"title":"Extended-Release & Long-Acting Opioids","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s10","snippet":"Extended-Release & Long-Acting Opioids ER/LA opioids are reserved for patients requiring continuous around-the-clock analgesia who have already been on stable opioid therapy. The FDA REMS requires prescriber education. Never initiate in opioid-naive patients (exception: specific ER formulations at l...","sourceLabel":"Section in Pain Management"},"2695":{"title":"Opioid Conversion & Rotation","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s11","snippet":"Opioid Conversion & Rotation Equianalgesic Dose Table Figure 15 - Opioid Receptor Signaling Pathways. Comprehensive overview of opioid receptor-mediated signaling, including G-protein coupling, ion channel modulation, beta-arrestin recruitment, receptor internalization, and the molecular mechanisms ...","sourceLabel":"Section in Pain Management"},"2696":{"title":"Opioid Risk Management","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s12","snippet":"Opioid Risk Management Risk Assessment Tools Tool Format Scoring Use ORT (Opioid Risk Tool) 5-item self-report 0-3 low; 4-7 moderate; &ge;8 high risk Pre-prescribing screen for aberrant behavior risk; assesses family/personal history of substance abuse, age, sexual abuse, psychological disease SOAPP...","sourceLabel":"Section in Pain Management"},"2697":{"title":"Epidural Steroid Injections","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s13","snippet":"Epidural Steroid Injections Approaches Figure 16 - Epidural Injection Anatomy. Cross-sectional anatomy of the lumbar spine showing the epidural space, ligamentum flavum, dura mater, and spinal cord. Epidural steroid injections deliver corticosteroid and local anesthetic into this space to reduce per...","sourceLabel":"Section in Pain Management"},"2698":{"title":"Facet Joint & Medial Branch Interventions","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s14","snippet":"Facet Joint & Medial Branch Interventions Facet-Mediated Pain Referral Patterns Level Referral Pattern C2-3 Occipital headache, upper cervical pain C3-4 Posterolateral neck, does not radiate past shoulder C5-6 Shoulder, suprascapular region (mimics rotator cuff) C6-7 Interscapular region L1-2 Groin,...","sourceLabel":"Section in Pain Management"},"2699":{"title":"Sacroiliac Joint Interventions","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s15","snippet":"Sacroiliac Joint Interventions Clinical Diagnosis Figure 21 - Sacroiliac Joint Anatomy. Posterior view of the sacroiliac joint showing the auricular articular surfaces, interosseous and posterior sacroiliac ligaments, and the relationship to surrounding structures. The SI joint is innervated by late...","sourceLabel":"Section in Pain Management"},"2700":{"title":"Joint & Soft Tissue Injections","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s16","snippet":"Joint & Soft Tissue Injections Major Joint Injections Joint Approach Agent Key Considerations Knee Suprapatellar (preferred - larger target, allows aspiration), inferolateral (seated, knee flexed 90&deg;, lateral to patellar tendon), medial midpatellar Triamcinolone 40 mg + lidocaine 5 mL; or hyalur...","sourceLabel":"Section in Pain Management"},"2701":{"title":"Neuromodulation","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s17","snippet":"Neuromodulation Spinal Cord Stimulation (SCS) Figure 24 - Spinal Cord Stimulator Anatomy. Components of a spinal cord stimulation system including percutaneous electrode leads placed in the posterior epidural space over the dorsal columns, extension cables, and the implantable pulse generator (IPG) ...","sourceLabel":"Section in Pain Management"},"2702":{"title":"Advanced & Emerging Procedures","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s18","snippet":"Advanced & Emerging Procedures Sympathetic Nerve Blocks Figure 27 - Stellate Ganglion Block. Anterolateral approach to the cervicothoracic sympathetic chain at the C6 level (Chassaignac tubercle). Successful blockade produces ipsilateral Horner syndrome (ptosis, miosis, anhidrosis), confirming sympa...","sourceLabel":"Section in Pain Management"},"2703":{"title":"Low Back Pain","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s19","snippet":"Low Back Pain Epidemiology & Natural History Low back pain (LBP) is the leading cause of disability worldwide (Global Burden of Disease). Lifetime prevalence 80%. Most acute LBP resolves within 6 weeks regardless of treatment. However, 10-15% develop chronic LBP (>12 weeks). Risk factors for chronif...","sourceLabel":"Section in Pain Management"},"2704":{"title":"Cervical & Headache Pain","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s20","snippet":"Cervical & Headache Pain Cervicogenic Headache Cervicogenic headache (CGH) originates from cervical structures and is referred to the head. The trigeminocervical nucleus (convergence of trigeminal afferents with C1-C3 dorsal horn neurons) is the anatomic basis. Most common sources: C2-3 facet joint ...","sourceLabel":"Section in Pain Management"},"2705":{"title":"Complex Regional Pain Syndrome","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s21","snippet":"Complex Regional Pain Syndrome Budapest Clinical Diagnostic Criteria (2003, IASP-adopted 2012) Budapest Criteria for CRPS Must meet ALL four of the following: Continuing pain disproportionate to any inciting event Must report at least one symptom in 3 of 4 categories : Sensory : Hyperesthesia and/or...","sourceLabel":"Section in Pain Management"},"2706":{"title":"Cancer Pain","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s22","snippet":"Cancer Pain WHO Analgesic Ladder (1986, Modified) Figure 37 - WHO Analgesic Ladder. The World Health Organization three-step analgesic ladder (1986, modified) for cancer pain: Step 1 (mild pain) with non-opioids, Step 2 (moderate pain) with weak opioids, Step 3 (severe pain) with strong opioids, and...","sourceLabel":"Section in Pain Management"},"2707":{"title":"Fibromyalgia & Central Sensitization","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s23","snippet":"Fibromyalgia & Central Sensitization 2016 ACR Revised Diagnostic Criteria Fibromyalgia Diagnostic Criteria (2016 ACR Revision) Widespread Pain Index (WPI) &ge;7 AND Symptom Severity Scale (SSS) &ge;5 , OR WPI 4-6 AND SSS &ge;9 Generalized pain in at least 4 of 5 regions (left upper, right upper, lef...","sourceLabel":"Section in Pain Management"},"2708":{"title":"Perioperative Pain & ERAS","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s24","snippet":"Perioperative Pain & ERAS Preemptive & Preventive Analgesia Preemptive analgesia is administration of analgesics before surgical incision to prevent central sensitization. Preventive analgesia (broader concept) encompasses any perioperative intervention that reduces post-surgical pain beyond the exp...","sourceLabel":"Section in Pain Management"},"2709":{"title":"Regulatory & Ethical Considerations","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s25","snippet":"Regulatory & Ethical Considerations DEA Scheduling of Controlled Substances Schedule Definition Pain-Relevant Examples Prescribing Rules Schedule I No accepted medical use, high abuse potential Heroin, MDMA, psilocybin (cannabis per federal law) Cannot prescribe; research only Schedule II High abuse...","sourceLabel":"Section in Pain Management"},"2710":{"title":"Equianalgesic & MME Conversion Tables","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s26","snippet":"Equianalgesic & MME Conversion Tables Comprehensive Equianalgesic Table Opioid PO (mg) IV/IM/SC (mg) PO:IV Ratio MME Factor Duration Morphine 30 10 3:1 1.0 3-4 h (IR) Oxycodone 20 - - 1.5 3-6 h (IR) Hydrocodone 30 - - 1.0 4-6 h Hydromorphone 6 1.5 4:1 4.0 3-4 h Oxymorphone 10 1 10:1 3.0 3-6 h Codein...","sourceLabel":"Section in Pain Management"},"2711":{"title":"Scoring Tools","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s27","snippet":"Scoring Tools Numeric Rating Scale (NRS) Patient rates pain intensity on a scale from 0 (no pain) to 10 (worst imaginable pain) . Clinically meaningful change: &ge;2 points or &ge;30% reduction. Mild: 1-3; Moderate: 4-6; Severe: 7-10. Most widely used pain scale in clinical practice. Limitation: uni...","sourceLabel":"Section in Pain Management"},"2712":{"title":"Abbreviations Master List","pageTitle":"Pain Management","pageUrl":"/clinical-settings/pain-management","url":"/clinical-settings/pain-management#s28","snippet":"Abbreviations Master List Abbreviation Full Term AAPM American Academy of Pain Medicine ACD Abuse-Deterrent Formulation APS American Pain Society ASRA American Society of Regional Anesthesia and Pain Medicine BPI Brief Pain Inventory BTcP Breakthrough Cancer Pain CGRP Calcitonin Gene-Related Peptide...","sourceLabel":"Section in Pain Management"},"2713":{"title":"Sleep Medicine","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine","snippet":"Specialty Reference Sleep Medicine Complete Specialty Reference Obstructive sleep apnea, insomnia, narcolepsy, circadian rhythm disorders, parasomnias, polysomnography interpretation, CPAP management, and every scoring system, diagnostic criterion, and treatment algorithm across the full scope of sl..."},"2714":{"title":"Sleep Neurophysiology","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s1","snippet":"Sleep Neurophysiology Sleep is an active, highly regulated neurobiological process governed by the interplay of circadian and homeostatic drives. Understanding the neuroanatomical centers, neurotransmitter systems, and electrophysiologic signatures of each sleep stage is the foundation for interpret...","sourceLabel":"Section in Sleep Medicine"},"2715":{"title":"Polysomnography & Scoring","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s2","snippet":"Polysomnography & Scoring Polysomnography (PSG) is the gold-standard diagnostic study in sleep medicine. It provides continuous, simultaneous recording of multiple physiologic parameters during sleep. Interpretation requires systematic application of AASM (American Academy of Sleep Medicine) scoring...","sourceLabel":"Section in Sleep Medicine"},"2716":{"title":"Terminology & Abbreviations","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s3","snippet":"Terminology & Abbreviations Term Definition Sleep latency Time from lights out to the first epoch of any sleep stage REM latency Time from sleep onset to the first epoch of REM. Normal: 70-120 min. Shortened in narcolepsy, depression, sleep deprivation, alcohol/drug withdrawal Sleep efficiency Total...","sourceLabel":"Section in Sleep Medicine"},"2717":{"title":"Obstructive Sleep Apnea","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s4","snippet":"Obstructive Sleep Apnea Obstructive sleep apnea (OSA) is characterized by repetitive upper airway collapse during sleep, leading to intermittent hypoxemia, hypercapnia, sleep fragmentation, and sympathetic surges. It is the most common sleep-related breathing disorder, affecting an estimated 10-30% ...","sourceLabel":"Section in Sleep Medicine"},"2718":{"title":"CPAP & PAP Therapy","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s5","snippet":"CPAP & PAP Therapy Continuous positive airway pressure (CPAP) is the first-line treatment for moderate-to-severe OSA. It acts as a pneumatic splint, maintaining positive intraluminal pressure throughout the respiratory cycle to prevent upper airway collapse. Optimal management requires proper titrat...","sourceLabel":"Section in Sleep Medicine"},"2719":{"title":"Surgical & Alternative Therapies for OSA","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s6","snippet":"Surgical & Alternative Therapies for OSA Non-PAP therapies are indicated when patients cannot tolerate or refuse CPAP, or as adjuncts to reduce the required CPAP pressure. Selection depends on the anatomic site of obstruction, OSA severity, and patient comorbidities. Uvulopalatopharyngoplasty (UPPP)...","sourceLabel":"Section in Sleep Medicine"},"2720":{"title":"Central Sleep Apnea","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s7","snippet":"Central Sleep Apnea Central sleep apnea (CSA) is characterized by repetitive cessation of airflow due to transient loss of respiratory drive from the brainstem, without upper airway obstruction. Respiratory effort is absent during events (flat thoracic and abdominal RIP belts on PSG). Figure 14 - Pa...","sourceLabel":"Section in Sleep Medicine"},"2721":{"title":"Obesity Hypoventilation Syndrome","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s8","snippet":"Obesity Hypoventilation Syndrome Obesity hypoventilation syndrome (OHS) , also known as Pickwickian syndrome, is defined by the triad of: (1) BMI ≥30 kg/m 2 , (2) awake daytime hypercapnia (PaCO2 ≥45 mmHg) , and (3) no alternative explanation for hypoventilation (excluding neuromuscular disease, sev...","sourceLabel":"Section in Sleep Medicine"},"2722":{"title":"Insomnia Disorder","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s9","snippet":"Insomnia Disorder Insomnia disorder is a subjective complaint of difficulty initiating sleep, maintaining sleep, or early-morning awakening, associated with daytime impairment, occurring despite adequate opportunity and circumstances for sleep. It is the most common sleep complaint, affecting 10-15%...","sourceLabel":"Section in Sleep Medicine"},"2723":{"title":"CBT-I - Cognitive Behavioral Therapy for Insomnia","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s10","snippet":"CBT-I - Cognitive Behavioral Therapy for Insomnia CBT-I is the first-line treatment for chronic insomnia disorder, recommended before pharmacotherapy by the AASM, ACP, and AAFP. It is a structured, typically 6-8 session intervention with durable effects that persist after treatment ends — unlike med...","sourceLabel":"Section in Sleep Medicine"},"2724":{"title":"Pharmacotherapy for Insomnia","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s11","snippet":"Pharmacotherapy for Insomnia Pharmacotherapy is second-line to CBT-I and should be considered when CBT-I is unavailable, inadequate, or while awaiting its effects. The choice of agent depends on the insomnia phenotype (sleep-onset vs. maintenance vs. both), comorbidities, abuse potential, and next-d...","sourceLabel":"Section in Sleep Medicine"},"2725":{"title":"Narcolepsy Type 1 & 2","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s12","snippet":"Narcolepsy Type 1 & 2 Narcolepsy is a chronic neurological disorder of central hypersomnolence caused by deficient orexin (hypocretin) signaling. It is classified into Type 1 (with cataplexy and/or low CSF orexin) and Type 2 (without cataplexy, normal CSF orexin). Narcolepsy Type 1 — Orexin/Hypocret...","sourceLabel":"Section in Sleep Medicine"},"2726":{"title":"Treatment of Narcolepsy","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s13","snippet":"Treatment of Narcolepsy Treatment targets the two core symptom domains: excessive daytime sleepiness (wake-promoting agents) and cataplexy/REM-related phenomena (anticataplectic agents). Behavioral measures — scheduled naps, regular sleep-wake schedules, driving safety — are essential adjuncts. Sodi...","sourceLabel":"Section in Sleep Medicine"},"2727":{"title":"Idiopathic Hypersomnia & Kleine-Levin Syndrome","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s14","snippet":"Idiopathic Hypersomnia & Kleine-Levin Syndrome Idiopathic Hypersomnia (IH) Idiopathic hypersomnia is a central disorder of hypersomnolence characterized by excessive daytime sleepiness despite normal or prolonged total sleep time, without cataplexy or the MSLT criteria for narcolepsy. Key distinguis...","sourceLabel":"Section in Sleep Medicine"},"2728":{"title":"Circadian Rhythm Sleep-Wake Disorders","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s15","snippet":"Circadian Rhythm Sleep-Wake Disorders Circadian rhythm sleep-wake disorders (CRSWDs) arise from a mismatch between the endogenous circadian pacemaker (SCN) and the desired or required sleep-wake schedule, or from dysfunction of the circadian system itself. All subtypes require documentation by sleep...","sourceLabel":"Section in Sleep Medicine"},"2729":{"title":"Chronotherapy & Light Therapy","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s16","snippet":"Chronotherapy & Light Therapy Phase Response Curve (PRC) The PRC describes the direction and magnitude of circadian phase shifts in response to a stimulus (light or melatonin) administered at different circadian times, using the core body temperature minimum (Tmin, approximately 4:00-5:00 AM in most...","sourceLabel":"Section in Sleep Medicine"},"2730":{"title":"Shift Work & Jet Lag Management","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s17","snippet":"Shift Work & Jet Lag Management Shift Work — Alertness & Safety Strategies Strategic napping: A 20-30 minute nap before the night shift (\"prophylactic nap\") and/or during a scheduled break significantly improves alertness. Naps >30 minutes risk sleep inertia upon awakening. The \"anchor sleep\" strate...","sourceLabel":"Section in Sleep Medicine"},"2731":{"title":"NREM Parasomnias","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s18","snippet":"NREM Parasomnias NREM parasomnias are disorders of arousal — they arise from partial arousal from slow-wave sleep (N3), typically during the first third of the night when N3 is most abundant. They share common features: impaired consciousness, amnesia for the event, autonomic activation, and difficu...","sourceLabel":"Section in Sleep Medicine"},"2732":{"title":"REM Sleep Behavior Disorder","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s19","snippet":"REM Sleep Behavior Disorder REM sleep behavior disorder (RBD) is characterized by loss of the normal skeletal muscle atonia during REM sleep, allowing patients to physically act out their dreams — often with violent or vigorous motor behaviors (punching, kicking, jumping out of bed, shouting). The d...","sourceLabel":"Section in Sleep Medicine"},"2733":{"title":"Restless Legs Syndrome","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s20","snippet":"Restless Legs Syndrome Restless legs syndrome (RLS) , also called Willis-Ekbom disease, is a sensorimotor disorder characterized by an irresistible urge to move the legs, usually accompanied by uncomfortable sensations, occurring primarily at rest and in the evening/nighttime, and relieved by moveme...","sourceLabel":"Section in Sleep Medicine"},"2734":{"title":"Other Sleep Movement Disorders","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s21","snippet":"Other Sleep Movement Disorders Sleep Bruxism Rhythmic or sustained jaw clenching and tooth grinding during sleep. Prevalence: 8-13% of adults. Manifests as tooth wear (attrition), jaw pain, temporal headache, and TMJ dysfunction. PSG shows rhythmic masticatory muscle activity (RMMA) — episodes of ma...","sourceLabel":"Section in Sleep Medicine"},"2735":{"title":"Sleep in Cardiovascular Disease","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s22","snippet":"Sleep in Cardiovascular Disease Figure 28 - Risk Factors Linking OSA to Cardiovascular Disease. Multiple pathophysiologic pathways connect obstructive sleep apnea to cardiovascular morbidity and mortality, including intermittent hypoxia-reoxygenation injury, sympathetic nervous system activation, sy...","sourceLabel":"Section in Sleep Medicine"},"2736":{"title":"Pediatric Sleep Medicine","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s23","snippet":"Pediatric Sleep Medicine Normal Sleep Duration by Age Age Recommended Sleep (24h, including naps) Notes Newborn (0-3 months) 14-17 hours Irregular pattern; no circadian rhythm established Infant (4-11 months) 12-15 hours Consolidated nocturnal sleep develops; 2-3 naps Toddler (1-2 years) 11-14 hours...","sourceLabel":"Section in Sleep Medicine"},"2737":{"title":"Sleep & Psychiatric Disorders","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s24","snippet":"Sleep & Psychiatric Disorders Figure 31 - Sleep Improvement and Mental Health Outcomes. Meta-analytic forest plot from 65 randomized controlled trials (n = 8,608) demonstrating that interventions improving sleep quality produce significant medium-sized effects on composite mental health measures, su...","sourceLabel":"Section in Sleep Medicine"},"2738":{"title":"Scoring Systems","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s25","snippet":"Scoring Systems STOP-BANG Questionnaire See Section 4 for full enumeration. Scoring: 0-2 low risk, 3-4 intermediate, 5-8 high risk for moderate-severe OSA. Epworth Sleepiness Scale (ESS) See Section 4 for full enumeration. 8 items, each 0-3. Total: 0-24. Abnormal: ≥10. Insomnia Severity Index (ISI) ...","sourceLabel":"Section in Sleep Medicine"},"2739":{"title":"PAP Settings & Troubleshooting Quick Reference","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s26","snippet":"PAP Settings & Troubleshooting Quick Reference Issue Likely Cause Solution Residual AHI >5 on CPAP Inadequate pressure, weight gain, mask leak, positional component, treatment-emergent CSA Check mask fit/leak data; consider pressure increase or repeat titration; evaluate for CSA; reassess weight Hig...","sourceLabel":"Section in Sleep Medicine"},"2740":{"title":"Medications Master Table","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s27","snippet":"Medications Master Table Hypnotics Drug Class Dose Range Half-Life Schedule Key Points Zolpidem IR BzRA 5-10 mg 2.5 h IV FDA lower dose for women (5 mg); complex sleep behaviors; take on empty stomach Zolpidem ER BzRA 6.25-12.5 mg 2.8 h IV Extended release for maintenance; same warnings Zaleplon BzR...","sourceLabel":"Section in Sleep Medicine"},"2741":{"title":"Abbreviations Master List","pageTitle":"Sleep Medicine","pageUrl":"/clinical-settings/sleep-medicine","url":"/clinical-settings/sleep-medicine#s28","snippet":"Abbreviations Master List Abbreviation Full Term AASM American Academy of Sleep Medicine AHI Apnea-Hypopnea Index ALTE Apparent Life-Threatening Event APAP Auto-titrating Positive Airway Pressure ASV Adaptive Servo-Ventilation AT Adenotonsillectomy AVAPS Average Volume-Assured Pressure Support BiPAP...","sourceLabel":"Section in Sleep Medicine"},"2742":{"title":"Wound Care","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care","snippet":"Specialty Reference Wound Care Complete Specialty Reference Wound healing physiology, chronic wound management, pressure injury staging, diabetic foot ulcers, venous and arterial ulcers, negative pressure therapy, debridement techniques, and every classification system, dressing selection, and treat..."},"2743":{"title":"Wound Healing Physiology","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s1","snippet":"Wound Healing Physiology Wound healing is a dynamic, highly orchestrated process involving the coordinated interaction of cells, growth factors, cytokines, and extracellular matrix components. Normal acute wound healing proceeds through four overlapping phases: hemostasis, inflammation, proliferatio...","sourceLabel":"Section in Wound Care"},"2744":{"title":"Wound Assessment & Documentation","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s2","snippet":"Wound Assessment & Documentation Accurate, reproducible wound assessment is the cornerstone of wound care practice. It drives treatment decisions, tracks healing trajectory, and provides medicolegal documentation. Every wound encounter requires systematic evaluation of wound dimensions, wound bed ch...","sourceLabel":"Section in Wound Care"},"2745":{"title":"Terminology & Abbreviations","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s3","snippet":"Terminology & Abbreviations Wound care uses a specialized vocabulary shared across nursing, medicine, and surgical disciplines. Consistent terminology ensures clear communication, accurate documentation, and proper coding. Using standardized wound care terminology across all disciplines reduces ambi...","sourceLabel":"Section in Wound Care"},"2746":{"title":"Pressure Injuries","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s4","snippet":"Pressure Injuries Pressure injuries (formerly pressure ulcers or decubitus ulcers) result from sustained pressure or pressure combined with shear, typically over bony prominences. They represent the most common chronic wound in acute and long-term care settings, affecting up to 3 million Americans a...","sourceLabel":"Section in Wound Care"},"2747":{"title":"Diabetic Foot Ulcers","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s5","snippet":"Diabetic Foot Ulcers Diabetic foot ulcers (DFUs) affect approximately 15-25% of people with diabetes during their lifetime and precede 85% of diabetes-related lower-extremity amputations. The triad of peripheral neuropathy (present in 60-70% of DFU patients), peripheral arterial disease (present in ...","sourceLabel":"Section in Wound Care"},"2748":{"title":"Vascular Ulcers","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s6","snippet":"Vascular Ulcers Vascular ulcers account for approximately 70-80% of chronic lower-extremity wounds. They are divided into venous (60-80% of leg ulcers), arterial (15-25%), and mixed (15-30%) etiologies. Accurate differentiation is critical because treatment strategies differ fundamentally - compress...","sourceLabel":"Section in Wound Care"},"2749":{"title":"Moist Wound Healing & Dressing Categories","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s7","snippet":"Moist Wound Healing & Dressing Categories In 1962, George Winter demonstrated that wounds covered with an occlusive dressing epithelialized twice as fast as those left to dry in the air, establishing the principle of moist wound healing . A moist wound environment promotes cell migration (keratinocy...","sourceLabel":"Section in Wound Care"},"2750":{"title":"Antimicrobial Dressings","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s8","snippet":"Antimicrobial Dressings Antimicrobial dressings play a critical role in managing the wound infection continuum, particularly at the level of critical colonization and local infection where systemic antibiotics are not indicated but bacterial burden impedes healing. Wound Infection Continuum Level De...","sourceLabel":"Section in Wound Care"},"2751":{"title":"Advanced Wound Products","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s9","snippet":"Advanced Wound Products Advanced wound therapies are indicated for chronic wounds that have failed to demonstrate adequate healing progress (&ge;40-50% area reduction) after 4 weeks of standard care including debridement, moisture balance, offloading/compression, infection management, and nutritiona...","sourceLabel":"Section in Wound Care"},"2752":{"title":"Negative Pressure Wound Therapy","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s10","snippet":"Negative Pressure Wound Therapy Negative pressure wound therapy (NPWT), also known as vacuum-assisted closure (VAC), applies sub-atmospheric pressure to a wound through a sealed dressing system. Since its introduction in the 1990s, NPWT has become one of the most widely used adjunctive wound therapi...","sourceLabel":"Section in Wound Care"},"2753":{"title":"Debridement Methods","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s11","snippet":"Debridement Methods Debridement - the removal of devitalized tissue, debris, and biofilm from a wound - is the single most important intervention in chronic wound management. Necrotic tissue provides a medium for bacterial growth, obscures wound assessment, impedes granulation tissue formation, and ...","sourceLabel":"Section in Wound Care"},"2754":{"title":"Wound Infection Management","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s12","snippet":"Wound Infection Management All chronic wounds contain bacteria; the clinical significance depends on the quantity, virulence, and host response. The wound infection continuum progresses from contamination through colonization, critical colonization (local infection), local infection, spreading infec...","sourceLabel":"Section in Wound Care"},"2755":{"title":"Osteomyelitis in Chronic Wounds","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s13","snippet":"Osteomyelitis in Chronic Wounds Osteomyelitis is a serious complication of chronic wounds, particularly diabetic foot ulcers and pressure injuries overlying bony prominences. Contiguous-spread osteomyelitis (from adjacent soft tissue infection to bone) is the predominant mechanism in wound-associate...","sourceLabel":"Section in Wound Care"},"2756":{"title":"Surgical Wounds & Dehiscence","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s14","snippet":"Surgical Wounds & Dehiscence Surgical wounds are the most common acute wounds encountered in clinical practice. They are classified by the method of closure and the level of contamination. Postoperative Wound Care Phases Immediate postoperative (0-48 hours): Surgical incisions closed by primary inte...","sourceLabel":"Section in Wound Care"},"2757":{"title":"Burn Wound Management","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s15","snippet":"Burn Wound Management Burns are tissue injuries caused by heat (thermal), electricity, chemicals, radiation, or friction. Burn wound management involves rapid assessment of burn depth and total body surface area (TBSA) to guide resuscitation, determine need for burn center referral, and select appro...","sourceLabel":"Section in Wound Care"},"2758":{"title":"Skin Tears","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s16","snippet":"Skin Tears Skin tears are traumatic wounds caused by shear, friction, or blunt force resulting in separation of the skin layers. They are the most common wound in elderly and neonatal populations, occurring primarily on the extremities (dorsal forearm and hands most common) due to age-related skin f...","sourceLabel":"Section in Wound Care"},"2759":{"title":"Atypical Wounds","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s17","snippet":"Atypical Wounds Atypical wounds are those whose etiology is not related to the common causes (pressure, neuropathy, venous/arterial insufficiency, or surgery). They should be suspected when a wound has an unusual appearance, location, or fails to respond to standard evidence-based treatment after 4-...","sourceLabel":"Section in Wound Care"},"2760":{"title":"Hyperbaric Oxygen Therapy","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s18","snippet":"Hyperbaric Oxygen Therapy Hyperbaric oxygen therapy (HBOT) involves breathing 100% oxygen at pressures greater than 1 atmosphere absolute (ATA) in a pressurized chamber. The resulting supraphysiologic tissue oxygen tensions produce therapeutic effects that support wound healing in selected patients....","sourceLabel":"Section in Wound Care"},"2761":{"title":"Offloading & Compression","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s19","snippet":"Offloading & Compression Mechanical offloading (reducing pressure on the wound) and compression therapy (applying external pressure to the limb) are the foundational non-pharmacologic treatments for diabetic foot ulcers and venous leg ulcers, respectively. No wound product can overcome the continued...","sourceLabel":"Section in Wound Care"},"2762":{"title":"Nutrition & Systemic Optimization","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s20","snippet":"Nutrition & Systemic Optimization Nutritional deficiency is among the most modifiable risk factors for impaired wound healing. Wound healing is an energy-intensive, anabolic process requiring adequate calories, protein, vitamins, minerals, and hydration. Systemic conditions (hyperglycemia, smoking, ...","sourceLabel":"Section in Wound Care"},"2763":{"title":"Wound Care Documentation","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s21","snippet":"Wound Care Documentation Complete and accurate wound care documentation serves clinical, legal, and reimbursement purposes. Every wound encounter must include a systematic assessment, treatment plan, and evidence of clinical decision-making. Wound Assessment Documentation Template Minimum Documentat...","sourceLabel":"Section in Wound Care"},"2764":{"title":"Quality Metrics & Prevention Programs","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s22","snippet":"Quality Metrics & Prevention Programs Wound care quality is measured through standardized metrics, regulatory requirements, and evidence-based prevention programs. Hospitals and long-term care facilities face financial penalties for hospital-acquired pressure injuries (HAPI) under CMS value-based pu...","sourceLabel":"Section in Wound Care"},"2765":{"title":"Staging Systems Master Table","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s23","snippet":"Staging Systems Master Table System Stage/Grade Description NPUAP Pressure Injury Stage 1 Non-blanchable erythema of intact skin Stage 2 Partial-thickness skin loss with exposed dermis; viable wound bed Stage 3 Full-thickness skin loss; fat visible; no bone/tendon/muscle exposed Stage 4 Full-thickne...","sourceLabel":"Section in Wound Care"},"2766":{"title":"Dressing Selection Guide","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s24","snippet":"Dressing Selection Guide This quick-reference table matches wound characteristics to the most appropriate dressing category with clinical rationale. Wound Characteristic Recommended Dressing Rationale Dry wound, minimal exudate Hydrogel (amorphous or sheet) Donates moisture to maintain moist healing...","sourceLabel":"Section in Wound Care"},"2767":{"title":"ABI Interpretation Table","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s25","snippet":"ABI Interpretation Table ABI Value Interpretation Clinical Significance >1.4 Non-compressible (calcified vessels) Common in diabetes, CKD, elderly; ABI unreliable; use toe pressures/TBI or TcPO2 instead; do NOT assume normal perfusion 1.0-1.4 Normal Adequate arterial perfusion; full compression ther...","sourceLabel":"Section in Wound Care"},"2768":{"title":"TIME Framework Quick Reference","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s26","snippet":"TIME Framework Quick Reference Component Clinical Question Red Flags Actions T — Tissue Is there non-viable tissue in the wound bed? Slough >50%, eschar, necrotic tissue, non-granulating wound bed Sharp debridement (preferred), enzymatic (collagenase), autolytic (hydrogel), biological (maggots); mai...","sourceLabel":"Section in Wound Care"},"2769":{"title":"Common Wound Care Products by Category","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s27","snippet":"Common Wound Care Products by Category Category Brand Names (Examples) Key Features Transparent Film Tegaderm, OpSite, Bioclusive, Mepore Film Moisture-retentive, waterproof, allows wound visualization Hydrocolloid DuoDERM, Comfeel, Tegasorb, Replicare Adhesive wafer, autolytic debridement, low-mode...","sourceLabel":"Section in Wound Care"},"2770":{"title":"Abbreviations Master List","pageTitle":"Wound Care","pageUrl":"/clinical-settings/wound-care","url":"/clinical-settings/wound-care#s28","snippet":"Abbreviations Master List Abbreviation Full Term ABI Ankle-brachial index ATA Atmospheres absolute BID Twice daily BMZ Basement membrane zone BWAT Bates-Jensen Wound Assessment Tool CAM Controlled ankle movement (boot) CDC Centers for Disease Control and Prevention CEAP Clinical-Etiology-Anatomy-Pat...","sourceLabel":"Section in Wound Care"},"2771":{"title":"Podiatry","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry","snippet":"Specialty Reference Podiatric Medicine Complete Specialty Reference Foot and ankle anatomy, biomechanics, diabetic foot care, bunion and hammertoe correction, plantar fasciitis, nail disorders, sports injuries, and every classification system, surgical technique, and management algorithm across the ..."},"2772":{"title":"Foot & Ankle Anatomy","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s1","snippet":"Foot & Ankle Anatomy The foot and ankle constitute one of the most complex mechanical structures in the human body, containing 26 bones , 33 joints, 107 ligaments, and 19 intrinsic muscles, all working in concert to absorb shock, adapt to terrain, and provide a rigid lever for propulsion. A thorough...","sourceLabel":"Section in Podiatry"},"2773":{"title":"Biomechanics & Gait Analysis","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s2","snippet":"Biomechanics & Gait Analysis Gait analysis and lower-extremity biomechanics underpin diagnosis and treatment planning across podiatric medicine. Abnormal mechanics cause overuse injuries, deformity progression, and ulceration in the neuropathic foot. The Gait Cycle A complete gait cycle (stride) run...","sourceLabel":"Section in Podiatry"},"2774":{"title":"Terminology & Abbreviations","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s3","snippet":"Terminology & Abbreviations Core terminology used in clinical podiatric documentation. A comprehensive abbreviations list appears in Section 28. Anatomic Planes & Motions Dorsiflexion - movement toward the shin (ankle) or superior surface of the foot (toes). Plantarflexion - movement toward the sole...","sourceLabel":"Section in Podiatry"},"2775":{"title":"Nail Disorders","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s4","snippet":"Nail Disorders Onychomycosis Fungal nail infection affects approximately 10% of the general population and up to 50% of adults over age 70. The most common pattern is distal lateral subungual onychomycosis (DLSO) , caused predominantly by dermatophytes ( Trichophyton rubrum , T. mentagrophytes ). Ot...","sourceLabel":"Section in Podiatry"},"2776":{"title":"Skin Conditions of the Foot","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s5","snippet":"Skin Conditions of the Foot Verrucae (Plantar Warts) Caused by human papillomavirus (HPV) , most commonly types 1, 2, 4, and 27. Present as well-circumscribed hyperkeratotic lesions on the plantar surface with interruption of skin lines, pinpoint bleeding on debridement (thrombosed capillaries), and...","sourceLabel":"Section in Podiatry"},"2777":{"title":"Corns, Calluses & Keratotic Lesions","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s6","snippet":"Corns, Calluses & Keratotic Lesions Hyperkeratotic lesions result from repetitive pressure and friction. Understanding the etiology is essential - treating the lesion without correcting the underlying biomechanical or structural cause guarantees recurrence. Classification Lesion Location Features He...","sourceLabel":"Section in Podiatry"},"2778":{"title":"Hallux Valgus (Bunion)","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s7","snippet":"Hallux Valgus (Bunion) Hallux valgus is the lateral deviation of the great toe at the first MTP joint, associated with medial deviation of the first metatarsal (metatarsus primus varus). It is the most common forefoot deformity, affecting approximately 23% of adults aged 18-65 and 36% of those over ...","sourceLabel":"Section in Podiatry"},"2779":{"title":"Lesser Toe Deformities","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s8","snippet":"Lesser Toe Deformities Hammertoe, Claw Toe, Mallet Toe Deformity MTP PIPJ DIPJ Key Feature Hammertoe Extension or neutral Flexion (primary deformity) Extension or neutral Most common lesser toe deformity; often 2nd toe; associated with hallux valgus pushing 2nd toe Claw toe Hyperextension Flexion Fl...","sourceLabel":"Section in Podiatry"},"2780":{"title":"Plantar Fasciitis & Heel Pain","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s9","snippet":"Plantar Fasciitis & Heel Pain Plantar fasciitis is the most common cause of inferior heel pain, accounting for approximately 80% of cases. It is a degenerative enthesopathy (not primarily inflammatory) of the plantar fascia at its origin on the medial calcaneal tuberosity. Risk Factors & Pathophysio...","sourceLabel":"Section in Podiatry"},"2781":{"title":"Flatfoot & Cavus Foot","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s10","snippet":"Flatfoot & Cavus Foot Adult-Acquired Flatfoot Deformity (AAFD) / Posterior Tibial Tendon Dysfunction Progressive degeneration of the posterior tibial tendon leads to loss of the medial longitudinal arch, hindfoot valgus, and forefoot abduction. Most common in women over 40. Risk factors: obesity, hy...","sourceLabel":"Section in Podiatry"},"2782":{"title":"Ankle & Rearfoot Conditions","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s11","snippet":"Ankle & Rearfoot Conditions Ankle Sprains Lateral ankle sprains (inversion injuries) account for 85% of all ankle sprains and are the most common musculoskeletal injury in athletes. The ATFL is injured first (weakest ligament, taut in plantarflexion), followed by the CFL (taut in dorsiflexion), and ...","sourceLabel":"Section in Podiatry"},"2783":{"title":"Diabetic Foot Assessment","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s12","snippet":"Diabetic Foot Assessment Diabetic foot complications are the leading cause of non-traumatic lower-extremity amputation. Approximately 15-25% of diabetic patients will develop a foot ulcer during their lifetime, and the 5-year mortality after a major amputation exceeds 50%. Systematic foot assessment...","sourceLabel":"Section in Podiatry"},"2784":{"title":"Diabetic Foot Ulcers","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s13","snippet":"Diabetic Foot Ulcers Wagner Classification Grade Description 0 Intact skin; at-risk foot (bony deformity, callus, neuropathy) 1 Superficial ulcer (epidermis and dermis only; no tendon, capsule, or bone exposure) 2 Deep ulcer penetrating to tendon, joint capsule, or bone (without abscess or osteomyel...","sourceLabel":"Section in Podiatry"},"2785":{"title":"Charcot Neuroarthropathy","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s14","snippet":"Charcot Neuroarthropathy A progressive destructive arthropathy affecting the bones and joints of the foot and ankle in patients with peripheral neuropathy, most commonly diabetic. The incidence in diabetic patients is approximately 0.1-0.9%. Pathophysiology involves unrecognized repetitive microtrau...","sourceLabel":"Section in Podiatry"},"2786":{"title":"Diabetic Foot Infections","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s15","snippet":"Diabetic Foot Infections Diabetic foot infection (DFI) is the most common reason for diabetes-related hospitalization and the proximate cause of ~60% of lower-extremity amputations in diabetic patients. It is a clinical diagnosis: presence of purulent drainage, or &ge;2 signs of inflammation (erythe...","sourceLabel":"Section in Podiatry"},"2787":{"title":"Foot & Ankle Fractures","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s16","snippet":"Foot & Ankle Fractures Ankle Fractures - Weber Classification Type Fibula Fracture Location Syndesmosis Stability Treatment Weber A Below the syndesmosis (at or below the joint line) Intact Stable Weight-bearing in a walking boot or short leg cast &times; 4-6 weeks; surgical fixation only if signifi...","sourceLabel":"Section in Podiatry"},"2788":{"title":"Sports Injuries","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s17","snippet":"Sports Injuries Turf Toe Sprain of the 1st MTP plantar plate/capsule complex from forced hyperextension (dorsiflexion) of the hallux, classically on artificial turf. Grade Pathology Treatment I Stretching of the plantar plate; minimal swelling/ecchymosis Taping, stiff-soled shoe, return to play as t...","sourceLabel":"Section in Podiatry"},"2789":{"title":"Pediatric Foot Conditions","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s18","snippet":"Pediatric Foot Conditions Clubfoot (Talipes Equinovarus) Congenital deformity occurring in ~1:1000 live births (bilateral in 50%). Components: CAVE - Cavus (high arch), Adductus (forefoot medially deviated), Varus (hindfoot inverted), Equinus (ankle plantarflexed). The Pirani scoring system grades s...","sourceLabel":"Section in Podiatry"},"2790":{"title":"Podiatric Surgical Principles","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s19","snippet":"Podiatric Surgical Principles Regional Anesthesia for Foot & Ankle Surgery Regional anesthesia provides excellent intraoperative anesthesia and prolonged postoperative analgesia, reducing opioid requirements. Block Nerves Targeted Coverage Technique Ankle block All 5 nerves at the ankle Entire foot ...","sourceLabel":"Section in Podiatry"},"2791":{"title":"Soft Tissue Procedures","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s20","snippet":"Soft Tissue Procedures Tendon Repair Techniques Krackow suture - a locking whipstitch pattern that provides superior pull-out strength; standard technique for Achilles tendon repair. Typically uses a strong non-absorbable suture (#2 FiberWire or equivalent). Two Krackow locking loops in each tendon ...","sourceLabel":"Section in Podiatry"},"2792":{"title":"Arthrodesis & Joint Replacement","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s21","snippet":"Arthrodesis & Joint Replacement First MTP Arthrodesis (Fusion) The gold standard for end-stage hallux rigidus and salvage for failed hallux valgus surgery. Optimal fusion position: 10-15&deg; dorsiflexion relative to the 1st metatarsal (allows toe-off without impingement), 10-15&deg; valgus (matches...","sourceLabel":"Section in Podiatry"},"2793":{"title":"Orthotic Therapy","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s22","snippet":"Orthotic Therapy Types of Orthotics Custom orthotics - fabricated from a cast or 3D scan of the patient's foot. They are prescribed based on individual biomechanical findings. Prefabricated (OTC) orthotics - mass-produced; available in standard sizes; adequate for mild biomechanical abnormalities an...","sourceLabel":"Section in Podiatry"},"2794":{"title":"Physical Therapy & Rehabilitation","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s23","snippet":"Physical Therapy & Rehabilitation Ankle Rehabilitation Protocol Following ankle sprain or surgery, a progressive rehabilitation program reduces recurrence and chronic instability: Phase 1 (Acute, 0-2 weeks): RICE (rest, ice, compression, elevation); gentle active ROM (ankle alphabet, towel pulls); i...","sourceLabel":"Section in Podiatry"},"2795":{"title":"Classification Systems","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s24","snippet":"Classification Systems Wagner Classification (Diabetic Foot Ulcers) Grade Description 0 At-risk foot: intact skin, bony deformity, neuropathy 1 Superficial ulcer 2 Deep ulcer to tendon, capsule, or bone 3 Deep ulcer with abscess, osteomyelitis, or septic arthritis 4 Localized gangrene (forefoot or h...","sourceLabel":"Section in Podiatry"},"2796":{"title":"Surgical Hardware Quick Reference","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s25","snippet":"Surgical Hardware Quick Reference Hardware Typical Size Common Applications Notes Cortical screw 2.7 mm, 3.5 mm, 4.5 mm Plate fixation, lag technique in cortical bone Fully threaded; use glide hole for lag effect Cancellous screw 4.0 mm, 6.5 mm, 7.0 mm Arthrodesis, metaphyseal fractures, calcaneus P...","sourceLabel":"Section in Podiatry"},"2797":{"title":"ABI & Vascular Assessment Interpretation","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s26","snippet":"ABI & Vascular Assessment Interpretation Ankle-Brachial Index (ABI) ABI Value Interpretation Clinical Significance >1.3 Non-compressible (calcified arteries) Common in diabetes and ESRD; ABI unreliable; use TBI or TcPO2 instead 1.0-1.3 Normal Adequate arterial perfusion for wound healing 0.9-0.99 Bo...","sourceLabel":"Section in Podiatry"},"2798":{"title":"Common Medications","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s27","snippet":"Common Medications NSAIDs Drug Dose Notes Ibuprofen 400-800 mg PO q6-8h (max 3200 mg/day) First-line OTC NSAID; GI risk; renal caution Naproxen 250-500 mg PO BID (max 1500 mg/day) Longer half-life; lower cardiovascular risk than other NSAIDs Meloxicam 7.5-15 mg PO daily COX-2 preferential; once dail...","sourceLabel":"Section in Podiatry"},"2799":{"title":"Abbreviations Master List","pageTitle":"Podiatry","pageUrl":"/clinical-settings/podiatry","url":"/clinical-settings/podiatry#s28","snippet":"Abbreviations Master List Abbreviation Definition AAFD Adult-acquired flatfoot deformity ABI Ankle-brachial index AFO Ankle-foot orthosis AOFAS American Orthopaedic Foot & Ankle Society ATFL Anterior talofibular ligament AVN Avascular necrosis BID Twice daily BKA Below-knee amputation BMD Bone miner...","sourceLabel":"Section in Podiatry"},"2800":{"title":"Occupational & Environmental Medicine","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine","snippet":"Specialty Reference Occupational Medicine Complete Specialty Reference Workplace injury management, workers' compensation, occupational lung disease, toxicant exposure, ergonomics, fitness-for-duty evaluation, DOT physicals, and every regulatory standard, screening protocol, and return-to-work algor..."},"2801":{"title":"Occupational Health Framework","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s1","snippet":"Occupational Health Framework Scope of Practice Occupational and environmental medicine (OEM) is the medical specialty devoted to the prevention, evaluation, treatment, and management of illness and injury arising from workplace or environmental exposures. The OEM physician serves as the interface b...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2802":{"title":"Exposure Assessment & Industrial Hygiene","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s2","snippet":"Exposure Assessment & Industrial Hygiene Occupational Exposure Limits (OELs) OELs are airborne concentration limits below which nearly all workers can be repeatedly exposed without adverse health effects. The three major systems are: Limit Setting Body Legal Status Update Frequency Notes PEL (Permis...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2803":{"title":"Terminology & Abbreviations","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s3","snippet":"Terminology & Abbreviations Term Definition Hazard An inherent property of an agent or situation capable of causing harm (e.g., a chemical is toxic, a machine has moving parts) Risk The probability that exposure to a hazard will result in harm — a function of hazard, exposure, and vulnerability Sent...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2804":{"title":"Pneumoconioses","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s4","snippet":"Pneumoconioses The pneumoconioses are a group of interstitial lung diseases caused by inhalation of certain dusts and the lung tissue's reaction to that dust. They are characterized by long latency periods, irreversibility, and the critical importance of exposure history for diagnosis. Asbestosis As...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2805":{"title":"Occupational Asthma","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s5","snippet":"Occupational Asthma Occupational asthma (OA) is the most common occupational lung disease in industrialized countries. It is defined as variable airflow limitation and airway hyperresponsiveness caused by conditions attributable to a particular occupational environment. Two major categories exist: S...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2806":{"title":"Hypersensitivity Pneumonitis","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s6","snippet":"Hypersensitivity Pneumonitis Hypersensitivity pneumonitis (HP) , also known as extrinsic allergic alveolitis, is a complex immune-mediated (type III and IV hypersensitivity) inflammatory lung disease caused by repeated inhalation of organic dusts or low-molecular-weight chemicals. Occupational HP is...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2807":{"title":"Occupational Cancer","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s7","snippet":"Occupational Cancer Occupational cancers account for an estimated 4-10% of all cancers. Key features include long latency periods (typically 10-40 years), dose-response relationships, and the existence of well-established agent-cancer associations classified by the International Agency for Research ...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2808":{"title":"Work-Related Musculoskeletal Disorders","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s8","snippet":"Work-Related Musculoskeletal Disorders Work-related musculoskeletal disorders (WMSDs) are the most common category of occupational injury and the leading cause of disability and workers' compensation claims. Low back pain is the single most common claim; carpal tunnel syndrome is the most common per...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2809":{"title":"Ergonomic Assessment & Workplace Design","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s9","snippet":"Ergonomic Assessment & Workplace Design Computer Workstation Ergonomics Proper computer workstation setup reduces risk of WMSDs of the neck, shoulder, wrist, and back. Key principles: Monitor — top of screen at or slightly below eye level; 50-70 cm (arm's length) from eyes; tilted slightly upward; p...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2810":{"title":"Return to Work & Disability Management","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s10","snippet":"Return to Work & Disability Management Biopsychosocial Model of Disability Disability is not determined solely by the medical condition. The biopsychosocial model recognizes that disability results from the interaction of biological factors (diagnosis, severity, comorbidities), psychological factors...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2811":{"title":"Lead Exposure","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s11","snippet":"Lead Exposure Occupational Sources Inorganic lead exposure remains a significant occupational hazard. High-risk industries include: battery manufacturing and recycling, lead smelting and refining, radiator repair, construction/demolition (removal of leaded paint), bridge and ship painting/scraping, ...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2812":{"title":"Solvent & Chemical Exposure","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s12","snippet":"Solvent & Chemical Exposure Organic Solvents — General Toxicology Organic solvents are lipophilic chemicals used as degreasers, diluents, and cleaning agents across nearly every industry. They share common toxicologic properties due to their lipid solubility: CNS depression (acute — dizziness, eupho...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2813":{"title":"Noise-Induced Hearing Loss","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s13","snippet":"Noise-Induced Hearing Loss Mechanism Noise-induced hearing loss (NIHL) results from damage to the outer hair cells of the organ of Corti in the cochlea. Outer hair cells are mechanosensory cells responsible for amplifying sound signals; they are the most vulnerable component of the auditory system. ...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2814":{"title":"Heat & Cold Illness","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s14","snippet":"Heat & Cold Illness Heat Stress Occupational heat illness results from the inability to dissipate metabolic and environmental heat. The Wet Bulb Globe Temperature (WBGT) index integrates air temperature, radiant heat, humidity, and wind speed and is the standard metric for assessing heat stress. ACG...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2815":{"title":"OSHA Regulations","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s15","snippet":"OSHA Regulations Recordkeeping Requirements Employers with >10 employees in most industries must maintain injury and illness records using three forms: OSHA 300 Log — the \"Log of Work-Related Injuries and Illnesses,\" listing each recordable case with details (name, job title, date, description, outc...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2816":{"title":"Medical Surveillance Programs","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s16","snippet":"Medical Surveillance Programs OSHA-Mandated Medical Surveillance OSHA requires specific medical surveillance programs for workers exposed to certain hazardous substances above action levels. These programs include pre-placement, periodic, and termination examinations. Substance/Standard Key Exam Com...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2817":{"title":"DOT / FMCSA Physical Examination","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s17","snippet":"DOT / FMCSA Physical Examination Overview The DOT physical examination is a federally mandated fitness-for-duty evaluation for commercial motor vehicle (CMV) operators, governed by FMCSA regulations (49 CFR Part 391). The examiner must be listed on the FMCSA National Registry of Certified Medical Ex...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2818":{"title":"Drug & Alcohol Testing","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s18","snippet":"Drug & Alcohol Testing DOT Regulations — 49 CFR Part 40 The DOT mandates drug and alcohol testing for safety-sensitive employees in transportation industries (FMCSA, FAA, FRA, FTA, PHMSA, USCG). Testing must be conducted according to the procedures in 49 CFR Part 40, which governs specimen collectio...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2819":{"title":"Needlestick & Bloodborne Pathogen Exposure","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s19","snippet":"Needlestick & Bloodborne Pathogen Exposure OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030) The BBP standard requires employers to have a written Exposure Control Plan, provide Hepatitis B vaccination (at no cost), use engineering and work practice controls (sharps containers, self-sheathing ne...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2820":{"title":"Respiratory Protection","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s20","snippet":"Respiratory Protection OSHA Respiratory Protection Standard (29 CFR 1910.134) Whenever engineering and administrative controls are insufficient to reduce airborne contaminant levels below the PEL, or when such controls are being implemented, respiratory protection is required. The employer must esta...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2821":{"title":"Travel & International Occupational Health","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s21","snippet":"Travel & International Occupational Health Pre-Travel Evaluation Workers deployed internationally require pre-travel medical assessment including: review of chronic medical conditions and stability for travel, baseline physical examination, dental clearance (for remote assignments), mental health sc...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2822":{"title":"Workers' Compensation & Medicolegal","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s22","snippet":"Workers' Compensation & Medicolegal No-Fault System Principles Workers' compensation is the exclusive remedy for work-related injuries and illnesses in most jurisdictions. The worker does not need to prove employer negligence; in return, the worker generally cannot sue the employer in tort. Exceptio...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2823":{"title":"Workplace Wellness Programs","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s23","snippet":"Workplace Wellness Programs Health Risk Assessment (HRA) The HRA is a questionnaire-based tool that evaluates individual health risks including lifestyle factors (diet, exercise, smoking, alcohol), family history, psychosocial stressors, and biometric data (BP, BMI, lipids, glucose). It serves as th...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2824":{"title":"Infection Control in Occupational Settings","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s24","snippet":"Infection Control in Occupational Settings Healthcare Worker (HCW) Screening Pre-employment and ongoing screening for HCWs includes: Tuberculosis — baseline TST (two-step) or IGRA (QuantiFERON-TB Gold Plus or T-SPOT); annual screening for those with potential TB exposure. Positive result requires CX...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2825":{"title":"OSHA PEL & ACGIH TLV Reference Table","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s25","snippet":"OSHA PEL & ACGIH TLV Reference Table Substance OSHA PEL (8-hr TWA) ACGIH TLV (8-hr TWA) NIOSH REL IDLH Primary Hazard Asbestos 0.1 f/cc 0.1 f/cc 0.1 f/cc N/A Asbestosis, mesothelioma, lung CA Benzene 1 ppm 0.5 ppm 0.1 ppm 500 ppm Leukemia, aplastic anemia Carbon monoxide 50 ppm 25 ppm 35 ppm 1,200 p...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2826":{"title":"Medical Surveillance Requirements by Substance","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s26","snippet":"Medical Surveillance Requirements by Substance OSHA Standard Substance Action Level (AL) / PEL Medical Exam Trigger Exam Components Frequency Special Provisions 1910.1001 Asbestos AL: 0.1 f/cc; PEL: 0.1 f/cc Exposure at or above AL for 30+ days/year History, exam, CXR (ILO), PFTs (FVC, FEV 1 ) Pre-p...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2827":{"title":"ILO Classification for Chest Radiographs","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s27","snippet":"ILO Classification for Chest Radiographs The ILO International Classification of Radiographs of Pneumoconioses (revised 2011) is a standardized system for systematically describing and recording radiographic abnormalities caused by inhaled dusts. B-readers are physicians who have passed the NIOSH-ad...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2828":{"title":"Abbreviations Master List","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/clinical-settings/occupational-medicine","url":"/clinical-settings/occupational-medicine#s28","snippet":"Abbreviations Master List Abbreviation Full Term ACGIH American Conference of Governmental Industrial Hygienists ADA Americans with Disabilities Act AMA American Medical Association AMS Acute Mountain Sickness APF Assigned Protection Factor BAL British Anti-Lewisite (dimercaprol) BBP Bloodborne Path...","sourceLabel":"Section in Occupational & Environmental Medicine"},"2829":{"title":"Toxicology","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology","snippet":"Specialty Reference Medical Toxicology Complete Specialty Reference Toxidrome recognition, acetaminophen and salicylate poisoning, opioid and sedative overdose, toxic alcohols, envenomation, heavy metals, antidote therapy, decontamination, and every scoring system, antidote protocol, and management ..."},"2830":{"title":"Toxicology Principles","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s1","snippet":"Toxicology Principles Medical toxicology applies pharmacokinetic and pharmacodynamic principles to the unique context of overdose, where drug concentrations far exceed therapeutic ranges. Dose-response relationships in poisoning are often non-linear: at supratherapeutic doses, metabolic pathways sat...","sourceLabel":"Section in Toxicology"},"2831":{"title":"Toxidrome Recognition","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s2","snippet":"Toxidrome Recognition A toxidrome is a constellation of signs and symptoms that suggests a specific class of poisoning. Rapid toxidrome identification narrows the differential and directs empiric therapy before laboratory confirmation. The five classic toxidromes plus serotonin syndrome and neurolep...","sourceLabel":"Section in Toxicology"},"2832":{"title":"Terminology & Abbreviations","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s3","snippet":"Terminology & Abbreviations Foundational toxicology abbreviations used throughout this reference. A comprehensive master list is provided in Section 30 . AC Activated charcoal AChE Acetylcholinesterase AG Anion gap BAL British Anti-Lewisite (dimercaprol) BLL Blood lead level CaEDTA Calcium disodium ...","sourceLabel":"Section in Toxicology"},"2833":{"title":"Decontamination","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s4","snippet":"Decontamination GI decontamination aims to reduce absorption of ingested toxins. The window for efficacy is narrow, and interventions must be weighed against aspiration risk, patient cooperation, and substance identity. No decontamination method has been shown in randomized trials to improve clinica...","sourceLabel":"Section in Toxicology"},"2834":{"title":"Enhanced Elimination","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s5","snippet":"Enhanced Elimination Urinary Alkalinization Sodium bicarbonate infusion (150 mEq NaHCO3 in 1 L D5W at 200-250 mL/hr) targeting urine pH 7.5-8.0. Ion trapping of weak acids in the renal tubule prevents reabsorption and enhances excretion. Effective for: Substance Mechanism Target Urine pH Monitoring ...","sourceLabel":"Section in Toxicology"},"2835":{"title":"Acetaminophen Toxicity","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s6","snippet":"Acetaminophen Toxicity Acetaminophen (APAP) is the most common cause of acute liver failure in the United States and the most frequent drug involved in intentional overdose. At therapeutic doses, APAP is metabolized primarily by glucuronidation (40%) and sulfation (20-40%). A small fraction (< 5%) i...","sourceLabel":"Section in Toxicology"},"2836":{"title":"Salicylate Toxicity","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s7","snippet":"Salicylate Toxicity Salicylate poisoning produces a characteristic mixed acid-base disturbance : early respiratory alkalosis (direct stimulation of the medullary respiratory center) followed by anion gap metabolic acidosis (uncoupling of oxidative phosphorylation, accumulation of organic acids). The...","sourceLabel":"Section in Toxicology"},"2837":{"title":"NSAID & COX-2 Overdose","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s8","snippet":"NSAID & COX-2 Overdose NSAID overdose is generally benign in most cases. The majority of patients develop only mild GI symptoms (nausea, vomiting, epigastric pain) and recover with supportive care alone. Serious toxicity is rare but may include seizures, renal failure, and metabolic acidosis with ma...","sourceLabel":"Section in Toxicology"},"2838":{"title":"Opioid Overdose","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s9","snippet":"Opioid Overdose Opioid overdose presents with the classic triad: CNS depression , respiratory depression , and miosis (pinpoint pupils). It remains the leading cause of poisoning death in the United States. The rise of illicitly manufactured fentanyl has dramatically altered the epidemiology and cli...","sourceLabel":"Section in Toxicology"},"2839":{"title":"Tricyclic Antidepressant Poisoning","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s10","snippet":"Tricyclic Antidepressant Poisoning TCAs (amitriptyline, nortriptyline, imipramine, desipramine) remain among the most lethal medications in overdose. Toxicity results from three primary mechanisms: sodium channel blockade (cardiac conduction delays), anticholinergic effects , and alpha-1 adrenergic ...","sourceLabel":"Section in Toxicology"},"2840":{"title":"Lithium Toxicity","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s11","snippet":"Lithium Toxicity Lithium has a narrow therapeutic index (0.6-1.2 mEq/L). Toxicity patterns differ significantly between acute ingestion (lithium-naive patient or single large ingestion) and chronic toxicity (gradual accumulation in a patient on lithium therapy). Chronic toxicity is more dangerous be...","sourceLabel":"Section in Toxicology"},"2841":{"title":"SSRI/SNRI & Serotonin Syndrome","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s12","snippet":"SSRI/SNRI & Serotonin Syndrome SSRIs (fluoxetine, sertraline, citalopram, escitalopram, paroxetine, fluvoxamine) and SNRIs (venlafaxine, duloxetine, desvenlafaxine) in isolated overdose are generally less toxic than TCAs, but they can cause serotonin syndrome, especially in combination with other se...","sourceLabel":"Section in Toxicology"},"2842":{"title":"Antipsychotic Overdose","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s13","snippet":"Antipsychotic Overdose Antipsychotic toxicity differs between first-generation (typical) and second-generation (atypical) agents. All antipsychotics share dopamine D2 receptor antagonism; toxicity profiles diverge based on additional receptor pharmacology. First vs Second Generation Feature First-Ge...","sourceLabel":"Section in Toxicology"},"2843":{"title":"Methanol & Ethylene Glycol","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s14","snippet":"Methanol & Ethylene Glycol The toxic alcohols (methanol, ethylene glycol) are relatively non-toxic as parent compounds - their danger lies in their metabolites, produced by alcohol dehydrogenase (ADH). The diagnostic hallmark is a combination of elevated osmolar gap (early, before metabolism) and el...","sourceLabel":"Section in Toxicology"},"2844":{"title":"Ethanol & Isopropanol","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s15","snippet":"Ethanol & Isopropanol Acute Ethanol Intoxication Management is primarily supportive: airway protection, glucose (check fingerstick - hypoglycemia is common, especially in children and malnourished adults), volume resuscitation, electrolyte correction, and observation until clinically sober. Serum et...","sourceLabel":"Section in Toxicology"},"2845":{"title":"Sympathomimetics - Cocaine, Methamphetamine, MDMA","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s16","snippet":"Sympathomimetics - Cocaine, Methamphetamine, MDMA Cocaine Cocaine blocks reuptake of norepinephrine, dopamine, and serotonin and also directly blocks sodium channels (local anesthetic effect). Toxicity includes: hypertensive emergency, acute coronary syndrome (even in young patients with normal coro...","sourceLabel":"Section in Toxicology"},"2846":{"title":"Cannabis, Hallucinogens & Novel Substances","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s17","snippet":"Cannabis, Hallucinogens & Novel Substances Cannabinoid Hyperemesis Syndrome (CHS) Cyclic vomiting in chronic cannabis users (typically daily use for &ge;1 year). Classic features: severe episodic nausea/vomiting, relief with hot showers/baths (pathognomonic behavior), diffuse abdominal pain. Diagnos...","sourceLabel":"Section in Toxicology"},"2847":{"title":"Carbon Monoxide Poisoning","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s18","snippet":"Carbon Monoxide Poisoning Carbon monoxide (CO) binds hemoglobin with 240&times; the affinity of oxygen, forming carboxyhemoglobin (COHb) and shifting the oxyhemoglobin dissociation curve leftward (impaired O2 unloading to tissues). CO also binds myoglobin and mitochondrial cytochrome oxidase, direct...","sourceLabel":"Section in Toxicology"},"2848":{"title":"Organophosphate & Nerve Agent Poisoning","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s19","snippet":"Organophosphate & Nerve Agent Poisoning Organophosphates (OPs) irreversibly inhibit acetylcholinesterase (AChE) , causing accumulation of acetylcholine at muscarinic, nicotinic, and CNS synapses. Sources: agricultural pesticides (malathion, parathion, chlorpyrifos), nerve agents (sarin, VX, novichok...","sourceLabel":"Section in Toxicology"},"2849":{"title":"Heavy Metals","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s20","snippet":"Heavy Metals Lead Poisoning Blood Lead Level (BLL) Age Group Clinical Effects Management &ge;3.5 mcg/dL Children CDC reference value (previously 5, revised 2021); triggers investigation Environmental assessment, source removal, nutritional counseling 20-44 mcg/dL Children Cognitive impairment, behav...","sourceLabel":"Section in Toxicology"},"2850":{"title":"Envenomation","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s21","snippet":"Envenomation Pit Viper (Crotalid) Envenomation Rattlesnakes, copperheads, and cottonmouths account for >95% of venomous snakebites in the US. Venom contains hemotoxins, cytotoxins, and myotoxins causing local tissue destruction, coagulopathy (thrombocytopenia, hypofibrinogenemia, elevated PT/INR), a...","sourceLabel":"Section in Toxicology"},"2851":{"title":"Caustic Ingestions","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s22","snippet":"Caustic Ingestions Caustic ingestion causes direct chemical injury to the GI mucosa. Alkalis (pH > 12: NaOH, KOH, bleach, drain cleaners, button batteries) cause liquefactive necrosis - deep penetrating injury through esophageal wall. Acids (pH < 2: HCl, H2SO4, battery acid) cause coagulative necros...","sourceLabel":"Section in Toxicology"},"2852":{"title":"Cardiac Drug Toxicity","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s23","snippet":"Cardiac Drug Toxicity Beta-Blocker Overdose Presents with bradycardia, hypotension, heart block, and hypoglycemia (especially propranolol). Propranolol also causes sodium channel blockade (QRS widening) and seizures. CNS-penetrant agents (propranolol, labetalol) are most lethal. Beta-Blocker Toxicit...","sourceLabel":"Section in Toxicology"},"2853":{"title":"Cyanide Poisoning","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s24","snippet":"Cyanide Poisoning Cyanide binds mitochondrial cytochrome oxidase a3, blocking the electron transport chain and halting aerobic metabolism. Cells switch to anaerobic glycolysis, producing profound lactic acidosis despite adequate oxygen delivery (PaO2 and SaO2 are normal). Sources: house fire smoke i...","sourceLabel":"Section in Toxicology"},"2854":{"title":"Withdrawal Syndromes","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s25","snippet":"Withdrawal Syndromes Alcohol Withdrawal Onset 6-24 hours after last drink. Spectrum: tremulousness (6-24h) &rarr; withdrawal seizures (12-48h) &rarr; alcoholic hallucinosis (12-48h) &rarr; delirium tremens (48-96h, mortality 5-15% if untreated). Monitor with CIWA-Ar (Clinical Institute Withdrawal As...","sourceLabel":"Section in Toxicology"},"2855":{"title":"Antidotes Master Table","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s26","snippet":"Antidotes Master Table Poison/Toxin Antidote Dose Route Acetaminophen N-acetylcysteine (NAC) 150 mg/kg load (IV) or 140 mg/kg load (PO) IV or PO Anticholinesterase/OP Atropine + Pralidoxime Atropine 2-4 mg; 2-PAM 1-2 g IV Benzodiazepines Flumazenil 0.2 mg IV q1min (max 3-5 mg) IV Beta-blockers Gluca...","sourceLabel":"Section in Toxicology"},"2856":{"title":"Toxidrome Summary Table","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s27","snippet":"Toxidrome Summary Table Toxidrome HR BP Temp Pupils Skin Mental Status Bowel Sounds Treatment Sympathomimetic &uarr; &uarr; &uarr; Mydriasis Diaphoretic Agitated &uarr; Benzodiazepines, cooling Anticholinergic &uarr; &uarr; &uarr; Mydriasis Dry, flushed Delirium &darr; Physostigmine (if no TCA); ben...","sourceLabel":"Section in Toxicology"},"2857":{"title":"Dialyzable Substances","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s28","snippet":"Dialyzable Substances Hemodialysis effectively removes substances that meet specific pharmacokinetic criteria. The ideal dialyzable toxin has: low molecular weight (< 500 Da, passes membrane pores easily), low volume of distribution (< 1 L/kg, drug remains in blood compartment), low protein binding ...","sourceLabel":"Section in Toxicology"},"2858":{"title":"Scoring Systems","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s29","snippet":"Scoring Systems Rumack-Matthew Nomogram Plots serum acetaminophen concentration versus time after a single, acute ingestion. The treatment line begins at 150 mcg/mL at 4 hours, 75 mcg/mL at 8 hours, 37.5 mcg/mL at 12 hours, and 4.7 mcg/mL at 24 hours (log-linear decline). Levels above the line indic...","sourceLabel":"Section in Toxicology"},"2859":{"title":"Abbreviations Master List","pageTitle":"Toxicology","pageUrl":"/clinical-settings/toxicology","url":"/clinical-settings/toxicology#s30","snippet":"Abbreviations Master List 2-PAM Pralidoxime (pyridine-2-aldoxime methiodide) 4F-PCC Four-factor prothrombin complex concentrate AACT American Academy of Clinical Toxicology AC Activated charcoal AChE Acetylcholinesterase ADH Alcohol dehydrogenase AG Anion gap AKA Alcoholic ketoacidosis ALF Acute liv...","sourceLabel":"Section in Toxicology"},"2860":{"title":"Internal Medicine","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine","snippet":"Internal Medicine - Complete Reference Every diagnosis, workup, procedure, medication, score, and documentation framework you need to survive inpatient and outpatient adult medicine from day one."},"2861":{"title":"Organ Systems - Physiology Essentials","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s1","snippet":"Organ Systems - Physiology Essentials Internal medicine is the specialty of adult general medicine. Internists diagnose and manage every non-surgical adult condition, from an outpatient with newly discovered hypertension to a critically ill septic patient in the ICU. As a scribe, you will rotate acr...","sourceLabel":"Section in Internal Medicine"},"2862":{"title":"Scribe Documentation Framework","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s2","snippet":"Scribe Documentation Framework The Problem-Based Note Unlike surgical SOAP notes organized around a single diagnosis, internal medicine notes are problem-oriented . The assessment and plan is written as a numbered list of active problems, each with a brief assessment sentence and a bulleted plan. A ...","sourceLabel":"Section in Internal Medicine"},"2863":{"title":"Chest Pain Workup","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s3","snippet":"Chest Pain Workup Chest pain is the single most common presenting complaint that triggers an IM admission or ED evaluation. The job of the internist is to risk-stratify the patient along two questions: is this acute coronary syndrome (ACS) , and if not, what else life-threatening could this be (PE, ...","sourceLabel":"Section in Internal Medicine"},"2864":{"title":"Dyspnea & Respiratory Failure","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s4","snippet":"Dyspnea & Respiratory Failure Dyspnea is another huge IM complaint. The differential is broad: cardiac (HF, ACS, pericardial effusion, arrhythmia), pulmonary (COPD/asthma exacerbation, pneumonia, PE, pneumothorax, effusion), hematologic (anemia), metabolic (acidosis), neuromuscular, and anxiety. Fig...","sourceLabel":"Section in Internal Medicine"},"2865":{"title":"Heart Failure (Acute & Chronic)","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s5","snippet":"Heart Failure (Acute & Chronic) Heart failure (HF) is one of the top causes of hospital admission in adults over 65. It is classified by ejection fraction: HFrEF (reduced EF, &le;40%), HFmrEF (mildly reduced, 41-49%), and HFpEF (preserved, &ge;50%). Figure 5 - Heart Failure Pathophysiology. Overview...","sourceLabel":"Section in Internal Medicine"},"2866":{"title":"Atrial Fibrillation & Arrhythmias","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s6","snippet":"Atrial Fibrillation & Arrhythmias Atrial fibrillation (AFib) is the most common sustained arrhythmia in adults. The two management questions are always: rate vs rhythm control , and stroke prevention . Figure 7 - AFib Rate Control Algorithm. Stepwise approach to rate control in atrial fibrillation, ...","sourceLabel":"Section in Internal Medicine"},"2867":{"title":"Hypertension - Chronic, Urgency, Emergency","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s7","snippet":"Hypertension - Chronic, Urgency, Emergency HTN affects nearly half of US adults and is a major driver of stroke, MI, HF, CKD, and dementia. The 2017 ACC/AHA HTN Guideline defines stages. Figure 8 - Adrenal & Renin-Angiotensin Axis. The hypothalamic-pituitary-adrenal axis and renin-angiotensin-aldost...","sourceLabel":"Section in Internal Medicine"},"2868":{"title":"COPD & Asthma","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s8","snippet":"COPD & Asthma COPD COPD is progressive airflow limitation from chronic bronchitis and/or emphysema, overwhelmingly caused by smoking (also alpha-1 antitrypsin deficiency, occupational exposures). Diagnosis requires spirometry with post-bronchodilator FEV1/FVC < 0.70. Severity by GOLD 2024 is based o...","sourceLabel":"Section in Internal Medicine"},"2869":{"title":"Community-Acquired Pneumonia","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s9","snippet":"Community-Acquired Pneumonia CAP is a leading infectious cause of hospital admission. Typical organisms: Streptococcus pneumoniae (#1), H. influenzae , Moraxella . Atypicals: Mycoplasma , Chlamydia pneumoniae , Legionella . Viral: influenza, RSV, SARS-CoV-2. Figure 11 - Lobar Pneumonia on Chest Radi...","sourceLabel":"Section in Internal Medicine"},"2870":{"title":"Venous Thromboembolism (DVT/PE)","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s10","snippet":"Venous Thromboembolism (DVT/PE) DVT and PE together constitute venous thromboembolism (VTE). PE is the third most common cardiovascular cause of death after MI and stroke. Risk factors include immobility, surgery, malignancy, pregnancy/postpartum, estrogen therapy, obesity, prior VTE, and inherited ...","sourceLabel":"Section in Internal Medicine"},"2871":{"title":"Sepsis & Septic Shock","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s11","snippet":"Sepsis & Septic Shock Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is sepsis with circulatory failure requiring vasopressors to maintain MAP &ge; 65 and lactate > 2 despite adequate fluid resuscitation. Figure 13 - Sepsis Fluid Resusc...","sourceLabel":"Section in Internal Medicine"},"2872":{"title":"Acute Kidney Injury & CKD","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s12","snippet":"Acute Kidney Injury & CKD AKI Definition (KDIGO) Figure 14 - ECG Changes in Potassium Disorders. Progressive ECG manifestations of hyperkalemia (peaked T waves, flattened P waves, widened QRS, sine wave) and hypokalemia (U waves, flattened T waves, ST depression), critical for rapid bedside diagnosi...","sourceLabel":"Section in Internal Medicine"},"2873":{"title":"Electrolyte & Acid-Base Derangements","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s13","snippet":"Electrolyte & Acid-Base Derangements Hyperkalemia Causes: renal failure, ACEi/ARB, spironolactone, rhabdomyolysis, tumor lysis, adrenal insufficiency, hemolyzed sample. EKG changes: peaked T waves, PR prolongation, QRS widening, sine wave, VFib/asystole. Treatment: calcium gluconate (membrane stabil...","sourceLabel":"Section in Internal Medicine"},"2874":{"title":"Diabetes, DKA & HHS","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s14","snippet":"Diabetes, DKA & HHS Type 2 DM Management Per the ADA Standards of Care 2024 , first-line therapy is metformin plus lifestyle modification. For patients with established ASCVD, HF, or CKD, add an SGLT2 inhibitor or GLP-1 receptor agonist with proven cardiovascular benefit regardless of A1C. Targets: ...","sourceLabel":"Section in Internal Medicine"},"2875":{"title":"GI Bleeding & Hepatology","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s15","snippet":"GI Bleeding & Hepatology Upper vs Lower GI Bleeding Upper GI bleed (UGIB): Proximal to the ligament of Treitz. Presents with hematemesis, coffee-ground emesis, or melena. Causes: peptic ulcer disease (#1), variceal bleeding, Mallory-Weiss tear, gastritis, malignancy, angiodysplasia. BUN is dispropor...","sourceLabel":"Section in Internal Medicine"},"2876":{"title":"UTI, Pyelonephritis & Cellulitis","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s16","snippet":"UTI, Pyelonephritis & Cellulitis UTI Uncomplicated cystitis in non-pregnant women: nitrofurantoin 100 mg BID &times; 5 days, TMP-SMX DS BID &times; 3 days (if local E. coli resistance < 20%), or fosfomycin 3 g &times; 1. Complicated UTI (males, catheterized, pregnant, immunocompromised, urologic abn...","sourceLabel":"Section in Internal Medicine"},"2877":{"title":"Anemia & Hematology","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s17","snippet":"Anemia & Hematology Anemia Workup by MCV Microcytic (MCV < 80): Iron deficiency (low ferritin, high TIBC), thalassemia (normal-high ferritin, target cells), anemia of chronic disease (can be normocytic or microcytic), lead poisoning, sideroblastic. Normocytic (MCV 80-100): Anemia of chronic disease,...","sourceLabel":"Section in Internal Medicine"},"2878":{"title":"Altered Mental Status, Syncope & Falls","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s18","snippet":"Altered Mental Status, Syncope & Falls AMS Workup AMS is a final common pathway with an enormous differential - use the AEIOU TIPS mnemonic: Alcohol/Acidosis, Epilepsy/Electrolytes/Encephalopathy, Insulin (hypo/hyperglycemia), Oxygen/Opioids, Uremia, Trauma/Temperature, Infection, Psychiatric/Poison...","sourceLabel":"Section in Internal Medicine"},"2879":{"title":"Thyroid, Adrenal & Endocrine Essentials","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s19","snippet":"Thyroid, Adrenal & Endocrine Essentials Hypothyroidism Elevated TSH with low free T4. Most common cause: Hashimoto thyroiditis. Symptoms: fatigue, cold intolerance, weight gain, constipation, dry skin, bradycardia, depression. Treatment: levothyroxine starting 1.6 mcg/kg/day (lower in elderly and CA...","sourceLabel":"Section in Internal Medicine"},"2880":{"title":"Preventive Medicine & Cancer Screening","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s20","snippet":"Preventive Medicine & Cancer Screening Preventive care is a core outpatient IM function. The USPSTF is the authoritative source for screening recommendations. Adult Cancer Screening (USPSTF, 2024) Cancer Population Test & Interval Breast Women 40-74 Biennial mammography Cervical Women 21-65 Pap q3y ...","sourceLabel":"Section in Internal Medicine"},"2881":{"title":"Perioperative Medicine & Transitions of Care","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s21","snippet":"Perioperative Medicine & Transitions of Care Preoperative Evaluation The IM consultant (or hospitalist) is asked to \"medically optimize\" and \"risk stratify\" surgical candidates. The framework comes from the ACC/AHA Perioperative Guideline : (1) urgency of surgery, (2) active cardiac conditions (unst...","sourceLabel":"Section in Internal Medicine"},"2882":{"title":"Procedures in Internal Medicine","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s22","snippet":"Procedures in Internal Medicine Inpatient internists perform a defined set of bedside procedures. As a scribe, you are often responsible for the procedure note including indication, consent, time-out, technique, operator, complications, estimated blood loss, and post-procedure plan. Core Procedures ...","sourceLabel":"Section in Internal Medicine"},"2883":{"title":"Medications You Must Know","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s23","snippet":"Medications You Must Know Internal medicine touches almost every non-controlled-substance drug class. Learn the generic-brand mappings and the indication in a sentence. Cardiovascular Class Examples (generic / brand) Use ACEi lisinopril (Zestril), enalapril, ramipril HTN, HFrEF, post-MI, DM nephropa...","sourceLabel":"Section in Internal Medicine"},"2884":{"title":"Classification & Risk Scores","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s24","snippet":"Classification & Risk Scores Internists live inside risk scores and clinical decision rules. Every one of these will come up on rounds. Full enumerations below. CHA 2 DS 2 -VASc Letter Criterion Points C CHF / LV dysfunction 1 H Hypertension 1 A 2 Age &ge; 75 2 D Diabetes 1 S 2 Stroke/TIA/thromboemb...","sourceLabel":"Section in Internal Medicine"},"2885":{"title":"Abbreviations Master List","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s25","snippet":"Abbreviations Master List Diagnoses HTN Hypertension DM Diabetes mellitus HLD Hyperlipidemia CAD Coronary artery disease CHF / HF Congestive heart failure / heart failure HFrEF / HFpEF Heart failure with reduced / preserved ejection fraction MI Myocardial infarction ACS Acute coronary syndrome STEMI...","sourceLabel":"Section in Internal Medicine"},"2886":{"title":"Sample HPI Templates","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s26","snippet":"Sample HPI Templates These templates show the rhythm and content of real IM notes covering the most common encounter types on both inpatient and outpatient services. Sample HPI - Chest Pain Admission \"Mr. [Name] is a 62-year-old male with a PMH of HTN, HLD, type 2 DM (A1C 7.4), 30-pack-year smoking ...","sourceLabel":"Section in Internal Medicine"},"2887":{"title":"References & Sources","pageTitle":"Internal Medicine","pageUrl":"/scribe-guides/internal-medicine","url":"/scribe-guides/internal-medicine#s27","snippet":"References & Sources Clinical Practice Guidelines Writing Committee. 2023 ACC/AHA/ACCP/ASPC Chest Pain Guideline. Circulation. 2023. Heidenreich PA et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Circulation. 2022. Joglar JA et al. 2023 ACC/AHA/ACCP/HRS Guideline for Atrial F...","sourceLabel":"Section in Internal Medicine"},"2888":{"title":"Family Medicine","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine","snippet":"Family Medicine - Complete Reference Every diagnosis, condition, procedure, medication, screening guideline, and documentation framework you need to scribe primary care from day one and beyond."},"2889":{"title":"Primary Care Foundations - The Family Medicine Philosophy","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#s1","snippet":"Primary Care Foundations - The Family Medicine Philosophy Family medicine is the broadest specialty in American medicine. A family physician cares for patients of every age, every sex, every organ system, and every stage of life - from the newborn nursery visit to end-of-life care. The scribe suppor...","sourceLabel":"Section in Family Medicine"},"2890":{"title":"Scribe Documentation Framework","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#s2","snippet":"Scribe Documentation Framework Family medicine notes follow the SOAP format but add a heavy emphasis on problem-based charting - each active chronic or acute issue is addressed individually in the assessment and plan, with its own brief status update and plan. Most EMRs (Epic, Athena, eClinicalWorks...","sourceLabel":"Section in Family Medicine"},"2891":{"title":"Hypertension (HTN)","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#s3","snippet":"Hypertension (HTN) Hypertension is the single most common diagnosis in primary care. Nearly half of all American adults meet the 2017 ACC/AHA criteria, and every family physician manages dozens of hypertensive patients per day. A scribe working in primary care will chart HTN on most of their encount...","sourceLabel":"Section in Family Medicine"},"2892":{"title":"Dyslipidemia & Lipid Management","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#s4","snippet":"Dyslipidemia & Lipid Management Dyslipidemia is managed in primary care based on 10-year atherosclerotic cardiovascular disease (ASCVD) risk. The 2018 AHA/ACC Cholesterol Guideline is the standard of care. Figure 3 - Diabetic Dyslipidemia and Lipoprotein Metabolism. Mechanisms underlying atherogenic...","sourceLabel":"Section in Family Medicine"},"2893":{"title":"Type 2 Diabetes, Prediabetes & Obesity","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#s5","snippet":"Type 2 Diabetes, Prediabetes & Obesity Diabetes management is a dominant share of any primary care panel. The ADA Standards of Care are updated annually and govern diagnostic thresholds, glycemic targets, and medication selection. Figure 4 - Type 2 Diabetes Mellitus Pathophysiology. Risk factors and...","sourceLabel":"Section in Family Medicine"},"2894":{"title":"Thyroid Disorders","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#s6","snippet":"Thyroid Disorders Hypothyroidism is common; hyperthyroidism less so but important to recognize. TSH is the screening and monitoring test of choice. Figure 6 - Endocrine Signaling Pathways. Molecular signaling cascades governing hormone secretion from endocrine cells. Dysfunction in these pathways is...","sourceLabel":"Section in Family Medicine"},"2895":{"title":"URIs, Sinusitis, Pharyngitis, Otitis & Allergic Rhinitis","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#s7","snippet":"URIs, Sinusitis, Pharyngitis, Otitis & Allergic Rhinitis Acute respiratory complaints fill every urgent slot in primary care. Figure 7 - Obstructive Pattern on Spirometry. Spirometry demonstrating an obstructive ventilatory defect with reduced FEV1/FVC ratio and a characteristic concave expiratory f...","sourceLabel":"Section in Family Medicine"},"2896":{"title":"Asthma & COPD","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#s8","snippet":"Asthma & COPD Asthma Chronic reversible airway inflammation with bronchospasm. Classic triggers: allergens, viral URIs, exercise, cold air, smoke. Management follows the NAEPP EPR-4 2020 Focused Updates and GINA strategy. Figure 8 - Bronchodilator Reversibility Testing. Overlaid flow-volume loops de...","sourceLabel":"Section in Family Medicine"},"2897":{"title":"GERD, IBS & Common GI Complaints","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#s9","snippet":"GERD, IBS & Common GI Complaints GERD Heartburn, regurgitation, chronic cough, dental erosion. Diagnose clinically; empiric PPI trial (omeprazole 20 mg daily, pantoprazole 40 mg daily, esomeprazole 40 mg) x 8 weeks. Lifestyle: weight loss, head of bed elevation, avoid late meals, avoid triggers (cof...","sourceLabel":"Section in Family Medicine"},"2898":{"title":"MSK - Low Back, Knee, Neck & Headache","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#s10","snippet":"MSK - Low Back, Knee, Neck & Headache Low Back Pain Figure 9 - Lumbar Disc Herniation Types. Schematic representation of disc herniation patterns, from contained protrusion to frank extrusion and sequestered fragments. These distinctions guide clinical decision-making regarding the urgency of imagin...","sourceLabel":"Section in Family Medicine"},"2899":{"title":"Depression, Anxiety, Insomnia & ADHD","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#s11","snippet":"Depression, Anxiety, Insomnia & ADHD Depression - PHQ-9 The PHQ-9 is administered at essentially every primary care visit where mood is addressed. It scores 9 DSM-5 criteria over the past 2 weeks on a 0-3 scale. Figure 12 - Depression and Anxiety Treatment Algorithm. Diagnostic and treatment algorit...","sourceLabel":"Section in Family Medicine"},"2900":{"title":"Geriatrics - Dementia, Falls, Osteoporosis","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#s12","snippet":"Geriatrics - Dementia, Falls, Osteoporosis Cognitive Screening Figure 13 - Progressive Hippocampal Atrophy in Alzheimer Disease. Serial coronal T1-weighted MRI demonstrating progressive hippocampal and medial temporal lobe atrophy in an individual with Alzheimer disease, progressing from memory comp...","sourceLabel":"Section in Family Medicine"},"2901":{"title":"Women's Health, Contraception & Prenatal","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#s13","snippet":"Women's Health, Contraception & Prenatal Contraception Figure 15 - Obesity and Cardiovascular Risk Progression. The cascade from obesity through the development of metabolic syndrome components, illustrating how each additional risk factor compounds overall cardiovascular morbidity and mortality rel...","sourceLabel":"Section in Family Medicine"},"2902":{"title":"Pediatrics - Well-Child, Immunizations & Common Infections","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#s14","snippet":"Pediatrics - Well-Child, Immunizations & Common Infections Well-Child Schedule AAP Bright Futures: newborn, 3-5 days, 1 month, 2, 4, 6, 9, 12, 15, 18, 24, 30 months, then annually through age 21. Each visit documents growth parameters on CDC/WHO curves, developmental surveillance (Ages & Stages at 9...","sourceLabel":"Section in Family Medicine"},"2903":{"title":"Dermatology in Primary Care","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#s15","snippet":"Dermatology in Primary Care Family physicians handle most everyday skin complaints before specialty referral. Figure 16 - Immunopathogenesis of Atopic Dermatitis. Immunological abnormalities in atopic dermatitis, including Th2-driven inflammation, cytokine signaling cascades, and the interplay betwe...","sourceLabel":"Section in Family Medicine"},"2904":{"title":"GU - UTI & Sexual Health","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#s16","snippet":"GU - UTI & Sexual Health Uncomplicated UTI Dysuria, frequency, urgency, suprapubic pain. UA with nitrite and leukocyte esterase, culture in complicated cases. First-line: nitrofurantoin 100 mg BID x 5 d, TMP-SMX DS BID x 3 d, fosfomycin 3 g x 1. Avoid fluoroquinolones first-line. Pyelonephritis (fev...","sourceLabel":"Section in Family Medicine"},"2905":{"title":"Preventive Care & USPSTF Screening","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#s17","snippet":"Preventive Care & USPSTF Screening Preventive care is central to family medicine billing and quality measures. Memorize the current USPSTF A and B recommendations . Figure 18 - Atherosclerotic Plaque Formation. Sequential stages of atheroma development from initial endothelial injury through fatty s...","sourceLabel":"Section in Family Medicine"},"2906":{"title":"Office Procedures","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#s18","snippet":"Office Procedures Figure 19 - Knee Joint Injection Landmarks. Anatomical landmarks for aspiration and injection of the knee joint. The patella is circled with the tibial tuberosity marked; lines indicate access points for medial and lateral midpatellar approaches. Procedure Indication Scribe Documen...","sourceLabel":"Section in Family Medicine"},"2907":{"title":"Labs, Imaging & Point-of-Care Diagnostics","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#s19","snippet":"Labs, Imaging & Point-of-Care Diagnostics Figure 20 - Normal Spirometry Flow-Volume Loop. A normal spirometry tracing showing that all measurements fall within expected ranges. The flow-volume loop demonstrates a sharp peak expiratory flow followed by a smooth, linear decline during expiration. Comm...","sourceLabel":"Section in Family Medicine"},"2908":{"title":"Primary Care Medication Formulary","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#s20","snippet":"Primary Care Medication Formulary Antihypertensives Class Examples Notes ACE-I Lisinopril, enalapril, ramipril, benazepril Cough, hyperkalemia, avoid pregnancy, angioedema ARB Losartan, valsartan, olmesartan, telmisartan Alternative when ACE-I not tolerated Thiazide HCTZ, chlorthalidone, indapamide ...","sourceLabel":"Section in Family Medicine"},"2909":{"title":"Classification & Scoring Systems","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#s21","snippet":"Classification & Scoring Systems PHQ-9 Depression Nine items scored 0-3: (1) little interest/pleasure, (2) depressed mood, (3) sleep, (4) energy, (5) appetite, (6) self-worth, (7) concentration, (8) psychomotor, (9) suicidal ideation. Totals: 0-4 none, 5-9 mild, 10-14 moderate, 15-19 moderately seve...","sourceLabel":"Section in Family Medicine"},"2910":{"title":"Physical Exam Templates","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#s22","snippet":"Physical Exam Templates General Adult Exam Template General: Alert, oriented x 3, no acute distress, well-appearing. HEENT: NCAT, PERRL, EOMI, sclerae anicteric, conjunctivae pink, oropharynx clear without erythema or exudate, TMs pearly gray bilaterally, moist mucous membranes. Neck: Supple, no lym...","sourceLabel":"Section in Family Medicine"},"2911":{"title":"Abbreviations Master List","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#s23","snippet":"Abbreviations Master List HTN - hypertension T2DM - type 2 diabetes mellitus HLD - hyperlipidemia CAD - coronary artery disease CHF - congestive heart failure HFrEF/HFpEF - HF reduced/preserved EF AFib - atrial fibrillation COPD - chronic obstructive pulmonary disease OSA - obstructive sleep apnea G...","sourceLabel":"Section in Family Medicine"},"2912":{"title":"Sample HPI Templates","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#s24","snippet":"Sample HPI Templates HPI #1 - Annual Physical 62-year-old female presents for her annual wellness visit. She reports she has been feeling generally well over the past year. No chest pain, palpitations, or dyspnea. No cough or weight change. Home BPs on lisinopril have averaged 124/76 over the past m...","sourceLabel":"Section in Family Medicine"},"2913":{"title":"References & Sources","pageTitle":"Family Medicine","pageUrl":"/scribe-guides/family-medicine","url":"/scribe-guides/family-medicine#references","snippet":"References & Sources Clinical Practice Guidelines Whelton PK, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension. 2018. Grundy SM, et al. 2018 AHA/ACC Guideline on the Managem...","sourceLabel":"Section in Family Medicine"},"2914":{"title":"Pediatrics","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics","snippet":"Pediatrics - Complete Reference Every diagnosis, condition, procedure, medication, abbreviation, and documentation framework you need to succeed on day one in a pediatric clinic, urgent care, or inpatient service."},"2915":{"title":"Pediatric Principles - Age Groups, Growth & Development","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics#s1","snippet":"Pediatric Principles - Age Groups, Growth & Development Pediatrics is the care of humans from birth through age 18 (and in many practices, into the early 20s). The foundational principle that separates pediatrics from adult medicine is that children are not small adults . Normal vital signs, drug do...","sourceLabel":"Section in Pediatrics"},"2916":{"title":"Scribe Documentation Framework - Well vs Sick Visits","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics#s2","snippet":"Scribe Documentation Framework - Well vs Sick Visits Pediatric notes split cleanly into two templates: the well-child check (WCC) and the sick visit . Every pediatric scribe must learn both rhythms because they are structured entirely differently. WCCs are scheduled, preventive, and heavily template...","sourceLabel":"Section in Pediatrics"},"2917":{"title":"Well-Child Care & Anticipatory Guidance","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics#s3","snippet":"Well-Child Care & Anticipatory Guidance The AAP Bright Futures guidelines define the recommended schedule of well-child visits: at 3-5 days, 1, 2, 4, 6, 9, 12, 15, 18, 24, and 30 months, then annually through age 21. Each visit has age-specific anticipatory guidance, screening, immunizations, and de...","sourceLabel":"Section in Pediatrics"},"2918":{"title":"Neonatal Problems - Jaundice, GERD, Colic, FTT","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics#s4","snippet":"Neonatal Problems - Jaundice, GERD, Colic, FTT Neonatal Jaundice Jaundice - yellow discoloration of skin and sclerae from elevated unconjugated bilirubin - is extraordinarily common: up to 60% of term and 80% of preterm newborns. Most is physiologic, from the combination of high bilirubin load (RBC ...","sourceLabel":"Section in Pediatrics"},"2919":{"title":"Fever in the Neonate & Infant","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics#s5","snippet":"Fever in the Neonate & Infant Fever is defined as rectal temperature &ge; 38.0&deg;C (100.4&deg;F). In a neonate (&le; 28 days), fever is a medical emergency. The 2021 AAP Clinical Practice Guideline on evaluating the well-appearing febrile infant 8-60 days old is the single most important guideline...","sourceLabel":"Section in Pediatrics"},"2920":{"title":"Upper Respiratory Infections (URI, OM, Strep, Croup)","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics#s6","snippet":"Upper Respiratory Infections (URI, OM, Strep, Croup) Viral URI (\"Common Cold\") Rhinovirus, coronavirus, RSV, adenovirus, parainfluenza. Children average 6-8 URIs per year (more in daycare). Symptoms: rhinorrhea, nasal congestion, cough, low-grade fever, sore throat - resolving in 7-10 days. Manageme...","sourceLabel":"Section in Pediatrics"},"2921":{"title":"Lower Respiratory Disease (Bronchiolitis, Pneumonia, Asthma)","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics#s7","snippet":"Lower Respiratory Disease (Bronchiolitis, Pneumonia, Asthma) Bronchiolitis Viral (RSV most common; also rhino, metapneumo, parainfluenza, COVID) infection of the small airways in children < 2 years, peaking at 2-6 months. Presents with URI prodrome followed by cough, tachypnea, wheeze, and retractio...","sourceLabel":"Section in Pediatrics"},"2922":{"title":"GI Disorders (Gastroenteritis, Constipation, Dehydration)","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics#s8","snippet":"GI Disorders (Gastroenteritis, Constipation, Dehydration) Acute Gastroenteritis (AGE) Usually viral (norovirus, rotavirus - now rare post-vaccine, enteric adenovirus, astrovirus). Bacterial causes include Salmonella , Shigella , Campylobacter , E. coli (including Shiga-toxin producing - avoid antibi...","sourceLabel":"Section in Pediatrics"},"2923":{"title":"Urinary Tract Infection & Renal Issues","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics#s9","snippet":"Urinary Tract Infection & Renal Issues UTI is a frequent occult source of fever in young children. Under 2 years, symptoms are nonspecific (fever, fussiness, poor feeding). School-age children present with classic dysuria, frequency, urgency, and suprapubic pain. E. coli accounts for 80-90% of cases...","sourceLabel":"Section in Pediatrics"},"2924":{"title":"Classic Pediatric Exanthems & Viral Illnesses","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics#s10","snippet":"Classic Pediatric Exanthems & Viral Illnesses The \"childhood exanthems\" are a core recognition task. Many are now rare because of immunization (measles, rubella, varicella), but scribes must recognize them all. Figure 12 - Measles (Rubeola) Rash. Erythematous maculopapular rash on the back of a chil...","sourceLabel":"Section in Pediatrics"},"2925":{"title":"Dermatologic Conditions (Atopic Dermatitis, Impetigo, Lice)","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics#s11","snippet":"Dermatologic Conditions (Atopic Dermatitis, Impetigo, Lice) Atopic Dermatitis (Eczema) Chronic relapsing itchy dermatitis; part of the atopic triad (eczema, allergic rhinitis, asthma). Infants: face and extensor surfaces. Children/adolescents: flexural surfaces (antecubital, popliteal fossae, neck)....","sourceLabel":"Section in Pediatrics"},"2926":{"title":"Pediatric Neurology (Febrile Seizure, Headache, Concussion)","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics#s12","snippet":"Pediatric Neurology (Febrile Seizure, Headache, Concussion) Febrile Seizure Seizure associated with fever in a child 6 months-5 years without CNS infection, metabolic disturbance, or prior afebrile seizures. Simple: generalized, < 15 minutes, no recurrence within 24 hours. Complex: focal, > 15 minut...","sourceLabel":"Section in Pediatrics"},"2927":{"title":"Chronic Disease & Genetic Conditions","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics#s13","snippet":"Chronic Disease & Genetic Conditions Asthma, Allergies, Anaphylaxis Already covered in §7. Food allergies - the \"Big 9\" (milk, egg, peanut, tree nut, wheat, soy, fish, shellfish, sesame). Early peanut introduction (LEAP) is now recommended to reduce peanut allergy. Anaphylaxis - IM epinephrine (0.01...","sourceLabel":"Section in Pediatrics"},"2928":{"title":"Behavioral, Developmental & Mental Health","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics#s14","snippet":"Behavioral, Developmental & Mental Health ADHD AAP ADHD guideline : DSM-5 criteria require 6+ inattentive and/or hyperactive-impulsive symptoms for &ge; 6 months, present before age 12, in &ge; 2 settings, causing impairment. Use Vanderbilt or Conners rating scales from parents and teachers. Prescho...","sourceLabel":"Section in Pediatrics"},"2929":{"title":"Adolescent Medicine & HEEADSSS","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics#s15","snippet":"Adolescent Medicine & HEEADSSS Adolescent care requires a major shift in interview style. The parent is asked to step out and the teen is interviewed alone (at minimum for part of the visit), with a clear explanation of confidentiality and its limits (harm to self, harm to others, abuse). The HEEADS...","sourceLabel":"Section in Pediatrics"},"2930":{"title":"Child Abuse, Neglect & Safety","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics#s16","snippet":"Child Abuse, Neglect & Safety All pediatric clinicians and scribes are mandated reporters. The scribe does not make reports but may hear the clinician say \"I'm concerned for non-accidental trauma (NAT)\" - and will document the concern, the findings, and the disposition precisely. Red flags for NAT: ...","sourceLabel":"Section in Pediatrics"},"2931":{"title":"Pediatric Procedures & Screening Tests","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics#s17","snippet":"Pediatric Procedures & Screening Tests Outpatient pediatric procedures are low-complexity but high-volume. Inpatient and ED pediatrics adds several invasive procedures the scribe must document with precision. Procedure Indication / Description Vaccinations IM (anterolateral thigh < 2 yr, deltoid &ge...","sourceLabel":"Section in Pediatrics"},"2932":{"title":"Immunizations & the ACIP Schedule","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics#s18","snippet":"Immunizations & the ACIP Schedule The ACIP childhood & adolescent immunization schedule is the authoritative reference - updated annually. Scribes must know which vaccines are given at each visit to document accurately. Routine Childhood Immunization Schedule (simplified) Age Vaccines Birth HepB #1 ...","sourceLabel":"Section in Pediatrics"},"2933":{"title":"Labs, Imaging & Diagnostic Interpretation","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics#s19","snippet":"Labs, Imaging & Diagnostic Interpretation Common Labs Pediatric reference ranges shift dramatically by age. Newborn Hgb is 14-22, drops to a physiologic nadir of 9-11 at 2-3 months, then rises. WBC trends from neutrophil-predominant (newborn) to lymphocyte-predominant (toddler) and back to neutrophi...","sourceLabel":"Section in Pediatrics"},"2934":{"title":"Medications & Weight-Based Dosing","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics#s20","snippet":"Medications & Weight-Based Dosing Pediatric dosing is weight-based in mg/kg with a ceiling at adult dose. Always document the child's weight (today's weight, in kg) before prescribing. Common pitfalls: concentration confusion for liquid medications (e.g., amoxicillin 250/5 vs 400/5), teaspoons vs mi...","sourceLabel":"Section in Pediatrics"},"2935":{"title":"Classification Systems & Scoring Tools","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics#s21","snippet":"Classification Systems & Scoring Tools APGAR Score (1 and 5 minutes after birth) Parameter 0 1 2 Appearance (color) Blue/pale Body pink, extremities blue All pink Pulse Absent < 100 &ge; 100 Grimace (reflex irritability) None Grimace Cry, cough, sneeze Activity (tone) Flaccid Some flexion Active mot...","sourceLabel":"Section in Pediatrics"},"2936":{"title":"Physical Exam by Age","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics#s22","snippet":"Physical Exam by Age The pediatric exam is performed in an order that respects the child's cooperation - from least to most distressing. Crying children are examined while held by the parent. Heart/lung auscultation is done early while the child is calm. Ear and throat exams are saved for last. Pedi...","sourceLabel":"Section in Pediatrics"},"2937":{"title":"Abbreviations Master List","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics#s23","snippet":"Abbreviations Master List Visits & Documentation WCC Well-child check NBS Newborn screen (metabolic) VIS Vaccine Information Statement DOB Date of birth EDD Estimated due date GA Gestational age SVD / C/S Spontaneous vaginal / cesarean delivery ROM Rupture of membranes NICU Neonatal intensive care u...","sourceLabel":"Section in Pediatrics"},"2938":{"title":"Sample HPI Templates & References","pageTitle":"Pediatrics","pageUrl":"/scribe-guides/pediatrics","url":"/scribe-guides/pediatrics#s24","snippet":"Sample HPI Templates & References These templates show the rhythm of a typical pediatric note. Use them as scaffolding during your first weeks of scribing. Sample HPI - 12-Month Well-Child Check \"[Name] is a 12-month-old previously healthy, full-term female presenting with mother for routine 12-mont...","sourceLabel":"Section in Pediatrics"},"2939":{"title":"Emergency Medicine","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine","snippet":"Emergency Medicine - Complete Reference Every chief complaint, diagnosis, procedure, medication, score, and documentation framework you need to survive your first ED shift and thrive beyond it."},"2940":{"title":"ED Flow, Triage & Core Principles","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine#s1","snippet":"ED Flow, Triage & Core Principles The emergency department is unlike any other clinical environment. Patients arrive undifferentiated, acuity ranges from life-threatening to trivial within the same hallway, and documentation must capture a rapidly changing clinical picture in real time. Every ED enc...","sourceLabel":"Section in Emergency Medicine"},"2941":{"title":"Scribe Documentation Framework","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine#s2","snippet":"Scribe Documentation Framework The ED Note Structure ED notes resemble SOAP but are heavily weighted toward the HPI, medical decision-making (MDM), and the course/reassessment sections. The note must show that the clinician considered life-threatening diagnoses, ruled in or ruled out each by history...","sourceLabel":"Section in Emergency Medicine"},"2942":{"title":"Chest Pain & Cardiovascular Emergencies","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine#s3","snippet":"Chest Pain & Cardiovascular Emergencies Chest pain is one of the highest-volume and highest-liability complaints in the ED. The scribe must anticipate documentation of six \"can't miss\" diagnoses: acute coronary syndrome (ACS) , pulmonary embolism (PE) , aortic dissection , tension pneumothorax , car...","sourceLabel":"Section in Emergency Medicine"},"2943":{"title":"Dyspnea & Respiratory Emergencies","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine#s4","snippet":"Dyspnea & Respiratory Emergencies Dyspnea is the complaint - the underlying diagnosis could be cardiac, pulmonary, metabolic, toxicologic, or neuromuscular. The ED differential focuses on CHF exacerbation, COPD exacerbation, asthma, pneumonia, PE, pneumothorax, and, increasingly, COVID-19. Figure 8 ...","sourceLabel":"Section in Emergency Medicine"},"2944":{"title":"Abdominal Pain & GI Emergencies","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine#s5","snippet":"Abdominal Pain & GI Emergencies Abdominal pain is the single highest-volume complaint in most EDs. The scribe must recognize the geography of the complaint and the \"can't miss\" diagnoses lurking behind it: appendicitis , cholecystitis , pancreatitis , small bowel obstruction (SBO) , AAA rupture , me...","sourceLabel":"Section in Emergency Medicine"},"2945":{"title":"Headache & Neurologic Emergencies","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine#s6","snippet":"Headache & Neurologic Emergencies Figure 11 - Subarachnoid Hemorrhage on CT Head. Non-contrast CT showing hyperdense blood in the basal cisterns, Sylvian fissures, and interhemispheric fissure, the classic distribution of aneurysmal SAH. CT sensitivity is highest within 6 hours of onset. Subarachnoi...","sourceLabel":"Section in Emergency Medicine"},"2946":{"title":"Stroke, Weakness & Altered Mental Status","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine#s7","snippet":"Stroke, Weakness & Altered Mental Status Figure 12 - CT Imaging in Acute Ischemic Stroke. Non-contrast CT and CT perfusion imaging in acute ischemic stroke. CT perfusion maps (CBF, CBV, MTT, Tmax) delineate the ischemic core and salvageable penumbra, guiding reperfusion therapy decisions. Acute Isch...","sourceLabel":"Section in Emergency Medicine"},"2947":{"title":"Syncope & Seizure","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine#s8","snippet":"Syncope & Seizure Syncope Syncope is defined as transient loss of consciousness with spontaneous recovery. Causes are vasovagal (most common), orthostatic, cardiac (arrhythmia, structural), and neurologic (rare). ED workup includes EKG, orthostatics, glucose, and targeted workup based on history. Th...","sourceLabel":"Section in Emergency Medicine"},"2948":{"title":"Sepsis, Fever & Infectious Emergencies","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine#s9","snippet":"Sepsis, Fever & Infectious Emergencies Figure 14 - Sepsis-3 Clinical Criteria and Definitions. Diagnostic framework for sepsis and septic shock per the 2016 Sepsis-3 definitions. Sepsis requires suspected infection plus acute organ dysfunction (SOFA increase of 2 or more points). Septic shock adds v...","sourceLabel":"Section in Emergency Medicine"},"2949":{"title":"GI Bleeding & OB/GYN Emergencies","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine#s10","snippet":"GI Bleeding & OB/GYN Emergencies Upper GI Bleed Presents with hematemesis, coffee-ground emesis, or melena. Common causes: peptic ulcer disease, esophageal varices, Mallory-Weiss tear, gastritis, malignancy. Initial management: 2 large-bore IVs, type and crossmatch, fluid resuscitation, transfusion ...","sourceLabel":"Section in Emergency Medicine"},"2950":{"title":"Trauma - Head to Toe","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine#s11","snippet":"Trauma - Head to Toe Trauma documentation follows the ATLS framework: primary survey (ABCDE) with immediate life-saving interventions, secondary survey (head-to-toe exam with AMPLE history: Allergies, Medications, PMH, Last meal, Events), and tertiary survey (detailed re-examination once the patient...","sourceLabel":"Section in Emergency Medicine"},"2951":{"title":"Burns, Environmental & Envenomation","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine#s12","snippet":"Burns, Environmental & Envenomation Burns Burns are classified by depth (superficial, partial-thickness, full-thickness) and by body surface area (BSA) using the Rule of Nines. Fluid resuscitation uses the Parkland formula: 4 mL &times; weight (kg) &times; %TBSA, with half given in the first 8 hours...","sourceLabel":"Section in Emergency Medicine"},"2952":{"title":"Toxicology & Overdose","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine#s13","snippet":"Toxicology & Overdose The toxicology differential is organized by toxidrome : a recognizable clinical syndrome from a drug class. Classic Toxidromes Toxidrome Findings Examples Antidote/Treatment Anticholinergic Hot, dry, red, blind, mad (\"mad as a hatter\") Diphenhydramine, TCAs, atropine Physostigm...","sourceLabel":"Section in Emergency Medicine"},"2953":{"title":"Endocrine, Electrolyte & Metabolic Emergencies","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine#s14","snippet":"Endocrine, Electrolyte & Metabolic Emergencies Diabetic Ketoacidosis (DKA) Diagnostic triad: hyperglycemia (> 250), anion-gap metabolic acidosis (pH < 7.3, bicarbonate < 18), and ketonemia/ketonuria. Treatment is aggressive IV fluids (normal saline, then half-normal), insulin infusion (0.1 units/kg/...","sourceLabel":"Section in Emergency Medicine"},"2954":{"title":"Anaphylaxis, Eye, ENT & Skin Emergencies","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine#s15","snippet":"Anaphylaxis, Eye, ENT & Skin Emergencies Anaphylaxis Diagnostic criteria: (1) acute onset with skin/mucosal involvement AND respiratory or cardiovascular compromise, OR (2) two or more organ systems involved after likely allergen exposure, OR (3) hypotension after known allergen exposure. Treatment ...","sourceLabel":"Section in Emergency Medicine"},"2955":{"title":"Orthopedic Emergencies & Lacerations","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine#s16","snippet":"Orthopedic Emergencies & Lacerations Fractures & Dislocations Document mechanism, neurovascular status, open vs closed, and deformity. Common reductions performed in the ED: shoulder (anterior dislocation most common), elbow, finger, hip (prosthetic), patella, and ankle. All reductions require pre- ...","sourceLabel":"Section in Emergency Medicine"},"2956":{"title":"Psychiatric Emergencies","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine#s17","snippet":"Psychiatric Emergencies Psychiatric presentations in the ED include suicidal ideation, homicidal ideation, psychosis, mania, severe anxiety/panic, substance-induced states, and acute agitation. Every psychiatric patient first gets medical clearance: vitals, glucose, and a targeted exam to exclude re...","sourceLabel":"Section in Emergency Medicine"},"2957":{"title":"ED Procedures - A to Z","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine#s18","snippet":"ED Procedures - A to Z Figure 24 - Intubation Checklist for Critically Ill Adults. Standardized RSI checklist covering patient preparation, equipment verification, team briefing, and failed airway contingency planning. Checklists reduce adverse events during emergency intubation. Procedure Indicatio...","sourceLabel":"Section in Emergency Medicine"},"2958":{"title":"Labs, Imaging & POCUS","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine#s19","snippet":"Labs, Imaging & POCUS Core ED Labs CBC: WBC (infection, stress), Hb/Hct (bleeding, anemia), platelets. BMP/CMP: electrolytes, renal function, glucose, liver function. Coags (PT/INR, PTT): bleeding, anticoagulation status. Troponin: myocardial injury; high-sensitivity assays allow 0/1 or 0/2 hour rul...","sourceLabel":"Section in Emergency Medicine"},"2959":{"title":"ED Medications & Antidotes","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine#s20","snippet":"ED Medications & Antidotes Class Generic (Brand) Use Key Notes Analgesic Morphine, hydromorphone (Dilaudid), fentanyl Moderate-severe pain Monitor respiratory rate; naloxone available Analgesic Ketorolac (Toradol) Renal colic, MSK pain Avoid in CKD, GI bleed, elderly Analgesic Acetaminophen, ibuprof...","sourceLabel":"Section in Emergency Medicine"},"2960":{"title":"Classification Systems & Clinical Scores","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine#s21","snippet":"Classification Systems & Clinical Scores HEART Score History: 0 slightly suspicious, 1 moderately, 2 highly. EKG: 0 normal, 1 non-specific repolarization, 2 significant ST deviation. Age: 0 <45, 1 45-64, 2 &ge;65. Risk factors: 0 none, 1 one or two, 2 three or more / known atherosclerosis. Troponin:...","sourceLabel":"Section in Emergency Medicine"},"2961":{"title":"Physical Exam & Abbreviations","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine#s22","snippet":"Physical Exam & Abbreviations The Focused ED Exam General: Well/ill/toxic appearing, alert, in no acute distress. HEENT: PERRL, EOMI, conjunctivae, oropharynx, tympanic membranes. Neck: supple, no meningismus, no JVD, no bruits, no LAD. Cardiovascular: rate, rhythm, murmurs, rubs, gallops, periphera...","sourceLabel":"Section in Emergency Medicine"},"2962":{"title":"Disposition & Documentation","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine#s23","snippet":"Disposition & Documentation Disposition is the final ED decision and must be clearly documented with supporting reasoning. Options include discharge home, admit (to observation, medicine, ICU, or specialty service), transfer to another facility, AMA (against medical advice), elopement, or death in t...","sourceLabel":"Section in Emergency Medicine"},"2963":{"title":"Sample HPI Templates & References","pageTitle":"Emergency Medicine","pageUrl":"/scribe-guides/emergency-medicine","url":"/scribe-guides/emergency-medicine#s24","snippet":"Sample HPI Templates & References These templates show the rhythm and content of an ED note for common presentations. Use them as frameworks during your first shifts. Sample HPI - Chest Pain / Possible ACS \"Mr. [Name] is a 62-year-old male with hypertension, hyperlipidemia, type 2 diabetes, and a 30...","sourceLabel":"Section in Emergency Medicine"},"2964":{"title":"Cardiology","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology","snippet":"Cardiology - Complete Reference Every diagnosis, arrhythmia, valve lesion, procedure, medication, classification, and documentation framework you need to succeed in a cardiology clinic, CCU, or cath lab on day one and beyond."},"2965":{"title":"Cardiac Anatomy & Physiology Essentials","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#s1","snippet":"Cardiac Anatomy & Physiology Essentials Cardiology is built on a tight coupling of anatomy, electrical conduction, and hemodynamic physiology. Every diagnosis in this guide - from a subtle ECG change to a failing left ventricle - becomes understandable once you can picture where the problem lives in...","sourceLabel":"Section in Cardiology"},"2966":{"title":"Scribe Documentation Framework","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#s2","snippet":"Scribe Documentation Framework Cardiology notes have their own rhythm. A good cardiology HPI is not just \"chest pain for 2 days\" - it quantifies exertion tolerance, maps symptoms to hemodynamic categories, and anchors every complaint to objective data (ECG, troponin, BNP, echo EF). Subjective Chief ...","sourceLabel":"Section in Cardiology"},"2967":{"title":"Hypertension (HTN)","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#s3","snippet":"Hypertension (HTN) Hypertension is the most common diagnosis in any cardiology clinic and the most important modifiable risk factor for stroke, MI, heart failure, and chronic kidney disease. Under the 2017 ACC/AHA hypertension guideline , stage 1 HTN begins at 130/80 mmHg rather than the older 140/9...","sourceLabel":"Section in Cardiology"},"2968":{"title":"Coronary Artery Disease & Stable Angina","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#s4","snippet":"Coronary Artery Disease & Stable Angina CAD is atherosclerotic narrowing of one or more epicardial coronary arteries. When a stenosis becomes flow-limiting (generally &ge; 70% angiographic or fractional flow reserve &le; 0.80), the myocardium distal to the lesion cannot meet oxygen demand during exe...","sourceLabel":"Section in Cardiology"},"2969":{"title":"Acute Coronary Syndromes (UA, NSTEMI, STEMI)","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#s5","snippet":"Acute Coronary Syndromes (UA, NSTEMI, STEMI) ACS is the spectrum of clinical presentations caused by acute reduction in coronary blood flow, almost always from atherosclerotic plaque rupture and thrombus formation. It includes three overlapping entities: unstable angina (UA) , NSTEMI , and STEMI . F...","sourceLabel":"Section in Cardiology"},"2970":{"title":"Heart Failure (HFrEF, HFpEF, HFmrEF)","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#s6","snippet":"Heart Failure (HFrEF, HFpEF, HFmrEF) Heart failure is a clinical syndrome in which structural or functional cardiac abnormality impairs the heart's ability to fill with or eject blood to meet metabolic demands. It is the final common pathway of almost every form of cardiac disease and the leading ca...","sourceLabel":"Section in Cardiology"},"2971":{"title":"Atrial Fibrillation & Atrial Flutter","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#s7","snippet":"Atrial Fibrillation & Atrial Flutter AFib is the most common sustained arrhythmia, characterized by disorganized atrial electrical activity, loss of effective atrial contraction, and an irregularly irregular ventricular response. It affects 1 in 4 adults over their lifetime and is the leading cardia...","sourceLabel":"Section in Cardiology"},"2972":{"title":"Supraventricular Tachycardias (SVT)","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#s8","snippet":"Supraventricular Tachycardias (SVT) SVT is any tachyarrhythmia (HR > 100) originating at or above the AV node. In common usage the term usually refers to the paroxysmal regular narrow-complex tachycardias: AV nodal reentrant tachycardia (AVNRT) , AV reentrant tachycardia (AVRT) involving an accessor...","sourceLabel":"Section in Cardiology"},"2973":{"title":"Ventricular Arrhythmias (VT/VF)","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#s9","snippet":"Ventricular Arrhythmias (VT/VF) Ventricular tachycardia is a wide-complex (> 120 ms) tachyarrhythmia originating below the bundle of His. It is classified by duration (sustained &ge; 30 sec or causing hemodynamic compromise, vs non-sustained) and morphology (monomorphic vs polymorphic). VT Types and...","sourceLabel":"Section in Cardiology"},"2974":{"title":"Bradyarrhythmias & Conduction Disease","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#s10","snippet":"Bradyarrhythmias & Conduction Disease Bradyarrhythmias involve either failure of impulse generation (sinus node dysfunction) or failure of impulse conduction (AV block). Common causes: aging, ischemia (especially inferior MI affecting the AV node), medications (BB, CCB, digoxin, amiodarone), Lyme di...","sourceLabel":"Section in Cardiology"},"2975":{"title":"Valvular Heart Disease","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#s11","snippet":"Valvular Heart Disease The 2020 ACC/AHA valvular heart disease guideline governs staging (A at-risk, B progressive, C asymptomatic severe, D symptomatic severe), imaging surveillance, and intervention thresholds. Every valve lesion should be documented by echo parameters (gradient, area, regurgitati...","sourceLabel":"Section in Cardiology"},"2976":{"title":"Pericardial Disease & Tamponade","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#s12","snippet":"Pericardial Disease & Tamponade Acute Pericarditis Inflammation of the pericardium, most commonly idiopathic/viral. Classic clinical features: pleuritic chest pain that is worse lying flat and improved sitting forward , pericardial friction rub on exam, widespread concave ST elevation with PR depres...","sourceLabel":"Section in Cardiology"},"2977":{"title":"Cardiomyopathies","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#s13","snippet":"Cardiomyopathies Hypertrophic Cardiomyopathy (HCM) Autosomal dominant disorder of sarcomeric protein genes producing asymmetric LVH, often with septal predominance. A subset has left ventricular outflow tract (LVOT) obstruction from systolic anterior motion (SAM) of the anterior mitral leaflet. Clin...","sourceLabel":"Section in Cardiology"},"2978":{"title":"Pulmonary Hypertension","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#s14","snippet":"Pulmonary Hypertension PH is defined by mean PA pressure > 20 mmHg at rest by right heart catheterization. The WHO classifies PH into five groups: Figure 18 - PAH Pharmacological Targets. The three key abnormal signaling pathways targeted in pulmonary arterial hypertension treatment: nitric oxide/cG...","sourceLabel":"Section in Cardiology"},"2979":{"title":"Infective Endocarditis","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#s15","snippet":"Infective Endocarditis Infection of the endocardial surface, most often the heart valves. Risk factors: prosthetic valves, prior endocarditis, IV drug use, structural heart disease, indwelling lines, immunosuppression. Organisms: Staphylococcus aureus (most common overall, especially acute and IVDU)...","sourceLabel":"Section in Cardiology"},"2980":{"title":"Syncope & Palpitations","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#s16","snippet":"Syncope & Palpitations Syncope is transient loss of consciousness from global cerebral hypoperfusion, followed by spontaneous complete recovery. The first task in evaluation is to separate benign causes (reflex/vasovagal) from dangerous ones (cardiac). Syncope Categories Reflex (neurally mediated): ...","sourceLabel":"Section in Cardiology"},"2981":{"title":"Cardiology Procedures - A to Z","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#s17","snippet":"Cardiology Procedures - A to Z Diagnostic & Interventional Cath Lab Procedure Description / Indication Left heart cath / coronary angiography Radial or femoral arterial access, selective coronary injection. For ACS, unexplained HF, pre-op evaluation, abnormal stress testing. Right heart cath Venous ...","sourceLabel":"Section in Cardiology"},"2982":{"title":"Post-Procedure Management & Complications","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#s18","snippet":"Post-Procedure Management & Complications Post-PCI Access site management is paramount. Radial access has largely replaced femoral because of lower bleeding risk. Monitor for: access site hematoma, retroperitoneal bleed (femoral), pseudoaneurysm, AV fistula, radial artery occlusion. Watch for contra...","sourceLabel":"Section in Cardiology"},"2983":{"title":"Cardiac Imaging & Diagnostics","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#s19","snippet":"Cardiac Imaging & Diagnostics 12-Lead ECG The first test in almost every cardiology encounter. Read systematically: rate, rhythm, axis, intervals (PR, QRS, QT/QTc), chamber hypertrophy, ST/T changes, pathological Q waves. Figure 21 - Normal ECG Waveform Components. Standard electrocardiogram display...","sourceLabel":"Section in Cardiology"},"2984":{"title":"Cardiology Medications You Must Know","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#s20","snippet":"Cardiology Medications You Must Know Antiplatelets Generic Brand Mechanism / Use Aspirin - COX-1 inhibitor; secondary prevention, ACS, post-PCI Clopidogrel Plavix P2Y₁₂ inhibitor; post-PCI, ASA intolerance Ticagrelor Brilinta Reversible P2Y₁₂; ACS; dyspnea side effect Prasugrel Effient P2Y₁₂; PCI in...","sourceLabel":"Section in Cardiology"},"2985":{"title":"Classification Systems","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#s21","snippet":"Classification Systems Every cardiology note leans on a classification system somewhere. These are the ones you will chart by name - memorize the full enumeration, not just the acronym. NYHA Functional Class Class Description I No limitation; ordinary activity does not cause symptoms II Slight limit...","sourceLabel":"Section in Cardiology"},"2986":{"title":"The Cardiovascular Physical Exam","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#s22","snippet":"The Cardiovascular Physical Exam The cardiology exam is precise and stylized. Document in the same order the cardiologist performs it. Cardiac Exam Template General: NAD, well-appearing, no distress Vitals: BP 128/76 (R arm, seated) HR 72 RR 14 SpO₂ 98% RA Neck: JVP 6 cm above sternal angle; no caro...","sourceLabel":"Section in Cardiology"},"2987":{"title":"Abbreviations Master List","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#s23","snippet":"Abbreviations Master List Diagnoses & Conditions CAD Coronary artery disease ACS Acute coronary syndrome UA Unstable angina NSTEMI Non-ST elevation myocardial infarction STEMI ST elevation myocardial infarction MI Myocardial infarction SIHD Stable ischemic heart disease HF Heart failure HFrEF HF wit...","sourceLabel":"Section in Cardiology"},"2988":{"title":"Sample HPI Templates","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#s24","snippet":"Sample HPI Templates These templates show the density, terminology, and structure expected in a cardiology clinic or consult note. Use them as scaffolding for your own documentation during your first weeks. Sample HPI - New HF Consult \"Mr. [Name] is a 64-year-old male with HTN, T2DM (A1C 8.1), forme...","sourceLabel":"Section in Cardiology"},"2989":{"title":"References & Sources","pageTitle":"Cardiology","pageUrl":"/scribe-guides/cardiology","url":"/scribe-guides/cardiology#references","snippet":"References & Sources Clinical Practice Guidelines Heidenreich PA, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Circulation. 2022. Virani SS, et al. 2023 AHA/ACC/Multisociety Guideline for the Management of Patients With Chronic Coronary Disease. Circulation. 2023. Joglar J...","sourceLabel":"Section in Cardiology"},"2990":{"title":"Pulmonology / Critical Care","pageTitle":"Pulmonology / Critical Care","pageUrl":"/scribe-guides/pulmonology","url":"/scribe-guides/pulmonology","snippet":"Pulmonology & Critical Care - Complete Reference Every diagnosis, procedure, medication, classification, and documentation framework a scribe needs to succeed in pulmonary and critical care medicine."},"2991":{"title":"The Respiratory System - Anatomy & Physiology","pageTitle":"Pulmonology / Critical Care","pageUrl":"/scribe-guides/pulmonology","url":"/scribe-guides/pulmonology#s1","snippet":"The Respiratory System - Anatomy & Physiology Pulmonology covers the airways, lung parenchyma, pleura, pulmonary vasculature, mediastinum, chest wall, respiratory muscles, and the neural control of breathing. Critical care adds multi-organ failure management layered on top of respiratory failure. A ...","sourceLabel":"Section in Pulmonology / Critical Care"},"2992":{"title":"Scribe Documentation Framework","pageTitle":"Pulmonology / Critical Care","pageUrl":"/scribe-guides/pulmonology","url":"/scribe-guides/pulmonology#s2","snippet":"Scribe Documentation Framework The SOAP Note in Pulmonology Pulmonary clinic notes and ICU progress notes both follow a SOAP-style skeleton, but the content differs. Clinic encounters emphasize symptom chronology, functional capacity, and PFT/imaging trends. ICU notes are system-based and often writ...","sourceLabel":"Section in Pulmonology / Critical Care"},"2993":{"title":"Asthma","pageTitle":"Pulmonology / Critical Care","pageUrl":"/scribe-guides/pulmonology","url":"/scribe-guides/pulmonology#s3","snippet":"Asthma Asthma is a chronic inflammatory airway disease characterized by reversible bronchoconstriction, airway hyperresponsiveness, and airway remodeling. It affects about 8% of US adults and is one of the top three diagnoses in any pulmonary clinic. Figure 4 - Asthma Airway Remodeling. Environmenta...","sourceLabel":"Section in Pulmonology / Critical Care"},"2994":{"title":"COPD & Asthma-COPD Overlap","pageTitle":"Pulmonology / Critical Care","pageUrl":"/scribe-guides/pulmonology","url":"/scribe-guides/pulmonology#s4","snippet":"COPD & Asthma-COPD Overlap COPD is the third leading cause of death worldwide. It is a chronic, progressive, largely irreversible airflow limitation caused by chronic inflammation of the airways and destruction of lung parenchyma, overwhelmingly due to cigarette smoking (though biomass fuel exposure...","sourceLabel":"Section in Pulmonology / Critical Care"},"2995":{"title":"Bronchiectasis & Cystic Fibrosis","pageTitle":"Pulmonology / Critical Care","pageUrl":"/scribe-guides/pulmonology","url":"/scribe-guides/pulmonology#s5","snippet":"Bronchiectasis & Cystic Fibrosis Bronchiectasis is the permanent, pathological dilation of bronchi caused by chronic inflammation and airway wall destruction, usually from a vicious cycle of infection and inflammation. CT imaging shows dilated airways with bronchial wall thickening, \"tram tracks,\" a...","sourceLabel":"Section in Pulmonology / Critical Care"},"2996":{"title":"Interstitial Lung Disease","pageTitle":"Pulmonology / Critical Care","pageUrl":"/scribe-guides/pulmonology","url":"/scribe-guides/pulmonology#s6","snippet":"Interstitial Lung Disease ILD is an umbrella term for >200 heterogeneous disorders that share inflammation and fibrosis of the lung interstitium - the space between alveolar walls and capillaries. The result is restrictive physiology (reduced TLC and FVC), decreased DLCO, and hypoxemia especially wi...","sourceLabel":"Section in Pulmonology / Critical Care"},"2997":{"title":"Pulmonary Hypertension","pageTitle":"Pulmonology / Critical Care","pageUrl":"/scribe-guides/pulmonology","url":"/scribe-guides/pulmonology#s7","snippet":"Pulmonary Hypertension Pulmonary hypertension (PH) is defined as a mean pulmonary artery pressure (mPAP) >20 mmHg at rest by right heart catheterization. The WHO clinical classification organizes PH into five groups based on mechanism, because treatment differs radically between them. Figure 10 - He...","sourceLabel":"Section in Pulmonology / Critical Care"},"2998":{"title":"Pulmonary Embolism & DVT","pageTitle":"Pulmonology / Critical Care","pageUrl":"/scribe-guides/pulmonology","url":"/scribe-guides/pulmonology#s8","snippet":"Pulmonary Embolism & DVT Pulmonary embolism is the obstruction of pulmonary arterial flow by a thrombus, almost always arising from a lower-extremity DVT. PE is the third most common cause of cardiovascular death. Figure 11 - Pulmonary Embolism on CTPA. CT pulmonary angiography demonstrating intralu...","sourceLabel":"Section in Pulmonology / Critical Care"},"2999":{"title":"Pneumonia & Lower Respiratory Infection","pageTitle":"Pulmonology / Critical Care","pageUrl":"/scribe-guides/pulmonology","url":"/scribe-guides/pulmonology#s9","snippet":"Pneumonia & Lower Respiratory Infection Pneumonia is infection of the lung parenchyma. Classification is epidemiological (CAP, HAP, VAP, HCAP is largely abandoned) and influences likely pathogens and antibiotic choice. Figure 12 - Normal Chest Radiograph Anatomy. Standard PA chest radiograph demonst...","sourceLabel":"Section in Pulmonology / Critical Care"},"3000":{"title":"Tuberculosis & NTM","pageTitle":"Pulmonology / Critical Care","pageUrl":"/scribe-guides/pulmonology","url":"/scribe-guides/pulmonology#s10","snippet":"Tuberculosis & NTM TB is caused by Mycobacterium tuberculosis . Latent TB infection (LTBI) is asymptomatic infection detected by IGRA (QuantiFERON, T-SPOT) or tuberculin skin test; active TB is symptomatic disease with cough >2-3 weeks, hemoptysis, night sweats, weight loss, fevers, and often cavita...","sourceLabel":"Section in Pulmonology / Critical Care"},"3001":{"title":"Pleural Disease","pageTitle":"Pulmonology / Critical Care","pageUrl":"/scribe-guides/pulmonology","url":"/scribe-guides/pulmonology#s11","snippet":"Pleural Disease Pleural Effusion Figure 14 - Pleural Effusion on Ultrasound. Bedside thoracic ultrasound demonstrating a pleural effusion with anechoic fluid between the visceral and parietal pleura. Ultrasound is the best bedside tool for detecting, characterizing, and guiding thoracentesis of effu...","sourceLabel":"Section in Pulmonology / Critical Care"},"3002":{"title":"Lung Cancer & Pulmonary Nodules","pageTitle":"Pulmonology / Critical Care","pageUrl":"/scribe-guides/pulmonology","url":"/scribe-guides/pulmonology#s12","snippet":"Lung Cancer & Pulmonary Nodules Lung cancer remains the leading cause of cancer death. The dominant histologic distinction is non-small cell lung cancer ( NSCLC , ~85% - adenocarcinoma, squamous, large cell) versus small cell lung cancer ( SCLC , ~15%). Workup: tissue diagnosis (bronchoscopy, EBUS-T...","sourceLabel":"Section in Pulmonology / Critical Care"},"3003":{"title":"Sleep-Disordered Breathing","pageTitle":"Pulmonology / Critical Care","pageUrl":"/scribe-guides/pulmonology","url":"/scribe-guides/pulmonology#s13","snippet":"Sleep-Disordered Breathing Obstructive Sleep Apnea (OSA) Figure 17 - OSA Pathophysiology. The Starling resistor model illustrates upper airway collapsibility mechanics. The balance between anatomically imposed mechanical loads (obesity, retrognathia) and compensatory neuromuscular responses determin...","sourceLabel":"Section in Pulmonology / Critical Care"},"3004":{"title":"ARDS & Mechanical Ventilation","pageTitle":"Pulmonology / Critical Care","pageUrl":"/scribe-guides/pulmonology","url":"/scribe-guides/pulmonology#s14","snippet":"ARDS & Mechanical Ventilation Acute Respiratory Distress Syndrome ARDS is acute-onset hypoxemic respiratory failure due to increased pulmonary capillary permeability and non-cardiogenic pulmonary edema. Common triggers: pneumonia, sepsis, aspiration, trauma, pancreatitis, transfusion, drug reactions...","sourceLabel":"Section in Pulmonology / Critical Care"},"3005":{"title":"Hemoptysis & Airway Emergencies","pageTitle":"Pulmonology / Critical Care","pageUrl":"/scribe-guides/pulmonology","url":"/scribe-guides/pulmonology#s15","snippet":"Hemoptysis & Airway Emergencies Hemoptysis is expectoration of blood from the lower respiratory tract. Massive hemoptysis is variably defined (>100-600 mL in 24 hours or any volume causing hemodynamic or respiratory compromise) and is a true airway emergency - the problem is airway flooding and asph...","sourceLabel":"Section in Pulmonology / Critical Care"},"3006":{"title":"Pulmonary Procedures","pageTitle":"Pulmonology / Critical Care","pageUrl":"/scribe-guides/pulmonology","url":"/scribe-guides/pulmonology#s16","snippet":"Pulmonary Procedures Scribes will document procedure notes for a range of bedside, bronchoscopic, and pleural interventions. Learn the core elements: indication, consent, time-out, technique, findings, specimens sent, estimated blood loss, complications, and post-procedure plan. Figure 21 - Chest Tu...","sourceLabel":"Section in Pulmonology / Critical Care"},"3007":{"title":"PFTs, Imaging & Diagnostics","pageTitle":"Pulmonology / Critical Care","pageUrl":"/scribe-guides/pulmonology","url":"/scribe-guides/pulmonology#s17","snippet":"PFTs, Imaging & Diagnostics Pulmonary Function Tests PFTs measure three things: spirometry (airflow), lung volumes (capacity), and diffusing capacity (gas transfer). Figure 22 - Pressure-Volume Loop. The pressure-volume loop provides information about lung compliance, overdistension, and optimal PEE...","sourceLabel":"Section in Pulmonology / Critical Care"},"3008":{"title":"Medications You Must Know","pageTitle":"Pulmonology / Critical Care","pageUrl":"/scribe-guides/pulmonology","url":"/scribe-guides/pulmonology#s18","snippet":"Medications You Must Know Inhaled Therapies Class Generic (Brand) Use SABA Albuterol (ProAir, Ventolin, Proventil); levalbuterol (Xopenex) Rescue bronchodilator SAMA Ipratropium (Atrovent) Acute COPD/asthma adjunct LABA Salmeterol (Serevent); formoterol; olodaterol Maintenance bronchodilator (always...","sourceLabel":"Section in Pulmonology / Critical Care"},"3009":{"title":"Classification Systems","pageTitle":"Pulmonology / Critical Care","pageUrl":"/scribe-guides/pulmonology","url":"/scribe-guides/pulmonology#s19","snippet":"Classification Systems mMRC Dyspnea Scale Grade Description 0 Only breathless with strenuous exercise 1 SOB when hurrying on level ground or walking up slight hill 2 Walks slower than peers on level ground, or must stop for breath at own pace 3 Stops for breath after ~100 meters or after a few minut...","sourceLabel":"Section in Pulmonology / Critical Care"},"3010":{"title":"Physical Exam - The Pulmonary Exam","pageTitle":"Pulmonology / Critical Care","pageUrl":"/scribe-guides/pulmonology","url":"/scribe-guides/pulmonology#s20","snippet":"Physical Exam - The Pulmonary Exam The pulmonary physical exam follows Inspection, Palpation, Percussion, Auscultation (IPPA). Document specific findings in each zone rather than summary labels. Figure 23 - Diaphragm and Chest Wall Anatomy. The diaphragm is the principal muscle of respiration, inner...","sourceLabel":"Section in Pulmonology / Critical Care"},"3011":{"title":"Abbreviations Master List","pageTitle":"Pulmonology / Critical Care","pageUrl":"/scribe-guides/pulmonology","url":"/scribe-guides/pulmonology#s21","snippet":"Abbreviations Master List Anatomy & Physiology RUL / RML / RLL Right upper / middle / lower lobe LUL / LLL Left upper / lower lobe PA Pulmonary artery (context: also physician assistant or posterior-anterior) PV Pulmonary vein V/Q Ventilation/perfusion ratio FRC Functional residual capacity TLC Tota...","sourceLabel":"Section in Pulmonology / Critical Care"},"3012":{"title":"Sample HPI Templates","pageTitle":"Pulmonology / Critical Care","pageUrl":"/scribe-guides/pulmonology","url":"/scribe-guides/pulmonology#s22","snippet":"Sample HPI Templates Use these as frameworks for the most common pulmonary and critical care encounters. Sample HPI - Asthma Exacerbation \"Ms. [Name] is a 32-year-old female with a history of moderate persistent asthma (GINA step 3, on fluticasone-salmeterol 250/50 BID and albuterol PRN) who present...","sourceLabel":"Section in Pulmonology / Critical Care"},"3013":{"title":"References & Sources","pageTitle":"Pulmonology / Critical Care","pageUrl":"/scribe-guides/pulmonology","url":"/scribe-guides/pulmonology#s23","snippet":"References & Sources Clinical Practice Guidelines Global Initiative for Chronic Obstructive Lung Disease. 2024 GOLD Report: Global Strategy for Prevention, Diagnosis, and Management of COPD. Global Initiative for Asthma. 2024 GINA Main Report: Global Strategy for Asthma Management and Prevention. Ra...","sourceLabel":"Section in Pulmonology / Critical Care"},"3014":{"title":"Gastroenterology","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology","snippet":"Gastroenterology - Complete Reference Every diagnosis, condition, procedure, medication, abbreviation, and documentation framework you need to succeed on day one and beyond."},"3015":{"title":"The GI System - Anatomy Essentials","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#s1","snippet":"The GI System - Anatomy Essentials Gastroenterology covers the entire alimentary canal from the upper esophageal sphincter to the anus, plus the accessory digestive organs (liver, gallbladder, biliary tree, and pancreas). A gastroenterologist's clinical domain spans luminal disease (reflux, ulcers, ...","sourceLabel":"Section in Gastroenterology"},"3016":{"title":"Scribe Documentation Framework","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#s2","snippet":"Scribe Documentation Framework GI encounters span clinic new patients, follow-ups, procedure visits, and inpatient consults (GIB, pancreatitis, decompensated cirrhosis). Each has a distinct documentation rhythm, but all use the standard SOAP structure. Your goal as a scribe is to capture the attendi...","sourceLabel":"Section in Gastroenterology"},"3017":{"title":"GERD & Esophagitis","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#s3","snippet":"GERD & Esophagitis Gastroesophageal reflux disease (GERD) is the retrograde movement of gastric contents into the esophagus causing troublesome symptoms or mucosal injury. It is the single most common diagnosis in a GI clinic. The mechanism is failure of the anti-reflux barrier - a hypotensive LES, ...","sourceLabel":"Section in Gastroenterology"},"3018":{"title":"Barrett Esophagus & Esophageal Cancer","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#s4","snippet":"Barrett Esophagus & Esophageal Cancer Barrett esophagus (BE) is the replacement of normal squamous esophageal epithelium with specialized intestinal metaplasia (columnar epithelium with goblet cells) in response to chronic acid reflux. It is the only known precursor to esophageal adenocarcinoma (EAC...","sourceLabel":"Section in Gastroenterology"},"3019":{"title":"Eosinophilic Esophagitis & Motility Disorders","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#s5","snippet":"Eosinophilic Esophagitis & Motility Disorders Eosinophilic Esophagitis (EoE) EoE is a chronic immune/antigen-mediated disease characterized by symptoms of esophageal dysfunction and histologic evidence of eosinophil-predominant inflammation (&ge; 15 eosinophils per high-power field on biopsy). It is...","sourceLabel":"Section in Gastroenterology"},"3020":{"title":"Peptic Ulcer Disease, H. pylori & Gastritis","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#s6","snippet":"Peptic Ulcer Disease, H. pylori & Gastritis Peptic ulcer disease (PUD) encompasses gastric and duodenal ulcers - mucosal defects extending through the muscularis mucosae. The two dominant causes are Helicobacter pylori infection and NSAID use . Other causes include Zollinger-Ellison syndrome, stress...","sourceLabel":"Section in Gastroenterology"},"3021":{"title":"Gastric Cancer & Gastric Neoplasms","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#s7","snippet":"Gastric Cancer & Gastric Neoplasms Gastric adenocarcinoma accounts for ~95% of gastric cancers. Two histologic types: intestinal type (well-differentiated, glandular, linked to H. pylori chronic atrophic gastritis, follows Correa cascade: normal &rarr; atrophic gastritis &rarr; intestinal metaplasia...","sourceLabel":"Section in Gastroenterology"},"3022":{"title":"Functional GI: IBS, Functional Dyspepsia, Constipation","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#s8","snippet":"Functional GI: IBS, Functional Dyspepsia, Constipation Functional GI disorders are now called disorders of gut-brain interaction (DGBIs) . They are defined by the Rome IV criteria and diagnosed on symptoms after exclusion of organic disease. They are real, common, and often debilitating - the \"funct...","sourceLabel":"Section in Gastroenterology"},"3023":{"title":"Inflammatory Bowel Disease (UC & Crohn)","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#s9","snippet":"Inflammatory Bowel Disease (UC & Crohn) Inflammatory bowel disease (IBD) encompasses ulcerative colitis (UC) and Crohn disease (CD) . Both are chronic relapsing immune-mediated conditions with bimodal age distribution (peak 15-35, second peak 50-70), increased risk with family history, smoking (prot...","sourceLabel":"Section in Gastroenterology"},"3024":{"title":"Celiac Disease & Microscopic Colitis","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#s10","snippet":"Celiac Disease & Microscopic Colitis Celiac Disease Celiac disease is an autoimmune enteropathy triggered by gluten (wheat, barley, rye) in genetically susceptible individuals (HLA-DQ2 or HLA-DQ8). It produces villous atrophy in the small intestine, malabsorption, and a wide spectrum of intestinal a...","sourceLabel":"Section in Gastroenterology"},"3025":{"title":"Diverticular Disease & Diverticulitis","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#s11","snippet":"Diverticular Disease & Diverticulitis Diverticulosis is the presence of diverticula (outpouchings of mucosa and submucosa through the muscularis propria at sites of vasa recta penetration), overwhelmingly in the sigmoid colon in Western populations. It is common (> 50% of adults over 60) and usually...","sourceLabel":"Section in Gastroenterology"},"3026":{"title":"Colorectal Cancer, Polyps & Screening","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#s12","snippet":"Colorectal Cancer, Polyps & Screening Colorectal cancer (CRC) is the third most common cancer and second leading cause of cancer death in the US. Most CRC arises from adenomatous polyps via the adenoma-carcinoma sequence (APC &rarr; KRAS &rarr; DCC &rarr; p53) or from sessile serrated lesions via th...","sourceLabel":"Section in Gastroenterology"},"3027":{"title":"Hemorrhoids & Anorectal Disease","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#s13","snippet":"Hemorrhoids & Anorectal Disease Hemorrhoids are dilated submucosal vascular cushions in the anal canal. Internal hemorrhoids arise above the dentate line, are covered by columnar/transitional epithelium, are usually painless, and present with bright red blood per rectum (BRBPR) on the tissue or coat...","sourceLabel":"Section in Gastroenterology"},"3028":{"title":"GI Bleeding (UGIB & LGIB)","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#s14","snippet":"GI Bleeding (UGIB & LGIB) Upper GI bleeding (UGIB) is bleeding from a source proximal to the ligament of Treitz; lower GI bleeding (LGIB) is from distal. Presentation varies: hematemesis and coffee-ground emesis are UGIB; melena (black tarry stool from digested blood) is usually UGIB but can occur w...","sourceLabel":"Section in Gastroenterology"},"3029":{"title":"Acute & Chronic Pancreatitis","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#s15","snippet":"Acute & Chronic Pancreatitis Acute Pancreatitis Acute pancreatitis diagnosis requires 2 of 3: (1) characteristic abdominal pain (epigastric, radiating to the back, constant), (2) lipase or amylase > 3x upper limit of normal, (3) characteristic findings on imaging. Most common etiologies: gallstones ...","sourceLabel":"Section in Gastroenterology"},"3030":{"title":"Pancreatic Cancer & Biliary Disease","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#s16","snippet":"Pancreatic Cancer & Biliary Disease Pancreatic Adenocarcinoma Pancreatic ductal adenocarcinoma (PDAC) is the most lethal common cancer in the US. Risk factors: smoking, family history, hereditary syndromes (BRCA1/2, Lynch, PRSS1, Peutz-Jeghers), chronic pancreatitis, long-standing diabetes, obesity....","sourceLabel":"Section in Gastroenterology"},"3031":{"title":"NAFLD/MASLD & Viral Hepatitis","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#s17","snippet":"NAFLD/MASLD & Viral Hepatitis MASLD (formerly NAFLD) Figure 19 - NAFLD/MASLD Fibrosis Assessment Algorithm. Sequential use of FIB-4 index and vibration-controlled transient elastography (VCTE/FibroScan) or MR elastography (MRE) for non-invasive risk stratification of liver fibrosis in NAFLD patients...","sourceLabel":"Section in Gastroenterology"},"3032":{"title":"Autoimmune Liver Disease (AIH, PBC, PSC)","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#s18","snippet":"Autoimmune Liver Disease (AIH, PBC, PSC) Autoimmune Hepatitis (AIH) AIH is an immune-mediated hepatitis classically in women, presenting with fatigue, jaundice, or asymptomatic transaminitis. Labs: elevated ALT/AST (hepatocellular pattern), hypergammaglobulinemia (IgG), positive ANA, anti-smooth mus...","sourceLabel":"Section in Gastroenterology"},"3033":{"title":"Cirrhosis, Portal HTN & HCC","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#s19","snippet":"Cirrhosis, Portal HTN & HCC Cirrhosis is the end-stage of chronic liver injury, characterized by fibrosis and nodular regeneration. Causes: MASLD/MASH, alcohol, chronic HCV, chronic HBV, autoimmune (AIH, PBC, PSC), hemochromatosis, Wilson disease, A1AT deficiency, cryptogenic. Clinically divided int...","sourceLabel":"Section in Gastroenterology"},"3034":{"title":"Endoscopic & GI Procedures","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#s20","snippet":"Endoscopic & GI Procedures Endoscopy is the defining procedural activity of gastroenterology. Scribes working in endoscopy suites will pre-populate procedure notes and chart findings, interventions, and specimens. Know each procedure cold. Figure 21 - Normal ERCP Cholangiogram. Fluoroscopic image du...","sourceLabel":"Section in Gastroenterology"},"3035":{"title":"GI Imaging, Labs & Diagnostics","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#s21","snippet":"GI Imaging, Labs & Diagnostics Key Labs Lab What It Reflects Scribe Notes ALT / AST Hepatocellular injury ALT is more liver-specific; AST:ALT > 2 suggests alcoholic hepatitis ALP Cholestasis or bone GGT confirms hepatic origin GGT Biliary epithelial injury Also elevated with alcohol, medications Tot...","sourceLabel":"Section in Gastroenterology"},"3036":{"title":"Medications You Must Know","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#s22","snippet":"Medications You Must Know Acid Suppression & Motility Drug Brand Class Use Omeprazole Prilosec PPI GERD, PUD, H. pylori Pantoprazole Protonix PPI IV option for GIB; fewer drug interactions Esomeprazole Nexium PPI GERD, erosive esophagitis Lansoprazole / Dexlansoprazole Prevacid / Dexilant PPI GERD R...","sourceLabel":"Section in Gastroenterology"},"3037":{"title":"Classification Systems - Consolidated","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#s23","snippet":"Classification Systems - Consolidated System What It Classifies Section LA classification Erosive esophagitis (Grade A-D) 03 Prague C&M Barrett esophagus extent 04 Chicago Classification Esophageal motility disorders by HRM 05 EREFS EoE endoscopic features 05 Forrest classification UGIB ulcer stigma...","sourceLabel":"Section in Gastroenterology"},"3038":{"title":"Physical Exam, Abbreviations & Sample HPIs","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#s24","snippet":"Physical Exam, Abbreviations & Sample HPIs The GI & Hepatology Physical Exam Abdominal Exam Template General: Alert, no jaundice/scleral icterus, no asterixis, no cachexia. Inspection: Abdomen flat/distended, no scars, no caput medusae, no spider angiomas, no gynecomastia. Auscultation: Normoactive ...","sourceLabel":"Section in Gastroenterology"},"3039":{"title":"References & Sources","pageTitle":"Gastroenterology","pageUrl":"/scribe-guides/gastroenterology","url":"/scribe-guides/gastroenterology#references","snippet":"References & Sources Clinical Practice Guidelines Katz PO, et al. ACG Clinical Guideline for the Diagnosis and Management of GERD. Am J Gastroenterol. 2022. Shaheen NJ, et al. ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus. Am J Gastroenterol. 2022. Chey WD, et al. ACG Clini...","sourceLabel":"Section in Gastroenterology"},"3040":{"title":"Nephrology","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology","snippet":"Nephrology - Complete Reference Every diagnosis, syndrome, electrolyte and acid-base disturbance, dialysis modality, transplant concept, medication, and documentation pattern a nephrology scribe needs."},"3041":{"title":"Renal Anatomy & Nephron Physiology","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s1","snippet":"Renal Anatomy & Nephron Physiology Nephrology is the medical specialty devoted to the kidneys - a pair of retroperitoneal, bean-shaped organs that filter roughly 180 liters of plasma per day, adjust salt and water balance, excrete nitrogenous waste, regulate acid-base status, control blood pressure ...","sourceLabel":"Section in Nephrology"},"3042":{"title":"Scribe Documentation Framework","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s2","snippet":"Scribe Documentation Framework Nephrology notes live at the intersection of internal medicine, critical care, and outpatient chronic disease management. A consult note on a hospitalized AKI patient, an outpatient CKD follow-up, a dialysis progress note, and a transplant clinic visit all have differe...","sourceLabel":"Section in Nephrology"},"3043":{"title":"Acute Kidney Injury (AKI)","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s3","snippet":"Acute Kidney Injury (AKI) Acute kidney injury is the abrupt decline in kidney function over hours to days. It is the bread-and-butter inpatient nephrology consult and is defined by the KDIGO 2012 AKI guidelines using serum creatinine and urine output criteria. AKI is classified mechanistically into ...","sourceLabel":"Section in Nephrology"},"3044":{"title":"ATN, AIN & Contrast Nephropathy","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s4","snippet":"ATN, AIN & Contrast Nephropathy Acute Tubular Necrosis (ATN) ATN is the most common cause of inpatient intrinsic AKI. Prolonged ischemia (essentially prerenal that was not reversed) or nephrotoxins (aminoglycosides, vancomycin, amphotericin, cisplatin, heme pigment from rhabdomyolysis, myeloma light...","sourceLabel":"Section in Nephrology"},"3045":{"title":"Rhabdomyolysis & Hepatorenal Syndrome","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s5","snippet":"Rhabdomyolysis & Hepatorenal Syndrome Rhabdomyolysis Skeletal muscle breakdown releases myoglobin, which precipitates in the tubules and causes a pigment nephropathy form of ATN. Triggers include crush injury, prolonged immobilization (\"long lie\"), seizures, extreme exertion, statins/fibrates, cocai...","sourceLabel":"Section in Nephrology"},"3046":{"title":"Chronic Kidney Disease (CKD)","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s6","snippet":"Chronic Kidney Disease (CKD) CKD is defined by KDIGO 2024 CKD guidelines as abnormalities of kidney structure or function present for > 3 months with implications for health. The diagnosis requires either GFR < 60 mL/min/1.73 m 2 OR markers of kidney damage (albuminuria UACR &ge; 30, urine sediment ...","sourceLabel":"Section in Nephrology"},"3047":{"title":"Diabetic & Hypertensive Kidney Disease","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s7","snippet":"Diabetic & Hypertensive Kidney Disease Diabetic Kidney Disease (DKD) Diabetes is the leading cause of CKD and ESRD in the United States. DKD progresses through predictable stages: hyperfiltration &rarr; microalbuminuria (A2) &rarr; overt proteinuria (A3) &rarr; declining GFR &rarr; ESRD, typically o...","sourceLabel":"Section in Nephrology"},"3048":{"title":"Nephrotic Syndrome","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s8","snippet":"Nephrotic Syndrome Nephrotic syndrome is the clinical pentad of heavy proteinuria (> 3.5 g/day), hypoalbuminemia (< 3.0 g/dL), edema, hyperlipidemia, and hypercoagulability (loss of antithrombin III, protein C/S). Patients present with frothy urine, peripheral and periorbital edema, and sometimes ac...","sourceLabel":"Section in Nephrology"},"3049":{"title":"Nephritic Syndrome & Glomerulonephritis","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s9","snippet":"Nephritic Syndrome & Glomerulonephritis Nephritic syndrome is the classic \"active urine\" presentation: hematuria with dysmorphic RBCs and RBC casts , subnephrotic proteinuria (usually < 3.5 g/day), hypertension, edema, and rising creatinine. Rapidly progressive glomerulonephritis (RPGN) is nephritic...","sourceLabel":"Section in Nephrology"},"3050":{"title":"Polycystic Kidney Disease & Inherited Tubulopathies","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s10","snippet":"Polycystic Kidney Disease & Inherited Tubulopathies Autosomal Dominant PKD (ADPKD) ADPKD is the most common inherited kidney disease, caused by mutations in PKD1 (~85%, chromosome 16, earlier and more severe) or PKD2 (~15%, chromosome 4, milder). Progressive cyst formation leads to massive kidney en...","sourceLabel":"Section in Nephrology"},"3051":{"title":"Renal Tubular Acidosis (RTA)","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s11","snippet":"Renal Tubular Acidosis (RTA) RTA is a non-anion-gap metabolic acidosis caused by impaired renal acidification. Three classic types plus a fourth, each with a distinct mechanism and signature. Type Defect Urine pH Serum K + Classic Causes Type 1 (Distal) &alpha;-intercalated cell H + secretion defect...","sourceLabel":"Section in Nephrology"},"3052":{"title":"Sodium & Water Disorders","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s12","snippet":"Sodium & Water Disorders Hyponatremia (Na < 135) Hyponatremia is the most common electrolyte disorder in hospitalized patients and is almost always a problem of too much water , not too little sodium. Workup is stepwise: (1) check serum osmolality to confirm hypotonicity (and exclude pseudohyponatre...","sourceLabel":"Section in Nephrology"},"3053":{"title":"Potassium, Calcium, Magnesium & Phosphate","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s13","snippet":"Potassium, Calcium, Magnesium & Phosphate Hyperkalemia (K > 5.0) Causes: pseudohyperkalemia (hemolyzed sample, fist clenching), transcellular shifts (acidosis, insulin deficiency, beta-blockers, succinylcholine, tumor lysis, rhabdomyolysis), decreased renal excretion (AKI, CKD, ACEi/ARB, MRA, NSAIDs...","sourceLabel":"Section in Nephrology"},"3054":{"title":"Acid-Base Disorders","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s14","snippet":"Acid-Base Disorders Every nephrology consult includes an acid-base assessment. Use a stepwise approach: Acid-Base Interpretation Rules Step 1 - pH: Acidemia (< 7.35) or alkalemia (> 7.45)? Step 2 - Primary disorder: If HCO 3 &minus; moves in the same direction as the pH, it is metabolic; if PaCO 2 m...","sourceLabel":"Section in Nephrology"},"3055":{"title":"Nephrolithiasis (Kidney Stones)","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s15","snippet":"Nephrolithiasis (Kidney Stones) Kidney stones affect ~10% of the US population. Presentation is sudden-onset unilateral flank pain radiating to the groin (\"renal colic\"), often with hematuria, nausea, and vomiting. Non-contrast CT of the abdomen/pelvis is the gold standard imaging; ultrasound is use...","sourceLabel":"Section in Nephrology"},"3056":{"title":"UTI, Pyelonephritis & Renal Artery Stenosis","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s16","snippet":"UTI, Pyelonephritis & Renal Artery Stenosis UTI & Pyelonephritis Cystitis presents with dysuria, frequency, urgency, and suprapubic discomfort without fever. Pyelonephritis adds fever, chills, flank pain, costovertebral angle tenderness, and often nausea/vomiting. E. coli causes ~80% of community-ac...","sourceLabel":"Section in Nephrology"},"3057":{"title":"Dialysis - HD, PD & Access","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s17","snippet":"Dialysis - HD, PD & Access Hemodialysis (HD) Standard in-center HD runs 3&times; per week for 3-4 hours per session. Blood is pumped from the patient through a dialyzer (semi-permeable membrane) where solute diffuses down its gradient into dialysate flowing counter-current, and excess water is remov...","sourceLabel":"Section in Nephrology"},"3058":{"title":"Kidney Transplant Management","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s18","snippet":"Kidney Transplant Management Kidney transplant is the definitive treatment for ESRD, offering superior survival and quality of life compared with dialysis. Sources: deceased donor (standard criteria, expanded criteria, donation after cardiac death) and living donor (related or unrelated). The graft ...","sourceLabel":"Section in Nephrology"},"3059":{"title":"Nephrology Procedures","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s19","snippet":"Nephrology Procedures Procedure Purpose Key Documentation Kidney biopsy (native) Diagnose GN, AKI of unclear etiology, proteinuria Indication, coagulation clearance, pre-procedure imaging, side, needle gauge, number of cores, light microscopy/IF/EM cores, post-procedure monitoring for bleeding Kidne...","sourceLabel":"Section in Nephrology"},"3060":{"title":"Labs, Urinalysis & Imaging","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s20","snippet":"Labs, Urinalysis & Imaging Urinalysis & Sediment The urinalysis is the nephrologist's EKG. Dipstick captures pH, specific gravity, blood, protein, glucose, ketones, leukocyte esterase, nitrite, bilirubin, and urobilinogen. Microscopy captures RBCs (dysmorphic suggests glomerular origin), WBCs, epith...","sourceLabel":"Section in Nephrology"},"3061":{"title":"Medications You Must Know","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s21","snippet":"Medications You Must Know Class Generic (Brand) Mechanism / Use Key Notes ACE inhibitors lisinopril, enalapril, ramipril, benazepril Block ACE &rarr; reduce AT-II &rarr; dilate efferent &rarr; reduce proteinuria Cough, hyperkalemia, AKI, angioedema; hold in AKI or K > 5.5 ARBs losartan, valsartan, i...","sourceLabel":"Section in Nephrology"},"3062":{"title":"Physical Exam - The Renal Exam","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s22","snippet":"Physical Exam - The Renal Exam The nephrology exam is dominated by volume assessment . Every patient, every visit, every note. Volume & Renal Exam Template General: Alert, oriented; asterixis absent/present; mental status; uremic fetor. Vitals/Weight: BP seated, orthostatics if indicated; weight vs ...","sourceLabel":"Section in Nephrology"},"3063":{"title":"Abbreviations Master List","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s23","snippet":"Abbreviations Master List Diagnoses & Syndromes AKI Acute kidney injury CKD Chronic kidney disease ESRD / ESKD End-stage renal disease / end-stage kidney disease ATN Acute tubular necrosis AIN Acute interstitial nephritis CA-AKI Contrast-associated AKI HRS Hepatorenal syndrome DKD Diabetic kidney di...","sourceLabel":"Section in Nephrology"},"3064":{"title":"Sample HPI Templates","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s24","snippet":"Sample HPI Templates These templates show the rhythm of a well-written nephrology HPI. Use them as patterns when you sit down to chart. Sample HPI - Inpatient AKI Consult \"Mr. [Name] is a 74-year-old male with a history of HTN, HFrEF (EF 30%), type 2 DM, and CKD G3a (baseline Cr 1.3, eGFR 55) admitt...","sourceLabel":"Section in Nephrology"},"3065":{"title":"References & Sources","pageTitle":"Nephrology","pageUrl":"/scribe-guides/nephrology","url":"/scribe-guides/nephrology#s25","snippet":"References & Sources Clinical Practice Guidelines KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of CKD. Kidney Int. 2024. KDIGO 2021 Clinical Practice Guideline for the Management of Blood P...","sourceLabel":"Section in Nephrology"},"3066":{"title":"Endocrinology","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology","snippet":"Endocrinology - Complete Reference Every diagnosis, hormonal axis, dynamic test, medication, and documentation framework you need to succeed on day one and beyond."},"3067":{"title":"The Endocrine System - Anatomy & Axes","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#s1","snippet":"The Endocrine System - Anatomy & Axes Endocrinology is the study of hormones - chemical messengers secreted by glands into the bloodstream that regulate metabolism, growth, reproduction, stress response, fluid balance, and mineral homeostasis. Unlike most specialties, endocrinology is organized arou...","sourceLabel":"Section in Endocrinology"},"3068":{"title":"Scribe Documentation Framework","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#s2","snippet":"Scribe Documentation Framework Endocrinology notes are lab-heavy, trend-heavy, and medication-titration-heavy. Unlike procedural specialties, the action of the visit is often interpreting numbers and adjusting dosages . Your job is to capture the numbers, the trend, and the dose changes accurately. ...","sourceLabel":"Section in Endocrinology"},"3069":{"title":"Type 2 Diabetes Mellitus (T2DM)","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#s3","snippet":"Type 2 Diabetes Mellitus (T2DM) T2DM is by far the most common diagnosis in an endocrinology clinic, accounting for >90% of all diabetes. It is a disorder of insulin resistance with progressive beta-cell failure. Early in disease, the pancreas compensates by producing more insulin; eventually beta-c...","sourceLabel":"Section in Endocrinology"},"3070":{"title":"Type 1 Diabetes Mellitus (T1DM)","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#s4","snippet":"Type 1 Diabetes Mellitus (T1DM) T1DM is an autoimmune destruction of pancreatic beta cells, leading to absolute insulin deficiency. It accounts for 5-10% of diabetes. Peak onset is in childhood and adolescence, but latent autoimmune diabetes of adults (LADA) can present at any age. Patients require ...","sourceLabel":"Section in Endocrinology"},"3071":{"title":"Diabetic Ketoacidosis (DKA) & HHS","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#s5","snippet":"Diabetic Ketoacidosis (DKA) & HHS Two life-threatening hyperglycemic emergencies. DKA predominates in T1DM (but occurs in T2DM, especially with SGLT2i use - \"euglycemic DKA\"). HHS (hyperosmolar hyperglycemic state) predominates in T2DM, especially elderly patients. Figure 5 - Pathophysiology of Diab...","sourceLabel":"Section in Endocrinology"},"3072":{"title":"Hypoglycemia","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#s6","snippet":"Hypoglycemia Hypoglycemia is defined by the Whipple triad : low plasma glucose, symptoms consistent with hypoglycemia, and resolution of symptoms with glucose administration. In diabetes, the ADA defines: Level 1 glucose < 70 mg/dL (alert value), Level 2 < 54 mg/dL (clinically significant), Level 3 ...","sourceLabel":"Section in Endocrinology"},"3073":{"title":"Gestational Diabetes & Prediabetes","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#s7","snippet":"Gestational Diabetes & Prediabetes Gestational diabetes (GDM) is diabetes first recognized in pregnancy, typically diagnosed at 24-28 weeks. Two-step screening: 50 g 1-hour glucose challenge test (GCT); if > 130-140 mg/dL, proceed to 100 g 3-hour OGTT (Carpenter-Coustan criteria: fasting &ge; 95, 1-...","sourceLabel":"Section in Endocrinology"},"3074":{"title":"Hypothyroidism","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#s8","snippet":"Hypothyroidism Hypothyroidism is deficiency of thyroid hormone. Primary hypothyroidism (thyroid gland failure) accounts for >95% of cases, most commonly from Hashimoto thyroiditis (chronic autoimmune lymphocytic thyroiditis with anti-TPO and anti-thyroglobulin antibodies). Other causes: post-ablatio...","sourceLabel":"Section in Endocrinology"},"3075":{"title":"Hyperthyroidism & Thyrotoxicosis","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#s9","snippet":"Hyperthyroidism & Thyrotoxicosis Thyrotoxicosis is the clinical state of excess thyroid hormone. Hyperthyroidism specifically refers to excess thyroid hormone production (as opposed to thyroiditis or exogenous intake). Major causes: Figure 10 - Immunopathogenesis of Graves Ophthalmopathy. Schematic ...","sourceLabel":"Section in Endocrinology"},"3076":{"title":"Thyroid Nodules & Thyroid Cancer","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#s10","snippet":"Thyroid Nodules & Thyroid Cancer Thyroid nodules are extremely common (up to 60% of adults on ultrasound) but only ~5% are malignant. The scribe's role is to document the size, sonographic features, TI-RADS category, FNA cytology (Bethesda), and management decisions. Figure 11 - Treatment Algorithm ...","sourceLabel":"Section in Endocrinology"},"3077":{"title":"Primary Hyperparathyroidism & Calcium Disorders","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#s11","snippet":"Primary Hyperparathyroidism & Calcium Disorders Primary hyperparathyroidism (PHPT) is autonomous PTH overproduction, usually from a single parathyroid adenoma (85%), four-gland hyperplasia (15%), or rarely carcinoma (< 1%). Most cases are discovered incidentally on routine chemistry showing hypercal...","sourceLabel":"Section in Endocrinology"},"3078":{"title":"Osteoporosis & Metabolic Bone Disease","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#s12","snippet":"Osteoporosis & Metabolic Bone Disease Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration, leading to increased fracture risk. The diagnosis is made by: (1) T-score &le; &minus;2.5 on DEXA at the lumbar spine, femoral neck, total hip, or 33...","sourceLabel":"Section in Endocrinology"},"3079":{"title":"Cushing Syndrome","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#s13","snippet":"Cushing Syndrome Cushing syndrome is the clinical state of chronic cortisol excess. The most common cause is exogenous (iatrogenic glucocorticoid use). Endogenous causes are divided into ACTH-dependent (80%) and ACTH-independent (20%): Cushing disease (pituitary ACTH-secreting adenoma) - most common...","sourceLabel":"Section in Endocrinology"},"3080":{"title":"Adrenal Insufficiency","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#s14","snippet":"Adrenal Insufficiency Adrenal insufficiency is deficient adrenal cortex hormone production. Primary (Addison disease) is adrenal gland failure - usually autoimmune adrenalitis in the developed world, TB globally - causing deficiency of cortisol, aldosterone, and adrenal androgens. Secondary is pitui...","sourceLabel":"Section in Endocrinology"},"3081":{"title":"Pheochromocytoma & Hyperaldosteronism","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#s15","snippet":"Pheochromocytoma & Hyperaldosteronism Pheochromocytoma Catecholamine-secreting tumor of adrenal medullary chromaffin cells (extra-adrenal paragangliomas arise from sympathetic chain). Classic triad: episodic headache, palpitations, diaphoresis - with paroxysmal or sustained hypertension. Rule of 10s...","sourceLabel":"Section in Endocrinology"},"3082":{"title":"Pituitary Disorders","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#s16","snippet":"Pituitary Disorders Prolactinoma Most common functional pituitary adenoma. Microadenoma < 10 mm, macroadenoma &ge; 10 mm. Symptoms: women - galactorrhea, oligomenorrhea/amenorrhea, infertility; men - hypogonadism, decreased libido, ED, visual field defects if macroadenoma compresses the optic chiasm...","sourceLabel":"Section in Endocrinology"},"3083":{"title":"Reproductive Endocrinology","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#s17","snippet":"Reproductive Endocrinology Polycystic Ovary Syndrome (PCOS) Most common endocrine disorder in reproductive-age women. Rotterdam criteria - at least 2 of 3: (1) oligo- or anovulation, (2) clinical or biochemical hyperandrogenism (hirsutism, acne, elevated free testosterone), (3) polycystic ovaries on...","sourceLabel":"Section in Endocrinology"},"3084":{"title":"Endocrine Procedures & Dynamic Testing","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#s18","snippet":"Endocrine Procedures & Dynamic Testing Unlike surgical specialties, endocrinology procedures are almost entirely diagnostic (dynamic hormonal testing) or office-based. You will chart these procedures in detail. Figure 21 - Thyroid Storm Management Algorithm. Clinical decision flowchart for the manag...","sourceLabel":"Section in Endocrinology"},"3085":{"title":"Labs, Imaging & Diagnostics","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#s19","snippet":"Labs, Imaging & Diagnostics Key Labs with Reference Ranges Lab Reference Range Use TSH 0.4-4.5 mIU/L Thyroid function screening Free T4 0.8-1.8 ng/dL Confirmation of thyroid dysfunction Free T3 2.3-4.2 pg/mL Hyperthyroidism confirmation, T3 toxicosis A1C < 5.7% normal Diabetes diagnosis and monitori...","sourceLabel":"Section in Endocrinology"},"3086":{"title":"Medications You Must Know","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#s20","snippet":"Medications You Must Know Diabetes Medications Class Generic (Brand) Mechanism Key Notes Biguanide Metformin (Glucophage) Decreases hepatic glucose production, improves insulin sensitivity First-line T2DM. Hold if eGFR < 30. GI side effects, B12 deficiency. No hypoglycemia. GLP-1 RA Semaglutide (Oze...","sourceLabel":"Section in Endocrinology"},"3087":{"title":"Classification Systems","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#s21","snippet":"Classification Systems Bethesda - Thyroid Cytopathology Category Description Malignancy Risk Management I Nondiagnostic / Unsatisfactory 5-10% Repeat FNA II Benign 0-3% Clinical follow-up III AUS/FLUS 10-30% Repeat FNA or molecular testing IV Follicular neoplasm / suspicious 25-40% Lobectomy or mole...","sourceLabel":"Section in Endocrinology"},"3088":{"title":"Abbreviations Master List","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#s22","snippet":"Abbreviations Master List Diagnoses & Axes T1DM / T2DM Type 1 / Type 2 diabetes mellitus GDM Gestational diabetes mellitus DKA Diabetic ketoacidosis HHS Hyperosmolar hyperglycemic state LADA Latent autoimmune diabetes of adults MODY Maturity-onset diabetes of the young IFG / IGT Impaired fasting glu...","sourceLabel":"Section in Endocrinology"},"3089":{"title":"Physical Exam - The Endocrine Exam","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#s23","snippet":"Physical Exam - The Endocrine Exam The endocrine exam is subtle and patterned. Unlike vascular or ortho, there are few maneuvers - but the inspection findings are diagnostic when you know what to look for. Thyroid Exam Template Inspection: Neck contour, visible goiter, surgical scars. Palpation: Thy...","sourceLabel":"Section in Endocrinology"},"3090":{"title":"Sample HPI Templates","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#s24","snippet":"Sample HPI Templates These templates show the kind of documentation expected in an endocrinology clinic. Each is a complete HPI of the type you'll be expected to pattern-match in your first week. Sample HPI - New T2DM Consult \"Mr. [Name] is a 54-year-old male with hypertension, hyperlipidemia, obesi...","sourceLabel":"Section in Endocrinology"},"3091":{"title":"References & Sources","pageTitle":"Endocrinology","pageUrl":"/scribe-guides/endocrinology","url":"/scribe-guides/endocrinology#references","snippet":"References & Sources Clinical Practice Guidelines American Diabetes Association. Standards of Care in Diabetes - 2024. Diabetes Care. 2024. Jonklaas J et al. Guidelines for the Treatment of Hypothyroidism. American Thyroid Association. Thyroid. 2014. Ross DS et al. 2016 ATA Guidelines for Diagnosis ...","sourceLabel":"Section in Endocrinology"},"3092":{"title":"Infectious Disease","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease","snippet":"Infectious Disease - Complete Reference Every syndrome, pathogen, antimicrobial, procedure, and documentation framework you need to survive the ID consult service and the inpatient ward."},"3093":{"title":"Microbiology & Immunology Essentials","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s1","snippet":"Microbiology & Immunology Essentials Infectious disease practice revolves around a simple question asked hundreds of times a day: which bug, which drug, which host, which site? As a scribe on the ID consult service you must learn to hear a clinician say \"gram-positive cocci in clusters from two bott...","sourceLabel":"Section in Infectious Disease"},"3094":{"title":"Scribe Documentation Framework","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s2","snippet":"Scribe Documentation Framework ID notes have a specific rhythm that differs from general internal medicine. They are consult-heavy, data-dense, and revolve around a structured \"bug-drug-source\" assessment. Whether you are charting a new inpatient consult, a daily follow-up, or an outpatient OPAT cli...","sourceLabel":"Section in Infectious Disease"},"3095":{"title":"Sepsis, Septic Shock & Bacteremia","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s3","snippet":"Sepsis, Septic Shock & Bacteremia Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. It is the single most common reason ID is consulted in the hospital, and it is the clinical scenario in which the speed and precision of your note matters most. The mod...","sourceLabel":"Section in Infectious Disease"},"3096":{"title":"Infective Endocarditis & Line Infections","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s4","snippet":"Infective Endocarditis & Line Infections Infective endocarditis (IE) is infection of the endocardial surface, usually a valve, producing a vegetation that embolizes and seeds distal organs. Left-sided IE (aortic, mitral) is the classic; right-sided IE (tricuspid) is associated with injection drug us...","sourceLabel":"Section in Infectious Disease"},"3097":{"title":"Pneumonia (CAP, HAP, VAP, Aspiration)","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s5","snippet":"Pneumonia (CAP, HAP, VAP, Aspiration) Pneumonia is categorized by where it was acquired because the pathogens and empiric therapy differ dramatically. Community-acquired pneumonia (CAP) develops outside the hospital. Hospital-acquired pneumonia (HAP) develops &ge; 48 hours after admission. Ventilato...","sourceLabel":"Section in Infectious Disease"},"3098":{"title":"Tuberculosis & Nontuberculous Mycobacteria","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s6","snippet":"Tuberculosis & Nontuberculous Mycobacteria Tuberculosis remains a top global infectious killer. As a scribe you will chart latent TB infection (LTBI), active pulmonary TB, extrapulmonary TB, and NTM disease - and you must understand the isolation implications of each. Figure 9 - Architecture of Tube...","sourceLabel":"Section in Infectious Disease"},"3099":{"title":"Viral Respiratory Infections","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s7","snippet":"Viral Respiratory Infections Influenza, SARS-CoV-2, and RSV are the big three viral respiratory pathogens in adults. Rhinovirus, parainfluenza, adenovirus, and human metapneumovirus round out the viral panel. Multiplex PCR respiratory panels report all of these simultaneously. Influenza Seasonal inf...","sourceLabel":"Section in Infectious Disease"},"3100":{"title":"Herpesviruses (HSV, VZV, EBV, CMV)","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s8","snippet":"Herpesviruses (HSV, VZV, EBV, CMV) All eight human herpesviruses establish lifelong latency after primary infection and can reactivate in immunocompromised hosts. The four you will chart most on ID consults: HSV-1 / HSV-2 : orolabial and genital herpes, herpetic whitlow, eczema herpeticum, HSV encep...","sourceLabel":"Section in Infectious Disease"},"3101":{"title":"HIV & AIDS-Defining Infections","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s9","snippet":"HIV & AIDS-Defining Infections HIV care is an enormous component of outpatient ID. You will chart routine follow-ups, new diagnoses, PrEP/PEP visits, opportunistic infections, and ART regimen changes. The DHHS Adult and Adolescent ARV Guidelines are the definitive U.S. reference. Figure 11 - HIV-1 L...","sourceLabel":"Section in Infectious Disease"},"3102":{"title":"Viral Hepatitis (A, B, C, D, E)","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s10","snippet":"Viral Hepatitis (A, B, C, D, E) Hepatitis A is fecal-oral, self-limited, and prevented by vaccine. Hepatitis E is similarly transmitted and can cause fulminant disease in pregnancy. These rarely need ID management beyond supportive care. Hepatitis B (HBV) is a DNA virus transmitted via blood, sexual...","sourceLabel":"Section in Infectious Disease"},"3103":{"title":"Sexually Transmitted Infections","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s11","snippet":"Sexually Transmitted Infections STIs account for a large share of outpatient ID visits. The core set: gonorrhea, chlamydia, syphilis, trichomoniasis, HSV, HPV, and HIV (covered separately). Document exposure history frankly: number of partners in the last 12 months, gender of partners, anatomic site...","sourceLabel":"Section in Infectious Disease"},"3104":{"title":"Urinary Tract Infections & Pyelonephritis","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s12","snippet":"Urinary Tract Infections & Pyelonephritis UTIs span uncomplicated cystitis, complicated UTI, pyelonephritis, catheter-associated UTI, and urosepsis. E. coli causes > 80% of community UTIs; Klebsiella , Proteus , enterococci, staphylococci, and pseudomonas appear in complicated and catheter-associate...","sourceLabel":"Section in Infectious Disease"},"3105":{"title":"Skin & Soft Tissue Infections","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s13","snippet":"Skin & Soft Tissue Infections SSTIs range from superficial impetigo and erysipelas to limb-threatening necrotizing fasciitis. Scribes must capture the exact borders (outline marked on skin with date/time), drainage, crepitus, and systemic signs. Figure 14 - CT Findings in Necrotizing Fasciitis. CT i...","sourceLabel":"Section in Infectious Disease"},"3106":{"title":"Bone & Joint Infections","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s14","snippet":"Bone & Joint Infections Osteomyelitis is infection of bone from hematogenous seeding, contiguous spread, or direct inoculation. Vertebral osteomyelitis presents with progressive back pain, fever, and elevated inflammatory markers; diagnosis requires MRI and CT-guided biopsy for culture before antibi...","sourceLabel":"Section in Infectious Disease"},"3107":{"title":"CNS Infections - Meningitis, Encephalitis, Abscess","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s15","snippet":"CNS Infections - Meningitis, Encephalitis, Abscess Bacterial Meningitis Acute bacterial meningitis presents with fever, headache, neck stiffness, photophobia, and altered mental status. The classic triad is present in only about half. Dominant pathogens by age: neonates - group B strep, E. coli , Li...","sourceLabel":"Section in Infectious Disease"},"3108":{"title":"GI Infections - C. difficile & Intra-abdominal","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s16","snippet":"GI Infections - C. difficile & Intra-abdominal Clostridioides difficile Infection (CDI) Risk factors: recent antibiotics (especially clindamycin, fluoroquinolones, cephalosporins), hospitalization, advanced age, PPIs. Diagnosis is by stool NAAT or GDH + toxin EIA in a symptomatic patient (&ge; 3 unf...","sourceLabel":"Section in Infectious Disease"},"3109":{"title":"Neutropenic Fever & Immunocompromised Host","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s17","snippet":"Neutropenic Fever & Immunocompromised Host Neutropenic fever is defined as a single oral temperature &ge; 38.3&deg;C (or &ge; 38.0&deg;C sustained over an hour) in a patient with ANC < 500 (or expected to drop below 500 within 48 hours). It is a medical emergency. Per the IDSA 2010 Fever in Neutrope...","sourceLabel":"Section in Infectious Disease"},"3110":{"title":"Travel & Tropical Medicine","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s18","snippet":"Travel & Tropical Medicine The \"fever in the returning traveler\" is a classic ID consult. Your HPI must capture: countries visited, rural vs urban, dates of travel, accommodations, food and water exposures, insect bites, freshwater exposure, animal contact, sexual exposures, pre-travel vaccines, and...","sourceLabel":"Section in Infectious Disease"},"3111":{"title":"Tick-Borne & Zoonotic Infections","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s19","snippet":"Tick-Borne & Zoonotic Infections Lyme disease ( Borrelia burgdorferi , Ixodes tick) progresses through early localized (erythema migrans target rash), early disseminated (multiple EM, carditis with AV block, facial palsy, meningitis), and late (arthritis, neuroborreliosis) stages. Treat early diseas...","sourceLabel":"Section in Infectious Disease"},"3112":{"title":"Fungal Infections","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s20","snippet":"Fungal Infections Candida Invasive candidiasis, candidemia, and deep-seated candida infections are managed per the IDSA 2016 Candidiasis Guideline . First-line therapy for candidemia is an echinocandin (caspofungin, micafungin, or anidulafungin), with step-down to fluconazole for susceptible isolate...","sourceLabel":"Section in Infectious Disease"},"3113":{"title":"Procedures - Cultures, LP, Paracentesis, I&D","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s21","snippet":"Procedures - Cultures, LP, Paracentesis, I&D ID is a largely cognitive specialty, but a handful of bedside procedures are essential for diagnosis and source control. You will document these on consult notes, procedure notes, and sometimes assist with timeout documentation. Procedure Indication Scrib...","sourceLabel":"Section in Infectious Disease"},"3114":{"title":"Antimicrobial Stewardship & Medications","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s22","snippet":"Antimicrobial Stewardship & Medications You will chart dozens of antimicrobials every day. Organize them by class and know the generic, brand, mechanism, primary use, and red-flag notes. Figure 22 - Mechanisms of Action of Major Antibiotic Classes. Comprehensive overview of antibiotic targets includ...","sourceLabel":"Section in Infectious Disease"},"3115":{"title":"Labs, Cultures & Imaging","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s23","snippet":"Labs, Cultures & Imaging ID notes are data-dense. Learn the normal ranges and how to interpret trends. Inflammatory Markers CBC with differential : leukocytosis with left shift or bandemia supports bacterial infection; leukopenia or neutropenia is ominous. CRP rises within 6-8 hours of inflammation ...","sourceLabel":"Section in Infectious Disease"},"3116":{"title":"Classification Systems","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s24","snippet":"Classification Systems Sepsis-3 Definitions Infection: Suspected or documented infection. Sepsis: Life-threatening organ dysfunction (SOFA rise &ge; 2) due to a dysregulated host response to infection. Septic shock: Sepsis + vasopressor requirement to maintain MAP &ge; 65 + lactate > 2 despite adequ...","sourceLabel":"Section in Infectious Disease"},"3117":{"title":"Physical Exam in ID","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s25","snippet":"Physical Exam in ID The ID exam is a head-to-toe search for an occult source. ID Head-to-Toe Template General: Ill-appearing vs well; rigors; diaphoresis; cachexia. Vitals: Tmax, Tcurrent, heart rate, respiratory rate, blood pressure, MAP, oxygen saturation, FiO2, pressor doses. HEENT: Oral thrush, ...","sourceLabel":"Section in Infectious Disease"},"3118":{"title":"Abbreviations Master List","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s26","snippet":"Abbreviations Master List Syndromes & Diagnoses CAP Community-acquired pneumonia HAP Hospital-acquired pneumonia VAP Ventilator-associated pneumonia UTI Urinary tract infection CAUTI Catheter-associated UTI SSTI Skin and soft tissue infection DFI Diabetic foot infection OM Osteomyelitis SA Septic ar...","sourceLabel":"Section in Infectious Disease"},"3119":{"title":"Sample HPI Templates","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#s27","snippet":"Sample HPI Templates These templates reflect the density, structure, and tone of real ID consult notes. Use them as scaffolding during your first weeks. Sample HPI - Sepsis Admission \"Mr. [Name] is a 68-year-old male with a history of type 2 diabetes (A1C 9.1), CKD stage 3, and BPH, admitted from th...","sourceLabel":"Section in Infectious Disease"},"3120":{"title":"References & Sources","pageTitle":"Infectious Disease","pageUrl":"/scribe-guides/infectious-disease","url":"/scribe-guides/infectious-disease#references","snippet":"References & Sources Clinical Practice Guidelines Evans L, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med. 2021. Metlay JP, et al. Diagnosis and Treatment of Adults with Community-Acquired Pneumonia. Am J Respir Crit Care Med ...","sourceLabel":"Section in Infectious Disease"},"3121":{"title":"Hematology / Oncology","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology","snippet":"Hematology / Oncology - Complete Reference Every diagnosis, condition, procedure, medication, classification, and documentation framework you need to survive and thrive in a heme/onc clinic."},"3122":{"title":"Hematopoiesis & Bone Marrow Essentials","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology#s1","snippet":"Hematopoiesis & Bone Marrow Essentials Hematology and oncology are two overlapping but distinct practices joined administratively because both depend on blood, bone marrow, and the cellular mechanics of proliferation. Hematology manages diseases of red cells, white cells, platelets, and coagulation....","sourceLabel":"Section in Hematology / Oncology"},"3123":{"title":"Scribe Documentation Framework","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology#s2","snippet":"Scribe Documentation Framework Heme/onc notes are problem-oriented and cycle-aware. Every note references where the patient is in their treatment journey: new consult, pre-treatment workup, on active therapy (cycle X day Y), surveillance, progression, or end-of-life care. Subjective Chief Complaint:...","sourceLabel":"Section in Hematology / Oncology"},"3124":{"title":"Iron Deficiency & Anemia of Chronic Disease","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology#s3","snippet":"Iron Deficiency & Anemia of Chronic Disease Iron deficiency anemia (IDA) is the most common anemia worldwide. Causes include GI blood loss (colon cancer must be ruled out in any adult male or postmenopausal female with new IDA), menstrual loss, poor absorption (celiac, post-bariatric surgery, PPI us...","sourceLabel":"Section in Hematology / Oncology"},"3125":{"title":"B12 / Folate Deficiency & Megaloblastic Anemia","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology#s4","snippet":"B12 / Folate Deficiency & Megaloblastic Anemia Macrocytic anemia (MCV > 100) with hypersegmented neutrophils on smear suggests a megaloblastic process. Vitamin B12 (cobalamin) deficiency is most commonly due to pernicious anemia (autoimmune loss of intrinsic factor), terminal ileum disease (Crohn's,...","sourceLabel":"Section in Hematology / Oncology"},"3126":{"title":"Hemolytic Anemias","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology#s5","snippet":"Hemolytic Anemias Hemolysis is premature RBC destruction. The labs are stereotyped: low haptoglobin, elevated LDH, elevated indirect bilirubin, and elevated reticulocyte count. A peripheral smear often clinches the diagnosis (spherocytes, schistocytes, bite cells). Figure 4 - Peripheral Blood Smear:...","sourceLabel":"Section in Hematology / Oncology"},"3127":{"title":"Sickle Cell Disease & Thalassemia","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology#s6","snippet":"Sickle Cell Disease & Thalassemia Sickle cell disease (SCD) is an autosomal recessive point mutation (Glu&rarr;Val at position 6 of beta-globin) producing HbS, which polymerizes in deoxygenated states, deforming RBCs into rigid sickles that occlude microvasculature and hemolyze. Patients present wit...","sourceLabel":"Section in Hematology / Oncology"},"3128":{"title":"Bleeding Disorders","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology#s7","snippet":"Bleeding Disorders ITP - Immune Thrombocytopenia Isolated thrombocytopenia from antiplatelet autoantibodies. Diagnosis of exclusion. Treat if platelets < 30 or bleeding: corticosteroids, IVIG, anti-D, rituximab, TPO receptor agonists (romiplostim, eltrombopag), splenectomy. Chronic ITP in adults; of...","sourceLabel":"Section in Hematology / Oncology"},"3129":{"title":"VTE & Anticoagulation","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology#s8","snippet":"VTE & Anticoagulation Venous thromboembolism - DVT and PE - is one of the most common heme consults. Virchow triad: stasis, endothelial injury, hypercoagulability. Provoked VTE occurs in the setting of surgery, hospitalization, trauma, OCPs, pregnancy, or immobilization. Unprovoked VTE raises suspic...","sourceLabel":"Section in Hematology / Oncology"},"3130":{"title":"Plasma Cell Disorders","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology#s9","snippet":"Plasma Cell Disorders MGUS (monoclonal gammopathy of undetermined significance) is the asymptomatic precursor - M-protein < 3 g/dL, < 10% plasma cells in marrow, no CRAB features. Progresses to myeloma at ~1%/year. Smoldering multiple myeloma sits between MGUS and active disease. Figure 12 - Multipl...","sourceLabel":"Section in Hematology / Oncology"},"3131":{"title":"MDS & Myeloproliferative Neoplasms","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology#s10","snippet":"MDS & Myeloproliferative Neoplasms Myelodysplastic syndromes (MDS) are clonal stem cell disorders with ineffective hematopoiesis - cytopenias with a hypercellular, dysplastic marrow. Risk is stratified by IPSS-R using cytogenetics, blast %, hemoglobin, platelets, and ANC (very low, low, intermediate...","sourceLabel":"Section in Hematology / Oncology"},"3132":{"title":"Acute Leukemias & CLL","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology#s11","snippet":"Acute Leukemias & CLL Risk Factors to Document on Every Onc Patient Tobacco: pack-year history and quit date. Alcohol: drinks/week. Family cancer history: first- and second-degree relatives with age at diagnosis - triggers hereditary cancer panels (BRCA1/2, Lynch, Li-Fraumeni, Cowden). Prior cancers...","sourceLabel":"Section in Hematology / Oncology"},"3133":{"title":"Lymphomas","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology#s12","snippet":"Lymphomas Hodgkin lymphoma (HL) features Reed-Sternberg cells (CD15+, CD30+). Bimodal age distribution. Classic HL subtypes: nodular sclerosing (most common), mixed cellularity, lymphocyte-rich, lymphocyte-depleted; plus nodular lymphocyte predominant HL. Presents with painless cervical/supraclavicu...","sourceLabel":"Section in Hematology / Oncology"},"3134":{"title":"Breast Cancer","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology#s13","snippet":"Breast Cancer Breast cancer is the most common non-skin cancer in women. Presents as a screen-detected abnormality, a palpable mass, or locally advanced disease with skin/nipple changes. Workup: diagnostic mammogram + ultrasound, core needle biopsy, staging imaging for high-risk or node-positive dis...","sourceLabel":"Section in Hematology / Oncology"},"3135":{"title":"Lung Cancer (NSCLC & SCLC)","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology#s14","snippet":"Lung Cancer (NSCLC & SCLC) Leading cause of cancer death in the US. Non-small cell lung cancer (NSCLC) accounts for ~85% and includes adenocarcinoma (most common), squamous cell, and large cell. Small cell lung cancer (SCLC) is a neuroendocrine malignancy almost always smoking-related with rapid gro...","sourceLabel":"Section in Hematology / Oncology"},"3136":{"title":"GI Malignancies","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology#s15","snippet":"GI Malignancies Colorectal cancer (CRC) : second leading cause of cancer death in the US. USPSTF recommends screening from age 45-75. Workup includes colonoscopy with biopsy, CEA, CT chest/abdomen/pelvis, MMR/MSI testing (all new CRC), RAS/BRAF/HER2 testing for metastatic disease. Stage-based treatm...","sourceLabel":"Section in Hematology / Oncology"},"3137":{"title":"GU Malignancies","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology#s16","snippet":"GU Malignancies Prostate cancer : Screening is a shared decision in men 55-69 ( USPSTF ). Diagnosis: elevated PSA &rarr; MRI &rarr; targeted biopsy. Grading uses Gleason score (3+3=6, 3+4=7, 4+3=7, 4+4=8, up to 5+5=10) translated into Grade Groups 1-5. Management: active surveillance for low-risk; r...","sourceLabel":"Section in Hematology / Oncology"},"3138":{"title":"Gynecologic, Head & Neck, Skin, CNS & Sarcoma","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology#s17","snippet":"Gynecologic, Head & Neck, Skin, CNS & Sarcoma Ovarian cancer : presents late with vague abdominal symptoms, ascites, pelvic mass. CA-125 tumor marker. Debulking surgery + carboplatin/paclitaxel &plusmn; bevacizumab. PARP inhibitors (olaparib, niraparib, rucaparib) for BRCA-mutant and HRD+ maintenanc...","sourceLabel":"Section in Hematology / Oncology"},"3139":{"title":"Oncologic Emergencies","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology#s18","snippet":"Oncologic Emergencies Figure 19 - Tumor Lysis Syndrome Pathophysiology. Clinical manifestations of TLS showing rapid tumor cell death releasing intracellular contents: hyperkalemia (cardiac arrhythmias), hyperphosphatemia (calcium-phosphate deposition), hyperuricemia (acute kidney injury), and hypoc...","sourceLabel":"Section in Hematology / Oncology"},"3140":{"title":"Procedures in Heme/Onc","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology#s19","snippet":"Procedures in Heme/Onc Procedure What It Is Key Documentation Bone marrow biopsy / aspirate Posterior iliac crest aspirate + core biopsy with Jamshidi needle under local &plusmn; conscious sedation Site, consent, specimen sent (cytogenetics, flow, FISH, NGS), complications Lumbar puncture (LP) Intra...","sourceLabel":"Section in Hematology / Oncology"},"3141":{"title":"Chemotherapy & Targeted / Immuno / Endocrine Agents","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology#s20","snippet":"Chemotherapy & Targeted / Immuno / Endocrine Agents Chemotherapy is organized by mechanism class. Each class has signature toxicities you must know because they drive the review of systems. Figure 20 - PD-1/PD-L1 Checkpoint Immunotherapy Mechanism. The PD-1/PD-L1 axis in tumor immune evasion: tumor ...","sourceLabel":"Section in Hematology / Oncology"},"3142":{"title":"Imaging, Labs & Tumor Markers","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology#s21","snippet":"Imaging, Labs & Tumor Markers Imaging: CT chest/abdomen/pelvis with contrast is the workhorse staging and restaging study. PET-CT (FDG) is central to lymphoma response (Deauville score 1-5) and many solid tumors. MRI brain for CNS staging, MRI breast for occult disease in dense tissue or BRCA, MRI p...","sourceLabel":"Section in Hematology / Oncology"},"3143":{"title":"Classification & Response Systems","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology#s22","snippet":"Classification & Response Systems ECOG Performance Status Grade Description 0 Fully active, no restrictions 1 Restricted in strenuous activity; ambulatory, light work 2 Ambulatory, self-care, unable to work, up > 50% waking hours 3 Limited self-care, confined to bed/chair > 50% waking hours 4 Comple...","sourceLabel":"Section in Hematology / Oncology"},"3144":{"title":"Physical Exam & Abbreviations","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology#s23","snippet":"Physical Exam & Abbreviations Universal Heme/Onc Note Header Dx: Stage IIIB HER2+ invasive ductal carcinoma, right breast Dx date: 02/2026 Biomarkers: ER 90% / PR 70% / HER2 3+ / Ki-67 35% Current regimen: TCHP, C4D1 Prior lines: none ECOG: 1 KPS: 80 Last imaging: CT 03/2026 - partial response Aller...","sourceLabel":"Section in Hematology / Oncology"},"3145":{"title":"Sample HPI Templates & References","pageTitle":"Hematology / Oncology","pageUrl":"/scribe-guides/hematology-oncology","url":"/scribe-guides/hematology-oncology#s24","snippet":"Sample HPI Templates & References These templates show the cadence of a real heme/onc clinic note. Every HPI in this specialty references diagnosis date, histology, stage, line of therapy, cycle/day, and toxicities. Sample HPI - New Breast Cancer Consult \"Ms. [Name] is a 54-year-old postmenopausal f...","sourceLabel":"Section in Hematology / Oncology"},"3146":{"title":"Rheumatology","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology","snippet":"Rheumatology - Complete Reference Every diagnosis, autoantibody, procedure, DMARD, classification criterion, and documentation framework you need to succeed on day one and beyond."},"3147":{"title":"Joint Anatomy & Immunology Essentials","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology#s1","snippet":"Joint Anatomy & Immunology Essentials Rheumatology sits at the intersection of musculoskeletal medicine and clinical immunology. Its patients almost always have one of two problems: joint pain or systemic autoimmune disease , and usually both. To document fluently you need a working knowledge of how...","sourceLabel":"Section in Rheumatology"},"3148":{"title":"Scribe Documentation Framework","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology#s2","snippet":"Scribe Documentation Framework The Rheumatology SOAP Note Rheumatology notes are SOAP-format but heavy on two things other specialties don't emphasize: the joint count and the medication timeline . Every visit the physician will document a tender joint count (TJC) and swollen joint count (SJC), ofte...","sourceLabel":"Section in Rheumatology"},"3149":{"title":"Rheumatoid Arthritis (RA)","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology#s3","snippet":"Rheumatoid Arthritis (RA) Rheumatoid arthritis is the prototypical chronic inflammatory arthritis and the single most common diagnosis in a general rheumatology clinic. It affects roughly 0.5-1% of the adult population, is three times more common in women than men, and peaks in incidence between age...","sourceLabel":"Section in Rheumatology"},"3150":{"title":"Osteoarthritis (OA)","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology#s4","snippet":"Osteoarthritis (OA) Osteoarthritis is the most common joint disease in the world and the most common reason an adult sees a physician for joint pain. While primarily managed by primary care and orthopedics, rheumatologists frequently see OA in the context of atypical presentations, inflammatory flar...","sourceLabel":"Section in Rheumatology"},"3151":{"title":"Systemic Lupus Erythematosus (SLE)","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology#s5","snippet":"Systemic Lupus Erythematosus (SLE) SLE is the prototype multisystem autoimmune disease. It predominantly affects women of childbearing age (female:male ratio 9:1) and is more prevalent and more severe in Black, Hispanic, and Asian patients. It can attack virtually every organ - skin, joints, kidneys...","sourceLabel":"Section in Rheumatology"},"3152":{"title":"Sjögren Disease","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology#s6","snippet":"Sjögren Disease Sjögren disease (formerly Sjögren syndrome) is a chronic autoimmune exocrinopathy with lymphocytic infiltration of the salivary and lacrimal glands, producing the classic sicca symptoms of dry eyes and dry mouth. It can be primary or secondary to another connective tissue disease (mo...","sourceLabel":"Section in Rheumatology"},"3153":{"title":"Systemic Sclerosis (Scleroderma)","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology#s7","snippet":"Systemic Sclerosis (Scleroderma) Systemic sclerosis is a connective tissue disease characterized by small-vessel vasculopathy, autoimmunity, and progressive fibrosis of the skin and internal organs. It is uncommon but devastating when organ involvement is severe. Figure 10 - Hand Changes in Systemic...","sourceLabel":"Section in Rheumatology"},"3154":{"title":"Inflammatory Myopathies (PM, DM, IBM, IMNM)","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology#s8","snippet":"Inflammatory Myopathies (PM, DM, IBM, IMNM) The idiopathic inflammatory myopathies are a group of autoimmune muscle diseases causing proximal weakness and elevated muscle enzymes. The major subtypes are polymyositis (PM) , dermatomyositis (DM) , inclusion body myositis (IBM) , and immune-mediated ne...","sourceLabel":"Section in Rheumatology"},"3155":{"title":"MCTD, UCTD & Antiphospholipid Syndrome","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology#s9","snippet":"MCTD, UCTD & Antiphospholipid Syndrome Mixed Connective Tissue Disease (MCTD) MCTD is an overlap syndrome with features of SLE, scleroderma, and polymyositis, defined by high-titer anti-U1-RNP antibodies. Patients typically have Raynaud, puffy hands, arthritis, myositis, and esophageal dysmotility; ...","sourceLabel":"Section in Rheumatology"},"3156":{"title":"ANCA-Associated Vasculitis (GPA, MPA, EGPA)","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology#s10","snippet":"ANCA-Associated Vasculitis (GPA, MPA, EGPA) The ANCA-associated vasculitides (AAVs) are small-vessel necrotizing vasculitides with few or no immune complex deposits, associated with antineutrophil cytoplasmic antibodies (ANCA) . The three entities are granulomatosis with polyangiitis (GPA, formerly ...","sourceLabel":"Section in Rheumatology"},"3157":{"title":"Large-Vessel Vasculitis (GCA, Takayasu) & PMR","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology#s11","snippet":"Large-Vessel Vasculitis (GCA, Takayasu) & PMR Giant Cell Arteritis (GCA) GCA is a granulomatous vasculitis of large and medium-sized arteries, particularly the cranial branches of the external carotid. It affects adults > 50 (almost always > 70) and is the most common primary vasculitis of the elder...","sourceLabel":"Section in Rheumatology"},"3158":{"title":"Small- & Medium-Vessel Vasculitis","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology#s12","snippet":"Small- & Medium-Vessel Vasculitis Beyond ANCA-associated vasculitis, the small- and medium-vessel vasculitides include several clinically important entities: IgA vasculitis (Henoch-Schönlein purpura): palpable purpura (lower extremities), arthritis, abdominal pain, and IgA nephropathy. Most common i...","sourceLabel":"Section in Rheumatology"},"3159":{"title":"Gout & Pseudogout (CPPD)","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology#s13","snippet":"Gout & Pseudogout (CPPD) Crystal arthropathies are among the most common reasons for acute rheumatology consultation. Definitive diagnosis requires joint aspiration with crystal analysis under polarized microscopy. Figure 14 - Gouty Tophus. Clinical photograph demonstrating a tophaceous deposit at t...","sourceLabel":"Section in Rheumatology"},"3160":{"title":"Spondyloarthropathies (AS, PsA, ReA, IBD-SpA)","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology#s14","snippet":"Spondyloarthropathies (AS, PsA, ReA, IBD-SpA) The spondyloarthropathies (SpA) are a family of seronegative (RF-negative) inflammatory arthritides sharing HLA-B27 association, axial skeleton involvement, enthesitis, dactylitis, uveitis, and extra-articular features. Subtypes: ankylosing spondylitis (...","sourceLabel":"Section in Rheumatology"},"3161":{"title":"Juvenile Idiopathic Arthritis & Adult-Onset Still Disease","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology#s15","snippet":"Juvenile Idiopathic Arthritis & Adult-Onset Still Disease Juvenile Idiopathic Arthritis (JIA) JIA is the umbrella term for chronic arthritis of unknown cause beginning before age 16 and lasting > 6 weeks. ILAR subtypes: oligoarticular (≤ 4 joints), polyarticular RF-negative, polyarticular RF-positiv...","sourceLabel":"Section in Rheumatology"},"3162":{"title":"Fibromyalgia","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology#s16","snippet":"Fibromyalgia Fibromyalgia is a chronic central pain amplification syndrome characterized by widespread musculoskeletal pain, fatigue, non-restorative sleep, cognitive dysfunction (\"fibro fog\"), and high rates of comorbid mood and anxiety disorders. It is not inflammatory, not autoimmune, and not joi...","sourceLabel":"Section in Rheumatology"},"3163":{"title":"IgG4-Related Disease, Sarcoidosis, Behçet & Relapsing Polychondritis","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology#s17","snippet":"IgG4-Related Disease, Sarcoidosis, Behçet & Relapsing Polychondritis IgG4-Related Disease IgG4-RD is a fibroinflammatory disease characterized by tumefactive lesions, lymphoplasmacytic infiltrates rich in IgG4+ plasma cells, storiform fibrosis, and obliterative phlebitis on biopsy. Can affect virtua...","sourceLabel":"Section in Rheumatology"},"3164":{"title":"Septic Arthritis & Osteoporosis Overlap","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology#s18","snippet":"Septic Arthritis & Osteoporosis Overlap Septic Arthritis Septic arthritis is a rheumatologic emergency. Any acutely hot, swollen, painful joint - especially monoarticular - must be aspirated before steroid injection to exclude infection. Classic organisms: Staphylococcus aureus (most common overall)...","sourceLabel":"Section in Rheumatology"},"3165":{"title":"Procedures - Injections, Aspirations & Biopsies","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology#s19","snippet":"Procedures - Injections, Aspirations & Biopsies Procedures in rheumatology are primarily diagnostic joint aspiration ( arthrocentesis ) and therapeutic joint or soft-tissue injection. You will document consent, site, approach, medication, volume, fluid appearance, complications, and patient toleranc...","sourceLabel":"Section in Rheumatology"},"3166":{"title":"Labs, Serologies & Imaging","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology#s20","snippet":"Labs, Serologies & Imaging Core Labs Every rheumatology visit typically includes CBC (anemia of chronic disease, leukopenia in SLE, thrombocytopenia), CMP (renal function, LFTs for medication monitoring), UA (proteinuria and hematuria for lupus nephritis, vasculitis), ESR, and CRP. ESR is slower and...","sourceLabel":"Section in Rheumatology"},"3167":{"title":"Medications - DMARDs, Biologics & Beyond","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology#s21","snippet":"Medications - DMARDs, Biologics & Beyond Rheumatology is a medication-heavy specialty. You must know every drug class, mechanism, brand name, and monitoring requirement. All biologics and JAK inhibitors require baseline screening for TB (QuantiFERON or PPD), hepatitis B and C, and HIV, and a review ...","sourceLabel":"Section in Rheumatology"},"3168":{"title":"Classification Systems - Full Enumeration","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology#s22","snippet":"Classification Systems - Full Enumeration DAS28 Disease Activity Categories (RA) Category DAS28-ESR / CRP Clinical Meaning Remission < 2.6 Treatment target Low 2.6 - 3.2 Acceptable if sustained Moderate > 3.2 - 5.1 Escalate therapy High > 5.1 Escalate therapy BILAG-2004 Organ Grading (SLE) Grade Mea...","sourceLabel":"Section in Rheumatology"},"3169":{"title":"Physical Exam - The Rheumatologic Exam","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology#s23","snippet":"Physical Exam - The Rheumatologic Exam The rheumatologic exam is the most specialized part of documentation. The physician performs a focused joint and skin exam every visit, and you need to capture it accurately and efficiently. Figure 23 - Pathogenesis of Raynaud Phenomenon. The interplay of vascu...","sourceLabel":"Section in Rheumatology"},"3170":{"title":"Abbreviations, Sample HPIs & Final Note","pageTitle":"Rheumatology","pageUrl":"/scribe-guides/rheumatology","url":"/scribe-guides/rheumatology#s24","snippet":"Abbreviations, Sample HPIs & Final Note Diseases RA Rheumatoid arthritis OA Osteoarthritis SLE Systemic lupus erythematosus SSc Systemic sclerosis (scleroderma) lcSSc / dcSSc Limited / diffuse cutaneous SSc MCTD Mixed connective tissue disease UCTD Undifferentiated connective tissue disease PM / DM ...","sourceLabel":"Section in Rheumatology"},"3171":{"title":"Neurology","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology","snippet":"Neurology - Complete Reference Every diagnosis, condition, procedure, medication, abbreviation, and documentation framework you need to succeed on day one and beyond in a neurology clinic, stroke service, or neurohospitalist setting."},"3172":{"title":"Neuroanatomy & Neurophysiology Essentials","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology#s1","snippet":"Neuroanatomy & Neurophysiology Essentials Neurology is the medical (non-surgical) specialty managing disorders of the brain, spinal cord, peripheral nerves, neuromuscular junction, and muscle. A strong scribe understands the anatomic substrate for every complaint because neurologists localize before...","sourceLabel":"Section in Neurology"},"3173":{"title":"Scribe Documentation Framework","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology#s2","snippet":"Scribe Documentation Framework Neurology notes are organized around localization and temporal profile . A well-written neurology HPI tells the reader, in order, what happened, when, how fast it came on, what systems are involved, and where in the nervous system the process lives. Neurology encounter...","sourceLabel":"Section in Neurology"},"3174":{"title":"Ischemic Stroke & TIA","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology#s3","snippet":"Ischemic Stroke & TIA Ischemic stroke accounts for roughly 87% of all strokes. It results from occlusion of a cerebral artery, producing focal neurologic deficit from infarction of the territory it supplies. Transient ischemic attack (TIA) is a brief episode of focal neurologic dysfunction from isch...","sourceLabel":"Section in Neurology"},"3175":{"title":"Intracerebral Hemorrhage (ICH)","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology#s4","snippet":"Intracerebral Hemorrhage (ICH) Spontaneous ICH accounts for ~10-15% of strokes but carries the highest mortality of any stroke subtype - 30-day mortality ~40% and only about 20% of survivors regain functional independence. Figure 8 - Intracerebral Hemorrhage on CT. Non-contrast CT demonstrating acut...","sourceLabel":"Section in Neurology"},"3176":{"title":"Subarachnoid Hemorrhage (SAH)","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology#s5","snippet":"Subarachnoid Hemorrhage (SAH) Non-traumatic SAH is most commonly due to rupture of a saccular (berry) aneurysm at the circle of Willis. The hallmark presentation is the thunderclap headache - \"the worst headache of my life,\" reaching maximum intensity within seconds. Associated features include neck...","sourceLabel":"Section in Neurology"},"3177":{"title":"Headache Disorders","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology#s6","snippet":"Headache Disorders Headache is the most common neurology complaint. The scribe must distinguish primary headaches (migraine, tension, cluster) from secondary causes (SAH, meningitis, tumor, IIH, dissection, giant cell arteritis). The red-flag mnemonic SNOOP - Systemic symptoms, Neurologic deficits, ...","sourceLabel":"Section in Neurology"},"3178":{"title":"Seizures & Epilepsy","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology#s7","snippet":"Seizures & Epilepsy A seizure is a transient occurrence of signs/symptoms due to abnormal excessive or synchronous neuronal activity. Epilepsy is defined as &ge;2 unprovoked seizures >24 hours apart, or one unprovoked seizure with high recurrence risk. The ILAE classification divides seizures into f...","sourceLabel":"Section in Neurology"},"3179":{"title":"Syncope & Transient Loss of Consciousness","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology#s8","snippet":"Syncope & Transient Loss of Consciousness Neurologists are consulted to distinguish syncope (global cerebral hypoperfusion, brief, rapid return to baseline) from seizure (cortical electrical event, often with postictal state). Cardiogenic syncope (arrhythmia, structural heart disease) is managed by ...","sourceLabel":"Section in Neurology"},"3180":{"title":"Multiple Sclerosis & Demyelinating Disease","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology#s9","snippet":"Multiple Sclerosis & Demyelinating Disease Multiple sclerosis (MS) is an autoimmune demyelinating disease of the CNS characterized by lesions disseminated in space and time. Onset is typically age 20-40, female predominant. Phenotypes: clinically isolated syndrome (CIS) , relapsing-remitting MS (RRM...","sourceLabel":"Section in Neurology"},"3181":{"title":"Amyotrophic Lateral Sclerosis","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology#s10","snippet":"Amyotrophic Lateral Sclerosis Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease affecting both upper motor neurons (corticospinal tract - spasticity, hyperreflexia, Babinski, pseudobulbar affect) and lower motor neurons (anterior horn cells - weakness, atrophy, fascicula...","sourceLabel":"Section in Neurology"},"3182":{"title":"Parkinson Disease & Parkinsonism","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology#s11","snippet":"Parkinson Disease & Parkinsonism Parkinson disease (PD) is the second most common neurodegenerative disorder after Alzheimer. Pathology: loss of dopaminergic neurons in the substantia nigra pars compacta with alpha-synuclein-containing Lewy bodies. The MDS Clinical Diagnostic Criteria ( Postuma et a...","sourceLabel":"Section in Neurology"},"3183":{"title":"Other Movement Disorders","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology#s12","snippet":"Other Movement Disorders Essential tremor (ET) is the most common movement disorder: bilateral, largely symmetric postural and kinetic hand tremor (worse with target-directed activity such as pouring or drinking from a cup), often with head (\"no-no\" or \"yes-yes\") and voice involvement, frequently fa...","sourceLabel":"Section in Neurology"},"3184":{"title":"Dementia & Cognitive Disorders","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology#s13","snippet":"Dementia & Cognitive Disorders Mild cognitive impairment (MCI) is cognitive decline beyond normal aging without functional impairment. Dementia (major neurocognitive disorder) requires cognitive decline sufficient to impair independent function in daily activities. Figure 18 - Neurofibrillary Tangle...","sourceLabel":"Section in Neurology"},"3185":{"title":"Peripheral Neuropathy","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology#s14","snippet":"Peripheral Neuropathy Peripheral neuropathy can be classified by distribution (symmetric length-dependent polyneuropathy vs mononeuropathy multiplex vs plexopathy vs radiculopathy vs polyradiculoneuropathy), by fiber type (large fiber - vibration/proprioception/motor; small fiber - pain/temperature/...","sourceLabel":"Section in Neurology"},"3186":{"title":"Neuromuscular Junction & Myopathies","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology#s15","snippet":"Neuromuscular Junction & Myopathies Myasthenia gravis (MG) is an autoimmune disease directed against postsynaptic acetylcholine receptors (AChR Ab positive in ~85% of generalized MG, ~50% of ocular MG) or MuSK (muscle-specific kinase, ~5-10%). A smaller subset is \"seronegative.\" Hallmark is fatigabl...","sourceLabel":"Section in Neurology"},"3187":{"title":"CNS Tumors & Neuro-Oncology","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology#s16","snippet":"CNS Tumors & Neuro-Oncology Primary CNS tumors are classified per WHO with both histology and molecular features. Gliomas include astrocytomas, oligodendrogliomas, and glioblastoma - graded I-IV by WHO with molecular classification integrating IDH mutation status, 1p/19q codeletion (defining oligode...","sourceLabel":"Section in Neurology"},"3188":{"title":"CNS Infections & Normal Pressure Hydrocephalus","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology#s17","snippet":"CNS Infections & Normal Pressure Hydrocephalus CNS infections overlap with infectious disease, but neurologists are frequently consulted for diagnosis and management. Bacterial meningitis : fever, headache, neck stiffness, altered mental status; classic triad is present in fewer than half of cases, ...","sourceLabel":"Section in Neurology"},"3189":{"title":"Vertigo & Dizziness","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology#s18","snippet":"Vertigo & Dizziness First distinguish vertigo (illusion of motion) from presyncope, disequilibrium, and non-specific dizziness. Then separate peripheral (inner ear/vestibular nerve) from central (brainstem/cerebellum) causes. The HINTS exam ( H ead I mpulse, N ystagmus, T est of S kew) in acute vest...","sourceLabel":"Section in Neurology"},"3190":{"title":"Neurologic Procedures & Diagnostics","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology#s19","snippet":"Neurologic Procedures & Diagnostics Neurology is a largely diagnostic specialty, but a scribe will document a defined set of procedures performed in clinic, at the bedside, or in specialized labs. Figure 23 - Spinal Needle Types for Lumbar Puncture. Comparison of cutting (Quincke) and atraumatic (Sp...","sourceLabel":"Section in Neurology"},"3191":{"title":"Neuroimaging & Electrodiagnostics","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology#s20","snippet":"Neuroimaging & Electrodiagnostics NCCT head: first-line for stroke alert to rule out hemorrhage, SAH (up to 6 hours), skull fracture, large mass effect. CTA head and neck: evaluates for LVO, aneurysm, dissection, vasculitis. CT perfusion: estimates ischemic core and salvageable penumbra using CBF/CB...","sourceLabel":"Section in Neurology"},"3192":{"title":"Medications You Must Know","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology#s21","snippet":"Medications You Must Know Class Agents Primary Use / Notes Antiplatelets Aspirin, clopidogrel, aspirin+dipyridamole, ticagrelor Secondary stroke prevention; DAPT 21-90 days after minor stroke/high-risk TIA Anticoagulants Warfarin, apixaban, rivaroxaban, dabigatran, edoxaban, LMWH, UFH Cardioembolic ...","sourceLabel":"Section in Neurology"},"3193":{"title":"Classification & Scoring Systems","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology#s22","snippet":"Classification & Scoring Systems NIH Stroke Scale (NIHSS) 15-item scale (0-42). Items: 1a LOC, 1b LOC questions, 1c LOC commands, 2 best gaze, 3 visual fields, 4 facial palsy, 5a/5b motor arm L/R, 6a/6b motor leg L/R, 7 limb ataxia, 8 sensory, 9 best language, 10 dysarthria, 11 extinction/inattentio...","sourceLabel":"Section in Neurology"},"3194":{"title":"Neurologic Physical Exam","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology#s23","snippet":"Neurologic Physical Exam The neurologic exam is the most specialty-defining part of the note. Master the components and the documentation rhythm. Standard Neurologic Exam Template Mental status: alert and oriented x 3 (or 4), attention (months backward, serial 7s), language (fluent, comprehension in...","sourceLabel":"Section in Neurology"},"3195":{"title":"Abbreviations, Sample HPIs & References","pageTitle":"Neurology","pageUrl":"/scribe-guides/neurology","url":"/scribe-guides/neurology#s24","snippet":"Abbreviations, Sample HPIs & References Abbreviations - Diagnoses & Syndromes CVA Cerebrovascular accident (stroke) TIA Transient ischemic attack ICH Intracerebral hemorrhage SAH Subarachnoid hemorrhage SDH / EDH Subdural / epidural hematoma LVO Large vessel occlusion CAA Cerebral amyloid angiopathy...","sourceLabel":"Section in Neurology"},"3196":{"title":"Dermatology","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology","snippet":"Dermatology - Complete Reference Every diagnosis, lesion morphology, procedure, biologic, and documentation framework you need to succeed on day one and beyond in a dermatology clinic."},"3197":{"title":"The Skin — Anatomy & Physiology Essentials","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s1","snippet":"The Skin — Anatomy & Physiology Essentials Dermatology is the study and treatment of the skin, hair, and nails. The skin is the largest organ of the body, weighing roughly 16% of total body weight and covering approximately 1.5 to 2 square meters in adults. It is simultaneously a mechanical barrier,...","sourceLabel":"Section in Dermatology"},"3198":{"title":"Scribe Documentation Framework","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s2","snippet":"Scribe Documentation Framework The Dermatology SOAP Note Dermatology notes are highly visual and morphology-driven. Where an internist describes a symptom, a dermatologist describes a lesion: its type, color, shape, border, distribution, and change over time. A scribe who cannot translate the attend...","sourceLabel":"Section in Dermatology"},"3199":{"title":"Primary & Secondary Lesion Morphology","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s3","snippet":"Primary & Secondary Lesion Morphology Morphology is the language of dermatology. Every encounter begins with the attending naming a primary lesion type, optionally layering on secondary changes, and then describing color, configuration, and distribution. You must memorize these terms cold — they are...","sourceLabel":"Section in Dermatology"},"3200":{"title":"Acne Vulgaris","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s4","snippet":"Acne Vulgaris Acne vulgaris is the most common dermatologic diagnosis worldwide, affecting up to 85% of adolescents and a significant minority of adults, especially women in their 20s and 30s. It is a chronic inflammatory disease of the pilosebaceous unit driven by four interacting factors: increase...","sourceLabel":"Section in Dermatology"},"3201":{"title":"Rosacea","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s5","snippet":"Rosacea Rosacea is a chronic inflammatory facial dermatosis characterized by persistent central facial erythema, flushing, telangiectasias, and inflammatory papules/pustules. It overwhelmingly affects fair-skinned adults (Fitzpatrick I–II), peaks between ages 30 and 60, and is more common in women (...","sourceLabel":"Section in Dermatology"},"3202":{"title":"Atopic Dermatitis (Eczema)","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s6","snippet":"Atopic Dermatitis (Eczema) Atopic dermatitis (AD) is a chronic, relapsing, intensely pruritic inflammatory skin disease driven by a combination of epidermal barrier dysfunction (notably filaggrin gene mutations) and Th2-skewed immune response (IL-4, IL-13, IL-31). It is the most common chronic skin ...","sourceLabel":"Section in Dermatology"},"3203":{"title":"Contact Dermatitis & Hand Dermatitis","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s7","snippet":"Contact Dermatitis & Hand Dermatitis Contact dermatitis divides into irritant contact dermatitis (ICD) — a direct cytotoxic reaction to a substance that requires no prior sensitization and affects anyone exposed at sufficient dose (80% of cases) — and allergic contact dermatitis (ACD) — a type IV de...","sourceLabel":"Section in Dermatology"},"3204":{"title":"Psoriasis","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s8","snippet":"Psoriasis Psoriasis is a chronic, immune-mediated, inflammatory disease of the skin and joints driven by a dysregulated IL-23/Th17 axis. Affected keratinocytes proliferate at roughly 7 times the normal rate, producing the characteristic thick silvery scale on an erythematous base. It affects approxi...","sourceLabel":"Section in Dermatology"},"3205":{"title":"Seborrheic Dermatitis","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s9","snippet":"Seborrheic Dermatitis Seborrheic dermatitis is a chronic, relapsing eruption characterized by erythematous patches with greasy yellow scale in sebum-rich areas: scalp (dandruff), eyebrows, nasolabial folds, ears, central chest, and intertriginous zones. It is driven by an inflammatory response to Ma...","sourceLabel":"Section in Dermatology"},"3206":{"title":"Hidradenitis Suppurativa & Urticaria","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s10","snippet":"Hidradenitis Suppurativa & Urticaria Hidradenitis Suppurativa (HS) HS is a chronic, recurrent, debilitating inflammatory disease of terminal hair follicles in apocrine-bearing skin (axillae, groin, inframammary, gluteal folds). Lesions progress from painful inflammatory nodules to abscesses, drainin...","sourceLabel":"Section in Dermatology"},"3207":{"title":"Drug Eruptions, SJS/TEN & DRESS","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s11","snippet":"Drug Eruptions, SJS/TEN & DRESS Cutaneous drug reactions range from trivial to life-threatening. The morbilliform (maculopapular) drug eruption is by far the most common, appearing 7–14 days after a new medication as a symmetric, pruritic, blanching erythematous eruption on the trunk that spreads ce...","sourceLabel":"Section in Dermatology"},"3208":{"title":"Melanoma","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s12","snippet":"Melanoma Melanoma is a malignant tumor arising from melanocytes, responsible for the majority of skin cancer mortality despite representing only about 1% of cutaneous malignancies. Early detection is life-saving: thin melanomas (< 1 mm Breslow depth) have > 95% 5-year survival, while thick metastati...","sourceLabel":"Section in Dermatology"},"3209":{"title":"Basal Cell Carcinoma (BCC)","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s13","snippet":"Basal Cell Carcinoma (BCC) BCC is the most common human cancer, arising from the basal layer of the epidermis and driven by chronic UV exposure and mutations in the Hedgehog signaling pathway (PTCH1, SMO). It rarely metastasizes but can be locally aggressive and destructive, especially in high-risk ...","sourceLabel":"Section in Dermatology"},"3210":{"title":"Squamous Cell Carcinoma (SCC) & Actinic Keratosis","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s14","snippet":"Squamous Cell Carcinoma (SCC) & Actinic Keratosis Actinic Keratosis (AK) AKs are precancerous proliferations of atypical keratinocytes on chronically sun-damaged skin, presenting as rough, scaly, pink or skin-colored macules/papules on the face, scalp, dorsal hands, forearms, and ears. Often better ...","sourceLabel":"Section in Dermatology"},"3211":{"title":"Benign Neoplasms & Dysplastic Nevi","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s15","snippet":"Benign Neoplasms & Dysplastic Nevi Dermatologists spend a significant portion of every clinic reassuring patients about benign lesions and distinguishing them from malignancies. A working vocabulary is essential. Lesion Description Seborrheic keratosis \"Stuck-on\" waxy brown papule, warty surface; ve...","sourceLabel":"Section in Dermatology"},"3212":{"title":"Alopecia (AGA, Areata, Scarring)","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s16","snippet":"Alopecia (AGA, Areata, Scarring) Androgenetic alopecia (AGA) is the most common cause of hair loss, driven by sensitivity of scalp hair follicles to dihydrotestosterone (DHT). Male pattern: bitemporal recession and vertex thinning (Norwood-Hamilton scale I–VII). Female pattern: diffuse central thinn...","sourceLabel":"Section in Dermatology"},"3213":{"title":"Bullous Diseases & Connective Tissue Disease","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s17","snippet":"Bullous Diseases & Connective Tissue Disease Bullous Diseases Pemphigus vulgaris — autoantibodies (IgG) against desmoglein 3 (and sometimes 1) cause intraepidermal acantholysis, producing flaccid bullae and painful erosions with prominent oral mucosal involvement. Nikolsky sign positive. Direct immu...","sourceLabel":"Section in Dermatology"},"3214":{"title":"Cutaneous Infections & Infestations","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s18","snippet":"Cutaneous Infections & Infestations Viral Warts (HPV): common (verruca vulgaris), plantar, flat, and anogenital (condyloma acuminatum). Treatment: cryotherapy, salicylic acid, imiquimod, cantharidin, intralesional candida antigen, laser. Molluscum contagiosum: pox virus producing umbilicated pearly ...","sourceLabel":"Section in Dermatology"},"3215":{"title":"Dermatologic Procedures — A to Z","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s19","snippet":"Dermatologic Procedures — A to Z Procedures are the backbone of a dermatology clinic day. A typical half-day may involve a dozen biopsies, several cryotherapy treatments, a Mohs case, and injections. Know the procedural vocabulary cold. Figure 21 - Punch Biopsy Technique. The punch biopsy instrument...","sourceLabel":"Section in Dermatology"},"3216":{"title":"Biopsy Interpretation & Pathology Reports","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s20","snippet":"Biopsy Interpretation & Pathology Reports Dermpath reports arrive 3–10 days after biopsy and are reviewed by the attending at every follow-up. You will document the path result in the assessment and plan, and you must be able to recognize the vocabulary. Figure 22 - Psoriasis Histopathology. Charact...","sourceLabel":"Section in Dermatology"},"3217":{"title":"Medications You Must Know","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s21","snippet":"Medications You Must Know Topical Corticosteroid Potency Classes 7-Class US Potency System Class Potency Examples I Super-potent Clobetasol 0.05%, halobetasol 0.05%, betamethasone dipropionate 0.05% (augmented) II High Fluocinonide 0.05%, mometasone furoate 0.1% ointment, desoximetasone 0.25% III Hi...","sourceLabel":"Section in Dermatology"},"3218":{"title":"Classification Systems & Fitzpatrick Scale","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s22","snippet":"Classification Systems & Fitzpatrick Scale Fitzpatrick Skin Type Type Description Sunburn / Tan Response I Pale white skin, red/blond hair, blue eyes, freckles Always burns, never tans II White skin, fair-haired, blue/green/hazel eyes Burns easily, tans poorly III Cream-white / light brown Burns som...","sourceLabel":"Section in Dermatology"},"3219":{"title":"Physical Exam & Dermoscopy Essentials","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s22b","snippet":"Physical Exam & Dermoscopy Essentials The dermatologic physical exam is equal parts pattern recognition and systematic technique. Every new patient should have a baseline TBSE offered; every established patient gets a focused exam with TBSE updated annually or more often for high-risk patients (pers...","sourceLabel":"Section in Dermatology"},"3220":{"title":"Abbreviations Master List","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s23","snippet":"Abbreviations Master List Diagnoses & Conditions AD Atopic dermatitis ACD Allergic contact dermatitis ICD Irritant contact dermatitis AK Actinic keratosis BCC Basal cell carcinoma SCC Squamous cell carcinoma SCCIS Squamous cell carcinoma in situ (Bowen's) MM Malignant melanoma MIS Melanoma in situ D...","sourceLabel":"Section in Dermatology"},"3221":{"title":"Risk Factors & Comorbidities","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s23b","snippet":"Risk Factors & Comorbidities Dermatology diagnoses rarely exist in isolation. Skin cancer is driven by cumulative UV exposure, immunosuppression, and genetics; inflammatory dermatoses are tightly linked to systemic disease. Capturing risk factors is a core scribe responsibility. Risk Factors — Docum...","sourceLabel":"Section in Dermatology"},"3222":{"title":"Sample HPI Templates & References","pageTitle":"Dermatology","pageUrl":"/scribe-guides/dermatology","url":"/scribe-guides/dermatology#s24","snippet":"Sample HPI Templates & References These templates show the kind of documentation expected in a dermatology clinic note. Use them as frameworks to internalize the rhythm and content of a good derm HPI. Sample HPI — New Acne Consult \"Ms. [Name] is a 24-year-old female with Fitzpatrick type IV skin pre...","sourceLabel":"Section in Dermatology"},"3223":{"title":"Allergy & Immunology","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology","snippet":"Allergy & Immunology - Complete Reference Every diagnosis, procedure, medication, classification, and documentation framework you need to function confidently in an allergy/immunology clinic."},"3224":{"title":"The Immune System - Essentials","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology#s1","snippet":"The Immune System - Essentials Allergy and immunology sits at the intersection of two problems that look opposite but share the same machinery: an immune system that reacts to things it should tolerate (allergy, hypersensitivity, autoimmunity), and an immune system that fails to respond to things it...","sourceLabel":"Section in Allergy & Immunology"},"3225":{"title":"Scribe Documentation Framework","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology#s2","snippet":"Scribe Documentation Framework Allergy/immunology encounters come in a few distinct flavors, and each has its own documentation rhythm. You need to recognize the visit type within the first minute and start pre-populating the correct template. Encounter Types New consult - the most common. A patient...","sourceLabel":"Section in Allergy & Immunology"},"3226":{"title":"Allergic Rhinitis & Conjunctivitis","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology#s3","snippet":"Allergic Rhinitis & Conjunctivitis Allergic rhinitis (AR) is the highest-volume diagnosis in most allergy clinics, affecting 10-30% of adults and up to 40% of children. It is IgE-mediated inflammation of the nasal mucosa triggered by aeroallergens (pollens, dust mites, pet dander, molds, cockroach)....","sourceLabel":"Section in Allergy & Immunology"},"3227":{"title":"Asthma (Allergy Perspective)","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology#s4","snippet":"Asthma (Allergy Perspective) Asthma is co-managed by allergy and pulmonology. Allergy clinics see asthma primarily when it is allergic-phenotype, uncontrolled on step-up therapy, or a candidate for biologics. GINA 2024 guidelines are the current standard. Figure 5 - Asthma Progression and Airway Rem...","sourceLabel":"Section in Allergy & Immunology"},"3228":{"title":"Atopic Dermatitis","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology#s5","snippet":"Atopic Dermatitis Atopic dermatitis (AD, eczema) is a chronic relapsing inflammatory skin disease - the first step on the atopic march. Allergy is often consulted for moderate-severe AD to evaluate allergic triggers, consider systemic therapy, and differentiate allergic from non-allergic skin diseas...","sourceLabel":"Section in Allergy & Immunology"},"3229":{"title":"Urticaria & Angioedema","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology#s6","snippet":"Urticaria & Angioedema Urticaria (hives) and angioedema frequently coexist but have distinct differential diagnoses and management. Getting the subtype right is critical because it drives whether the physician orders C1 esterase inhibitor levels, pursues autoimmune workup, or starts omalizumab. Figu...","sourceLabel":"Section in Allergy & Immunology"},"3230":{"title":"Anaphylaxis","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology#s7","snippet":"Anaphylaxis Anaphylaxis is the highest-acuity allergy diagnosis and the one the attending will care most about documenting precisely. Miss an anaphylaxis diagnosis and the patient does not get epinephrine auto-injectors, an action plan, or proper follow-up - decisions with life-or-death consequences...","sourceLabel":"Section in Allergy & Immunology"},"3231":{"title":"Food Allergy & Food Intolerance","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology#s8","snippet":"Food Allergy & Food Intolerance Food allergy affects ~8% of children and ~10% of adults. The NIAID Expert Panel Food Allergy Guidelines (Sampson criteria) and the AAAAI/ACAAI JTF Food Allergy Practice Parameter are the standard references. Figure 13 - Pathogenesis of IgE-Mediated Food Allergy. Exter...","sourceLabel":"Section in Allergy & Immunology"},"3232":{"title":"Drug Hypersensitivity","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology#s9","snippet":"Drug Hypersensitivity Drug reactions span all four Gell & Coombs types. The most common clinic scenarios are penicillin allergy evaluation (often delabeling), NSAID reactions, sulfa allergy evaluation, perioperative anaphylaxis workup, and delayed cutaneous reactions. The 2022 AAAAI/ACAAI JTF Drug A...","sourceLabel":"Section in Allergy & Immunology"},"3233":{"title":"Insect Sting (Venom) Allergy","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology#s10","snippet":"Insect Sting (Venom) Allergy Stinging Hymenoptera include honeybee, yellow jacket, wasp, hornet, and fire ant. Reactions range from normal local swelling to large local reactions to systemic anaphylaxis. Systemic reactions carry a ~30-60% risk of recurrence without treatment, dropping to <5% with ve...","sourceLabel":"Section in Allergy & Immunology"},"3234":{"title":"Latex & Contact Allergies","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology#s11","snippet":"Latex & Contact Allergies Latex allergy is IgE-mediated hypersensitivity to natural rubber latex proteins; high-risk groups include healthcare workers, children with spina bifida (repeated surgical exposure), and workers with occupational latex exposure. Symptoms range from contact urticaria to anap...","sourceLabel":"Section in Allergy & Immunology"},"3235":{"title":"Eosinophilic Disorders","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology#s12","snippet":"Eosinophilic Disorders Eosinophilic Esophagitis (EoE) Chronic, immune-mediated esophageal disease with eosinophil-predominant inflammation causing dysphagia, food impaction, chest pain, GERD-like symptoms, and in children feeding difficulties. Diagnosis: endoscopy with biopsy showing &ge;15 eosinoph...","sourceLabel":"Section in Allergy & Immunology"},"3236":{"title":"Mast Cell Disorders","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology#s13","snippet":"Mast Cell Disorders Mastocytosis Clonal mast cell proliferation. Cutaneous mastocytosis : skin-limited, most common in children, includes urticaria pigmentosa (maculopapular cutaneous mastocytosis) and mastocytoma. Systemic mastocytosis : bone marrow and other organ involvement, almost always harbor...","sourceLabel":"Section in Allergy & Immunology"},"3237":{"title":"Primary Immunodeficiency Diseases","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology#s14","snippet":"Primary Immunodeficiency Diseases More than 450 inborn errors of immunity are now recognized. The clinic sees a handful frequently: CVID, selective IgA deficiency, specific antibody deficiency, X-linked agammaglobulinemia (XLA), chronic granulomatous disease (CGD), complement deficiencies, and in pe...","sourceLabel":"Section in Allergy & Immunology"},"3238":{"title":"Secondary Immunodeficiency & ALPS","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology#s15","snippet":"Secondary Immunodeficiency & ALPS Secondary immunodeficiency is far more common than PID. Causes include medications (rituximab, steroids, chemotherapy, anti-seizure drugs), protein loss (nephrotic syndrome, protein-losing enteropathy), malignancy (CLL, multiple myeloma, lymphoma), infection (HIV), ...","sourceLabel":"Section in Allergy & Immunology"},"3239":{"title":"Allergy/Immunology Procedures","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology#s16","snippet":"Allergy/Immunology Procedures Skin Prick Testing (SPT) A drop of standardized allergen extract is placed on the skin (volar forearm or back) and a lancet introduces the allergen into the epidermis. Positive control = histamine; negative control = saline/glycerin. Read at 15-20 minutes. A wheal &ge;3...","sourceLabel":"Section in Allergy & Immunology"},"3240":{"title":"Immunotherapy & Biologics","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology#s17","snippet":"Immunotherapy & Biologics Subcutaneous Immunotherapy (SCIT) & Sublingual Immunotherapy (SLIT) Allergen-specific immunotherapy is the only disease-modifying treatment for allergic rhinitis, allergic asthma, and stinging insect allergy. SCIT involves a build-up phase (weekly for 3-6 months, escalating...","sourceLabel":"Section in Allergy & Immunology"},"3241":{"title":"Laboratory Testing & Imaging","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology#s18","snippet":"Laboratory Testing & Imaging Immunologic Labs You Will See Figure 22 - Complement System Activation Pathways. The classical, lectin, and alternative pathways all converge at C3 convertase, generating anaphylatoxins (C3a, C5a) and ultimately forming the membrane attack complex (C5b-9). Total IgE - el...","sourceLabel":"Section in Allergy & Immunology"},"3242":{"title":"Medications You Must Know","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology#s19","snippet":"Medications You Must Know Antihistamines Generic Brand Class / Generation Notes Diphenhydramine Benadryl 1st gen H1 Sedating; anticholinergic; IV/PO; short-acting Hydroxyzine Atarax, Vistaril 1st gen H1 Sedating; antipruritic Cetirizine Zyrtec 2nd gen H1 Minimally sedating; once daily Levocetirizine...","sourceLabel":"Section in Allergy & Immunology"},"3243":{"title":"Classification Systems","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology#s20","snippet":"Classification Systems Several systems beyond those already enumerated in disease sections appear in allergy notes. Document the named system whenever the attending references it. Selected Additional Classifications NIAID/FAAN 2006 Anaphylaxis Criteria - the predecessor to the WAO 2020 criteria; sti...","sourceLabel":"Section in Allergy & Immunology"},"3244":{"title":"Physical Exam - The Allergy Exam","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology#s21","snippet":"Physical Exam - The Allergy Exam Allergy exams are focused but systematic. Document these elements by system. Allergy/Immunology Exam Template Gen: well-appearing, NAD HEENT: Eyes - conjunctivae clear/injected, no chemosis, allergic shiners absent/present Ears - TMs clear bilaterally, no effusion No...","sourceLabel":"Section in Allergy & Immunology"},"3245":{"title":"Abbreviations Master List","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology#s22","snippet":"Abbreviations Master List Diagnoses & Conditions AR Allergic rhinitis AD Atopic dermatitis AC Allergic conjunctivitis CSU Chronic spontaneous urticaria CIndU Chronic inducible urticaria HAE Hereditary angioedema ACEi-AE ACE inhibitor-induced angioedema EoE Eosinophilic esophagitis EGID Eosinophilic ...","sourceLabel":"Section in Allergy & Immunology"},"3246":{"title":"Sample HPI Templates","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology#s23","snippet":"Sample HPI Templates These templates show the kind of documentation expected in an allergy/immunology clinic note. Use them as frameworks to internalize the rhythm and content of a good allergy HPI. Sample HPI - Allergic Rhinitis (New Consult) \"Ms. [Name] is a 32-year-old female with a history of ch...","sourceLabel":"Section in Allergy & Immunology"},"3247":{"title":"References & Sources","pageTitle":"Allergy & Immunology","pageUrl":"/scribe-guides/allergy-immunology","url":"/scribe-guides/allergy-immunology#s24","snippet":"References & Sources Clinical Practice Guidelines Cardona V, et al. World Allergy Organization Anaphylaxis Guidance 2020. World Allergy Organ J. 2020. Shaker MS, et al. Anaphylaxis - a 2020 practice parameter update, systematic review, and GRADE analysis. J Allergy Clin Immunol. 2020. Dykewicz MS, e...","sourceLabel":"Section in Allergy & Immunology"},"3248":{"title":"Geriatrics","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics","snippet":"Geriatrics - Complete Reference Every diagnosis, syndrome, assessment tool, medication, abbreviation, and documentation framework you need to succeed on day one in a geriatrics practice."},"3249":{"title":"Aging Physiology - What Changes with Age","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics#s1","snippet":"Aging Physiology - What Changes with Age Geriatrics is the care of older adults, typically 65 and older, with particular focus on those with multiple chronic conditions, functional decline, cognitive impairment, and complex social circumstances. Unlike most specialties, geriatrics is defined not by ...","sourceLabel":"Section in Geriatrics"},"3250":{"title":"Scribe Documentation Framework","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics#s2","snippet":"Scribe Documentation Framework The Geriatrics SOAP Note Geriatrics notes use the standard SOAP structure but with extra emphasis on function , cognition , mood , mobility , and the medication list . A note that documents only diagnoses and labs will miss the core of a geriatric encounter. Subjective...","sourceLabel":"Section in Geriatrics"},"3251":{"title":"Comprehensive Geriatric Assessment (CGA)","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics#s3","snippet":"Comprehensive Geriatric Assessment (CGA) The Comprehensive Geriatric Assessment is the signature tool of geriatric medicine - a multidimensional, multidisciplinary evaluation that covers medical, functional, cognitive, psychological, social, and environmental domains. A CGA is the default framework ...","sourceLabel":"Section in Geriatrics"},"3252":{"title":"Dementia - Alzheimer, Vascular, DLB, FTD, Mixed, MCI","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics#s4","snippet":"Dementia - Alzheimer, Vascular, DLB, FTD, Mixed, MCI Dementia (now formally called major neurocognitive disorder in DSM-5) is an acquired decline in one or more cognitive domains that interferes with independence in daily activities. It is not a single disease but a syndrome with many causes. Roughl...","sourceLabel":"Section in Geriatrics"},"3253":{"title":"Delirium","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics#s5","snippet":"Delirium Delirium is an acute, fluctuating disturbance of attention and awareness, with altered cognition or perception, caused by an underlying medical condition, substance, or medication. It is not a psychiatric diagnosis - it is a medical emergency. Delirium affects up to 50% of hospitalized olde...","sourceLabel":"Section in Geriatrics"},"3254":{"title":"Depression & Anxiety in the Elderly","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics#s6","snippet":"Depression & Anxiety in the Elderly Depression in older adults is underdiagnosed because it often presents somatically (fatigue, pain, weight loss, insomnia) rather than with classic sadness. Late-life depression is a major risk factor for suicide (white men over 85 have the highest suicide rate of ...","sourceLabel":"Section in Geriatrics"},"3255":{"title":"Falls & Gait Disorders","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics#s7","snippet":"Falls & Gait Disorders One in three community-dwelling adults over 65 falls each year; one in ten falls results in a serious injury. Falls are a sentinel event and a mandatory documentation item at every geriatric visit. The USPSTF recommendation on fall prevention endorses exercise interventions in...","sourceLabel":"Section in Geriatrics"},"3256":{"title":"Syncope in the Older Adult","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics#s8","snippet":"Syncope in the Older Adult Syncope is transient loss of consciousness from global cerebral hypoperfusion with spontaneous complete recovery. In older adults it is frequently multifactorial and often difficult to distinguish from an unwitnessed mechanical fall. The key categories are reflex/vasovagal...","sourceLabel":"Section in Geriatrics"},"3257":{"title":"Urinary Incontinence","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics#s9","snippet":"Urinary Incontinence Urinary incontinence affects up to half of community-dwelling older women and a significant minority of men. It is a major driver of caregiver burden and nursing home placement. It is not a normal part of aging and almost always deserves evaluation. Types Type Mechanism Classic ...","sourceLabel":"Section in Geriatrics"},"3258":{"title":"Frailty, Sarcopenia & Unintentional Weight Loss","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics#s10","snippet":"Frailty, Sarcopenia & Unintentional Weight Loss Frailty is a state of increased vulnerability to stressors due to decline across multiple physiologic systems. It predicts disability, falls, hospitalization, and death independently of comorbidity and disability. Two dominant operational definitions e...","sourceLabel":"Section in Geriatrics"},"3259":{"title":"Polypharmacy & Deprescribing","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics#s11","snippet":"Polypharmacy & Deprescribing Polypharmacy is commonly defined as the use of 5 or more regular medications. It is the rule, not the exception, in older adults and is strongly associated with adverse drug events, falls, hospitalization, and nonadherence. Deprescribing - the structured process of ident...","sourceLabel":"Section in Geriatrics"},"3260":{"title":"Osteoporosis & Fragility Fractures","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics#s12","snippet":"Osteoporosis & Fragility Fractures Osteoporosis is a skeletal disorder of compromised bone strength leading to increased fracture risk. Hip, vertebral, and wrist fractures are the dominant morbidities. A fragility fracture is a fracture from a fall from standing height or less and is itself diagnost...","sourceLabel":"Section in Geriatrics"},"3261":{"title":"Pressure Injuries, Constipation, Sleep & Sensory Decline","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics#s13","snippet":"Pressure Injuries, Constipation, Sleep & Sensory Decline Pressure Injuries Staged by the NPUAP/NPIAP system. Risk assessed with the Braden scale (sensory perception, moisture, activity, mobility, nutrition, friction/shear; total 6-23; &le; 18 = at risk). Prevention: turning q2h, pressure-redistribut...","sourceLabel":"Section in Geriatrics"},"3262":{"title":"Decisional Capacity, Advance Care Planning & Elder Abuse","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics#s14","snippet":"Decisional Capacity, Advance Care Planning & Elder Abuse Decisional Capacity Capacity is the clinical determination that a patient can make a specific medical decision. It has four elements (Appelbaum): (1) understand relevant information; (2) appreciate the situation and its consequences; (3) reaso...","sourceLabel":"Section in Geriatrics"},"3263":{"title":"Palliative, Hospice & End-of-Life Care","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics#s15","snippet":"Palliative, Hospice & End-of-Life Care Palliative care is specialized medical care focused on symptom relief and quality of life at any stage of serious illness, alongside curative or life-prolonging therapy. Hospice is a Medicare benefit for patients with a prognosis of &le; 6 months if the disease...","sourceLabel":"Section in Geriatrics"},"3264":{"title":"Assessment Tools & Office Procedures","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics#s16","snippet":"Assessment Tools & Office Procedures Geriatrics is a cognitively-demanding specialty with relatively few bedside procedures. The \"procedures\" are the structured assessments themselves. Cognitive Screens Mini-Cog 3-item recall (apple, table, penny) + clock drawing test. Scoring: recall 0 = impaired; ...","sourceLabel":"Section in Geriatrics"},"3265":{"title":"Treatment Monitoring & Adverse Drug Events","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics#s17","snippet":"Treatment Monitoring & Adverse Drug Events Adverse drug events (ADEs) are among the most common reasons for geriatric hospitalization. High-risk drug classes are warfarin, insulins, oral antiplatelets/anticoagulants, and oral hypoglycemics - together responsible for nearly two-thirds of ADE-related ...","sourceLabel":"Section in Geriatrics"},"3266":{"title":"Labs, Imaging & Diagnostics","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics#s18","snippet":"Labs, Imaging & Diagnostics Core Labs CBC, CMP (creatinine, eGFR, glucose, electrolytes, liver panel), TSH, B12, vitamin D (25-OH), A1C (diabetics), lipid panel, PSA (shared decision-making after 70), UA, INR if on warfarin, ferritin/iron studies for anemia. Any cognitive decline, weight loss, or ne...","sourceLabel":"Section in Geriatrics"},"3267":{"title":"Medications - High-Yield Geriatric Drug Classes","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics#s19","snippet":"Medications - High-Yield Geriatric Drug Classes Dementia Drug Brand Class / Mechanism Key Notes Donepezil Aricept Cholinesterase inhibitor 5-10 mg QHS; GI side effects; bradycardia Rivastigmine Exelon Cholinesterase inhibitor Patch preferred (fewer GI side effects); also approved in PDD Galantamine ...","sourceLabel":"Section in Geriatrics"},"3268":{"title":"Classification Systems - Full Enumerations","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics#s20","snippet":"Classification Systems - Full Enumerations Clinical Frailty Scale (Rockwood, CFS) Level Label Description 1 Very fit Robust, active, energetic, exercise regularly 2 Well No active disease; less fit than category 1 3 Managing well Medical problems well controlled; not regularly active 4 Vulnerable Sy...","sourceLabel":"Section in Geriatrics"},"3269":{"title":"Physical Exam - The Geriatric Exam","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics#s21","snippet":"Physical Exam - The Geriatric Exam The geriatric physical exam is longer and more function-focused than the standard adult exam. Core components: Geriatric Exam Template General: well-appearing, cachectic, frail, groomed, appropriate for age; cognitive engagement. Vitals: BP supine and standing (ort...","sourceLabel":"Section in Geriatrics"},"3270":{"title":"Abbreviations Master List","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics#s22","snippet":"Abbreviations Master List Syndromes & Diagnoses AD Alzheimer disease MCI Mild cognitive impairment DLB Dementia with Lewy bodies FTD Frontotemporal dementia PDD Parkinson disease dementia NCD Neurocognitive disorder (DSM-5) BPSD Behavioral and psychological symptoms of dementia NPH Normal pressure h...","sourceLabel":"Section in Geriatrics"},"3271":{"title":"Sample HPI Templates","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics#s23","snippet":"Sample HPI Templates These templates show the kind of documentation expected in a geriatrics clinic. Use them as frameworks to internalize the content and rhythm of a geriatric HPI. Sample HPI - Memory Complaints / Cognitive Evaluation \"Mrs. [Name] is an 82-year-old right-handed widowed female with ...","sourceLabel":"Section in Geriatrics"},"3272":{"title":"References & Sources","pageTitle":"Geriatrics","pageUrl":"/scribe-guides/geriatrics","url":"/scribe-guides/geriatrics#references","snippet":"References & Sources Clinical Practice Guidelines American Geriatrics Society Beers Criteria&reg; Update Expert Panel. AGS Beers Criteria&reg; for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2023. O'Mahony D, et al. STOPP/START criteria for potentially inappropriate p...","sourceLabel":"Section in Geriatrics"},"3273":{"title":"Palliative Care / Hospice","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care","snippet":"Palliative Care & Hospice - Complete Reference Every symptom, syndrome, medication, opioid conversion, goals-of-care framework, abbreviation, and documentation pattern you need to chart palliative encounters with confidence."},"3274":{"title":"Palliative Care Principles & Scope","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care#s1","snippet":"Palliative Care Principles & Scope Palliative care is specialized medical care for people living with serious illness. Its focus is the relief of physical symptoms, psychological distress, and existential suffering, as well as support for families and caregivers. Unlike hospice, palliative care can ...","sourceLabel":"Section in Palliative Care / Hospice"},"3275":{"title":"Scribe Documentation Framework","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care#s2","snippet":"Scribe Documentation Framework The Palliative HPI A palliative HPI is symptom-centric, goal-centric, and psychosocial-centric all at once. It typically opens with a one-line summary of the patient's life-limiting illness - \"78-year-old man with metastatic castration-resistant prostate cancer to bone...","sourceLabel":"Section in Palliative Care / Hospice"},"3276":{"title":"Pain Assessment & Classification","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care#s3","snippet":"Pain Assessment & Classification Pain is the most common reason for palliative consultation. The first task in any pain encounter is to characterize the pain mechanistically, because the right analgesic depends on what kind of pain you are treating. Figure 3 - Conceptual Model of Total Pain. This di...","sourceLabel":"Section in Palliative Care / Hospice"},"3277":{"title":"Opioid Pharmacology & Equianalgesic Conversion","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care#s4","snippet":"Opioid Pharmacology & Equianalgesic Conversion Opioids are the cornerstone of moderate-to-severe pain management in palliative care. A competent scribe must recognize every commonly used opioid, its routes, its relative potency, and the conversion math, because the physician will dictate conversions...","sourceLabel":"Section in Palliative Care / Hospice"},"3278":{"title":"Adjuvant Analgesics & Neuropathic Pain","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care#s5","snippet":"Adjuvant Analgesics & Neuropathic Pain Adjuvants are non-opioid medications that enhance analgesia, particularly for neuropathic, bone, and visceral pain. They are the second pillar of cancer pain management. Figure 7 - Mechanisms of Pain in Malignant Spinal Cord Compression. This diagram illustrate...","sourceLabel":"Section in Palliative Care / Hospice"},"3279":{"title":"Dyspnea & Respiratory Symptoms","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care#s6","snippet":"Dyspnea & Respiratory Symptoms Dyspnea is the subjective sensation of breathlessness and is the second most common distressing symptom at the end of life. It is not synonymous with hypoxia - patients with normal oxygen saturation can be profoundly dyspneic, and patients with SpO2 of 85% can feel fin...","sourceLabel":"Section in Palliative Care / Hospice"},"3280":{"title":"Nausea, Vomiting & GI Symptoms","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care#s7","snippet":"Nausea, Vomiting & GI Symptoms Palliative nausea is treated by mechanism , not by trial-and-error. Identifying the likely dominant pathway directs you to the most effective antiemetic. Figure 10 - Emetic Pathways: Central and Peripheral Mechanisms. This diagram illustrates the central and peripheral...","sourceLabel":"Section in Palliative Care / Hospice"},"3281":{"title":"Constipation, Malignant Bowel Obstruction & Ascites","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care#s8","snippet":"Constipation, Malignant Bowel Obstruction & Ascites Opioid-Induced Constipation Every patient on opioids needs a scheduled bowel regimen from day one. The standard is a stimulant laxative (senna) plus an osmotic laxative (polyethylene glycol) titrated to a soft bowel movement every 1-2 days. Stool s...","sourceLabel":"Section in Palliative Care / Hospice"},"3282":{"title":"Anorexia, Cachexia & Fatigue","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care#s9","snippet":"Anorexia, Cachexia & Fatigue Cancer cachexia is a multifactorial syndrome of ongoing loss of skeletal muscle mass (with or without fat loss) that cannot be fully reversed by conventional nutritional support and leads to progressive functional decline. Figure 15 - Total Pain Distribution in Cancer Pa...","sourceLabel":"Section in Palliative Care / Hospice"},"3283":{"title":"Delirium, Anxiety & Depression","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care#s10","snippet":"Delirium, Anxiety & Depression Delirium Delirium occurs in up to 85% of patients in the final days of life ( terminal delirium ). It presents as acute onset of inattention, disorganized thinking, and altered level of consciousness, and can be hyperactive (agitation, restlessness, hallucinations), hy...","sourceLabel":"Section in Palliative Care / Hospice"},"3284":{"title":"Terminal Phase: Secretions, Agitation, Palliative Sedation","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care#s11","snippet":"Terminal Phase: Secretions, Agitation, Palliative Sedation In the final hours to days of life, patients develop a predictable pattern of changes: decreased oral intake, decreased urine output, mottling of extremities, cool skin, Cheyne-Stokes respirations, altered consciousness, and pooled oral secr...","sourceLabel":"Section in Palliative Care / Hospice"},"3285":{"title":"Other Symptoms: Pruritus, Hiccups, Mucositis, Wounds","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care#s12","snippet":"Other Symptoms: Pruritus, Hiccups, Mucositis, Wounds Pruritus - opioid-induced (rotate, low-dose ondansetron, antihistamines), cholestatic (rifampin, ursodeoxycholic acid, naltrexone, sertraline), uremic (gabapentin, UVB), paraneoplastic. Hiccups (singultus) - first-line baclofen 5-10 mg TID or meto...","sourceLabel":"Section in Palliative Care / Hospice"},"3286":{"title":"Prognostication Tools & Performance Scales","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care#s13","snippet":"Prognostication Tools & Performance Scales Accurate prognostication is central to palliative decision-making. Clinicians are famously optimistic (by a factor of 3-5 in advanced cancer), so structured tools are used to anchor the conversation. Figure 18 - Typical Heart Failure Trajectory. Unlike canc...","sourceLabel":"Section in Palliative Care / Hospice"},"3287":{"title":"Goals of Care, SPIKES & Family Meetings","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care#s14","snippet":"Goals of Care, SPIKES & Family Meetings A goals-of-care (GOC) discussion aligns medical care with what matters most to the patient. It is a procedure as much as a chest tube is, with preparation, consent, technique, and documentation. Figure 19 - SPIKES Protocol for Delivering Bad News. An illustrat...","sourceLabel":"Section in Palliative Care / Hospice"},"3288":{"title":"Code Status, Advance Directives, POLST/MOLST","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care#s15","snippet":"Code Status, Advance Directives, POLST/MOLST Code Status Terminology Full code - all resuscitative efforts including CPR, intubation, defibrillation, vasopressors DNR / DNAR / AND - do not resuscitate / do not attempt resuscitation / allow natural death; no CPR, no defibrillation DNI - do not intuba...","sourceLabel":"Section in Palliative Care / Hospice"},"3289":{"title":"Capacity, Surrogates & Ethics","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care#s16","snippet":"Capacity, Surrogates & Ethics Decisional Capacity Capacity is a clinical determination (anyone can make it) distinct from competency (a legal determination by a court). Capacity is decision-specific and time-specific. The four-part Appelbaum-Grisso standard asks whether the patient can: (1) understa...","sourceLabel":"Section in Palliative Care / Hospice"},"3290":{"title":"Hospice Eligibility & Medicare Criteria","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care#s17","snippet":"Hospice Eligibility & Medicare Criteria The Medicare Hospice Benefit requires two physician certifications (the hospice medical director and the attending) that the patient has a prognosis of six months or less if the disease runs its normal course. Patients elect hospice and waive Medicare coverage...","sourceLabel":"Section in Palliative Care / Hospice"},"3291":{"title":"Palliative Procedures & PCA Management","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care#s18","snippet":"Palliative Procedures & PCA Management Procedures Palliative Teams Perform or Order Procedure Indication Key documentation Therapeutic paracentesis Symptomatic ascites Volume removed, relief, albumin replacement if applicable Indwelling peritoneal (PleurX) Recurrent malignant ascites Home drainage t...","sourceLabel":"Section in Palliative Care / Hospice"},"3292":{"title":"Medications You Must Know","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care#s19","snippet":"Medications You Must Know Core Palliative Formulary Drug Brand Class Primary use in palliative care Morphine MSIR, MS Contin, Roxanol Strong opioid Pain, dyspnea Oxycodone Roxicodone, OxyContin Strong opioid Pain Hydromorphone Dilaudid Strong opioid Pain in renal failure Fentanyl patch Duragesic Str...","sourceLabel":"Section in Palliative Care / Hospice"},"3293":{"title":"Classification & Assessment Systems","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care#s20","snippet":"Classification & Assessment Systems Figure 25 - Pain and Quality of Life Domains. Ferrell's conceptual model demonstrates the bidirectional relationships between pain and domains of well-being: physical, spiritual/existential, psychological, and social. Pain impacts quality of life across all domain...","sourceLabel":"Section in Palliative Care / Hospice"},"3294":{"title":"Abbreviations Master List","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care#s21","snippet":"Abbreviations Master List AD - Advance Directive ADL - Activities of Daily Living AND - Allow Natural Death BiPAP - Bilevel Positive Airway Pressure BPI - Brief Pain Inventory CAM - Confusion Assessment Method CHF - Congestive Heart Failure CINV - Chemotherapy-Induced Nausea and Vomiting CIPN - Chem...","sourceLabel":"Section in Palliative Care / Hospice"},"3295":{"title":"Sample HPI Templates","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care#s22","snippet":"Sample HPI Templates HPI 1 - Inpatient Pain Crisis Consult Mr. L is a 64-year-old man with metastatic pancreatic adenocarcinoma (diagnosed 11 months ago, s/p FOLFIRINOX x 8, now on second-line gemcitabine/nab-paclitaxel), ECOG 3, PPS 40%, admitted yesterday from home with a 3-day history of escalati...","sourceLabel":"Section in Palliative Care / Hospice"},"3296":{"title":"References & Sources","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care#s23","snippet":"References & Sources Clinical Practice Guidelines National Consensus Project. Clinical Practice Guidelines for Quality Palliative Care, 4th edition. 2018. NCCN Clinical Practice Guidelines in Oncology: Adult Cancer Pain. NCCN Clinical Practice Guidelines in Oncology: Palliative Care. NCCN Guidelines...","sourceLabel":"Section in Palliative Care / Hospice"},"3297":{"title":"A Final Word","pageTitle":"Palliative Care / Hospice","pageUrl":"/scribe-guides/palliative-care","url":"/scribe-guides/palliative-care#closing","snippet":"A Final Word Palliative care scribing is different from any other specialty. Your notes are not just billing documents - they become part of the permanent record of how a patient's last months, weeks, or hours were managed, how decisions were made, and how families were supported. A well-documented ...","sourceLabel":"Section in Palliative Care / Hospice"},"3298":{"title":"Sports Medicine","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine","snippet":"Sports Medicine - Complete Reference Every diagnosis, injury, procedure, medication, classification, and documentation framework you need to succeed in a sports medicine clinic from day one."},"3299":{"title":"Musculoskeletal Anatomy & Exercise Physiology","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine#s1","snippet":"Musculoskeletal Anatomy & Exercise Physiology Sports medicine is the diagnosis, treatment, rehabilitation, and prevention of injuries related to physical activity. The field spans nonoperative orthopedics, primary care sports medicine, athletic training, and return-to-play decision-making. A scribe ...","sourceLabel":"Section in Sports Medicine"},"3300":{"title":"Scribe Documentation Framework","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine#s2","snippet":"Scribe Documentation Framework The Sports Medicine SOAP Note Sports medicine visits are usually structured as SOAP notes with strong emphasis on mechanism of injury, sport/position, training volume, and return-to-play timeline. The HPI is often longer and more mechanism-focused than a typical primar...","sourceLabel":"Section in Sports Medicine"},"3301":{"title":"Shoulder Injuries","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine#s3","snippet":"Shoulder Injuries The shoulder is the most mobile joint in the body and the most commonly injured upper extremity region in overhead athletes. Injuries fall into overuse tendinopathies, traumatic tears, and instability events. Figure 4 - Bursa Anatomy. Bursae are synovial fluid-filled sacs that redu...","sourceLabel":"Section in Sports Medicine"},"3302":{"title":"Elbow Injuries","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine#s4","snippet":"Elbow Injuries Lateral Epicondylitis (Tennis Elbow) Tendinopathy of the common extensor origin (extensor carpi radialis brevis most involved). Pain over the lateral epicondyle reproduced with resisted wrist extension or middle finger extension (Maudsley test) and with a handshake grip. Managed with ...","sourceLabel":"Section in Sports Medicine"},"3303":{"title":"Wrist & Hand Injuries","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine#s5","snippet":"Wrist & Hand Injuries TFCC Injury The triangular fibrocartilage complex stabilizes the distal radioulnar joint and the ulnar carpus. Ulnar-sided wrist pain with gripping and forearm rotation; positive TFCC load and press tests. Palmer classification (I traumatic, II degenerative). MRA is diagnostic....","sourceLabel":"Section in Sports Medicine"},"3304":{"title":"Cervical & Lumbar Spine Injuries","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine#s6","snippet":"Cervical & Lumbar Spine Injuries Cervical Strain / Sprain (Whiplash) Acceleration-deceleration mechanism (football tackle, MVC). Paraspinal pain and limited ROM without neurologic findings. Imaging only if red flags (NEXUS or Canadian C-spine rule positive). Short course of NSAIDs, soft collar <72 h...","sourceLabel":"Section in Sports Medicine"},"3305":{"title":"Hip & Pelvis Injuries","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine#s7","snippet":"Hip & Pelvis Injuries Hip Flexor & Adductor Strains Iliopsoas or rectus femoris strains present with anterior hip/groin pain after sprinting or kicking. Adductor strains produce medial groin pain. Graded I-III. Managed with rest, ice, progressive PT; most return to play in 2-6 weeks depending on gra...","sourceLabel":"Section in Sports Medicine"},"3306":{"title":"Knee Injuries","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine#s8","snippet":"Knee Injuries The knee is the highest-volume body part in most sports medicine clinics. Scribes should become fluent in ACL, meniscus, and patellofemoral vocabulary before anything else. Figure 12 - Stress Fracture Pathophysiology Loop. When repetitive loading exceeds bone remodeling capacity, a pos...","sourceLabel":"Section in Sports Medicine"},"3307":{"title":"Lower Leg & Stress Injuries","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine#s9","snippet":"Lower Leg & Stress Injuries Medial Tibial Stress Syndrome (Shin Splints) Diffuse tenderness along the posteromedial tibia in runners, usually early in training. Rest, ice, gait analysis, gradual return. If focal tenderness and night pain, suspect tibial stress fracture. Stress Fractures Overuse bone...","sourceLabel":"Section in Sports Medicine"},"3308":{"title":"Ankle & Foot Injuries","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine#s10","snippet":"Ankle & Foot Injuries Lateral Ankle Sprain Inversion mechanism. ATFL injured most often, then CFL, rarely PTFL. Use the Ottawa ankle rules to decide on radiographs. Grade I-III based on ligament disruption and instability. Functional rehab with bracing, proprioceptive training, and early weight-bear...","sourceLabel":"Section in Sports Medicine"},"3309":{"title":"Concussion & Head Injury","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine#s11","snippet":"Concussion & Head Injury Concussion is a traumatic brain injury induced by biomechanical forces, producing a functional disturbance without structural abnormality on standard imaging. It is a clinical diagnosis. Sports concussion management is governed by the 2023 Amsterdam CISG Consensus Statement ...","sourceLabel":"Section in Sports Medicine"},"3310":{"title":"Medical Issues in Athletes","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine#s12","snippet":"Medical Issues in Athletes Exercise-Induced Bronchoconstriction (EIB) Transient airway narrowing triggered by exercise. Common in endurance and cold-weather athletes. Symptoms: cough, wheeze, chest tightness 5-15 minutes after exercise onset, resolving with rest. Diagnosis by exercise challenge or e...","sourceLabel":"Section in Sports Medicine"},"3311":{"title":"Cardiovascular Issues & Sudden Cardiac Death","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine#s13","snippet":"Cardiovascular Issues & Sudden Cardiac Death Sudden cardiac death (SCD) in athletes is rare (~1 per 50,000-80,000 per year) but catastrophic. The preparticipation physical evaluation (PPE) is the primary screening tool. The AHA/ACC 14-element cardiovascular screening guides history and exam; ECG scr...","sourceLabel":"Section in Sports Medicine"},"3312":{"title":"Female Athlete Triad / RED-S & Eating Disorders","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine#s14","snippet":"Female Athlete Triad / RED-S & Eating Disorders The female athlete triad describes the interrelationship among low energy availability (with or without disordered eating), menstrual dysfunction, and low bone mineral density. The broader Relative Energy Deficiency in Sport (RED-S) framework from the ...","sourceLabel":"Section in Sports Medicine"},"3313":{"title":"Environmental & Exertional Illness","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine#s15","snippet":"Environmental & Exertional Illness Exertional Heat Illness Spectrum Heat Illness Progression Heat cramps: Painful muscle cramps, likely sodium depletion. Rest, oral hydration with electrolytes. Heat exhaustion: Fatigue, dizziness, nausea, rectal temp typically <40&deg;C (104&deg;F), intact mental st...","sourceLabel":"Section in Sports Medicine"},"3314":{"title":"Procedures & Office-Based Interventions","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine#s16","snippet":"Procedures & Office-Based Interventions Pre-Participation Physical Evaluation (PPE) The PPE clears athletes for sport and identifies at-risk individuals. Uses the PPE Monograph (AAP/ACSM/AMSSM/AOSSM/AAFP). History is more sensitive than exam; the 14-element AHA cardiovascular screen is embedded. Mus...","sourceLabel":"Section in Sports Medicine"},"3315":{"title":"Imaging & Diagnostics","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine#s17","snippet":"Imaging & Diagnostics Plain Radiographs First-line for fracture, dislocation, arthritis, and bony alignment. Specific views: Ottawa knee/ankle rules (decide if XR is needed), sunrise/Merchant (patellofemoral), stress views (AC joint, syndesmosis), weight-bearing views (Lisfranc, knee OA), scaphoid v...","sourceLabel":"Section in Sports Medicine"},"3316":{"title":"Medications You Must Know","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine#s18","snippet":"Medications You Must Know Class Generic (Brand) Mechanism Key Use Critical Notes Oral NSAIDs Ibuprofen (Motrin), naproxen (Aleve), celecoxib (Celebrex), meloxicam (Mobic), diclofenac (Voltaren) COX-1/2 inhibition Acute sprains, strains, tendinopathy, postop pain GI, renal, CV risk; avoid with active...","sourceLabel":"Section in Sports Medicine"},"3317":{"title":"Classification & Outcome Scales","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine#s19","snippet":"Classification & Outcome Scales Muscle & Ligament Injury Grading Grade Muscle Strain Ligament Sprain I (mild) <5% fiber disruption, mild pain, full strength Stretching, no instability II (moderate) Partial tear, weakness, ecchymosis Partial tear, mild instability III (severe) Complete rupture, palpa...","sourceLabel":"Section in Sports Medicine"},"3318":{"title":"Physical Exam - Special Tests by Joint","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine#s20","snippet":"Physical Exam - Special Tests by Joint Joint Test What It Assesses Shoulder Neer, Hawkins-Kennedy Subacromial impingement Shoulder Jobe (empty can), drop arm Supraspinatus Shoulder External rotation lag, lift-off, belly press Infraspinatus, subscapularis Shoulder Apprehension, relocation Anterior in...","sourceLabel":"Section in Sports Medicine"},"3319":{"title":"Return-to-Play Frameworks","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine#s21","snippet":"Return-to-Play Frameworks Return-to-play decisions integrate tissue healing, rehab milestones, sport demands, psychological readiness, and legal/medical considerations. A \"shared decision-making\" model between physician, athlete, family, athletic trainer, and coach is standard. Figure 23 - Bone Remo...","sourceLabel":"Section in Sports Medicine"},"3320":{"title":"Abbreviations Master List","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine#s22","snippet":"Abbreviations Master List Anatomy ACL / PCL Anterior / Posterior cruciate ligament MCL / LCL Medial / Lateral collateral ligament UCL Ulnar collateral ligament ATFL / CFL / PTFL Anterior/calcaneo/posterior talofibular ligament TFCC Triangular fibrocartilage complex MPFL Medial patellofemoral ligamen...","sourceLabel":"Section in Sports Medicine"},"3321":{"title":"Sample HPI Templates","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine#s23","snippet":"Sample HPI Templates These templates illustrate the rhythm and depth of a sports medicine HPI. Use them as patterns during your first weeks in clinic. Sample HPI - ACL Tear \"Ms. [Name] is a 17-year-old right-hand-dominant female varsity soccer forward with no prior knee injury who presents with acut...","sourceLabel":"Section in Sports Medicine"},"3322":{"title":"References & Sources","pageTitle":"Sports Medicine","pageUrl":"/scribe-guides/sports-medicine","url":"/scribe-guides/sports-medicine#s24","snippet":"References & Sources Clinical Practice Guidelines & Position Statements Patricios JS et al. Consensus Statement on Concussion in Sport - 6th International Conference, Amsterdam 2022. Br J Sports Med. 2023. McCrory P et al. Consensus Statement on Concussion in Sport - 5th International Conference, Be...","sourceLabel":"Section in Sports Medicine"},"3323":{"title":"PM&R","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr","snippet":"Physical Medicine & Rehabilitation (PM&R) - Complete Reference Every diagnosis, procedure, medication, classification, abbreviation, and documentation framework you need to succeed as a physiatry scribe on day one and beyond."},"3324":{"title":"Rehabilitation Medicine - Scope & Anatomy Essentials","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr#s1","snippet":"Rehabilitation Medicine - Scope & Anatomy Essentials Physical Medicine & Rehabilitation (PM&R), also called physiatry , is the medical specialty focused on restoring function after illness or injury. While most specialties ask \"what is the disease?\", physiatrists ask \"what can this patient do, and h...","sourceLabel":"Section in PM&R"},"3325":{"title":"Scribe Documentation Framework (Function-Focused)","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr#s2","snippet":"Scribe Documentation Framework (Function-Focused) PM&R notes look similar to other specialty notes on the surface but have a distinctive functional layer baked into every section. Whereas a hospitalist might write \"weakness, ambulating with assistance,\" a physiatrist will document exactly which musc...","sourceLabel":"Section in PM&R"},"3326":{"title":"Stroke Rehabilitation","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr#s3","snippet":"Stroke Rehabilitation Stroke is the most common diagnosis on an acute inpatient rehab unit. Rehabilitation begins within 24-48 hours of medical stability. The physiatrist inherits a patient from neurology or neurosurgery and must now translate the acute infarct or hemorrhage into a functional recove...","sourceLabel":"Section in PM&R"},"3327":{"title":"Spinal Cord Injury (SCI) Rehabilitation","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr#s4","snippet":"Spinal Cord Injury (SCI) Rehabilitation SCI is classified by level (the most caudal segment with normal motor and sensory function bilaterally) and by completeness , using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) maintained by ASIA/ISCoS. Tetraplegi...","sourceLabel":"Section in PM&R"},"3328":{"title":"Traumatic Brain Injury (TBI) & Post-Concussion","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr#s5","snippet":"Traumatic Brain Injury (TBI) & Post-Concussion TBI severity is classified by initial Glasgow Coma Scale (GCS), duration of loss of consciousness (LOC), and duration of post-traumatic amnesia (PTA). Severity GCS LOC PTA Mild (concussion) 13-15 0-30 min < 24 hr Moderate 9-12 30 min - 24 hr 1-7 days Se...","sourceLabel":"Section in PM&R"},"3329":{"title":"Amputee Rehabilitation & Prosthetics","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr#s6","snippet":"Amputee Rehabilitation & Prosthetics Amputation is most commonly performed for complications of diabetes and peripheral arterial disease, followed by trauma and malignancy. The physiatrist coordinates pre-prosthetic training, residual limb shaping, prosthetic prescription, and gait training. Figure ...","sourceLabel":"Section in PM&R"},"3330":{"title":"Neurodegenerative & Neuromuscular Rehab","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr#s7","snippet":"Neurodegenerative & Neuromuscular Rehab Multiple Sclerosis (MS) Demyelinating autoimmune disease of CNS. Rehab targets fatigue (amantadine, modafinil), spasticity, gait, bladder dysfunction, and cognitive symptoms. Exercise is safe and beneficial. Disease-modifying therapies managed by neurology (in...","sourceLabel":"Section in PM&R"},"3331":{"title":"Pediatric Rehabilitation","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr#s8","snippet":"Pediatric Rehabilitation Pediatric physiatry manages congenital and acquired disability in children. The core diagnoses: Figure 13 - GMFCS Levels I through V. The five levels of the Gross Motor Function Classification System (GMFCS) Expanded and Revised, depicted for children ages 6-12 years. Level ...","sourceLabel":"Section in PM&R"},"3332":{"title":"Spasticity, Dystonia & Contracture Management","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr#s9","snippet":"Spasticity, Dystonia & Contracture Management Spasticity is velocity-dependent increased muscle tone from upper motor neuron injury (stroke, SCI, TBI, MS, CP). Untreated, it causes pain, contractures, impaired hygiene, and functional loss. Dystonia is involuntary sustained muscle contraction produci...","sourceLabel":"Section in PM&R"},"3333":{"title":"Musculoskeletal & Spine Disorders","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr#s10","snippet":"Musculoskeletal & Spine Disorders Low Back Pain The most common outpatient physiatry complaint. Categories: mechanical/axial (strain, facet arthropathy, discogenic, sacroiliac joint dysfunction), radicular (disc herniation compressing a nerve root - L5 or S1 most common), and specific causes (fractu...","sourceLabel":"Section in PM&R"},"3334":{"title":"Chronic Pain, Fibromyalgia, CRPS","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr#s11","snippet":"Chronic Pain, Fibromyalgia, CRPS Chronic pain is defined as pain lasting > 3 months. PM&R manages it biopsychosocially: exercise, cognitive behavioral therapy, graded activity, pacing, sleep hygiene, mood management, and judicious use of medication and interventional procedures. Fibromyalgia Widespr...","sourceLabel":"Section in PM&R"},"3335":{"title":"Rehab Complications","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr#s12","snippet":"Rehab Complications Autonomic Dysreflexia A life-threatening reflex in patients with SCI at T6 or above. Noxious stimulus below the injury (most commonly bladder distention or fecal impaction) triggers sympathetic surge causing severe HTN, pounding headache, flushing and sweating above the level, an...","sourceLabel":"Section in PM&R"},"3336":{"title":"Cognitive, Speech & Swallowing Disorders","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr#s13","snippet":"Cognitive, Speech & Swallowing Disorders Aphasia: Broca (non-fluent, expressive, comprehension intact), Wernicke (fluent but nonsensical, comprehension impaired), global (both), conduction (impaired repetition), anomic (word-finding). Treated by SLP with constraint-induced language therapy, melodic ...","sourceLabel":"Section in PM&R"},"3337":{"title":"Cancer, Cardiac, Pulmonary & Post-COVID Rehab","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr#s14","snippet":"Cancer, Cardiac, Pulmonary & Post-COVID Rehab Cancer Rehabilitation: Addresses deconditioning, chemotherapy-induced peripheral neuropathy, radiation fibrosis, cognitive impairment (\"chemo brain\"), lymphedema, and post-surgical functional loss. Prehabilitation before cancer surgery improves outcomes....","sourceLabel":"Section in PM&R"},"3338":{"title":"Geriatric Rehab, Deconditioning, Falls & Sarcopenia","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr#s15","snippet":"Geriatric Rehab, Deconditioning, Falls & Sarcopenia Geriatric rehab addresses post-hospitalization deconditioning, post-fracture rehabilitation (especially hip fracture), fall prevention, and sarcopenia. Sarcopenia is age-related loss of muscle mass and strength, diagnosed by low grip strength, low ...","sourceLabel":"Section in PM&R"},"3339":{"title":"Electrodiagnostics & Injection Procedures","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr#s16","snippet":"Electrodiagnostics & Injection Procedures Electrodiagnostics (EMG/NCS) The nerve conduction study (NCS) records the electrical response of a nerve to supramaximal stimulation. Measured parameters include amplitude (axonal integrity), latency and conduction velocity (myelination), and presence of con...","sourceLabel":"Section in PM&R"},"3340":{"title":"Orthotics, Prosthetics & Adaptive Equipment","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr#s17","snippet":"Orthotics, Prosthetics & Adaptive Equipment Figure 23 - Types of Plastic Ankle-Foot Orthoses. Common plastic AFO designs: (A) Solid ankle-foot orthosis for severe foot drop with spasticity; (B) Posterior leaf spring orthosis for pure foot drop without spasticity; (C) Hinged (articulated) ankle-foot ...","sourceLabel":"Section in PM&R"},"3341":{"title":"Inpatient Rehab Levels of Care & Team Model","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr#s18","snippet":"Inpatient Rehab Levels of Care & Team Model Setting Intensity Typical Stay Who Qualifies Acute Inpatient Rehab Facility (IRF) 3 hours of therapy/day, 5 days/week; daily MD visits 10-20 days Stroke, SCI, TBI, amputation, hip fracture; must tolerate 3 hrs/day and need &ge; 2 therapy disciplines Long-T...","sourceLabel":"Section in PM&R"},"3342":{"title":"Imaging & Diagnostics in PM&R","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr#s19","snippet":"Imaging & Diagnostics in PM&R Modality Use in PM&R X-ray Fractures, joint alignment, hardware assessment, scoliosis, HO. MRI brain Stroke, TBI (DAI on SWI/GRE), MS plaques, tumor. MRI spine Disc herniation, stenosis, cord compression, syrinx, SCI level, cauda equina. MSK MRI Rotator cuff, meniscus, ...","sourceLabel":"Section in PM&R"},"3343":{"title":"Medications You Must Know","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr#s20","snippet":"Medications You Must Know Spasticity Drug Brand Mechanism Notes Baclofen Lioresal GABA-B agonist Oral or intrathecal (ITB pump); sedation, withdrawal risk if abruptly stopped Tizanidine Zanaflex Central alpha-2 agonist Sedation, hypotension, hepatotoxicity Dantrolene Dantrium Direct muscle action (r...","sourceLabel":"Section in PM&R"},"3344":{"title":"Classification & Outcome Measures","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr#s21","snippet":"Classification & Outcome Measures MRC Strength Grading (0-5) Grade Finding 0 No contraction 1 Flicker of contraction, no movement 2 Active movement with gravity eliminated 3 Active movement against gravity 4 Active movement against gravity and some resistance (4&minus;, 4, 4+) 5 Normal strength Brun...","sourceLabel":"Section in PM&R"},"3345":{"title":"Physical Exam - Functional, MSK & Neurologic","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr#s22","snippet":"Physical Exam - Functional, MSK & Neurologic PM&R Exam Template General: Alert, oriented x3 (or note deficits), cooperative, in no acute distress. Mental status: MMSE/MoCA if performed; attention, memory, executive function descriptors. Cranial nerves: II-XII grossly intact or list deficits (visual ...","sourceLabel":"Section in PM&R"},"3346":{"title":"Abbreviations Master List","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr#s23","snippet":"Abbreviations Master List Diagnoses & Conditions SCI Spinal cord injury TBI Traumatic brain injury CVA Cerebrovascular accident (stroke) TIA Transient ischemic attack MS Multiple sclerosis ALS Amyotrophic lateral sclerosis PD Parkinson disease GBS Guillain-Barr&eacute; syndrome CP Cerebral palsy DMD...","sourceLabel":"Section in PM&R"},"3347":{"title":"Sample HPI Templates & References","pageTitle":"PM&R","pageUrl":"/scribe-guides/pmr","url":"/scribe-guides/pmr#s24","snippet":"Sample HPI Templates & References Sample HPI - Acute Rehab Admission After Stroke \"Mr. [Name] is a 68-year-old right-handed male with PMH of HTN, HLD, T2DM (A1C 8.1), and atrial fibrillation on apixaban admitted to acute inpatient rehab following a left MCA ischemic stroke on [date]. He underwent me...","sourceLabel":"Section in PM&R"},"3348":{"title":"Medical Genetics","pageTitle":"Medical Genetics","pageUrl":"/scribe-guides/medical-genetics","url":"/scribe-guides/medical-genetics","snippet":"Medical Genetics - Complete Reference Every syndrome, inheritance pattern, genetic test, therapy, abbreviation, and documentation framework you need to scribe in a medical genetics clinic."},"3349":{"title":"Genetics Essentials - Inheritance & Molecular Foundations","pageTitle":"Medical Genetics","pageUrl":"/scribe-guides/medical-genetics","url":"/scribe-guides/medical-genetics#s1","snippet":"Genetics Essentials - Inheritance & Molecular Foundations Medical genetics is the specialty that evaluates, diagnoses, and manages patients with inherited or congenital disorders. A genetics clinic sees an exceptionally broad population: newborns with dysmorphic features, children with developmental...","sourceLabel":"Section in Medical Genetics"},"3350":{"title":"Scribe Documentation Framework & Pedigree Charting","pageTitle":"Medical Genetics","pageUrl":"/scribe-guides/medical-genetics","url":"/scribe-guides/medical-genetics#s2","snippet":"Scribe Documentation Framework & Pedigree Charting Genetics notes look different from most clinic notes. The HPI is often thinner than the family history, and the assessment frequently discusses probabilities rather than binary diagnoses. Three elements define a genetics note: the detailed three-gen...","sourceLabel":"Section in Medical Genetics"},"3351":{"title":"Chromosomal Aneuploidies","pageTitle":"Medical Genetics","pageUrl":"/scribe-guides/medical-genetics","url":"/scribe-guides/medical-genetics#s3","snippet":"Chromosomal Aneuploidies Aneuploidies - abnormal chromosome numbers - account for a large share of genetics referrals, particularly in pediatric and prenatal settings. They are most commonly caused by meiotic nondisjunction, with risk rising sharply with advanced maternal age. Figure 3 - Chromatin S...","sourceLabel":"Section in Medical Genetics"},"3352":{"title":"Microdeletion & Microduplication Syndromes","pageTitle":"Medical Genetics","pageUrl":"/scribe-guides/medical-genetics","url":"/scribe-guides/medical-genetics#s4","snippet":"Microdeletion & Microduplication Syndromes Figure 4 - Euchromatin vs. Heterochromatin. Nucleosomes appear as beads on a string. Euchromatin is loosely packed and transcriptionally active, while heterochromatin is tightly condensed and associated with gene silencing. Microdeletion syndromes disrupt d...","sourceLabel":"Section in Medical Genetics"},"3353":{"title":"Imprinting & Trinucleotide Repeat Disorders","pageTitle":"Medical Genetics","pageUrl":"/scribe-guides/medical-genetics","url":"/scribe-guides/medical-genetics#s5","snippet":"Imprinting & Trinucleotide Repeat Disorders Figure 5 - CpG Island Methylation and Gene Expression. CpG islands located on gene promoter regions can be unmethylated (allowing transcription factor access and gene expression) or methylated (blocking transcription and silencing the gene). This mechanism...","sourceLabel":"Section in Medical Genetics"},"3354":{"title":"Connective Tissue & Skeletal Dysplasias","pageTitle":"Medical Genetics","pageUrl":"/scribe-guides/medical-genetics","url":"/scribe-guides/medical-genetics#s6","snippet":"Connective Tissue & Skeletal Dysplasias Marfan Syndrome Gene: FBN1 (fibrillin-1), 15q21.1, AD. Features (revised Ghent criteria): aortic root dilation/dissection, ectopia lentis, tall stature with long limbs and arachnodactyly (positive wrist and thumb signs), pectus deformity, scoliosis, high-arche...","sourceLabel":"Section in Medical Genetics"},"3355":{"title":"Neurocutaneous & Tumor Predisposition Syndromes","pageTitle":"Medical Genetics","pageUrl":"/scribe-guides/medical-genetics","url":"/scribe-guides/medical-genetics#s7","snippet":"Neurocutaneous & Tumor Predisposition Syndromes Neurofibromatosis Type 1 (NF1) Gene: NF1 (neurofibromin), 17q11.2, AD, near-complete penetrance with variable expressivity. NIH diagnostic criteria (need 2+): &ge; 6 cafe-au-lait macules (&ge; 5 mm prepubertal, &ge; 15 mm postpubertal), &ge; 2 neurofib...","sourceLabel":"Section in Medical Genetics"},"3356":{"title":"Hereditary Cancer Syndromes","pageTitle":"Medical Genetics","pageUrl":"/scribe-guides/medical-genetics","url":"/scribe-guides/medical-genetics#s8","snippet":"Hereditary Cancer Syndromes Adult cancer genetics is a major portion of most clinics. Testing and surveillance are governed by the NCCN Genetic/Familial High-Risk Assessment: Breast, Ovarian, Pancreatic and NCCN Colorectal Genetic/Familial High-Risk guidelines, which a scribe will see referenced con...","sourceLabel":"Section in Medical Genetics"},"3357":{"title":"Multiple Endocrine Neoplasia & Endocrine Genetics","pageTitle":"Medical Genetics","pageUrl":"/scribe-guides/medical-genetics","url":"/scribe-guides/medical-genetics#s9","snippet":"Multiple Endocrine Neoplasia & Endocrine Genetics MEN1 (Wermer Syndrome) Gene: MEN1 (menin), AD. Triad - \"3 Ps\": Parathyroid hyperplasia/adenomas (most common, earliest), Pancreatic neuroendocrine tumors (gastrinoma, insulinoma), Pituitary adenomas (prolactinoma most common). Foregut carcinoids and ...","sourceLabel":"Section in Medical Genetics"},"3358":{"title":"Inborn Errors of Metabolism","pageTitle":"Medical Genetics","pageUrl":"/scribe-guides/medical-genetics","url":"/scribe-guides/medical-genetics#s10","snippet":"Inborn Errors of Metabolism Inborn errors of metabolism (IEM) are a broad category of typically autosomal recessive enzyme deficiencies. Many present in the neonatal period with encephalopathy, vomiting, hypoglycemia, acidosis, or hyperammonemia. The ACMG Recommended Uniform Screening Panel (RUSP) g...","sourceLabel":"Section in Medical Genetics"},"3359":{"title":"Lysosomal Storage & Glycogen Storage Disorders","pageTitle":"Medical Genetics","pageUrl":"/scribe-guides/medical-genetics","url":"/scribe-guides/medical-genetics#s11","snippet":"Lysosomal Storage & Glycogen Storage Disorders Gaucher Disease Gene: GBA (glucocerebrosidase), AR. Type 1 (non-neuronopathic - most common, Ashkenazi Jewish founder effect) - hepatosplenomegaly, cytopenias, bone pain, avascular necrosis. Type 2 (acute neuronopathic, infantile). Type 3 (chronic neuro...","sourceLabel":"Section in Medical Genetics"},"3360":{"title":"Mitochondrial Disorders","pageTitle":"Medical Genetics","pageUrl":"/scribe-guides/medical-genetics","url":"/scribe-guides/medical-genetics#s12","snippet":"Mitochondrial Disorders Mitochondrial disorders can be caused by variants in either mitochondrial DNA (mtDNA, maternal inheritance, heteroplasmy) or nuclear-encoded mitochondrial proteins (Mendelian inheritance). They classically affect high-energy tissues: brain, muscle, eye, heart, and endocrine. ...","sourceLabel":"Section in Medical Genetics"},"3361":{"title":"Hematologic Genetic Disorders & Hypercoagulable States","pageTitle":"Medical Genetics","pageUrl":"/scribe-guides/medical-genetics","url":"/scribe-guides/medical-genetics#s13","snippet":"Hematologic Genetic Disorders & Hypercoagulable States Sickle Cell Disease Gene: HBB, AR. Homozygous HbSS or compound heterozygotes (HbSC, HbS/beta-thal). Glu6Val substitution in beta-globin causes polymerization of deoxyhemoglobin. Features: vaso-occlusive crises, acute chest syndrome, stroke, sple...","sourceLabel":"Section in Medical Genetics"},"3362":{"title":"Neuromuscular & Neurogenetic Disorders","pageTitle":"Medical Genetics","pageUrl":"/scribe-guides/medical-genetics","url":"/scribe-guides/medical-genetics#s14","snippet":"Neuromuscular & Neurogenetic Disorders Duchenne / Becker Muscular Dystrophy Gene: DMD (dystrophin), Xp21, X-linked recessive. Duchenne - out-of-frame deletions/duplications with absent dystrophin; onset ages 2-5, Gowers sign, calf pseudohypertrophy, loss of ambulation by early teens, dilated cardiom...","sourceLabel":"Section in Medical Genetics"},"3363":{"title":"Cystic Fibrosis & Congenital Multisystem Disorders","pageTitle":"Medical Genetics","pageUrl":"/scribe-guides/medical-genetics","url":"/scribe-guides/medical-genetics#s15","snippet":"Cystic Fibrosis & Congenital Multisystem Disorders Cystic Fibrosis Gene: CFTR, 7q31.2, AR. F508del accounts for ~70% of CF alleles in individuals of European ancestry. Features: chronic sinopulmonary disease with Pseudomonas colonization, pancreatic insufficiency, meconium ileus in neonates, male in...","sourceLabel":"Section in Medical Genetics"},"3364":{"title":"Genetic Testing & Procedures","pageTitle":"Medical Genetics","pageUrl":"/scribe-guides/medical-genetics","url":"/scribe-guides/medical-genetics#s16","snippet":"Genetic Testing & Procedures A genetics clinician chooses among several tiers of testing depending on the clinical question. You will document which test was ordered, the lab, and the pre-test counseling provided. Figure 23 - Next-Generation Sequencing Technologies. Overview of major NGS platforms u...","sourceLabel":"Section in Medical Genetics"},"3365":{"title":"Prenatal Diagnosis & Reproductive Genetics","pageTitle":"Medical Genetics","pageUrl":"/scribe-guides/medical-genetics","url":"/scribe-guides/medical-genetics#s17","snippet":"Prenatal Diagnosis & Reproductive Genetics Prenatal Screening First-trimester combined screen (10-13+6 weeks): nuchal translucency + PAPP-A + free beta-hCG. Quad screen (15-22 weeks): AFP, hCG, uE3, inhibin A. Integrated/sequential combines first- and second-trimester markers. Cell-free DNA (NIPT/NI...","sourceLabel":"Section in Medical Genetics"},"3366":{"title":"Medications & Targeted Therapies","pageTitle":"Medical Genetics","pageUrl":"/scribe-guides/medical-genetics","url":"/scribe-guides/medical-genetics#s18","snippet":"Medications & Targeted Therapies Genetic therapeutics have expanded dramatically in the last decade. Below are the drug classes a scribe will encounter in a modern genetics clinic. Drug Class Example (Generic / Brand) Indication Mechanism Enzyme replacement (ERT) Imiglucerase (Cerezyme) Gaucher type...","sourceLabel":"Section in Medical Genetics"},"3367":{"title":"ACMG Variant Classification & Reporting","pageTitle":"Medical Genetics","pageUrl":"/scribe-guides/medical-genetics","url":"/scribe-guides/medical-genetics#s19","snippet":"ACMG Variant Classification & Reporting Every genetic test result you document uses the ACMG/AMP 2015 variant interpretation standards . Variants are classified on a 5-tier scale based on population, computational, functional, segregation, de novo, and allelic evidence. ACMG Variant Classification T...","sourceLabel":"Section in Medical Genetics"},"3368":{"title":"Dysmorphology Physical Exam","pageTitle":"Medical Genetics","pageUrl":"/scribe-guides/medical-genetics","url":"/scribe-guides/medical-genetics#s20","snippet":"Dysmorphology Physical Exam The dysmorphology exam is the most specialty-specific physical exam in medicine. Clinical geneticists and dysmorphologists systematically describe every body region using standardized terminology from the Elements of Morphology consensus . Your job is to transcribe these ...","sourceLabel":"Section in Medical Genetics"},"3369":{"title":"Abbreviations Master List","pageTitle":"Medical Genetics","pageUrl":"/scribe-guides/medical-genetics","url":"/scribe-guides/medical-genetics#s21","snippet":"Abbreviations Master List Inheritance & Molecular AD Autosomal dominant AR Autosomal recessive XLR / XLD X-linked recessive / dominant mtDNA Mitochondrial DNA (maternal inheritance) UPD Uniparental disomy LOH Loss of heterozygosity CNV Copy number variant SNV Single nucleotide variant SV Structural ...","sourceLabel":"Section in Medical Genetics"},"3370":{"title":"Sample HPI Templates","pageTitle":"Medical Genetics","pageUrl":"/scribe-guides/medical-genetics","url":"/scribe-guides/medical-genetics#s22","snippet":"Sample HPI Templates These HPIs reflect the pace and content of a real medical genetics clinic. Use them as scaffolds. Sample HPI - New Consult for Family History of Cancer \"Ms. [Name] is a 38-year-old G2P2 female of Ashkenazi Jewish ancestry referred for hereditary cancer risk assessment. She is pe...","sourceLabel":"Section in Medical Genetics"},"3371":{"title":"References & Sources","pageTitle":"Medical Genetics","pageUrl":"/scribe-guides/medical-genetics","url":"/scribe-guides/medical-genetics#s23","snippet":"References & Sources Clinical Practice Guidelines Richards S, et al. Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the ACMG and AMP. Genet Med. 2015. Miller DT, et al. ACMG SF v3.2 list for reporting of secondary findings in clinical exome ...","sourceLabel":"Section in Medical Genetics"},"3372":{"title":"General Surgery","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery","snippet":"General Surgery - Complete Reference Every diagnosis, condition, procedure, medication, abbreviation, and documentation framework you need to succeed on day one and beyond."},"3373":{"title":"Surgical Anatomy - Abdomen & GI Tract","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery#s1","snippet":"Surgical Anatomy - Abdomen & GI Tract General surgery covers an enormous anatomic footprint: the entire gastrointestinal tract from the esophagus to the anus, the hepatobiliary system, the pancreas and spleen, the endocrine organs (thyroid, parathyroid, adrenals), the breast, the abdominal wall and ...","sourceLabel":"Section in General Surgery"},"3374":{"title":"Scribe Documentation Framework","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery#s2","snippet":"Scribe Documentation Framework General surgery scribes document a mix of outpatient clinic consultations (new referrals, post-op follow-ups, surveillance), inpatient consults (ED calls, ward consults, ICU patients), and operative H&Ps. Each encounter type has its own rhythm, but they all follow SOAP...","sourceLabel":"Section in General Surgery"},"3375":{"title":"Appendicitis","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery#s3","snippet":"Appendicitis Acute appendicitis is the most common surgical emergency in the United States, with a lifetime risk of approximately 7-8%. It is caused by luminal obstruction of the appendix - typically from a fecalith, lymphoid hyperplasia, or less commonly a tumor or parasite - leading to increased i...","sourceLabel":"Section in General Surgery"},"3376":{"title":"Gallbladder & Biliary Disease","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery#s4","snippet":"Gallbladder & Biliary Disease Biliary disease accounts for a huge share of general surgery volume. The common spectrum runs from asymptomatic cholelithiasis to biliary colic , acute cholecystitis , chronic cholecystitis , choledocholithiasis (stones in the common bile duct), ascending cholangitis , ...","sourceLabel":"Section in General Surgery"},"3377":{"title":"Pancreatitis & Pancreatic Disease","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery#s5","snippet":"Pancreatitis & Pancreatic Disease Acute pancreatitis is one of the most common admissions in general surgery. The two leading causes are gallstones (~40%) and alcohol (~30%); the remainder include hypertriglyceridemia, hypercalcemia, medications, ERCP, trauma, and autoimmune pancreatitis. Diagnosis ...","sourceLabel":"Section in General Surgery"},"3378":{"title":"Gastric Disease & Peptic Ulcer Disease","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery#s6","snippet":"Gastric Disease & Peptic Ulcer Disease Peptic ulcer disease (PUD) is mucosal ulceration of the stomach or duodenum caused by H. pylori infection or NSAID use. Most PUD is managed medically (PPI + H. pylori eradication), but general surgery is involved when complications occur: perforation , bleeding...","sourceLabel":"Section in General Surgery"},"3379":{"title":"Foregut: GERD, Hiatal Hernia, Achalasia, Esophageal Cancer","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery#s7","snippet":"Foregut: GERD, Hiatal Hernia, Achalasia, Esophageal Cancer Figure 9 - Digestive System Anatomy. Overview of the gastrointestinal tract illustrating the relationship of the esophagus, stomach, small and large intestine. Understanding the anatomical course of the GI tract is essential for identifying ...","sourceLabel":"Section in General Surgery"},"3380":{"title":"Small & Large Bowel Obstruction, Ileus","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery#s8","snippet":"Small & Large Bowel Obstruction, Ileus Figure 10 - Anatomy of the Small and Large Intestine. Illustration demonstrating the segments of the small bowel (jejunum, ileum) and large bowel (cecum, ascending, transverse, descending, sigmoid colon, and rectum). Understanding these segments is essential fo...","sourceLabel":"Section in General Surgery"},"3381":{"title":"Mesenteric Ischemia","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery#s9","snippet":"Mesenteric Ischemia Mesenteric ischemia is rare but deadly - mortality for acute mesenteric ischemia remains 50-80% despite advances in diagnosis and treatment. Acute mesenteric ischemia (AMI) is classically described as \"pain out of proportion to exam\" - the patient has severe abdominal pain but a ...","sourceLabel":"Section in General Surgery"},"3382":{"title":"Colorectal Disease & Colon Cancer","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery#s10","snippet":"Colorectal Disease & Colon Cancer Colorectal cancer (CRC) is the third most common cancer and second-leading cause of cancer death in the US. Most CRCs arise from adenomatous polyps via the classic adenoma-carcinoma sequence (APC &rarr; KRAS &rarr; p53). Screening is recommended starting at age 45 p...","sourceLabel":"Section in General Surgery"},"3383":{"title":"Diverticulitis & Colonic Perforation","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery#s11","snippet":"Diverticulitis & Colonic Perforation Colonic diverticula are acquired outpouchings of mucosa and submucosa through weaknesses in the colonic wall, most commonly in the sigmoid colon . Diverticulitis is inflammation of a diverticulum, often from microperforation. Patients present with LLQ pain, fever...","sourceLabel":"Section in General Surgery"},"3384":{"title":"Anorectal Disease","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery#s12","snippet":"Anorectal Disease Anorectal complaints are extremely common in general surgery clinic. The dentate (pectinate) line is the key anatomic landmark separating endoderm-derived (internal, insensate, portal venous drainage) from ectoderm-derived (external, richly innervated somatically, systemic venous d...","sourceLabel":"Section in General Surgery"},"3385":{"title":"Inflammatory Bowel Disease (Surgical)","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery#s13","snippet":"Inflammatory Bowel Disease (Surgical) Crohn's disease (transmural, \"skip lesions,\" any segment from mouth to anus, strictures and fistulas) and ulcerative colitis (mucosal, continuous from rectum proximally, limited to colon) both have surgical indications. Approximately 50-70% of Crohn's patients w...","sourceLabel":"Section in General Surgery"},"3386":{"title":"GI Bleeding (Surgical Management)","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery#s14","snippet":"GI Bleeding (Surgical Management) Most GI bleeding is managed medically and endoscopically, but general surgeons are consulted on every major bleed and are the backstop when less-invasive measures fail. The scribe's job is to capture the resuscitation timeline, transfusion counts, hemodynamic trends...","sourceLabel":"Section in General Surgery"},"3387":{"title":"Hernias - Inguinal, Femoral, Ventral, Incisional, Umbilical","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery#s15","snippet":"Hernias - Inguinal, Femoral, Ventral, Incisional, Umbilical Hernias are one of the highest-volume diagnoses in any general surgery clinic. A hernia is the protrusion of abdominal contents through a defect in the abdominal wall. Hernias may be reducible , incarcerated (non-reducible but not ischemic)...","sourceLabel":"Section in General Surgery"},"3388":{"title":"Breast Disease","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery#s16","snippet":"Breast Disease Breast disease is a major pillar of general surgery practice in most communities, accounting for a significant share of clinic volume. A scribe must be comfortable charting the full workup of a palpable mass, an imaging abnormality, and a new cancer diagnosis. Figure 18 - Female Breas...","sourceLabel":"Section in General Surgery"},"3389":{"title":"Endocrine Surgery - Thyroid, Parathyroid, Adrenal","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery#s17","snippet":"Endocrine Surgery - Thyroid, Parathyroid, Adrenal Endocrine surgery is a distinct subspecialty within general surgery at most centers, but every general surgery scribe will chart thyroid, parathyroid, and adrenal cases. Figure 20 - Thyroid Gland Anatomy. Illustration demonstrating the anatomy of the...","sourceLabel":"Section in General Surgery"},"3390":{"title":"Skin, Soft Tissue, Spleen & Trauma","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery#s18","snippet":"Skin, Soft Tissue, Spleen & Trauma Soft Tissue Infections Cellulitis is managed medically. Abscesses require incision and drainage. Necrotizing soft tissue infection (NSTI, \"necrotizing fasciitis\") is a surgical emergency - rapid progression, pain out of proportion, skin discoloration, crepitus, bul...","sourceLabel":"Section in General Surgery"},"3391":{"title":"General Surgery Procedures - A to Z","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery#s19","snippet":"General Surgery Procedures - A to Z This is the reference list of procedures you will hear named repeatedly. Each is performed open, laparoscopically, or robotically depending on the indication, patient factors, and surgeon preference. Procedure Indication Key Notes Laparoscopic appendectomy Acute a...","sourceLabel":"Section in General Surgery"},"3392":{"title":"Imaging, Labs & Diagnostics","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery#s20","snippet":"Imaging, Labs & Diagnostics Surgical decision-making is driven by imaging and lab data. A scribe who understands what each study shows and when it is ordered will anticipate the surgeon's next move and chart faster. Imaging Modalities Key Studies CT abdomen/pelvis with IV contrast: Workhorse for acu...","sourceLabel":"Section in General Surgery"},"3393":{"title":"Medications & ERAS Protocols","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery#s21","snippet":"Medications & ERAS Protocols Preoperative Antibiotics (SSI Prevention) Timing: within 60 minutes of incision (120 min for vancomycin/fluoroquinolones). Per IDSA/SHEA surgical antimicrobial prophylaxis guidelines and CDC SSI prevention guidelines . Clean (hernia, breast): Cefazolin 2 g (3 g if >120 k...","sourceLabel":"Section in General Surgery"},"3394":{"title":"Classification Systems","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery#s22","snippet":"Classification Systems ASA Physical Status Classification ASA I: Normal healthy patient. ASA II: Mild systemic disease (controlled HTN, DM, obesity BMI 30-40, smoker, social drinker). ASA III: Severe systemic disease with functional limitation (poorly controlled DM/HTN, COPD, BMI >40, active hepatit...","sourceLabel":"Section in General Surgery"},"3395":{"title":"Abbreviations, Physical Exam & Sample HPIs","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery#s23","snippet":"Abbreviations, Physical Exam & Sample HPIs Physical Exam Template General Surgery Abdominal Exam General: A&O x3, NAD vs in distress CV: RRR, no m/r/g Resp: CTA bilaterally, no respiratory distress Abdomen: Inspection (scars, distension, visible hernia, ecchymosis); Auscultation (BS present/absent/h...","sourceLabel":"Section in General Surgery"},"3396":{"title":"References & Sources","pageTitle":"General Surgery","pageUrl":"/scribe-guides/general-surgery","url":"/scribe-guides/general-surgery#s24","snippet":"References & Sources Clinical Practice Guidelines Yokoe M et al. Tokyo Guidelines 2018 (TG18): diagnostic criteria and severity grading of acute cholecystitis. J Hepatobiliary Pancreat Sci. 2018. Kiriyama S et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis. ...","sourceLabel":"Section in General Surgery"},"3397":{"title":"Trauma Surgery","pageTitle":"Trauma Surgery","pageUrl":"/scribe-guides/trauma-surgery","url":"/scribe-guides/trauma-surgery","snippet":"Trauma Surgery - Complete Reference Every injury pattern, ATLS principle, procedure, medication, classification, and documentation framework you need to survive the trauma bay and beyond."},"3398":{"title":"ATLS Principles & Trauma Activation","pageTitle":"Trauma Surgery","pageUrl":"/scribe-guides/trauma-surgery","url":"/scribe-guides/trauma-surgery#s1","snippet":"ATLS Principles & Trauma Activation Trauma surgery is an acuity-driven specialty. Every encounter begins with a structured, time-critical assessment framework derived from Advanced Trauma Life Support (ATLS) , the American College of Surgeons Committee on Trauma (ACS COT) curriculum now in its 10th ...","sourceLabel":"Section in Trauma Surgery"},"3399":{"title":"Scribe Documentation Framework","pageTitle":"Trauma Surgery","pageUrl":"/scribe-guides/trauma-surgery","url":"/scribe-guides/trauma-surgery#s2","snippet":"Scribe Documentation Framework Trauma documentation differs fundamentally from clinic documentation. You are not writing a SOAP note in real time; you are writing a trauma flow sheet that captures a resuscitation, then an admission H&P , then operative notes , and finally ICU progress notes . Each f...","sourceLabel":"Section in Trauma Surgery"},"3400":{"title":"Primary & Secondary Survey (ABCDE)","pageTitle":"Trauma Surgery","pageUrl":"/scribe-guides/trauma-surgery","url":"/scribe-guides/trauma-surgery#s3","snippet":"Primary & Secondary Survey (ABCDE) The primary survey is the first 60 seconds of the resuscitation. Its only purpose is to identify and treat immediately life-threatening problems. It follows the ABCDE mnemonic: Airway with cervical spine protection, Breathing and ventilation, Circulation with hemor...","sourceLabel":"Section in Trauma Surgery"},"3401":{"title":"Airway Management & RSI in Trauma","pageTitle":"Trauma Surgery","pageUrl":"/scribe-guides/trauma-surgery","url":"/scribe-guides/trauma-surgery#s4","snippet":"Airway Management & RSI in Trauma Airway compromise kills trauma patients faster than anything else. The decision to intubate in trauma is based on inability to protect the airway (GCS &le; 8, massive facial trauma, expanding neck hematoma, inhalation injury), inability to oxygenate/ventilate, expec...","sourceLabel":"Section in Trauma Surgery"},"3402":{"title":"Hemorrhagic Shock & Resuscitation","pageTitle":"Trauma Surgery","pageUrl":"/scribe-guides/trauma-surgery","url":"/scribe-guides/trauma-surgery#s5","snippet":"Hemorrhagic Shock & Resuscitation Hemorrhage is the leading cause of preventable death after trauma. The ATLS classification of hemorrhagic shock is based on estimated blood loss and physiologic parameters. Figure 4 - Physiological Classification of Hemorrhagic Shock. Summary of the classification p...","sourceLabel":"Section in Trauma Surgery"},"3403":{"title":"Damage Control Surgery & Resuscitation","pageTitle":"Trauma Surgery","pageUrl":"/scribe-guides/trauma-surgery","url":"/scribe-guides/trauma-surgery#s6","snippet":"Damage Control Surgery & Resuscitation Damage control surgery (DCS) is an abbreviated operative approach for the physiologically compromised trauma patient. Instead of completing a definitive repair, the surgeon controls hemorrhage and contamination, leaves the abdomen open, and returns the patient ...","sourceLabel":"Section in Trauma Surgery"},"3404":{"title":"Traumatic Brain Injury (TBI)","pageTitle":"Trauma Surgery","pageUrl":"/scribe-guides/trauma-surgery","url":"/scribe-guides/trauma-surgery#s7","snippet":"Traumatic Brain Injury (TBI) TBI is the leading cause of trauma mortality in young adults. Severity is graded by initial GCS: mild TBI (13–15) , moderate TBI (9–12) , severe TBI (3–8) . The Brain Trauma Foundation severe TBI guidelines (4th edition) are the reference standard for ICU management. Fig...","sourceLabel":"Section in Trauma Surgery"},"3405":{"title":"Maxillofacial & Neck Trauma","pageTitle":"Trauma Surgery","pageUrl":"/scribe-guides/trauma-surgery","url":"/scribe-guides/trauma-surgery#s8","snippet":"Maxillofacial & Neck Trauma Le Fort Fractures Figure 11 - Le Fort Fracture Classification. Illustration of the three Le Fort fracture patterns: Type I (horizontal, separating the palate), Type II (pyramidal, through the nasion and infraorbital rim), and Type III (craniofacial disjunction through the...","sourceLabel":"Section in Trauma Surgery"},"3406":{"title":"Cervical & Spinal Cord Injury","pageTitle":"Trauma Surgery","pageUrl":"/scribe-guides/trauma-surgery","url":"/scribe-guides/trauma-surgery#s9","snippet":"Cervical & Spinal Cord Injury Cervical spine clearance uses validated decision rules. The NEXUS criteria allow clinical clearance if all five are met: no midline tenderness, no focal neurologic deficit, normal alertness, no intoxication, no distracting injury. The Canadian C-spine rule offers simila...","sourceLabel":"Section in Trauma Surgery"},"3407":{"title":"Thoracic Trauma","pageTitle":"Trauma Surgery","pageUrl":"/scribe-guides/trauma-surgery","url":"/scribe-guides/trauma-surgery#s10","snippet":"Thoracic Trauma Chest injuries account for approximately 25% of trauma deaths. Most are managed non-operatively; only ~10–15% require thoracotomy. The EAST rib fracture guidelines are the reference standard for blunt chest trauma. Figure 14 - Tension Pneumothorax on Chest Radiograph. Chest X-ray dem...","sourceLabel":"Section in Trauma Surgery"},"3408":{"title":"Abdominal Trauma","pageTitle":"Trauma Surgery","pageUrl":"/scribe-guides/trauma-surgery","url":"/scribe-guides/trauma-surgery#s11","snippet":"Abdominal Trauma Abdominal trauma is divided into blunt (MVC, fall, assault) and penetrating (GSW, stab). The approach differs radically. Figure 16 - FAST Examination Overview. Schematic showing the four standard views of the Focused Assessment with Sonography in Trauma: right upper quadrant (Morris...","sourceLabel":"Section in Trauma Surgery"},"3409":{"title":"Pelvic & Genitourinary Trauma","pageTitle":"Trauma Surgery","pageUrl":"/scribe-guides/trauma-surgery","url":"/scribe-guides/trauma-surgery#s12","snippet":"Pelvic & Genitourinary Trauma Pelvic fractures from high-energy blunt trauma are associated with significant mortality (5–20%), driven largely by retroperitoneal hemorrhage from the posterior venous plexus and small arterial branches. Two classification systems are used: Figure 19 - Young-Burgess Cl...","sourceLabel":"Section in Trauma Surgery"},"3410":{"title":"Vascular & Extremity Trauma","pageTitle":"Trauma Surgery","pageUrl":"/scribe-guides/trauma-surgery","url":"/scribe-guides/trauma-surgery#s13","snippet":"Vascular & Extremity Trauma Hard vs. Soft Signs of Vascular Injury Hard Signs (Go to OR) Pulsatile bleeding, expanding hematoma, palpable thrill, audible bruit, signs of distal ischemia (pulseless, pale, paresthetic, paralyzed, poikilothermic, painful — the 6 P's). Soft Signs (CTA / Observe) History...","sourceLabel":"Section in Trauma Surgery"},"3411":{"title":"Burns & Environmental Trauma","pageTitle":"Trauma Surgery","pageUrl":"/scribe-guides/trauma-surgery","url":"/scribe-guides/trauma-surgery#s14","snippet":"Burns & Environmental Trauma TBSA and Depth Figure 22 - Rule of Nines for Burn TBSA Estimation. The Wallace Rule of Nines divides the adult body into regions representing 9% (or multiples of 9%) of total body surface area: head/neck 9%, each arm 9%, anterior trunk 18%, posterior trunk 18%, each leg ...","sourceLabel":"Section in Trauma Surgery"},"3412":{"title":"Special Populations","pageTitle":"Trauma Surgery","pageUrl":"/scribe-guides/trauma-surgery","url":"/scribe-guides/trauma-surgery#s15","snippet":"Special Populations Pediatric Trauma Children have unique physiology: larger head relative to body (higher TBI risk), more compliant chest wall (pulmonary contusion without rib fracture), and maintained BP until late (tachycardia is the earliest sign of shock). Use weight-based resuscitation (20 mL/...","sourceLabel":"Section in Trauma Surgery"},"3413":{"title":"Trauma Procedures — A to Z","pageTitle":"Trauma Surgery","pageUrl":"/scribe-guides/trauma-surgery","url":"/scribe-guides/trauma-surgery#s16","snippet":"Trauma Procedures — A to Z Procedures that a trauma scribe will see and document. Each procedure note follows a standard template: indication, consent (emergent or obtained), time-out, prep/drape, anesthesia, position, technique, findings, estimated blood loss, complications, disposition. Figure 23 ...","sourceLabel":"Section in Trauma Surgery"},"3414":{"title":"Trauma Imaging & Diagnostics","pageTitle":"Trauma Surgery","pageUrl":"/scribe-guides/trauma-surgery","url":"/scribe-guides/trauma-surgery#s17","snippet":"Trauma Imaging & Diagnostics Plain radiographs: The \"trauma series\" traditionally includes chest, pelvis, and lateral C-spine X-rays during the primary survey. In modern Level 1 centers, portable chest and pelvis are obtained while CT is prepared. Figure 24 - Positive eFAST: Right Upper Quadrant Vie...","sourceLabel":"Section in Trauma Surgery"},"3415":{"title":"Medications You Must Know","pageTitle":"Trauma Surgery","pageUrl":"/scribe-guides/trauma-surgery","url":"/scribe-guides/trauma-surgery#s18","snippet":"Medications You Must Know Drug Class Use Notes Tranexamic acid (TXA) Antifibrinolytic Bleeding trauma within 3 h 1 g IV load, 1 g over 8 h (CRASH-2/3) 4-factor PCC (Kcentra) Coagulation factor concentrate Warfarin/DOAC reversal 25–50 U/kg Fresh frozen plasma (FFP) Plasma product MTP, coagulopathy 1:...","sourceLabel":"Section in Trauma Surgery"},"3416":{"title":"Classification & Scoring Systems","pageTitle":"Trauma Surgery","pageUrl":"/scribe-guides/trauma-surgery","url":"/scribe-guides/trauma-surgery#s19","snippet":"Classification & Scoring Systems Glasgow Coma Scale (GCS) Component Response Score Eye (E) Spontaneous 4 To voice 3 To pain 2 None 1 Verbal (V) Oriented 5 Confused 4 Inappropriate words 3 Incomprehensible sounds 2 None 1 Motor (M) Obeys commands 6 Localizes pain 5 Withdraws from pain 4 Abnormal flex...","sourceLabel":"Section in Trauma Surgery"},"3417":{"title":"Physical Exam — The Trauma Exam","pageTitle":"Trauma Surgery","pageUrl":"/scribe-guides/trauma-surgery","url":"/scribe-guides/trauma-surgery#s20","snippet":"Physical Exam — The Trauma Exam The trauma exam is a rapid, systematic, head-to-toe assessment, documented region by region. A scribe should memorize the structure so it can be typed while the surgeon dictates. Head-to-Toe Template General: A&Ox_ / sedated / intubated HEENT: Atraumatic / lacerations...","sourceLabel":"Section in Trauma Surgery"},"3418":{"title":"Abbreviations Master List","pageTitle":"Trauma Surgery","pageUrl":"/scribe-guides/trauma-surgery","url":"/scribe-guides/trauma-surgery#s21","snippet":"Abbreviations Master List Anatomy & Injury Patterns TBI Traumatic brain injury EDH Epidural hematoma SDH Subdural hematoma SAH Subarachnoid hemorrhage IPH / ICH Intraparenchymal / intracranial hemorrhage DAI Diffuse axonal injury BCVI Blunt cerebrovascular injury TAI Traumatic aortic injury PTX Pneu...","sourceLabel":"Section in Trauma Surgery"},"3419":{"title":"Sample HPI Templates","pageTitle":"Trauma Surgery","pageUrl":"/scribe-guides/trauma-surgery","url":"/scribe-guides/trauma-surgery#s22","snippet":"Sample HPI Templates These templates show the documentation rhythm expected in a trauma bay and on the trauma admit service. Each template uses realistic mechanism, timing, and injury patterns. Sample HPI — Level 1 Activation, High-Speed MVC \"Patient is a 34-year-old unrestrained male driver involve...","sourceLabel":"Section in Trauma Surgery"},"3420":{"title":"References & Sources","pageTitle":"Trauma Surgery","pageUrl":"/scribe-guides/trauma-surgery","url":"/scribe-guides/trauma-surgery#s23","snippet":"References & Sources Clinical Practice Guidelines American College of Surgeons. Advanced Trauma Life Support (ATLS) Student Course Manual, 10th Edition. 2018. CDC Guidelines for Field Triage of Injured Patients. MMWR. 2011 (updated 2021). ACS Committee on Trauma. Trauma Quality Improvement Program (...","sourceLabel":"Section in Trauma Surgery"},"3421":{"title":"Orthopedic Surgery","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery","snippet":"Orthopedic Surgery - Complete Reference Every musculoskeletal diagnosis, fracture, procedure, medication, classification system, and documentation framework you need to survive day one in ortho clinic, the OR, and the ED."},"3422":{"title":"Musculoskeletal Anatomy Essentials","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery#s1","snippet":"Musculoskeletal Anatomy Essentials Orthopedic surgery is the care of the musculoskeletal (MSK) system - bones, joints, ligaments, tendons, muscles, cartilage, menisci, peripheral nerves, and the spinal column. A scribe in ortho must be able to picture every major joint in three dimensions and know t...","sourceLabel":"Section in Orthopedic Surgery"},"3423":{"title":"Scribe Documentation Framework","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery#s2","snippet":"Scribe Documentation Framework Ortho-Specific HPI Elements An orthopedic HPI is anatomy-first and mechanism-driven. For every musculoskeletal complaint capture: laterality (right vs left vs bilateral, and hand dominance), mechanism of injury (MVC with restraint? fall from standing? twisting non-cont...","sourceLabel":"Section in Orthopedic Surgery"},"3424":{"title":"Osteoarthritis - Hip, Knee, Shoulder, Hand, Ankle","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery#s3","snippet":"Osteoarthritis - Hip, Knee, Shoulder, Hand, Ankle Osteoarthritis (OA) is the most common diagnosis in any general orthopedic clinic. It is a degenerative, wear-and-tear arthropathy characterized by progressive loss of articular hyaline cartilage, subchondral sclerosis, osteophyte formation, and subc...","sourceLabel":"Section in Orthopedic Surgery"},"3425":{"title":"Shoulder - Rotator Cuff, Impingement, AC Joint, Biceps","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery#s4","snippet":"Shoulder - Rotator Cuff, Impingement, AC Joint, Biceps Rotator Cuff Tears Rotator cuff tears are among the most common shoulder diagnoses. They are categorized as partial-thickness (articular-sided, bursal-sided, or intrasubstance) or full-thickness (complete communication through the tendon). Full-...","sourceLabel":"Section in Orthopedic Surgery"},"3426":{"title":"Shoulder Instability, Labral Tears & Frozen Shoulder","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery#s5","snippet":"Shoulder Instability, Labral Tears & Frozen Shoulder Glenohumeral Dislocation & Instability The glenohumeral joint is the most commonly dislocated joint in the body. Over 95% of dislocations are anterior, caused by an abducted and externally rotated arm receiving a force. Posterior dislocations are ...","sourceLabel":"Section in Orthopedic Surgery"},"3427":{"title":"Shoulder & Humerus Fractures","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery#s6","snippet":"Shoulder & Humerus Fractures Proximal Humerus Fractures Common in elderly osteoporotic patients after low-energy falls. Classified by the Neer classification based on displacement (>1 cm or >45&deg; angulation) of four segments: humeral head, greater tuberosity, lesser tuberosity, shaft. One-part (m...","sourceLabel":"Section in Orthopedic Surgery"},"3428":{"title":"Elbow - Epicondylitis, Tendon Ruptures, UCL, Fractures","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery#s7","snippet":"Elbow - Epicondylitis, Tendon Ruptures, UCL, Fractures Lateral Epicondylitis (\"Tennis Elbow\") Tendinosis of the extensor carpi radialis brevis origin at the lateral epicondyle. Overuse (not just tennis) in 35-55 year olds. Pain and tenderness at the lateral epicondyle, worse with resisted wrist exte...","sourceLabel":"Section in Orthopedic Surgery"},"3429":{"title":"Forearm, Wrist & Hand Fractures","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery#s8","snippet":"Forearm, Wrist & Hand Fractures Forearm Shaft Fractures \"Both-bone forearm\" fractures in adults require anatomic ORIF with compression plating because any malunion disrupts forearm rotation. Special named patterns: Monteggia (proximal ulnar shaft fracture with radial head dislocation), Galeazzi (dis...","sourceLabel":"Section in Orthopedic Surgery"},"3430":{"title":"Hand & Wrist Soft-Tissue Conditions","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery#s9","snippet":"Hand & Wrist Soft-Tissue Conditions Carpal Tunnel Syndrome Median nerve compression at the wrist under the transverse carpal ligament. Numbness and paresthesia in the thumb, index, middle, and radial half of the ring finger; worse at night; relieved by shaking the hand (\"flick sign\"). Thenar atrophy...","sourceLabel":"Section in Orthopedic Surgery"},"3431":{"title":"Spine - Disc Herniation, Stenosis, Cervical Disease","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery#s10","snippet":"Spine - Disc Herniation, Stenosis, Cervical Disease Lumbar Disc Herniation Nucleus pulposus herniates through a defect in the annulus fibrosus, compressing a nerve root. Most common at L4-L5 and L5-S1. Patients report acute low back pain radiating down the leg (sciatica) in a dermatomal distribution...","sourceLabel":"Section in Orthopedic Surgery"},"3432":{"title":"Hip & Femur Fractures","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery#s11","snippet":"Hip & Femur Fractures Hip Fractures Overview Hip fractures in the elderly are a major source of morbidity and mortality - 1-year mortality approaches 20-30%. Divided anatomically into: femoral neck (intracapsular), intertrochanteric (extracapsular), and subtrochanteric. Figure 13 - Garden Classifica...","sourceLabel":"Section in Orthopedic Surgery"},"3433":{"title":"Knee - Ligament & Meniscus Injuries, Patellar Disorders","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery#s12","snippet":"Knee - Ligament & Meniscus Injuries, Patellar Disorders ACL Tear Non-contact pivoting injury in an athlete. Audible \"pop,\" immediate swelling (hemarthrosis), giving way. Exam: positive Lachman (most sensitive), anterior drawer, pivot shift. MRI confirms. Treatment: PT with bracing for low-demand pat...","sourceLabel":"Section in Orthopedic Surgery"},"3434":{"title":"Tibia, Ankle & Foot Fractures","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery#s13","snippet":"Tibia, Ankle & Foot Fractures Patellar Fracture Direct blow or forceful eccentric quadriceps contraction. Inability to perform straight leg raise indicates extensor mechanism disruption. Nondisplaced: cylinder cast 4-6 weeks. Displaced or extensor lag: ORIF with tension-band wiring. Tibial Plateau F...","sourceLabel":"Section in Orthopedic Surgery"},"3435":{"title":"Foot & Ankle Soft-Tissue Conditions","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery#s14","snippet":"Foot & Ankle Soft-Tissue Conditions Achilles Tendon Rupture Middle-aged \"weekend warrior\" with sudden calf pain and \"pop\" during push-off. Positive Thompson test (squeezing the calf does not plantarflex the foot). Palpable gap. Treatment: functional bracing with progressive weight-bearing protocol O...","sourceLabel":"Section in Orthopedic Surgery"},"3436":{"title":"Infection, Tumor, Pediatric & Compartment Syndrome","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery#s15","snippet":"Infection, Tumor, Pediatric & Compartment Syndrome Septic Arthritis Acute joint pain, warmth, effusion, refusal to move, fever. Most common in knee and hip; Staph aureus is the #1 pathogen. Urgent arthrocentesis: synovial WBC typically >50,000 with >75% PMN. Treatment is emergent surgical washout (a...","sourceLabel":"Section in Orthopedic Surgery"},"3437":{"title":"Orthopedic Procedures A-Z","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery#s16","snippet":"Orthopedic Procedures A-Z Arthroplasty (Joint Replacement) Total Hip Arthroplasty (THA): Replacement of femoral head with metal/ceramic ball on a stem, and acetabulum with a polyethylene-lined metal cup. Approaches: direct anterior (Hueter interval, muscle-sparing, lower dislocation rate), posterior...","sourceLabel":"Section in Orthopedic Surgery"},"3438":{"title":"Post-Op Care & Complications","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery#s17","snippet":"Post-Op Care & Complications Standard Post-Op Course For every post-op visit you must document: POD number , wound status (incision clean/dry/intact, erythema, drainage, dehiscence), surgical site pain, sensation and motor function distal to surgery, pulses/perfusion, ROM achieved, WB status progres...","sourceLabel":"Section in Orthopedic Surgery"},"3439":{"title":"Imaging & Diagnostics","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery#s18","snippet":"Imaging & Diagnostics Plain Radiographs The workhorse of orthopedics. Always order at least two orthogonal views (AP and lateral) - \"one view is no view.\" For joints, add obliques; for hips, add pelvis AP and frog-leg lateral; for knees, add weight-bearing PA flexion (Rosenberg) view and sunrise/mer...","sourceLabel":"Section in Orthopedic Surgery"},"3440":{"title":"Medications You Must Know","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery#s19","snippet":"Medications You Must Know Drug Brand Class / Mechanism Use Notes Acetaminophen Tylenol Analgesic First-line OA pain Max 3 g/day; caution in liver disease Ibuprofen Motrin, Advil NSAID (COX-1/2) OA, tendonitis, post-op GI, renal, CV risk Naproxen Aleve NSAID OA, musculoskeletal pain Lowest CV risk of...","sourceLabel":"Section in Orthopedic Surgery"},"3441":{"title":"Classification Systems","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery#s20","snippet":"Classification Systems Orthopedics is obsessed with classification systems because they dictate treatment. Memorize these - they will appear in nearly every surgeon's dictation. The most important systems are enumerated within their respective condition sections above; this section is a consolidated...","sourceLabel":"Section in Orthopedic Surgery"},"3442":{"title":"Physical Exam - The Ortho Exam","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery#s21","snippet":"Physical Exam - The Ortho Exam The orthopedic exam is joint-specific. You will memorize the sequence for each joint and chart it almost verbatim. Below are the must-know special tests by joint. Joint-Specific Special Tests Shoulder: Neer, Hawkins-Kennedy (impingement); Jobe/empty can (supraspinatus)...","sourceLabel":"Section in Orthopedic Surgery"},"3443":{"title":"Abbreviations Master List","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery#s22","snippet":"Abbreviations Master List Anatomy & Joints GH Glenohumeral AC Acromioclavicular SC Sternoclavicular RC Rotator cuff LHB Long head of biceps UCL Ulnar collateral ligament LCL Lateral collateral ligament (elbow or knee) MCL Medial collateral ligament ACL Anterior cruciate ligament PCL Posterior crucia...","sourceLabel":"Section in Orthopedic Surgery"},"3444":{"title":"Sample HPI Templates","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery#s23","snippet":"Sample HPI Templates These templates show the rhythm and content of a real orthopedic HPI. Pattern-match off them during your first week. Sample HPI - Knee OA for TKA Evaluation \"Mr. [Name] is a 67-year-old right-hand-dominant male with BMI 31, HTN, and type 2 DM (A1C 6.9) presenting for evaluation ...","sourceLabel":"Section in Orthopedic Surgery"},"3445":{"title":"References & Sources","pageTitle":"Orthopedic Surgery","pageUrl":"/scribe-guides/orthopedic-surgery","url":"/scribe-guides/orthopedic-surgery#s24","snippet":"References & Sources Clinical Practice Guidelines AAOS. Management of Osteoarthritis of the Knee (Non-Arthroplasty), 3rd Edition. J Am Acad Orthop Surg. 2022. Kolasinski SL, et al. 2019 ACR/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Rheu...","sourceLabel":"Section in Orthopedic Surgery"},"3446":{"title":"Neurosurgery","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery","snippet":"Neurosurgery - Complete Reference Every diagnosis, procedure, medication, classification, and documentation framework a neurosurgery scribe needs to function from day one in clinic, OR, and ICU."},"3447":{"title":"Neuroanatomy Essentials","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s1","snippet":"Neuroanatomy Essentials Neurosurgery covers the entire central nervous system - brain, spinal cord, meninges, ventricular system - plus the peripheral nerves and the bony, vascular, and CSF compartments that surround them. You do not need to memorize a medical school neuroanatomy textbook, but you d...","sourceLabel":"Section in Neurosurgery"},"3448":{"title":"Scribe Documentation Framework","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s2","snippet":"Scribe Documentation Framework Neurosurgery encounters span clinic consults, pre-op evaluations, inpatient progress notes, ICU notes on EVD/ICP patients, emergency consults for TBI or SAH, and post-op follow-ups. The note format shifts with the venue, but the content backbone is consistent. Subjecti...","sourceLabel":"Section in Neurosurgery"},"3449":{"title":"Traumatic Brain Injury (TBI)","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s3","snippet":"Traumatic Brain Injury (TBI) TBI is one of the most common reasons neurosurgery is consulted in any hospital. Scribes are expected to document the mechanism, initial GCS, pupil exam, imaging findings, and the neurosurgical disposition (observation, ICU, OR) with precision. Severity is graded by init...","sourceLabel":"Section in Neurosurgery"},"3450":{"title":"Intracranial Pressure, Edema & Herniation","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s4","snippet":"Intracranial Pressure, Edema & Herniation The skull is a closed box. Any increase in the volume of brain, blood, or CSF must be offset by a decrease in another compartment ( Monro-Kellie doctrine ) or ICP will rise. Normal adult ICP is 7-15 mmHg. Sustained ICP >22 mmHg in severe TBI is associated wi...","sourceLabel":"Section in Neurosurgery"},"3451":{"title":"Subarachnoid Hemorrhage & Cerebral Aneurysms","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s5","snippet":"Subarachnoid Hemorrhage & Cerebral Aneurysms Nontraumatic SAH is most commonly caused by rupture of a saccular (berry) aneurysm at the circle of Willis. Classic presentation: sudden onset \"worst headache of life\" (thunderclap headache), meningismus, photophobia, possible LOC. Mortality approaches 30...","sourceLabel":"Section in Neurosurgery"},"3452":{"title":"Vascular Malformations","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s6","snippet":"Vascular Malformations Arteriovenous Malformation (AVM) Abnormal tangle (nidus) of vessels in which arteries connect directly to veins without an intervening capillary bed. Presentation: hemorrhage (most common), seizure, headache, or focal deficit. Graded by Spetzler-Martin scale (size, eloquence, ...","sourceLabel":"Section in Neurosurgery"},"3453":{"title":"ICH & Surgical Ischemic Stroke","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s7","snippet":"ICH & Surgical Ischemic Stroke Spontaneous Intracerebral Hemorrhage Most commonly from hypertensive vasculopathy (deep locations: basal ganglia, thalamus, pons, cerebellum) or cerebral amyloid angiopathy (lobar locations in the elderly). Other causes: AVM, tumor, coagulopathy, drug use. Document loc...","sourceLabel":"Section in Neurosurgery"},"3454":{"title":"Hydrocephalus & Shunt Management","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s8","snippet":"Hydrocephalus & Shunt Management Hydrocephalus is an abnormal accumulation of CSF in the ventricles. Three broad categories: communicating (CSF flows freely out of the ventricles but is not reabsorbed, e.g. post-SAH), non-communicating (obstructive) (blockage within the ventricular system, e.g. aque...","sourceLabel":"Section in Neurosurgery"},"3455":{"title":"Brain Tumors","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s9","snippet":"Brain Tumors Brain tumors are classified as primary (arising from brain tissue) or metastatic (from extracranial cancer). The WHO Classification of Tumors of the CNS, 5th edition (2021) and NCCN Guidelines for CNS Cancers are the reference standards. Figure 15 - Glioblastoma on MRI. Axial T1-weighte...","sourceLabel":"Section in Neurosurgery"},"3456":{"title":"Pituitary & Sellar Lesions","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s10","snippet":"Pituitary & Sellar Lesions Pituitary adenomas are classified by size ( microadenoma <10 mm, macroadenoma &ge;10 mm) and by hormone secretion (prolactinoma, GH-secreting causing acromegaly, ACTH-secreting causing Cushing disease, TSH-secreting, gonadotroph, nonfunctioning). Presentation: visual field...","sourceLabel":"Section in Neurosurgery"},"3457":{"title":"Functional & Epilepsy Neurosurgery","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s11","snippet":"Functional & Epilepsy Neurosurgery Deep Brain Stimulation (DBS) Implanted electrodes in deep nuclei connected to a pulse generator. Indications: medically refractory Parkinson disease (STN or GPi), essential tremor (VIM thalamus), dystonia (GPi), and selectively OCD and treatment-resistant depressio...","sourceLabel":"Section in Neurosurgery"},"3458":{"title":"Cranial Nerve & Skull Base Disorders","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s12","snippet":"Cranial Nerve & Skull Base Disorders Skull base surgery is a technically demanding subspecialty targeting lesions at the base of the brain adjacent to critical neurovascular structures. Tumors include meningiomas (sphenoid wing, olfactory groove, petroclival, tuberculum sellae), schwannomas (trigemi...","sourceLabel":"Section in Neurosurgery"},"3459":{"title":"CNS Infections","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s13","snippet":"CNS Infections Brain abscess: Focal collection of pus within the brain parenchyma. Routes: hematogenous (endocarditis, pulmonary), contiguous (sinusitis, otitis, dental), direct inoculation (trauma, surgery). MRI with contrast shows a ring-enhancing lesion with restricted diffusion centrally (a usef...","sourceLabel":"Section in Neurosurgery"},"3460":{"title":"Degenerative Cervical Spine","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s14","snippet":"Degenerative Cervical Spine Cervical disc herniation: Nucleus pulposus herniates laterally or centrally, compressing a nerve root or the cord. Lateral herniation causes radiculopathy in a dermatomal pattern (C5: shoulder/deltoid weakness; C6: biceps, radial forearm, thumb; C7: triceps, middle finger...","sourceLabel":"Section in Neurosurgery"},"3461":{"title":"Degenerative Thoracolumbar Spine","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s15","snippet":"Degenerative Thoracolumbar Spine Lumbar disc herniation: The classic cause of sciatica. A paracentral L4-L5 herniation typically affects the L5 root (foot drop, dorsiflexion weakness, lateral leg and dorsum of foot sensory loss), and an L5-S1 herniation affects the S1 root (plantarflexion weakness, ...","sourceLabel":"Section in Neurosurgery"},"3462":{"title":"Spinal Deformity","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s16","snippet":"Spinal Deformity Scoliosis: Three-dimensional deformity of the spine with lateral curvature (Cobb angle >10&deg;) and rotation. Adolescent idiopathic scoliosis is most common in pediatrics. Surgery (posterior spinal fusion with pedicle screw instrumentation) is indicated for curves >40-50&deg; in sk...","sourceLabel":"Section in Neurosurgery"},"3463":{"title":"Spinal Trauma & SCI","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s17","snippet":"Spinal Trauma & SCI Spinal trauma is classified by level (cervical, thoracic, thoracolumbar, lumbar) and by fracture pattern. The AO Spine classification categorizes injuries as A (compression), B (distraction), or C (translation), with modifiers for neurologic status. Unstable injuries require stab...","sourceLabel":"Section in Neurosurgery"},"3464":{"title":"Spinal Tumors & Vascular Lesions","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s18","snippet":"Spinal Tumors & Vascular Lesions Spinal tumors are classified by compartment: extradural (~60%, mostly metastases from lung, breast, prostate, renal, and myeloma), intradural-extramedullary (meningioma, schwannoma, neurofibroma), and intramedullary (ependymoma, astrocytoma, hemangioblastoma). Presen...","sourceLabel":"Section in Neurosurgery"},"3465":{"title":"Peripheral Nerve Surgery","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s19","snippet":"Peripheral Nerve Surgery Carpal tunnel syndrome: Median nerve compression at the wrist. Numbness and tingling in the thumb, index, middle, and radial half of the ring finger; nocturnal paresthesias; thenar atrophy in severe cases. Positive Tinel and Phalen tests. Confirmed by EMG/NCS. Treatment: spl...","sourceLabel":"Section in Neurosurgery"},"3466":{"title":"Neurosurgical Procedures - A to Z","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s20","snippet":"Neurosurgical Procedures - A to Z Procedure What it is Typical indication Craniotomy Removal and replacement of a bone flap to access the brain Tumor, aneurysm, SDH/EDH, AVM, abscess Decompressive craniectomy Craniotomy in which the bone flap is not replaced Refractory ICP, malignant MCA infarct Bur...","sourceLabel":"Section in Neurosurgery"},"3467":{"title":"Neuroimaging & Diagnostics","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s21","snippet":"Neuroimaging & Diagnostics Noncontrast CT head: First-line for acute trauma and suspected intracranial hemorrhage. Acute blood is hyperdense (~60-80 HU). Document midline shift in mm, ventricular size, cisternal effacement, and any mass effect. CT angiography (CTA): Demonstrates vascular anatomy, an...","sourceLabel":"Section in Neurosurgery"},"3468":{"title":"Medications You Must Know","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s22","snippet":"Medications You Must Know Drug Class / Use Key notes Mannitol Osmotic diuretic for elevated ICP 0.25-1 g/kg IV; watch serum osm (<320), Na, renal function Hypertonic saline 3% / 23.4% Osmotherapy for ICP / edema 23.4% is a bolus via central line; 3% by infusion. Target Na 145-155. Nimodipine CCB for...","sourceLabel":"Section in Neurosurgery"},"3469":{"title":"Classification Systems","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s23","snippet":"Classification Systems Glasgow Coma Scale (GCS, 3-15) Component Score Criteria Eye (E, 1-4) 4 Spontaneous 3 To voice 2 To pain 1 None Verbal (V, 1-5) 5 Oriented 4 Confused conversation 3 Inappropriate words 2 Incomprehensible sounds 1 None Motor (M, 1-6) 6 Obeys commands 5 Localizes pain 4 Withdraws...","sourceLabel":"Section in Neurosurgery"},"3470":{"title":"Physical & Neurologic Exam","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s24","snippet":"Physical & Neurologic Exam The neurologic exam is the core physical exam of neurosurgery and must be documented at every encounter. It is organized by system and graded with objective scales. Standard Neuro Exam Template MS: A&Ox3, fluent speech, follows commands CN: II PERRL 3&rarr;2 mm, visual fie...","sourceLabel":"Section in Neurosurgery"},"3471":{"title":"Abbreviations Master List","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s25","snippet":"Abbreviations Master List Anatomy & Diagnoses ACA / MCA / PCA Anterior / middle / posterior cerebral artery ACom / PCom Anterior / posterior communicating artery ICA / ECA / CCA Internal / external / common carotid artery PICA / AICA / SCA Posterior / anterior inferior / superior cerebellar artery C...","sourceLabel":"Section in Neurosurgery"},"3472":{"title":"Sample HPI Templates","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s26","snippet":"Sample HPI Templates Sample HPI - TBI / Subdural Hematoma \"Mr. [Name] is a 78-year-old male on apixaban for atrial fibrillation who presents after an unwitnessed fall at home. He was found confused by his wife approximately 2 hours ago. EMS documented GCS 13 (E3 V4 M6) in the field, improving to 14 ...","sourceLabel":"Section in Neurosurgery"},"3473":{"title":"References & Sources","pageTitle":"Neurosurgery","pageUrl":"/scribe-guides/neurosurgery","url":"/scribe-guides/neurosurgery#s27","snippet":"References & Sources Clinical Practice Guidelines Carney N, et al. Brain Trauma Foundation Guidelines for the Management of Severe Traumatic Brain Injury, 4th Edition. Neurosurgery. 2017. Hawryluk GWJ, et al. Seattle International Severe TBI Consensus Conference (SIBICC) Tier-Based Algorithm. Intens...","sourceLabel":"Section in Neurosurgery"},"3474":{"title":"Vascular Surgery","pageTitle":"Vascular Surgery","pageUrl":"/scribe-guides/vascular-surgery","url":"/scribe-guides/vascular-surgery","snippet":"Vascular Surgery - Complete Reference Every diagnosis, condition, procedure, medication, abbreviation, and documentation framework you need to succeed on day one and beyond."},"3475":{"title":"The Vascular System — Anatomy Essentials","pageTitle":"Vascular Surgery","pageUrl":"/scribe-guides/vascular-surgery","url":"/scribe-guides/vascular-surgery#s1","snippet":"The Vascular System — Anatomy Essentials Vascular surgery covers every blood vessel in the body except the coronary arteries (managed by cardiothoracic/interventional cardiologists) and the intracranial vessels (managed by neurosurgeons). This means a vascular surgeon's domain includes the aorta in ...","sourceLabel":"Section in Vascular Surgery"},"3476":{"title":"Scribe Documentation Framework","pageTitle":"Vascular Surgery","pageUrl":"/scribe-guides/vascular-surgery","url":"/scribe-guides/vascular-surgery#s2","snippet":"Scribe Documentation Framework The SOAP Note in Vascular Surgery Many vascular surgery encounters are documented in a SOAP-style format. As a scribe, you are writing the physician's note in real time, so understanding each section's purpose and what belongs where is essential. Subjective Chief Compl...","sourceLabel":"Section in Vascular Surgery"},"3477":{"title":"Peripheral Arterial Disease (PAD)","pageTitle":"Vascular Surgery","pageUrl":"/scribe-guides/vascular-surgery","url":"/scribe-guides/vascular-surgery#s3","snippet":"Peripheral Arterial Disease (PAD) PAD is the single most common diagnosis in vascular surgery. It refers to atherosclerotic narrowing or occlusion of the arteries supplying the extremities, overwhelmingly affecting the lower limbs. PAD is a systemic manifestation of atherosclerosis — patients with P...","sourceLabel":"Section in Vascular Surgery"},"3478":{"title":"Carotid Artery Disease & Cerebrovascular","pageTitle":"Vascular Surgery","pageUrl":"/scribe-guides/vascular-surgery","url":"/scribe-guides/vascular-surgery#s4","snippet":"Carotid Artery Disease & Cerebrovascular Carotid artery disease is a common vascular diagnosis. Atherosclerotic plaque builds up at the carotid bifurcation, narrowing the internal carotid artery (ICA). This is dangerous because plaque can rupture and send emboli to the brain, causing a stroke or tra...","sourceLabel":"Section in Vascular Surgery"},"3479":{"title":"Aortic Aneurysms (AAA & TAA)","pageTitle":"Vascular Surgery","pageUrl":"/scribe-guides/vascular-surgery","url":"/scribe-guides/vascular-surgery#s5","snippet":"Aortic Aneurysms (AAA & TAA) An aneurysm is an abnormal dilation of a blood vessel to greater than 1.5 times its normal diameter. For the infrarenal abdominal aorta, the normal diameter is approximately 2.0 cm, so an abdominal aortic aneurysm (AAA) is defined as a diameter ≥ 3.0 cm. Aneurysms are da...","sourceLabel":"Section in Vascular Surgery"},"3480":{"title":"Aortic Dissection & Acute Aortic Syndromes","pageTitle":"Vascular Surgery","pageUrl":"/scribe-guides/vascular-surgery","url":"/scribe-guides/vascular-surgery#s6","snippet":"Aortic Dissection & Acute Aortic Syndromes The 2022 ACC/AHA aortic guideline is the best single reference for acute aortic syndrome terminology, while INSTEAD-XL is the trial most often cited when TEVAR is discussed in subacute or chronic uncomplicated type B disease. Aortic dissection is a tear in ...","sourceLabel":"Section in Vascular Surgery"},"3481":{"title":"Acute Limb Ischemia (ALI)","pageTitle":"Vascular Surgery","pageUrl":"/scribe-guides/vascular-surgery","url":"/scribe-guides/vascular-surgery#s7","snippet":"Acute Limb Ischemia (ALI) ALI is a surgical emergency defined as a sudden decrease in limb perfusion that threatens limb viability, typically occurring within 14 days. The classic teaching mnemonic is the 6 P's : Pain, Pallor, Pulselessness, Poikilothermia (cold), Paresthesia, and Paralysis. The las...","sourceLabel":"Section in Vascular Surgery"},"3482":{"title":"Chronic Limb-Threatening Ischemia (CLTI)","pageTitle":"Vascular Surgery","pageUrl":"/scribe-guides/vascular-surgery","url":"/scribe-guides/vascular-surgery#s8","snippet":"Chronic Limb-Threatening Ischemia (CLTI) The modern WIfI, GLASS, and PLAN language in this section comes from the SVS Global Vascular Guidelines on CLTI . CLTI is the advanced stage of PAD, defined by the presence of ischemic rest pain, non-healing ischemic ulceration, or gangrene for > 2 weeks. Thi...","sourceLabel":"Section in Vascular Surgery"},"3483":{"title":"Deep Vein Thrombosis (DVT)","pageTitle":"Vascular Surgery","pageUrl":"/scribe-guides/vascular-surgery","url":"/scribe-guides/vascular-surgery#s9","snippet":"Deep Vein Thrombosis (DVT) DVT is the formation of a blood clot within a deep vein, most commonly in the lower extremities (femoral, popliteal, iliac veins). The pathogenesis is described by Virchow's triad : venous stasis (immobilization, prolonged travel, heart failure), endothelial injury (surger...","sourceLabel":"Section in Vascular Surgery"},"3484":{"title":"Chronic Venous Insufficiency (CVI)","pageTitle":"Vascular Surgery","pageUrl":"/scribe-guides/vascular-surgery","url":"/scribe-guides/vascular-surgery#s10","snippet":"Chronic Venous Insufficiency (CVI) CVI results from incompetent (leaky) venous valves, leading to sustained venous hypertension in the lower extremities. The most common cause is prior DVT (post-thrombotic syndrome), followed by primary valvular incompetence. Venous blood pools in the legs, causing ...","sourceLabel":"Section in Vascular Surgery"},"3485":{"title":"Varicose Veins & Superficial Venous Disease","pageTitle":"Vascular Surgery","pageUrl":"/scribe-guides/vascular-surgery","url":"/scribe-guides/vascular-surgery#s11","snippet":"Varicose Veins & Superficial Venous Disease Varicose veins are dilated, tortuous superficial veins ≥ 3 mm in diameter, resulting from incompetent valves in the superficial venous system (usually the GSV or SSV). While often considered a cosmetic concern, varicose veins can cause significant symptoms...","sourceLabel":"Section in Vascular Surgery"},"3486":{"title":"Dialysis Access (AVF, AVG, CVC)","pageTitle":"Vascular Surgery","pageUrl":"/scribe-guides/vascular-surgery","url":"/scribe-guides/vascular-surgery#s12","snippet":"Dialysis Access (AVF, AVG, CVC) KDOQI 2019 vascular access guidance is the key reference for access preference, maturation targets, and how fistulas, grafts, and catheters are prioritized. Vascular surgeons create and maintain vascular access for hemodialysis in patients with end-stage renal disease...","sourceLabel":"Section in Vascular Surgery"},"3487":{"title":"Mesenteric & Renal Artery Disease","pageTitle":"Vascular Surgery","pageUrl":"/scribe-guides/vascular-surgery","url":"/scribe-guides/vascular-surgery#s13","snippet":"Mesenteric & Renal Artery Disease Mesenteric Ischemia Acute mesenteric ischemia (AMI) is a surgical emergency with mortality rates of 60–80%. Causes include superior mesenteric artery (SMA) embolism (most common, often from a cardiac source), SMA thrombosis (on pre-existing atherosclerotic disease),...","sourceLabel":"Section in Vascular Surgery"},"3488":{"title":"Thoracic Outlet Syndrome (TOS)","pageTitle":"Vascular Surgery","pageUrl":"/scribe-guides/vascular-surgery","url":"/scribe-guides/vascular-surgery#s14","snippet":"Thoracic Outlet Syndrome (TOS) TOS encompasses a group of disorders caused by compression of the neurovascular bundle (brachial plexus, subclavian artery, subclavian vein) as it passes through the thoracic outlet — the space between the clavicle, first rib, and scalene muscles. TOS is classified int...","sourceLabel":"Section in Vascular Surgery"},"3489":{"title":"Diabetic Foot & Wound Care","pageTitle":"Vascular Surgery","pageUrl":"/scribe-guides/vascular-surgery","url":"/scribe-guides/vascular-surgery#s15","snippet":"Diabetic Foot & Wound Care IWGDF/IDSA diabetic foot infection guidance is the best citation for multidisciplinary wound assessment, infection severity, and when surgical source control is required. Diabetic foot disease is an enormous part of vascular surgery practice. Diabetes causes both macrovasc...","sourceLabel":"Section in Vascular Surgery"},"3490":{"title":"Lymphedema","pageTitle":"Vascular Surgery","pageUrl":"/scribe-guides/vascular-surgery","url":"/scribe-guides/vascular-surgery#s16","snippet":"Lymphedema Lymphedema is the accumulation of protein-rich interstitial fluid due to impaired lymphatic drainage. Primary lymphedema results from congenital malformation of the lymphatic system (lymphedema praecox presents before age 35, lymphedema tarda presents after 35). Secondary lymphedema is fa...","sourceLabel":"Section in Vascular Surgery"},"3491":{"title":"Vascular Procedures — A to Z","pageTitle":"Vascular Surgery","pageUrl":"/scribe-guides/vascular-surgery","url":"/scribe-guides/vascular-surgery#s17","snippet":"Vascular Procedures — A to Z Procedure What It Is When It's Used Angioplasty (PTA) Balloon dilation of a stenosed artery PAD, renal artery stenosis, venous stenosis Stenting Metal mesh scaffold placed to hold artery/vein open Iliac, SFA, carotid (CAS), venous (iliac, SVC) Atherectomy Removal of plaq...","sourceLabel":"Section in Vascular Surgery"},"3492":{"title":"Vascular Imaging & Diagnostics","pageTitle":"Vascular Surgery","pageUrl":"/scribe-guides/vascular-surgery","url":"/scribe-guides/vascular-surgery#s18","snippet":"Vascular Imaging & Diagnostics Modality What It Shows Key Notes for Scribes Ankle-Brachial Index (ABI) Ratio of ankle to arm blood pressure Document exact numbers bilaterally; note if exercise ABIs were done Toe-Brachial Index (TBI) Same as ABI but at the toe; avoids calcification artifact Used when...","sourceLabel":"Section in Vascular Surgery"},"3493":{"title":"Medications You Must Know","pageTitle":"Vascular Surgery","pageUrl":"/scribe-guides/vascular-surgery","url":"/scribe-guides/vascular-surgery#s19","snippet":"Medications You Must Know Antiplatelet Agents Drug Brand Mechanism Typical Use in Vasc Surg Key Notes Aspirin — Irreversible COX-1 inhibitor All PAD, post-CEA, post-stenting 81 mg or 325 mg daily; hold 7 days pre-op if needed Clopidogrel Plavix Irreversible P2Y12 (ADP) receptor blocker PAD, dual ant...","sourceLabel":"Section in Vascular Surgery"},"3494":{"title":"Classification Systems","pageTitle":"Vascular Surgery","pageUrl":"/scribe-guides/vascular-surgery","url":"/scribe-guides/vascular-surgery#s20","snippet":"Classification Systems Vascular surgery uses many classification systems. You do not need to memorize every detail, but you need to know what each system classifies and the basic stages. The most important ones: Classification What It Classifies Key Features Fontaine Chronic PAD severity 4 stages ba...","sourceLabel":"Section in Vascular Surgery"},"3495":{"title":"Abbreviations Master List","pageTitle":"Vascular Surgery","pageUrl":"/scribe-guides/vascular-surgery","url":"/scribe-guides/vascular-surgery#s21","snippet":"Abbreviations Master List You will hear and use these every single day. Know them cold. Anatomy & Vessels CCA Common carotid artery ICA Internal carotid artery ECA External carotid artery CFA Common femoral artery SFA Superficial femoral artery DFA Deep femoral artery (profunda femoris) AT Anterior ...","sourceLabel":"Section in Vascular Surgery"},"3496":{"title":"Physical Exam — The Vascular Exam","pageTitle":"Vascular Surgery","pageUrl":"/scribe-guides/vascular-surgery","url":"/scribe-guides/vascular-surgery#s22","snippet":"Physical Exam — The Vascular Exam The vascular physical exam is the most specialized part of documentation. The surgeon performs a focused exam every visit, and you need to capture it accurately and efficiently. Pulse Documentation Template Pulses are documented bilaterally and graded: 0 = absent, 1...","sourceLabel":"Section in Vascular Surgery"},"3497":{"title":"Risk Factors & Comorbidities","pageTitle":"Vascular Surgery","pageUrl":"/scribe-guides/vascular-surgery","url":"/scribe-guides/vascular-surgery#s23","snippet":"Risk Factors & Comorbidities Vascular disease does not exist in isolation. Almost every vascular patient has multiple comorbidities, and documenting them thoroughly is critical because they affect surgical risk, anesthetic choice, and long-term outcomes. Major Risk Factors — Document These on Every ...","sourceLabel":"Section in Vascular Surgery"},"3498":{"title":"Cardiothoracic Surgery","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery","snippet":"Cardiothoracic Surgery - Complete Reference Every diagnosis, condition, procedure, medication, abbreviation, and documentation framework you need to succeed on day one and beyond."},"3499":{"title":"Cardiothoracic Anatomy Essentials","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery#s1","snippet":"Cardiothoracic Anatomy Essentials Cardiothoracic surgery (CT surgery) covers the heart, great vessels, lungs, mediastinum, esophagus, chest wall, diaphragm, and pleural space. In most US centers, the field splits into adult cardiac (coronary, valvular, aortic root and arch, arrhythmia surgery, mecha...","sourceLabel":"Section in Cardiothoracic Surgery"},"3500":{"title":"Scribe Documentation Framework","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery#s2","snippet":"Scribe Documentation Framework Cardiothoracic surgery documentation straddles the operating room, the ICU, the stepdown floor, and the outpatient clinic. As a scribe, you will shift between pre-op clinic notes, post-op day notes, weaning and extubation notes, and discharge summaries. Each has its ow...","sourceLabel":"Section in Cardiothoracic Surgery"},"3501":{"title":"Coronary Artery Disease & CABG Indications","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery#s3","snippet":"Coronary Artery Disease & CABG Indications Coronary artery disease (CAD) is the most common reason patients enter a cardiac surgeon's clinic. Atherosclerotic plaque in the epicardial coronaries reduces myocardial perfusion, producing angina, infarction, ischemic cardiomyopathy, and sudden death. The...","sourceLabel":"Section in Cardiothoracic Surgery"},"3502":{"title":"Aortic Valve Disease (AS, AR)","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery#s4","snippet":"Aortic Valve Disease (AS, AR) Aortic Stenosis (AS) Aortic stenosis is narrowing of the aortic valve, most commonly from calcific degeneration in elderly patients, bicuspid aortic valve (BAV) in younger adults (presenting in the 50s-60s), or rheumatic disease . The classic triad is angina , syncope ,...","sourceLabel":"Section in Cardiothoracic Surgery"},"3503":{"title":"Mitral Valve Disease (MR, MS)","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery#s5","snippet":"Mitral Valve Disease (MR, MS) Mitral Regurgitation (MR) MR is divided into primary (degenerative) - a leaflet or chordal problem, most often myxomatous degeneration with prolapse (Barlow disease, fibroelastic deficiency) or flail leaflet from ruptured chordae - and secondary (functional) - a ventric...","sourceLabel":"Section in Cardiothoracic Surgery"},"3504":{"title":"Tricuspid & Pulmonic Valve Disease","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery#s6","snippet":"Tricuspid & Pulmonic Valve Disease Tricuspid regurgitation (TR) is most often functional, driven by RV dilation from left-sided disease, pulmonary hypertension, or atrial fibrillation with annular dilation. Primary causes include endocarditis (IVDU), carcinoid, Ebstein anomaly, and pacemaker lead im...","sourceLabel":"Section in Cardiothoracic Surgery"},"3505":{"title":"Infective Endocarditis (Surgical)","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery#s7","snippet":"Infective Endocarditis (Surgical) Infective endocarditis (IE) is infection of the endocardial surface, most commonly the valves, producing vegetations of fibrin, platelets, and organisms. The cardiac surgeon is consulted when medical therapy alone will not clear infection or when mechanical complica...","sourceLabel":"Section in Cardiothoracic Surgery"},"3506":{"title":"Thoracic Aortic Aneurysm & Dissection","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery#s8","snippet":"Thoracic Aortic Aneurysm & Dissection The thoracic aorta is divided into the root (sinuses of Valsalva, sinotubular junction), ascending aorta , arch , and descending thoracic aorta . Aneurysmal dilation (&ge; 1.5&times; normal) and acute dissection are the two dominant surgical diseases. Connective...","sourceLabel":"Section in Cardiothoracic Surgery"},"3507":{"title":"Atrial Fibrillation & Maze Procedure","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery#s9","snippet":"Atrial Fibrillation & Maze Procedure Atrial fibrillation (AF) is the most common arrhythmia and is managed surgically when a patient is undergoing another cardiac operation or rarely as a standalone procedure for refractory drug-failed AF. Most AF originates from ectopic foci near the pulmonary vein...","sourceLabel":"Section in Cardiothoracic Surgery"},"3508":{"title":"Heart Failure, LVAD & Transplant","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery#s10","snippet":"Heart Failure, LVAD & Transplant Advanced heart failure refractory to maximal medical therapy (INTERMACS profiles 1-4) is evaluated for mechanical circulatory support (MCS) and heart transplant . Cardiothoracic surgeons lead both programs. LVAD The left ventricular assist device (LVAD) is an implant...","sourceLabel":"Section in Cardiothoracic Surgery"},"3509":{"title":"Cardiac Tumors, Pericardial & Adult Congenital Disease","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery#s11","snippet":"Cardiac Tumors, Pericardial & Adult Congenital Disease Cardiac myxoma is the most common primary cardiac tumor, most often a pedunculated left atrial mass arising from the fossa ovalis. Patients present with embolic events, positional obstructive symptoms (classic \"tumor plop\"), and constitutional s...","sourceLabel":"Section in Cardiothoracic Surgery"},"3510":{"title":"Lung Cancer & Pulmonary Nodules","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery#s12","snippet":"Lung Cancer & Pulmonary Nodules Lung cancer is the leading cause of cancer death in the US and the dominant diagnosis on a general thoracic service. The pathologic split: non-small cell lung cancer (NSCLC, ~85%) - adenocarcinoma, squamous cell, large cell - and small cell lung cancer (SCLC, ~15%) , ...","sourceLabel":"Section in Cardiothoracic Surgery"},"3511":{"title":"Pleural Disease","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery#s13","snippet":"Pleural Disease Pleural effusion: Fluid in the pleural space, classified as transudative (heart failure, cirrhosis) or exudative (infection, malignancy, PE) by Light's criteria . Thoracic surgery is involved when drainage is required: thoracentesis (bedside), chest tube, indwelling pleural catheter ...","sourceLabel":"Section in Cardiothoracic Surgery"},"3512":{"title":"Esophageal Cancer & Benign Esophageal Disease","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery#s14","snippet":"Esophageal Cancer & Benign Esophageal Disease Esophageal Cancer Two dominant histologies: adenocarcinoma (distal esophagus and GEJ, associated with reflux and Barrett esophagus, rising in incidence in Western populations) and squamous cell carcinoma (proximal and mid esophagus, associated with smoki...","sourceLabel":"Section in Cardiothoracic Surgery"},"3513":{"title":"Mediastinal & Thymic Disease","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery#s15","snippet":"Mediastinal & Thymic Disease Mediastinal masses are classified by compartment. Anterior compartment masses dominate thoracic surgery referrals: the differential is the \"4 T's\" - thymoma , teratoma (and other germ cell tumors), thyroid (substernal goiter), and \" terrible lymphoma .\" Figure 21 - Thymo...","sourceLabel":"Section in Cardiothoracic Surgery"},"3514":{"title":"Chest Wall, Tracheal & Diaphragm Disease","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery#s16","snippet":"Chest Wall, Tracheal & Diaphragm Disease Pectus excavatum is a posterior displacement of the sternum producing a \"funnel chest.\" Severity is graded by the Haller index on CT (transverse chest diameter divided by sternum-to-vertebra distance); > 3.25 is considered severe. Repair options are the minim...","sourceLabel":"Section in Cardiothoracic Surgery"},"3515":{"title":"Cardiac Procedures A to Z","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery#s17","snippet":"Cardiac Procedures A to Z Figure 23 - Cabrol Root Replacement Technique. The Cabrol modification uses interposition grafts (Dacron tube) connecting the composite valve graft to the coronary ostia, used when coronary button mobilization is difficult (e.g., redo surgery, heavily calcified coronary but...","sourceLabel":"Section in Cardiothoracic Surgery"},"3516":{"title":"Thoracic Procedures A to Z","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery#s18","snippet":"Thoracic Procedures A to Z Figure 24 - Thoracoabdominal Aortic Aneurysm Repair Techniques. Schematic representation of open surgical repair for Crawford Extents I-V, demonstrating graft configurations with reimplantation of visceral and intercostal arteries. Procedure Description / Indication Poster...","sourceLabel":"Section in Cardiothoracic Surgery"},"3517":{"title":"Post-Operative ICU Care & Complications","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery#s19","snippet":"Post-Operative ICU Care & Complications Early Post-Cardiac Surgery Post-CABG/valve patients arrive in the CVICU intubated, with invasive monitoring (arterial line, central venous catheter, often PA catheter or continuous cardiac output device), mediastinal and pleural chest tubes , temporary epicard...","sourceLabel":"Section in Cardiothoracic Surgery"},"3518":{"title":"Imaging, Labs & Diagnostics","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery#s20","snippet":"Imaging, Labs & Diagnostics Cardiac Imaging & Studies Transthoracic echocardiography (TTE): First-line for valve disease, EF, chamber sizes, pericardial effusion. Document EF, valve gradients and areas, chamber dimensions, RVSP (estimated PA pressure). Transesophageal echo (TEE): Higher resolution f...","sourceLabel":"Section in Cardiothoracic Surgery"},"3519":{"title":"Medications You Must Know","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery#s21","snippet":"Medications You Must Know Intraoperative & Early Post-Op Drug Class / Use Notes Heparin (UFH) Anticoagulation for CPB Bolus 300-400 units/kg; target ACT > 400 sec Protamine Heparin reversal 1 mg per 100 units heparin; risk of hypotension / anaphylaxis Tranexamic acid (TXA) Antifibrinolytic Reduces b...","sourceLabel":"Section in Cardiothoracic Surgery"},"3520":{"title":"Classification Systems","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery#s22","snippet":"Classification Systems NYHA Functional Classification (Heart Failure) Class I: No limitation of activity; ordinary activity does not cause symptoms. Class II: Slight limitation; comfortable at rest, ordinary activity causes symptoms. Class III: Marked limitation; less than ordinary activity causes s...","sourceLabel":"Section in Cardiothoracic Surgery"},"3521":{"title":"Physical Exam & Abbreviations Master List","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery#s23","snippet":"Physical Exam & Abbreviations Master List The Cardiothoracic Physical Exam Pre-Op Cardiac Exam Template General: [NAD / ill-appearing], [A&O x3] Neck: JVP [cm above sternal angle]; carotid upstrokes [normal/delayed]; no bruits Chest: clear to auscultation bilaterally; no dullness, no egophony Cardia...","sourceLabel":"Section in Cardiothoracic Surgery"},"3522":{"title":"Sample HPI Templates & References","pageTitle":"Cardiothoracic Surgery","pageUrl":"/scribe-guides/cardiothoracic-surgery","url":"/scribe-guides/cardiothoracic-surgery#s24","snippet":"Sample HPI Templates & References These templates show the kind of documentation expected in a cardiothoracic clinic or consult. Use them as frameworks for the rhythm and content of a good CT HPI. Sample HPI - Pre-Op CABG Consult \"Mr. [Name] is a 67-year-old male with hypertension, hyperlipidemia, t...","sourceLabel":"Section in Cardiothoracic Surgery"},"3523":{"title":"Surgical Oncology","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology","snippet":"Surgical Oncology - Complete Reference Every cancer, operation, staging system, medication, abbreviation, and documentation framework you need to survive day one in surgical oncology clinic and the OR."},"3524":{"title":"Surgical Oncology - Principles & Anatomy Essentials","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology#s1","snippet":"Surgical Oncology - Principles & Anatomy Essentials Surgical oncology is the surgical subspecialty dedicated to the diagnosis, staging, and operative management of solid tumors. Unlike general surgery, the surgical oncologist works within a multidisciplinary team - medical oncology, radiation oncolo...","sourceLabel":"Section in Surgical Oncology"},"3525":{"title":"Multidisciplinary Cancer Care & Tumor Board","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology#s2","snippet":"Multidisciplinary Cancer Care & Tumor Board Nearly every cancer patient in a modern surgical oncology practice is reviewed at a multidisciplinary tumor board before, during, or after treatment. This is where the surgeon, medical oncologist, radiation oncologist, radiologist, pathologist, genetic cou...","sourceLabel":"Section in Surgical Oncology"},"3526":{"title":"Scribe Documentation Framework","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology#s3","snippet":"Scribe Documentation Framework The Oncology SOAP Note Surgical oncology notes are SOAP-structured but heavier on staging, prior-treatment history, and multidisciplinary planning than general surgery notes. Every new-patient HPI must capture: the tissue diagnosis (when, where, by whom), the histology...","sourceLabel":"Section in Surgical Oncology"},"3527":{"title":"Breast Cancer","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology#s4","snippet":"Breast Cancer Breast cancer is the most common visceral cancer in women and the bread-and-butter of most surgical oncology practices. The diagnosis arrives via screening mammogram, a palpable mass, nipple discharge, or skin change. Your job as a scribe is to capture histology, receptor status, stage...","sourceLabel":"Section in Surgical Oncology"},"3528":{"title":"Melanoma & Cutaneous Malignancy","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology#s5","snippet":"Melanoma & Cutaneous Malignancy Melanoma arises from cutaneous melanocytes and is the deadliest common skin cancer. Scribes will see new diagnoses referred from dermatology after punch or excisional biopsy, patients for wide local excision (WLE) with or without sentinel node biopsy, and surveillance...","sourceLabel":"Section in Surgical Oncology"},"3529":{"title":"Soft Tissue Sarcoma & GIST","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology#s6","snippet":"Soft Tissue Sarcoma & GIST Soft tissue sarcomas are a heterogeneous group of mesenchymal malignancies comprising < 1% of adult cancers but requiring specialized multidisciplinary care. Over 70 histologic subtypes exist - the most common are undifferentiated pleomorphic sarcoma (UPS), liposarcoma (we...","sourceLabel":"Section in Surgical Oncology"},"3530":{"title":"Gastric & Esophageal Cancer","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology#s7","snippet":"Gastric & Esophageal Cancer Gastric Cancer Most gastric adenocarcinomas present at locally advanced stage with epigastric pain, early satiety, weight loss, or iron-deficiency anemia. Endoscopy with biopsy establishes diagnosis; EUS stages depth (T) and regional nodes (N); CT and often staging laparo...","sourceLabel":"Section in Surgical Oncology"},"3531":{"title":"Pancreatic Cancer & Pancreatic NETs","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology#s8","snippet":"Pancreatic Cancer & Pancreatic NETs Pancreatic ductal adenocarcinoma (PDAC) is lethal: 5-year survival ~12% overall, with only ~20% of patients presenting with resectable disease. Scribes will document painless jaundice (head lesions), weight loss, new-onset diabetes, steatorrhea, and epigastric/bac...","sourceLabel":"Section in Surgical Oncology"},"3532":{"title":"Hepatobiliary Malignancies","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology#s9","snippet":"Hepatobiliary Malignancies Hepatocellular Carcinoma (HCC) HCC almost always arises in the setting of chronic liver disease - hepatitis B, hepatitis C, alcoholic cirrhosis, NAFLD/NASH, hemochromatosis. AFP is elevated in ~60%. Diagnosis is often made radiographically in a cirrhotic liver using LI-RAD...","sourceLabel":"Section in Surgical Oncology"},"3533":{"title":"Colorectal & Anal Cancer (Surgical Onc Overlap)","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology#s10","snippet":"Colorectal & Anal Cancer (Surgical Onc Overlap) Although most colorectal cancer is managed by colorectal surgery, surgical oncologists frequently participate in liver metastasectomy, recurrent/locally advanced cases, peritoneal disease, and hereditary syndromes. Key documentation elements: MSI/MMR s...","sourceLabel":"Section in Surgical Oncology"},"3534":{"title":"Peritoneal Carcinomatosis, CRS & HIPEC","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology#s11","snippet":"Peritoneal Carcinomatosis, CRS & HIPEC Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a defining surgical oncology intervention for peritoneal surface malignancies: appendiceal mucinous neoplasms / pseudomyxoma peritonei, peritoneal mesothelioma, selected color...","sourceLabel":"Section in Surgical Oncology"},"3535":{"title":"Endocrine Malignancy - Thyroid, Parathyroid, Adrenal","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology#s12","snippet":"Endocrine Malignancy - Thyroid, Parathyroid, Adrenal Thyroid Cancer Papillary (PTC, ~80%): Excellent prognosis; lymphatic spread. Treated by lobectomy or total thyroidectomy &plusmn; central neck dissection, RAI ablation for intermediate/high risk. Follicular (FTC, ~10%): Hematogenous spread (lung, ...","sourceLabel":"Section in Surgical Oncology"},"3536":{"title":"Neuroendocrine Tumors (Carcinoid & NETs)","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology#s13","snippet":"Neuroendocrine Tumors (Carcinoid & NETs) Neuroendocrine tumors arise from enterochromaffin cells throughout the GI tract, pancreas, and lung. Most are low-grade (Ki-67 < 3%, G1) or intermediate (3-20%, G2), with high-grade neuroendocrine carcinoma (G3) being an aggressive exception. The classic carc...","sourceLabel":"Section in Surgical Oncology"},"3537":{"title":"Oligometastatic Disease & Hereditary / Prophylactic Surgery","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology#s14","snippet":"Oligometastatic Disease & Hereditary / Prophylactic Surgery Oligometastatic disease - a small, potentially resectable number of metastases (classically &le; 5 lesions in &le; 2-3 organs) - is increasingly treated with curative intent. Colorectal and neuroendocrine liver metastases and sarcoma pulmon...","sourceLabel":"Section in Surgical Oncology"},"3538":{"title":"Surgical Oncology Procedures - A to Z","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology#s15","snippet":"Surgical Oncology Procedures - A to Z This table is the scribe's quick-reference for procedure names as they are spoken in clinic and the OR. Use it to correctly chart what was performed, proposed, or declined. Procedure What It Involves Primary Indication Lumpectomy / partial mastectomy Excision of...","sourceLabel":"Section in Surgical Oncology"},"3539":{"title":"Perioperative Oncology & Post-Op Complications","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology#s16","snippet":"Perioperative Oncology & Post-Op Complications Cancer patients present unique perioperative challenges: malnutrition, immunosuppression from chemotherapy, bone marrow suppression, deconditioning, and elevated thromboembolic risk. Enhanced Recovery After Surgery (ERAS) protocols are now standard for ...","sourceLabel":"Section in Surgical Oncology"},"3540":{"title":"Imaging, Staging & Pathology Reports","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology#s17","snippet":"Imaging, Staging & Pathology Reports Surgical oncology documentation is imaging- and pathology-heavy. Every note references report findings and measurements; scribes must transcribe verbatim numbers and impressions. Figure 22 - TNM T-Category Classification. Dendrogram illustrating the hierarchical ...","sourceLabel":"Section in Surgical Oncology"},"3541":{"title":"Medications You Must Know","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology#s18","snippet":"Medications You Must Know Surgical oncologists don't prescribe most chemotherapy themselves, but they must document what the patient has received and manage perioperative medications. Know these drugs by both generic and brand names. Perioperative Drug Class / Use Notes Cefazolin (Ancef) First-gen c...","sourceLabel":"Section in Surgical Oncology"},"3542":{"title":"Classification & Staging Systems (AJCC 8)","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology#s19","snippet":"Classification & Staging Systems (AJCC 8) All staging in the United States follows AJCC Cancer Staging Manual 8th Edition . The following tables enumerate the most important systems you will hear cited in surgical oncology clinic. Every cancer has its own T, N, and M definitions - below is the conce...","sourceLabel":"Section in Surgical Oncology"},"3543":{"title":"Physical Exam - The Surgical Oncology Exam","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology#s20","snippet":"Physical Exam - The Surgical Oncology Exam Surgical oncology exam is organ-directed but always includes a general oncologic survey: performance status observation, cachexia, jaundice, adenopathy (cervical, supraclavicular/Virchow, axillary, inguinal), liver edge, ascites, and palpable masses. Breast...","sourceLabel":"Section in Surgical Oncology"},"3544":{"title":"Risk Factors, Genetics & Comorbidities","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology#s21","snippet":"Risk Factors, Genetics & Comorbidities Cancer risk factor documentation is central to the surgical oncology HPI. Every patient's note should capture the following domains, because they drive screening, genetic referral, and treatment decisions. Core Documentation Categories Tobacco: Pack-years, curr...","sourceLabel":"Section in Surgical Oncology"},"3545":{"title":"Abbreviations Master List","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology#s22","snippet":"Abbreviations Master List Diseases & Histology DCIS Ductal carcinoma in situ LCIS Lobular carcinoma in situ IDC Invasive ductal carcinoma ILC Invasive lobular carcinoma TNBC Triple-negative breast cancer IBC Inflammatory breast cancer HCC Hepatocellular carcinoma CCA Cholangiocarcinoma PDAC Pancreat...","sourceLabel":"Section in Surgical Oncology"},"3546":{"title":"Sample HPI Templates","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology#s23","snippet":"Sample HPI Templates These templates read like real surgical oncology clinic notes. Use them as pattern templates during your first weeks. Sample HPI - New Breast Cancer Consult \"Ms. [Name] is a 54-year-old postmenopausal female with no prior oncologic history referred for newly diagnosed right brea...","sourceLabel":"Section in Surgical Oncology"},"3547":{"title":"References & Sources","pageTitle":"Surgical Oncology","pageUrl":"/scribe-guides/surgical-oncology","url":"/scribe-guides/surgical-oncology#s24","snippet":"References & Sources Clinical Practice Guidelines NCCN Clinical Practice Guidelines in Oncology (Version Category 1 panels). National Comprehensive Cancer Network. NCCN Breast Cancer Guideline. NCCN Cutaneous Melanoma Guideline. NCCN Soft Tissue Sarcoma Guideline. NCCN Gastric Cancer Guideline. NCCN...","sourceLabel":"Section in Surgical Oncology"},"3548":{"title":"Colorectal Surgery","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery","snippet":"Colorectal Surgery - Complete Reference Every diagnosis, procedure, medication, classification, and documentation framework you need to succeed as a colorectal surgery scribe from day one."},"3549":{"title":"Colorectal Anatomy Essentials","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery#s1","snippet":"Colorectal Anatomy Essentials Colorectal surgery encompasses the colon, rectum, anus, and pelvic floor, along with the small bowel when it overlaps with colorectal pathology. A scribe cannot chart effectively without a solid mental map of the large bowel, its vascular supply, and the anatomy of the ...","sourceLabel":"Section in Colorectal Surgery"},"3550":{"title":"Scribe Documentation Framework","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery#s2","snippet":"Scribe Documentation Framework Colorectal notes are structured around a few recurring encounter types: new consult for a colonoscopy finding (polyp, mass, bleeding), inflammatory bowel disease follow-up, diverticulitis presentation (clinic or ED), anorectal complaint, pre-op and post-op cancer clini...","sourceLabel":"Section in Colorectal Surgery"},"3551":{"title":"Colorectal Cancer","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery#s3","snippet":"Colorectal Cancer Colorectal cancer (CRC) is the third most common cancer in both sexes in the United States and the second leading cause of cancer death overall. It is the defining diagnosis of colorectal surgery clinic. CRC arises almost exclusively from the adenoma-carcinoma sequence or the serra...","sourceLabel":"Section in Colorectal Surgery"},"3552":{"title":"Polyps & Hereditary Polyposis Syndromes","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery#s4","snippet":"Polyps & Hereditary Polyposis Syndromes Most colorectal cancers begin as polyps, so polyp management and surveillance are central to colorectal practice. Polyps are classified histologically and by morphology (Paris classification: pedunculated, sessile, flat, depressed). Polyp Histology Type Malign...","sourceLabel":"Section in Colorectal Surgery"},"3553":{"title":"Inflammatory Bowel Disease (Surgical)","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery#s5","snippet":"Inflammatory Bowel Disease (Surgical) Ulcerative colitis (UC) and Crohn disease are the two major inflammatory bowel diseases. Colorectal surgeons see them when medical therapy fails, when dysplasia or cancer is found, or when complications develop (stricture, fistula, perforation, toxic megacolon)....","sourceLabel":"Section in Colorectal Surgery"},"3554":{"title":"Diverticular Disease","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery#s6","snippet":"Diverticular Disease Diverticula are mucosal outpouchings through the colonic wall at points of weakness where the vasa recta penetrate. They are overwhelmingly sigmoid in Western populations (high-pressure segment, narrow caliber, low-fiber diets). Diverticulosis is the presence of diverticula; div...","sourceLabel":"Section in Colorectal Surgery"},"3555":{"title":"Volvulus & Large Bowel Obstruction","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery#s7","snippet":"Volvulus & Large Bowel Obstruction Volvulus is rotation of a bowel loop around its mesenteric axis, producing obstruction and potentially ischemia. Sigmoid volvulus (most common, 60-75%) affects elderly, debilitated, institutionalized patients with chronic constipation. Classic imaging: \"coffee bean...","sourceLabel":"Section in Colorectal Surgery"},"3556":{"title":"Small Bowel Obstruction & Ileus","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery#s8","snippet":"Small Bowel Obstruction & Ileus Though technically general surgery territory, colorectal surgeons manage SBO in their post-op patients constantly. Causes of SBO in a colorectal patient: adhesions (far and away most common after any abdominal surgery), internal hernia, parastomal hernia, incisional h...","sourceLabel":"Section in Colorectal Surgery"},"3557":{"title":"Hemorrhoidal Disease","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery#s9","snippet":"Hemorrhoidal Disease Hemorrhoids are normal vascular cushions in the submucosa of the anal canal; they become symptomatic when engorged, prolapsed, or thrombosed. Internal hemorrhoids arise above the dentate line, are covered by columnar mucosa, and are insensate - they bleed painlessly. External he...","sourceLabel":"Section in Colorectal Surgery"},"3558":{"title":"Anal Fissure","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery#s10","snippet":"Anal Fissure An anal fissure is a linear tear in the anoderm distal to the dentate line. Posterior midline (90%) is classic; anterior midline is more common in women post-delivery. Fissures off the midline should raise suspicion for Crohn, HIV, tuberculosis, syphilis, or malignancy. Presentation: sh...","sourceLabel":"Section in Colorectal Surgery"},"3559":{"title":"Perianal Abscess & Anal Fistula","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery#s11","snippet":"Perianal Abscess & Anal Fistula The cryptoglandular theory: infection of an anal gland at the dentate line spreads through the intersphincteric plane to form an abscess, and when the abscess drains (spontaneously or surgically), a chronic epithelialized tract can remain as a fistula-in-ano . Figure ...","sourceLabel":"Section in Colorectal Surgery"},"3560":{"title":"Pilonidal Disease","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery#s12","snippet":"Pilonidal Disease Pilonidal disease is a chronic inflammatory condition of the natal cleft, caused by hair penetration and foreign-body reaction. Common in young males with thick body hair, obesity, prolonged sitting. Presents as an acute midline abscess or chronic draining sinus with lateral openin...","sourceLabel":"Section in Colorectal Surgery"},"3561":{"title":"Anal Cancer & HPV-Related Disease","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery#s13","snippet":"Anal Cancer & HPV-Related Disease Anal cancer is overwhelmingly squamous cell carcinoma (SCC) of the anal canal, strongly linked to HPV (types 16, 18), HIV, immunosuppression, receptive anal intercourse, and smoking. Adenocarcinoma of the anal canal is rare and usually arises from anal glands or duc...","sourceLabel":"Section in Colorectal Surgery"},"3562":{"title":"Rectal Prolapse, Rectocele & Pelvic Floor","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery#s14","snippet":"Rectal Prolapse, Rectocele & Pelvic Floor Full-thickness rectal prolapse (procidentia) is protrusion of all layers of the rectal wall through the anus. Classic in elderly multiparous women. Symptoms: visible prolapse with Valsalva, mucus, bleeding, incontinence, constipation. Differentiate from muco...","sourceLabel":"Section in Colorectal Surgery"},"3563":{"title":"Fecal Incontinence & Constipation","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery#s15","snippet":"Fecal Incontinence & Constipation Fecal incontinence is involuntary passage of gas, liquid, or solid stool. Causes: obstetric sphincter injury (most common in women), prior anorectal surgery, neurologic disease, diabetes, diarrhea, rectal prolapse, radiation. Workup includes anorectal manometry , en...","sourceLabel":"Section in Colorectal Surgery"},"3564":{"title":"Ischemic & Infectious Colitis","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery#s16","snippet":"Ischemic & Infectious Colitis Ischemic colitis most commonly affects watershed zones (splenic flexure, rectosigmoid). Non-occlusive in elderly with atherosclerosis, hypotension, cardiac surgery, vasopressors, cocaine, hypercoagulable states. Presents with sudden cramping lower abdominal pain, bloody...","sourceLabel":"Section in Colorectal Surgery"},"3565":{"title":"Ostomy Management & Complications","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery#s17","snippet":"Ostomy Management & Complications Stomas are a central feature of colorectal surgery. A scribe must be able to describe a stoma accurately on exam. Stoma Types Type Configuration Typical Output Common Indication End colostomy Single barrel, usually LLQ Formed stool Hartmann, APR Loop colostomy Two l...","sourceLabel":"Section in Colorectal Surgery"},"3566":{"title":"Anastomotic Leak & Post-Op Complications","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery#s18","snippet":"Anastomotic Leak & Post-Op Complications Anastomotic leak is the most feared complication of colorectal surgery. Incidence: 3-6% for colonic anastomosis, up to 15% for low pelvic (LAR) anastomosis. Risk factors: male sex, low anastomosis, neoadjuvant radiation, smoking, malnutrition, steroids, poor ...","sourceLabel":"Section in Colorectal Surgery"},"3567":{"title":"Colorectal Procedures - A to Z","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery#s19","snippet":"Colorectal Procedures - A to Z A colorectal scribe must recognize every procedure name. Operations can be performed open, laparoscopic, or robotic; robotic is increasingly favored for rectal cancer due to superior pelvic visualization. ICG fluorescence is used for perfusion assessment and sentinel n...","sourceLabel":"Section in Colorectal Surgery"},"3568":{"title":"Imaging, Endoscopy & Labs","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery#s20","snippet":"Imaging, Endoscopy & Labs Endoscopy Colonoscopy is the workhorse - diagnostic and therapeutic. Quality metrics: adequate prep (Boston Bowel Prep Scale &ge; 6, no segment < 2), cecal intubation rate > 95%, adenoma detection rate > 25% in screening. Document findings by location (cm from anal verge or...","sourceLabel":"Section in Colorectal Surgery"},"3569":{"title":"Medications You Must Know","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery#s21","snippet":"Medications You Must Know Bowel Preparation Agent Type Notes Polyethylene glycol (GoLYTELY, MiraLAX) Osmotic, isotonic Large volume (4 L) split dose Suprep (sodium sulfate) Hypertonic saline Low volume alternative Magnesium citrate Saline laxative Adjunct; avoid in renal failure Oral neomycin + metr...","sourceLabel":"Section in Colorectal Surgery"},"3570":{"title":"Classification Systems","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery#s22","snippet":"Classification Systems Wexner Constipation Score Scores 0-30 summing eight items: frequency of BMs, difficult/painful evacuation, incomplete evacuation, abdominal pain, minutes per attempt, assistance required (laxatives/digital/enema), unsuccessful attempts per 24 h, duration of constipation. Highe...","sourceLabel":"Section in Colorectal Surgery"},"3571":{"title":"Physical Exam - Anorectal & Abdominal","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery#s23","snippet":"Physical Exam - Anorectal & Abdominal Standard Colorectal Exam Template General: NAD, well-appearing Abdomen: soft, non-distended, non-tender, no masses, no hernia, normal BS; [scar description]; [stoma description: site, type, color, output] Anorectal: Inspection: no external hemorrhoids, skin tags...","sourceLabel":"Section in Colorectal Surgery"},"3572":{"title":"Abbreviations, HPIs & References","pageTitle":"Colorectal Surgery","pageUrl":"/scribe-guides/colorectal-surgery","url":"/scribe-guides/colorectal-surgery#s24","snippet":"Abbreviations, HPIs & References Abbreviations Master List CRC Colorectal cancer IBD Inflammatory bowel disease UC Ulcerative colitis CD Crohn disease FAP Familial adenomatous polyposis HNPCC Hereditary non-polyposis colorectal cancer (Lynch) MMR Mismatch repair MSI Microsatellite instability CEA Ca...","sourceLabel":"Section in Colorectal Surgery"},"3573":{"title":"Bariatric / Metabolic Surgery","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery","snippet":"Bariatric & Metabolic Surgery - Complete Reference Every diagnosis, comorbidity, procedure, medication, classification, abbreviation, and documentation framework you need to succeed in a bariatric clinic from day one."},"3574":{"title":"Obesity & Metabolic Disease — Foundations","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery#s1","snippet":"Obesity & Metabolic Disease — Foundations Bariatric and metabolic surgery is the branch of general surgery that treats obesity and its metabolic consequences with operations on the stomach and small intestine. Unlike most surgical fields, bariatrics is as much about disease remission as it is about ...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"3575":{"title":"GI & Foregut Anatomy for Bariatrics","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery#s2","snippet":"GI & Foregut Anatomy for Bariatrics Every bariatric operation reshapes or reroutes the stomach and small intestine. You cannot chart a sleeve gastrectomy, gastric bypass, or duodenal switch accurately without a working map of the foregut. Figure 2 - Gastric and Small Bowel Anatomy Relevant to Bariat...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"3576":{"title":"Scribe Documentation Framework","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery#s3","snippet":"Scribe Documentation Framework The Bariatric SOAP Note Bariatric notes are longer than a typical surgical note because they must capture the entire metabolic picture. Every visit documents weight, BMI, comorbidity status, nutritional compliance, and (post-op) operative anatomy and limb lengths. Subj...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"3577":{"title":"Obesity Classification & Metabolic Syndrome","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery#s4","snippet":"Obesity Classification & Metabolic Syndrome Precise classification matters because it determines surgical candidacy, insurance coverage, and the expected magnitude of weight loss. Memorize the BMI categories cold — you will use them every encounter. Figure 3 - Major Determinants of Appetite Control....","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"3578":{"title":"Type 2 Diabetes & Insulin Resistance","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery#s5","snippet":"Type 2 Diabetes & Insulin Resistance T2DM is the single most important metabolic comorbidity driving bariatric referrals. Bariatric surgery — particularly RYGB and duodenal switch — produces diabetes remission that is rapid (within days, before significant weight loss), durable (years), and largely ...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"3579":{"title":"OSA & Obesity Hypoventilation Syndrome","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery#s6","snippet":"OSA & Obesity Hypoventilation Syndrome Obstructive sleep apnea (OSA) is present in 60–90% of bariatric surgical candidates. Untreated OSA increases perioperative pulmonary complications, arrhythmias, and mortality. Pre-operative polysomnography or home sleep testing is standard in most bariatric pro...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"3580":{"title":"NAFLD / MASLD & Hepatic Disease","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery#s7","snippet":"NAFLD / MASLD & Hepatic Disease The condition formerly called non-alcoholic fatty liver disease (NAFLD) was renamed metabolic dysfunction-associated steatotic liver disease (MASLD) in 2023 to emphasize its metabolic etiology and reduce stigma. It is present in the majority of bariatric surgical cand...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"3581":{"title":"GERD & Esophageal Disease in Obesity","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery#s8","snippet":"GERD & Esophageal Disease in Obesity Obesity is an independent risk factor for GERD because increased intra-abdominal pressure promotes reflux across the gastroesophageal junction. GERD status is critical in bariatric surgical planning because sleeve gastrectomy can worsen reflux while Roux-en-Y gas...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"3582":{"title":"Cardiovascular, Pulmonary HTN & Venous Disease","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery#s9","snippet":"Cardiovascular, Pulmonary HTN & Venous Disease Obesity-related cardiovascular burden extends beyond hypertension and coronary disease. Scribes should document the full constellation of cardiopulmonary comorbidities on every patient. Hypertension & Heart Failure Obesity causes eccentric left ventricu...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"3583":{"title":"MSK, Reproductive & Psychiatric Comorbidities","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery#s10","snippet":"MSK, Reproductive & Psychiatric Comorbidities Musculoskeletal Weight-bearing joint osteoarthritis (especially knees and hips), chronic low back pain, and reduced mobility are near-universal in severe obesity. Many patients are referred for bariatric surgery specifically to qualify for joint replacem...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"3584":{"title":"Pre-Operative Evaluation & Patient Selection","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery#s11","snippet":"Pre-Operative Evaluation & Patient Selection Bariatric programs follow a multidisciplinary evaluation pathway that spans 3–6 months before surgery. Scribes will chart pieces of this process at multiple encounters. ASMBS / IFSO 2022 Indications 2022 Indications for Metabolic & Bariatric Surgery Per t...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"3585":{"title":"Core Bariatric Procedures","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery#s12","snippet":"Core Bariatric Procedures Four operations dominate modern bariatric practice. Learn their anatomy, expected weight loss, comorbidity impact, and complication profile cold. Figure 8 - Comparison of Bariatric Surgical Procedures. Anatomical illustrations comparing the major bariatric procedures: (A) l...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"3586":{"title":"Revisional & Endoscopic Bariatric Therapies","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery#s13","snippet":"Revisional & Endoscopic Bariatric Therapies Revisional Surgery Common conversion operations reflect the evolution of the field: Figure 15 - Transoral Outlet Reduction (TORe) for Weight Regain. Endoscopic view of a dilated gastrojejunal anastomosis (GJA greater than 2 cm) after RYGB — a common anatom...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"3587":{"title":"Post-Operative Course & Nutrition","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery#s14","snippet":"Post-Operative Course & Nutrition Figure 18 - Expected RYGB Anatomy on Upper GI Series. Normal postoperative upper GI series after Roux-en-Y gastric bypass, demonstrating contrast opacifying the small gastric pouch and passing through the gastrojejunal anastomosis into the Roux limb. This imaging st...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"3588":{"title":"Nutrient Deficiencies After Bariatric Surgery","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery#s15","snippet":"Nutrient Deficiencies After Bariatric Surgery Every bariatric patient is at lifelong risk of micronutrient deficiency. The risk profile depends on the operation (malabsorptive procedures > restrictive) and on supplement adherence. The 2019 ASMBS nutritional guidelines codify screening and supplement...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"3589":{"title":"Surgical Complications","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery#s16","snippet":"Surgical Complications Anastomotic / Staple Line Leak The most feared early complication. Occurs in 1–3% of sleeves (typically at the angle of His) and 1–2% of gastric bypasses (at the gastrojejunostomy). Presents within 3–7 days post-op with tachycardia (> 120 often the first and only sign), fever,...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"3590":{"title":"Late Metabolic & Behavioral Complications","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery#s17","snippet":"Late Metabolic & Behavioral Complications Dumping Syndrome Early vs Late Dumping Early dumping (15–30 min after meals): Rapid delivery of hyperosmolar food into the small bowel triggers fluid shifts and GI hormone release. Symptoms: nausea, cramping, diarrhea, palpitations, diaphoresis, lightheadedn...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"3591":{"title":"Weight Regain & Body Contouring","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery#s18","snippet":"Weight Regain & Body Contouring Weight Regain Weight regain after bariatric surgery is common: most patients regain 5–10% of their lost weight after nadir (typically at 12–18 months post-op), and a subset regain significantly more. Contributing factors include dietary non-adherence, pouch dilation, ...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"3592":{"title":"Medications in Bariatric Care","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery#s19","snippet":"Medications in Bariatric Care Figure 25 - PYY and GLP-1 in Appetite Regulation. The role of peptide YY (PYY) and glucagon-like peptide-1 (GLP-1) in appetite control. Both hormones are secreted by L-cells of the distal ileum and colon, acting on the brainstem nucleus tractus solitarius and hypothalam...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"3593":{"title":"Classification & Risk Systems","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery#s20","snippet":"Classification & Risk Systems IFSO Weight Loss Success Grading %EWL Outcome > 75% Excellent 50–75% Good 25–50% Poor < 25% Failure Weight Loss Definitions %EWL (Excess Weight Loss): ((Starting weight − current weight) / (Starting weight − ideal body weight at BMI 25)) × 100 %TWL (Total Weight Loss): ...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"3594":{"title":"Physical Exam in the Bariatric Patient","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery#s21","snippet":"Physical Exam in the Bariatric Patient The bariatric exam is focused but thorough. Key elements to document on every visit: Bariatric Exam Template General: Appearance, mobility, distress level, body habitus. Vitals: Weight (to nearest 0.1 kg), BMI, blood pressure (use appropriate large cuff), heart...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"3595":{"title":"Abbreviations Master List","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery#s22","snippet":"Abbreviations Master List Anatomy & Procedures RYGB Roux-en-Y gastric bypass SG / LSG / VSG Sleeve gastrectomy / laparoscopic / vertical sleeve gastrectomy OAGB / MGB One-anastomosis gastric bypass / mini-gastric bypass BPD-DS Biliopancreatic diversion with duodenal switch SADI-S Single anastomosis ...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"3596":{"title":"Sample HPI Templates","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery#s23","snippet":"Sample HPI Templates These templates show the level of detail and rhythm expected in a bariatric clinic note. Use them as patterns to internalize specialty-specific documentation. Sample HPI — Initial Bariatric Consultation \"Ms. [Name] is a 42-year-old female with a BMI of 44 (weight 115 kg, height ...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"3597":{"title":"References & Sources","pageTitle":"Bariatric / Metabolic Surgery","pageUrl":"/scribe-guides/bariatric-surgery","url":"/scribe-guides/bariatric-surgery#s24","snippet":"References & Sources Clinical Practice Guidelines Eisenberg D, et al. 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery. Surg Obes Relat Dis. 2022. ...","sourceLabel":"Section in Bariatric / Metabolic Surgery"},"3598":{"title":"Plastic & Reconstructive Surgery","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery","snippet":"Plastic & Reconstructive Surgery - Complete Reference Every diagnosis, flap, procedure, medication, classification, and documentation framework you need to succeed on day one and beyond."},"3599":{"title":"Skin & Soft Tissue - Anatomy Essentials","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#s1","snippet":"Skin & Soft Tissue - Anatomy Essentials Plastic and reconstructive surgery is the specialty of form and function of the integument and soft tissues. Plastic surgeons operate everywhere on the body: face, scalp, breast, trunk, perineum, upper extremity, lower extremity, and intraoral/pharyngeal struc...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3600":{"title":"Scribe Documentation Framework","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#s2","snippet":"Scribe Documentation Framework The Plastic Surgery SOAP Note Plastic surgery clinics run a wide mix of encounters: post-op flap checks, oncologic reconstruction consults, trauma follow-ups, cosmetic consultations, suture removals, and scar management. Each has a different note rhythm, but all follow...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3601":{"title":"Skin Cancer Reconstruction","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#s3","snippet":"Skin Cancer Reconstruction Plastic surgeons receive an enormous volume of referrals for reconstruction of skin cancer defects, most commonly from Mohs micrographic surgery dermatologists who have excised the tumor but left a defect that exceeds what can be closed primarily. The three main skin cance...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3602":{"title":"Breast Cancer Reconstruction","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#s4","snippet":"Breast Cancer Reconstruction Breast reconstruction restores the shape and appearance of the breast after mastectomy or lumpectomy. It can be immediate (at the time of mastectomy) or delayed (weeks to years later). The two main techniques are implant-based and autologous (flap-based) , and the choice...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3603":{"title":"Head & Neck Reconstruction","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#s5","snippet":"Head & Neck Reconstruction Head and neck cancer (most commonly oral cavity, oropharynx, larynx, and cutaneous) generates some of the most complex reconstructions in plastic surgery. Defects may involve skin, mucosa, muscle, bone (mandible, maxilla, orbit), and nerves. The plastic surgeon works along...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3604":{"title":"Lower Extremity Reconstruction","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#s6","snippet":"Lower Extremity Reconstruction Lower extremity reconstruction is performed for trauma (Gustilo IIIB/C open fractures), oncologic resection (sarcoma), infection (osteomyelitis), and diabetic/vascular wounds. The principle: cover exposed bone, tendon, or hardware with durable, well-vascularized tissue...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3605":{"title":"Upper Extremity & Hand Reconstruction","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#s7","snippet":"Upper Extremity & Hand Reconstruction Hand surgery has a large overlap with plastic surgery - many plastic surgeons complete hand fellowships and run hand call. The specialty covers fingertip injuries, nail bed lacerations, flexor and extensor tendon injuries, digital nerve repair, replantation of a...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3606":{"title":"Burns - Acute Care & Reconstruction","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#s8","snippet":"Burns - Acute Care & Reconstruction Burn care sits at the intersection of critical care, plastic surgery, and rehabilitation. In the acute phase, burn surgeons (often plastic or general surgery trained) manage fluid resuscitation, airway, debridement, and grafting. In the late phase, reconstruction ...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3607":{"title":"Facial Trauma & Fractures","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#s9","snippet":"Facial Trauma & Fractures Plastic surgeons cover facial trauma call alongside OMFS and ENT. Fractures are evaluated clinically and with CT maxillofacial (thin-cut, coronal and sagittal reformats). Major Fracture Patterns Mandibular fractures: Most common sites are body, angle, condyle, symphysis, pa...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3608":{"title":"Soft Tissue Facial Wounds & Dog Bites","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#s10","snippet":"Soft Tissue Facial Wounds & Dog Bites Lip, cheek, eyelid, ear, and scalp lacerations and dog bites make up the bulk of ED plastic surgery consults. Principles: copious irrigation, conservative debridement (the face has excellent blood supply - preserve tissue), meticulous layered repair, align landm...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3609":{"title":"Cleft Lip, Cleft Palate & Craniofacial","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#s11","snippet":"Cleft Lip, Cleft Palate & Craniofacial Craniofacial surgery is a plastic surgery subspecialty addressing congenital and developmental anomalies of the skull and face. Patients are typically managed in multidisciplinary cleft/craniofacial teams (plastic surgery, ENT, orthodontics, speech, audiology, ...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3610":{"title":"Lymphedema Surgery","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#s12","snippet":"Lymphedema Surgery Lymphedema is chronic swelling from impaired lymphatic drainage, most commonly after axillary or inguinal lymph node dissection for cancer (secondary) but also congenital (primary). Conservative management includes complete decongestive therapy (manual lymphatic drainage, compress...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3611":{"title":"Peripheral Nerve & Brachial Plexus","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#s13","snippet":"Peripheral Nerve & Brachial Plexus Plastic surgery peripheral nerve practice includes compression neuropathies (carpal tunnel, cubital tunnel, tarsal tunnel), traumatic nerve lacerations, brachial plexus birth and adult injuries, facial nerve paralysis, and painful neuromas. Figure 14 - Nerve Injury...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3612":{"title":"Pressure Injuries & Chronic Wounds","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#s14","snippet":"Pressure Injuries & Chronic Wounds Pressure injuries (formerly \"pressure ulcers\" or \"decubiti\") occur when prolonged pressure over bony prominences exceeds capillary closing pressure and causes ischemic soft-tissue necrosis. Common locations: sacrum, ischial tuberosity, greater trochanter, heel, occ...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3613":{"title":"Gender-Affirming Surgery","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#s15","snippet":"Gender-Affirming Surgery Gender-affirming surgery (GAS) is a growing subspecialty. Patients are evaluated per WPATH standards of care with mental health and hormone therapy criteria met before surgery. Top Surgery Masculinizing chest (female-to-male): Double incision mastectomy with free nipple graf...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3614":{"title":"Aesthetic Surgery - Face","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#s16","snippet":"Aesthetic Surgery - Face Aesthetic (cosmetic) surgery makes up a large portion of many plastic surgery practices. Consultations focus on the patient's goals, realistic expectations, surgical risk, and recovery planning. Figure 16 - Nasal Cartilage Framework and Tip Support. The nasal tip is supporte...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3615":{"title":"Aesthetic Surgery - Breast & Body","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#s17","snippet":"Aesthetic Surgery - Breast & Body Breast Aesthetic Surgery Augmentation mammaplasty: Saline or silicone implants (smooth round, form-stable \"gummy bear\"), placed subglandular, subfascial, subpectoral (dual plane), or prepectoral. Incisions: inframammary fold (most common), periareolar, transaxillary...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3616":{"title":"Flaps, Grafts & Reconstructive Ladder","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#s18","snippet":"Flaps, Grafts & Reconstructive Ladder The reconstructive ladder guides the choice of wound coverage from simplest to most complex: Figure 19 - The Reconstructive Ladder. The classic reconstructive ladder progresses from simple (bottom) to complex (top): secondary intention &rarr; primary closure &ra...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3617":{"title":"Imaging & Diagnostics","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#s19","snippet":"Imaging & Diagnostics CTA abdomen/pelvis: Pre-DIEP perforator mapping - shows DIEA/perforator location, size, intramuscular course. CTA lower extremity: Pre-fibula harvest - confirms 3-vessel runoff. CT maxillofacial: Facial fracture evaluation. Thin cuts with coronal and sagittal reconstructions. C...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3618":{"title":"Medications You Must Know","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#s20","snippet":"Medications You Must Know Perioperative Antibiotics Cefazolin (Ancef) 2 g IV pre-op (3 g if > 120 kg) - standard for clean plastic cases. Clindamycin 900 mg IV - penicillin/cephalosporin allergy. Ampicillin-sulbactam (Unasyn) 3 g IV - head and neck contaminated cases. Amoxicillin-clavulanate (Augmen...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3619":{"title":"Classification Systems","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#s21","snippet":"Classification Systems Caprini VTE Risk Score (Abbreviated) Score Risk Recommendation 0 Very low Early ambulation 1-2 Low Mechanical (SCDs) 3-4 Moderate Mechanical + chemical (LMWH) 5-8 High Mechanical + chemical, consider extended &ge; 9 Very high (superhigh) Extended chemoprophylaxis 7-14+ days Po...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3620":{"title":"Physical Exam & Flap Monitoring","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#s22","snippet":"Physical Exam & Flap Monitoring The Plastic Surgery Exam The exam varies enormously by encounter but always includes focused inspection and palpation of the affected area. Document dimensions, tissue quality, scar maturity, and functional status. Figure 24 - Microsurgical Flap Monitoring. Free flap ...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3621":{"title":"Abbreviations Master List","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#s23","snippet":"Abbreviations Master List Anatomy SMAS Superficial musculoaponeurotic system NAC Nipple-areolar complex IMF Inframammary fold DIEA / DIEP Deep inferior epigastric artery / perforator SIEA Superficial inferior epigastric artery ALT Anterolateral thigh (flap) LD Latissimus dorsi TRAM Transverse rectus...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3622":{"title":"Sample HPI Templates","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#s24","snippet":"Sample HPI Templates These templates show the rhythm and content of a good plastic surgery clinic note. Use them as frameworks during your first week. Sample HPI - Post-Mastectomy Breast Reconstruction Consult \"Ms. [Name] is a 52-year-old premenopausal female with newly diagnosed left breast invasiv...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3623":{"title":"References & Sources","pageTitle":"Plastic & Reconstructive Surgery","pageUrl":"/scribe-guides/plastic-reconstructive-surgery","url":"/scribe-guides/plastic-reconstructive-surgery#references","snippet":"References & Sources Clinical Practice Guidelines NCCN Guidelines: Squamous Cell Skin Cancer & Basal Cell Skin Cancer. JNCCN. NCCN Guidelines: Cutaneous Melanoma. JNCCN. NCCN Guidelines: Breast Cancer. JNCCN. ACS NCDB analysis of breast reconstruction trends and outcomes. Ann Surg Oncol. American Bu...","sourceLabel":"Section in Plastic & Reconstructive Surgery"},"3624":{"title":"Pediatric Surgery","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery","snippet":"Pediatric Surgery - Complete Reference Every diagnosis, congenital anomaly, procedure, medication, abbreviation, and documentation framework you need to succeed on day one in a pediatric surgical practice."},"3625":{"title":"Pediatric Surgery - Scope & Age-Based Essentials","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s1","snippet":"Pediatric Surgery - Scope & Age-Based Essentials Pediatric surgery is the surgical care of patients from the moment of birth (and sometimes before, in fetal surgery centers) through late adolescence. Unlike adult general surgery, where the patient population is relatively homogeneous physiologically...","sourceLabel":"Section in Pediatric Surgery"},"3626":{"title":"Scribe Documentation Framework","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s2","snippet":"Scribe Documentation Framework Pediatric surgical notes are SOAP-structured but with several specialty-specific twists: the historian is almost never the patient, the birth history is part of every neonatal note, growth percentiles matter, and the physical exam language is developmentally staged. Su...","sourceLabel":"Section in Pediatric Surgery"},"3627":{"title":"Congenital Diaphragmatic Hernia (CDH)","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s3","snippet":"Congenital Diaphragmatic Hernia (CDH) CDH is a developmental failure of the diaphragm to close, most commonly at the posterolateral foramen of Bochdalek on the left (80-85%). Abdominal viscera herniate into the chest during fetal life, impairing lung development on the affected side and producing pu...","sourceLabel":"Section in Pediatric Surgery"},"3628":{"title":"Tracheoesophageal Fistula & Esophageal Atresia (TEF/EA)","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s4","snippet":"Tracheoesophageal Fistula & Esophageal Atresia (TEF/EA) TEF/EA is a failure of septation between the primitive foregut and trachea. The most common anatomy (~85%) is a proximal esophageal atresia with a distal tracheoesophageal fistula ( Type C / Gross Type C ). Isolated EA without a fistula (Type A...","sourceLabel":"Section in Pediatric Surgery"},"3629":{"title":"Abdominal Wall Defects: Gastroschisis & Omphalocele","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s5","snippet":"Abdominal Wall Defects: Gastroschisis & Omphalocele The two major congenital abdominal wall defects differ in location, covering, associated anomalies, and prognosis - and confusing them in a chart is a serious documentation error. Figure 5 - Gastroschisis Management. Illustration demonstrating the ...","sourceLabel":"Section in Pediatric Surgery"},"3630":{"title":"Hypertrophic Pyloric Stenosis (HPS)","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s6","snippet":"Hypertrophic Pyloric Stenosis (HPS) HPS is hypertrophy of the pyloric muscle producing gastric outlet obstruction. It classically presents in a first-born male infant aged 3-6 weeks with progressive, projectile, non-bilious, post-prandial vomiting and an insatiable appetite afterward (the \"hungry vo...","sourceLabel":"Section in Pediatric Surgery"},"3631":{"title":"Malrotation & Midgut Volvulus","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s7","snippet":"Malrotation & Midgut Volvulus During fetal development, the midgut rotates 270&deg; counterclockwise around the superior mesenteric artery (SMA) and is fixed by the ligament of Treitz in the left upper quadrant and the cecum in the right lower quadrant, producing a broad mesenteric base. In malrotat...","sourceLabel":"Section in Pediatric Surgery"},"3632":{"title":"Intestinal Atresias","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s8","snippet":"Intestinal Atresias Intestinal atresias are developmental interruptions in bowel continuity. Duodenal atresia is most often a failure of recanalization ; jejunoileal and colonic atresias are thought to arise from in utero vascular accidents . Figure 9 - Double Bubble Sign in Duodenal Atresia. Repres...","sourceLabel":"Section in Pediatric Surgery"},"3633":{"title":"Hirschsprung Disease","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s9","snippet":"Hirschsprung Disease Hirschsprung disease (HD) is congenital absence of ganglion cells in the distal bowel due to failed caudal migration of neural crest cells. The aganglionic segment cannot relax, producing a functional obstruction. Short-segment disease (rectosigmoid) accounts for ~80%; long-segm...","sourceLabel":"Section in Pediatric Surgery"},"3634":{"title":"Anorectal Malformations & Cloaca","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s10","snippet":"Anorectal Malformations & Cloaca Anorectal malformations ( ARM ), formerly called \"imperforate anus,\" are a spectrum from low defects (perineal fistula, easy repair) to high complex defects (rectourethral, rectovesical, or cloacal). The Krickenbeck classification (2005) is the current international ...","sourceLabel":"Section in Pediatric Surgery"},"3635":{"title":"Meconium Ileus & CF-Associated GI Disease","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s11","snippet":"Meconium Ileus & CF-Associated GI Disease Meconium ileus is obstruction of the distal ileum by thick, inspissated meconium and is strongly associated with cystic fibrosis (nearly 100% of patients with meconium ileus have CF). Simple meconium ileus presents with distension, bilious emesis, and failur...","sourceLabel":"Section in Pediatric Surgery"},"3636":{"title":"Necrotizing Enterocolitis (NEC)","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s12","snippet":"Necrotizing Enterocolitis (NEC) NEC is a devastating inflammatory and ischemic disease of the neonatal intestine, predominantly affecting premature infants (the more premature, the higher the risk). It is the most common surgical GI emergency in the NICU. Pathophysiology involves an immature mucosal...","sourceLabel":"Section in Pediatric Surgery"},"3637":{"title":"Intussusception","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s13","snippet":"Intussusception Intussusception is telescoping of one segment of bowel (intussusceptum) into an adjacent distal segment (intussuscipiens). The most common location is ileocolic . Peak age is 6 months to 3 years. In children under 2, most cases are idiopathic - likely triggered by enlarged Peyer's pa...","sourceLabel":"Section in Pediatric Surgery"},"3638":{"title":"Meckel Diverticulum","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s14","snippet":"Meckel Diverticulum Meckel diverticulum is a true diverticulum of the ileum - a persistent remnant of the omphalomesenteric (vitelline) duct. The mnemonic \"rule of 2s\" : 2% of population, within 2 feet of the ileocecal valve, 2 inches long, 2 types of heterotopic mucosa (gastric, pancreatic), sympto...","sourceLabel":"Section in Pediatric Surgery"},"3639":{"title":"Pediatric Appendicitis","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s15","snippet":"Pediatric Appendicitis Appendicitis is the most common surgical emergency in children. Pathophysiology is luminal obstruction (fecalith, lymphoid hyperplasia after viral illness) followed by distension, ischemia, bacterial overgrowth, and perforation. Figure 15 - Pediatric Appendicitis Imaging. Diag...","sourceLabel":"Section in Pediatric Surgery"},"3640":{"title":"Inguinal, Umbilical & Other Hernias","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s16","snippet":"Inguinal, Umbilical & Other Hernias Pediatric inguinal hernias are almost always indirect , resulting from a patent processus vaginalis. Incidence is ~1-5% of term infants, much higher (up to 30%) in preterms. Right-sided predominance (60%). Bilateral in ~10-15%. Repair is recommended at diagnosis b...","sourceLabel":"Section in Pediatric Surgery"},"3641":{"title":"Undescended Testis, Hydrocele, Varicocele & Torsion","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s17","snippet":"Undescended Testis, Hydrocele, Varicocele & Torsion Cryptorchidism (undescended testis) affects ~3% of term males and ~30% of preterms. Spontaneous descent is uncommon after 6 months of age. Evaluation distinguishes palpable (inguinal canal, ectopic) from non-palpable (intra-abdominal, absent, atrop...","sourceLabel":"Section in Pediatric Surgery"},"3642":{"title":"Pediatric Solid Tumors","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s18","snippet":"Pediatric Solid Tumors Pediatric surgical oncology is a multidisciplinary enterprise in partnership with pediatric oncology, radiation oncology, and pathology, coordinated through Children's Oncology Group (COG) protocols. Figure 19 - Wilms Tumor (Nephroblastoma) CT Imaging. Contrast-enhanced CT dem...","sourceLabel":"Section in Pediatric Surgery"},"3643":{"title":"Congenital Lung Lesions & Thoracic Disease","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s19","snippet":"Congenital Lung Lesions & Thoracic Disease Congenital lung lesions are increasingly diagnosed prenatally. Key entities: Figure 21 - Congenital Pulmonary Airway Malformation (CPAM) Imaging. CT imaging demonstrating a congenital lung lesion with its vascular anatomy. CPAM presents as cystic and/or sol...","sourceLabel":"Section in Pediatric Surgery"},"3644":{"title":"Hepatobiliary: Biliary Atresia & Choledochal Cyst","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s20","snippet":"Hepatobiliary: Biliary Atresia & Choledochal Cyst Biliary atresia is a progressive obliterative cholangiopathy of unknown cause and the leading indication for pediatric liver transplant. Presents with persistent jaundice beyond 2 weeks of life, acholic (pale) stools, dark urine, and direct hyperbili...","sourceLabel":"Section in Pediatric Surgery"},"3645":{"title":"Head & Neck Masses","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s21","snippet":"Head & Neck Masses Thyroglossal duct cyst: Midline neck mass that elevates with tongue protrusion, sitting just below the hyoid. Treatment is the Sistrunk procedure - cyst excision with the central portion of the hyoid bone and a core of tongue-base tissue to the foramen cecum. Branchial cleft cysts...","sourceLabel":"Section in Pediatric Surgery"},"3646":{"title":"Pediatric Trauma, Burns & Foreign Bodies","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s22","snippet":"Pediatric Trauma, Burns & Foreign Bodies Pediatric trauma is the leading cause of childhood death in the US. Children compensate with tachycardia and peripheral vasoconstriction; hypotension is a terminal sign. Large heads, small airways, and thin compliant chest walls mean significant internal inju...","sourceLabel":"Section in Pediatric Surgery"},"3647":{"title":"Pectus Deformities & Miscellaneous Entities","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s23","snippet":"Pectus Deformities & Miscellaneous Entities Pectus excavatum: Most common chest wall deformity, a posterior depression of the sternum. The Haller index (transverse chest diameter / anteroposterior diameter on CT) > 3.25 supports operative repair. The Nuss procedure is a minimally invasive pectus bar...","sourceLabel":"Section in Pediatric Surgery"},"3648":{"title":"Pediatric Surgical Procedures - A to Z","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s24","snippet":"Pediatric Surgical Procedures - A to Z Procedure Description / Indication Laparoscopic pyloromyotomy Longitudinal splitting of pyloric muscle for HPS Ladd procedure Derotation, Ladd's band division, broadening of mesentery, appendectomy for malrotation Laparoscopic Nissen fundoplication 360&deg; gas...","sourceLabel":"Section in Pediatric Surgery"},"3649":{"title":"Imaging, Medications & Fluids","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s25","snippet":"Imaging, Medications & Fluids Imaging Pediatric imaging is driven by the ALARA principle (As Low As Reasonably Achievable). Ultrasound and MRI are favored over CT whenever possible to minimize cumulative radiation. Key studies: Abdominal X-ray: NEC (pneumatosis, portal venous gas, pneumoperitoneum),...","sourceLabel":"Section in Pediatric Surgery"},"3650":{"title":"Classification Systems & Staging","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s26","snippet":"Classification Systems & Staging APGAR Score APGAR (assessed at 1 and 5 minutes) A ppearance (color): 0 blue/pale, 1 acrocyanotic, 2 completely pink. P ulse (HR): 0 absent, 1 < 100, 2 &ge; 100. G rimace (reflex): 0 none, 1 grimace, 2 cough/sneeze/cry. A ctivity (tone): 0 limp, 1 some flexion, 2 acti...","sourceLabel":"Section in Pediatric Surgery"},"3651":{"title":"Physical Exam, Abbreviations & Sample HPIs","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s27","snippet":"Physical Exam, Abbreviations & Sample HPIs Pediatric Surgical Physical Exam Template Exam Template Gen: Well-appearing / toxic-appearing; alert / lethargic / irritable / consolable Vitals: T ___ HR ___ RR ___ BP ___ SpO2 ___ Wt ___ kg (__%ile) HEENT: Fontanelle ___; MMM; no scleral icterus CV: RRR, ...","sourceLabel":"Section in Pediatric Surgery"},"3652":{"title":"References & Sources","pageTitle":"Pediatric Surgery","pageUrl":"/scribe-guides/pediatric-surgery","url":"/scribe-guides/pediatric-surgery#s28","snippet":"References & Sources Clinical Practice Guidelines Snoek KG, et al. Standardized Postnatal Management of Infants with Congenital Diaphragmatic Hernia in Europe: The CDH EURO Consortium Consensus - 2015 Update. Neonatology. 2016. Kolon TF, et al. Evaluation and Treatment of Cryptorchidism: AUA Guideli...","sourceLabel":"Section in Pediatric Surgery"},"3653":{"title":"Transplant Surgery","pageTitle":"Transplant Surgery","pageUrl":"/scribe-guides/transplant-surgery","url":"/scribe-guides/transplant-surgery","snippet":"Transplant Surgery - Complete Reference Every organ, immunosuppressant, rejection pattern, opportunistic infection, procedure, classification, and documentation framework you need to succeed on day one on the transplant service."},"3654":{"title":"Transplant Immunology - Foundations","pageTitle":"Transplant Surgery","pageUrl":"/scribe-guides/transplant-surgery","url":"/scribe-guides/transplant-surgery#s1","snippet":"Transplant Immunology - Foundations Transplant surgery exists at the intersection of technical surgery and applied immunology. Every operation is only half the story - the other half is preventing the recipient's immune system from destroying the graft. As a scribe, you cannot document rejection, dr...","sourceLabel":"Section in Transplant Surgery"},"3655":{"title":"Scribe Documentation Framework","pageTitle":"Transplant Surgery","pageUrl":"/scribe-guides/transplant-surgery","url":"/scribe-guides/transplant-surgery#s2","snippet":"Scribe Documentation Framework Transplant notes are among the most complex in medicine because they must simultaneously track the graft, the immunosuppression regimen, infection prophylaxis, opportunistic surveillance, and the patient's underlying comorbidities. Most transplant centers use structure...","sourceLabel":"Section in Transplant Surgery"},"3656":{"title":"Donor Evaluation & Organ Procurement","pageTitle":"Transplant Surgery","pageUrl":"/scribe-guides/transplant-surgery","url":"/scribe-guides/transplant-surgery#s3","snippet":"Donor Evaluation & Organ Procurement Deceased Donor Categories Donation after Brain Death (DBD) donors have been declared neurologically dead but have an intact cardiac circulation supported by the ventilator until organ retrieval. This is the historically standard donor and still yields the best ou...","sourceLabel":"Section in Transplant Surgery"},"3657":{"title":"Brain Death & DCD Determination","pageTitle":"Transplant Surgery","pageUrl":"/scribe-guides/transplant-surgery","url":"/scribe-guides/transplant-surgery#s4","snippet":"Brain Death & DCD Determination Brain death determination is a medical and legal prerequisite for DBD organ donation. The 2023 update to the AAN consensus practice guideline on brain death/death by neurologic criteria provides the current standard. Figure 6 - Three-Signal Model of T-Cell Activation....","sourceLabel":"Section in Transplant Surgery"},"3658":{"title":"Allocation Systems (OPTN/UNOS)","pageTitle":"Transplant Surgery","pageUrl":"/scribe-guides/transplant-surgery","url":"/scribe-guides/transplant-surgery#s5","snippet":"Allocation Systems (OPTN/UNOS) In the United States, the Organ Procurement and Transplantation Network (OPTN), operated under contract by the United Network for Organ Sharing (UNOS), governs all allocation. Each organ has its own scoring system. Figure 7 - HLA Haplotype Inheritance. Diagram showing ...","sourceLabel":"Section in Transplant Surgery"},"3659":{"title":"Kidney Transplantation","pageTitle":"Transplant Surgery","pageUrl":"/scribe-guides/transplant-surgery","url":"/scribe-guides/transplant-surgery#s6","snippet":"Kidney Transplantation Indications & Recipient Evaluation Kidney transplantation is the treatment of choice for end-stage renal disease (ESRD). Common etiologies include diabetic nephropathy (the single most common cause in the US), hypertensive nephrosclerosis, glomerulonephritis (FSGS, IgA nephrop...","sourceLabel":"Section in Transplant Surgery"},"3660":{"title":"Liver Transplantation","pageTitle":"Transplant Surgery","pageUrl":"/scribe-guides/transplant-surgery","url":"/scribe-guides/transplant-surgery#s7","snippet":"Liver Transplantation Indications The most common indications for liver transplant in adults are non-alcoholic steatohepatitis (NASH, now MASH), alcohol-associated liver disease (ALD), chronic hepatitis C (declining dramatically in the DAA era), hepatocellular carcinoma (HCC) within Milan criteria, ...","sourceLabel":"Section in Transplant Surgery"},"3661":{"title":"Pancreas & Islet Transplantation","pageTitle":"Transplant Surgery","pageUrl":"/scribe-guides/transplant-surgery","url":"/scribe-guides/transplant-surgery#s8","snippet":"Pancreas & Islet Transplantation Pancreas transplantation cures type 1 diabetes (and highly selected insulin-dependent type 2) by restoring endogenous insulin secretion. Three configurations: Figure 14 - Bench Preparation of Donor Kidney. Back-table preparation of the donor kidney showing assessment...","sourceLabel":"Section in Transplant Surgery"},"3662":{"title":"Heart Transplantation","pageTitle":"Transplant Surgery","pageUrl":"/scribe-guides/transplant-surgery","url":"/scribe-guides/transplant-surgery#s9","snippet":"Heart Transplantation Indications End-stage heart failure refractory to maximal medical and device therapy, with expected one-year survival without transplant <50%. Etiologies: ischemic cardiomyopathy, non-ischemic dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, cong...","sourceLabel":"Section in Transplant Surgery"},"3663":{"title":"Lung Transplantation","pageTitle":"Transplant Surgery","pageUrl":"/scribe-guides/transplant-surgery","url":"/scribe-guides/transplant-surgery#s10","snippet":"Lung Transplantation Indications End-stage lung disease with expected survival <2 years without transplant. Common indications: idiopathic pulmonary fibrosis (IPF) - now the single most common indication, COPD/emphysema, cystic fibrosis (CF), pulmonary arterial hypertension (PAH), alpha-1 antitrypsi...","sourceLabel":"Section in Transplant Surgery"},"3664":{"title":"Intestinal, Multi-Visceral & VCA","pageTitle":"Transplant Surgery","pageUrl":"/scribe-guides/transplant-surgery","url":"/scribe-guides/transplant-surgery#s11","snippet":"Intestinal, Multi-Visceral & VCA Intestinal Transplantation Indicated for irreversible intestinal failure with life-threatening TPN complications (liver failure, loss of central venous access, recurrent line sepsis, severe dehydration). Three configurations: isolated intestine, combined liver-intest...","sourceLabel":"Section in Transplant Surgery"},"3665":{"title":"HSCT / Bone Marrow Transplant Overview","pageTitle":"Transplant Surgery","pageUrl":"/scribe-guides/transplant-surgery","url":"/scribe-guides/transplant-surgery#s12","snippet":"HSCT / Bone Marrow Transplant Overview Hematopoietic stem cell transplant (HSCT) is not solid organ transplant but scribes on inpatient consult services will encounter these patients. HSCT replaces the recipient's hematopoietic system with donor stem cells, typically for hematologic malignancies (AM...","sourceLabel":"Section in Transplant Surgery"},"3666":{"title":"Transplant Procedures - A to Z","pageTitle":"Transplant Surgery","pageUrl":"/scribe-guides/transplant-surgery","url":"/scribe-guides/transplant-surgery#s13","snippet":"Transplant Procedures - A to Z Procedure Description Key Documentation Deceased donor multi-organ procurement Simultaneous retrieval of thoracic and abdominal organs from DBD/DCD donor. WIT, CIT, procurement anatomy, anomalies. Laparoscopic donor nephrectomy Hand-assisted or pure lap removal of a li...","sourceLabel":"Section in Transplant Surgery"},"3667":{"title":"Rejection - Diagnosis & Treatment","pageTitle":"Transplant Surgery","pageUrl":"/scribe-guides/transplant-surgery","url":"/scribe-guides/transplant-surgery#s14","snippet":"Rejection - Diagnosis & Treatment Rejection Categories by Timing & Mechanism Rejection Types Hyperacute rejection: Minutes to hours. Preformed antibodies (ABO or DSA) cause complement activation and graft thrombosis. Now virtually eliminated by modern crossmatching. Accelerated acute rejection: Days...","sourceLabel":"Section in Transplant Surgery"},"3668":{"title":"Induction & Maintenance Immunosuppression","pageTitle":"Transplant Surgery","pageUrl":"/scribe-guides/transplant-surgery","url":"/scribe-guides/transplant-surgery#s15","snippet":"Induction & Maintenance Immunosuppression Induction Agents Induction is a short course of intense immunosuppression at the time of transplant to blunt the early alloimmune response. Figure 20 - Immunosuppressive Drug Targets. Schematic showing how commonly used transplant immunosuppressants target s...","sourceLabel":"Section in Transplant Surgery"},"3669":{"title":"Opportunistic Infections & Prophylaxis","pageTitle":"Transplant Surgery","pageUrl":"/scribe-guides/transplant-surgery","url":"/scribe-guides/transplant-surgery#s16","snippet":"Opportunistic Infections & Prophylaxis Infection timelines in the post-transplant patient follow a predictable pattern. Months 0-1: nosocomial and surgical site infections. Months 1-6: opportunistic infections (CMV, PJP, BK, fungi). Beyond 6 months: community-acquired and late opportunistic infectio...","sourceLabel":"Section in Transplant Surgery"},"3670":{"title":"Post-Transplant Malignancy & PTLD","pageTitle":"Transplant Surgery","pageUrl":"/scribe-guides/transplant-surgery","url":"/scribe-guides/transplant-surgery#s17","snippet":"Post-Transplant Malignancy & PTLD Chronic immunosuppression raises the risk of de novo malignancy. The major categories: Non-melanoma skin cancer (SCC, BCC): The most common malignancy post-transplant, with a 65-fold increased risk of SCC. Annual dermatology exam and photoprotection counseling are s...","sourceLabel":"Section in Transplant Surgery"},"3671":{"title":"Surgical & Medical Complications","pageTitle":"Transplant Surgery","pageUrl":"/scribe-guides/transplant-surgery","url":"/scribe-guides/transplant-surgery#s18","snippet":"Surgical & Medical Complications Vascular Complications Renal artery/vein thrombosis: Early graft loss; Doppler US for diagnosis. Hepatic artery thrombosis: Re-exploration or re-transplant. Transplant renal artery stenosis (TRAS): Uncontrolled HTN, elevated Cr; duplex US and angioplasty/stent. Urolo...","sourceLabel":"Section in Transplant Surgery"},"3672":{"title":"Classification Systems - Full Enumeration","pageTitle":"Transplant Surgery","pageUrl":"/scribe-guides/transplant-surgery","url":"/scribe-guides/transplant-surgery#s19","snippet":"Classification Systems - Full Enumeration Banff Kidney Allograft Rejection (abbreviated) Figure 22 - Vascular Rejection - Intimal Arteritis. Biopsy findings in Banff grade IIA-III rejection demonstrating intimal arteritis (endothelialitis) with mononuclear cells infiltrating beneath the arterial end...","sourceLabel":"Section in Transplant Surgery"},"3673":{"title":"Transplant Physical Exam","pageTitle":"Transplant Surgery","pageUrl":"/scribe-guides/transplant-surgery","url":"/scribe-guides/transplant-surgery#s20","snippet":"Transplant Physical Exam General Document Cushingoid features (moon facies, buffalo hump, striae, central adiposity - common with chronic steroids), tremor (a CNI signature), gum hypertrophy and hirsutism (cyclosporine), acne and weight gain (steroids), and overall frailty. Organ-Specific Exam Kidne...","sourceLabel":"Section in Transplant Surgery"},"3674":{"title":"Abbreviations Master List","pageTitle":"Transplant Surgery","pageUrl":"/scribe-guides/transplant-surgery","url":"/scribe-guides/transplant-surgery#s21","snippet":"Abbreviations Master List Organs & Procedures KT / KTx - kidney transplant DDKT - deceased donor kidney transplant LDKT - living donor kidney transplant LT / OLT - (orthotopic) liver transplant LDLT - living donor liver transplant HT / OHT - (orthotopic) heart transplant BLT - bilateral lung transpl...","sourceLabel":"Section in Transplant Surgery"},"3675":{"title":"Sample HPI Templates","pageTitle":"Transplant Surgery","pageUrl":"/scribe-guides/transplant-surgery","url":"/scribe-guides/transplant-surgery#s22","snippet":"Sample HPI Templates Sample HPI 1 - Pre-Kidney Transplant Evaluation 58-year-old woman with ESRD secondary to type 2 diabetic nephropathy and hypertension, on in-center hemodialysis MWF via a left upper arm brachiocephalic AVF since 2022, presenting for initial kidney transplant evaluation. PMH nota...","sourceLabel":"Section in Transplant Surgery"},"3676":{"title":"References & Sources","pageTitle":"Transplant Surgery","pageUrl":"/scribe-guides/transplant-surgery","url":"/scribe-guides/transplant-surgery#s23","snippet":"References & Sources Clinical Practice Guidelines KDIGO. Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation. Transplantation. 2020. AASLD. Evaluation for Liver Transplantation in Adults: 2013 Practice Guideline (updated 2018). Hepatology. ISHLT. Lis...","sourceLabel":"Section in Transplant Surgery"},"3677":{"title":"Hand Surgery","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery","snippet":"Hand Surgery - Complete Reference Every diagnosis, condition, procedure, medication, abbreviation, and documentation framework you need to succeed on day one and beyond."},"3678":{"title":"Hand, Wrist & Forearm Anatomy Essentials","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#s1","snippet":"Hand, Wrist & Forearm Anatomy Essentials Hand surgery covers the fingertips to the elbow. The hand surgeon operates on bone, tendon, nerve, vessel, skin, and joint in a space the size of a deck of cards - which means anatomic precision is everything. Scribes must master the vocabulary of this anatom...","sourceLabel":"Section in Hand Surgery"},"3679":{"title":"Scribe Documentation Framework","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#s2","snippet":"Scribe Documentation Framework Hand surgery encounters split into three main flavors: acute trauma (ED consults, fractures, lacerations, infections), chronic elective (carpal tunnel, trigger finger, arthritis, Dupuytren), and post-operative follow-up . Each has a distinct documentation rhythm. Subje...","sourceLabel":"Section in Hand Surgery"},"3680":{"title":"Distal Radius Fractures","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#s3","snippet":"Distal Radius Fractures The distal radius fracture is the most common fracture of the upper extremity. It occurs across three demographic peaks: pediatric falls, young high-energy trauma (MVCs, sports, falls from height), and low-energy osteoporotic fractures in older adults - particularly postmenop...","sourceLabel":"Section in Hand Surgery"},"3681":{"title":"Scaphoid & Carpal Bone Fractures","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#s4","snippet":"Scaphoid & Carpal Bone Fractures The scaphoid is the most commonly fractured carpal bone (60-70% of carpal fractures). It is notorious for nonunion and avascular necrosis because its blood supply enters through the distal pole - a proximal pole fracture interrupts flow to the proximal fragment. Clas...","sourceLabel":"Section in Hand Surgery"},"3682":{"title":"Carpal Instability & Perilunate Injuries","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#s5","snippet":"Carpal Instability & Perilunate Injuries The carpus is held together by intrinsic (bone-to-bone) and extrinsic (forearm-to-carpus) ligaments. Disruption produces instability patterns. Figure 7 - Scapholunate Dissociation - Terry Thomas Sign. PA radiograph demonstrating widened scapholunate interval ...","sourceLabel":"Section in Hand Surgery"},"3683":{"title":"TFCC Injury & DRUJ Instability","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#s6","snippet":"TFCC Injury & DRUJ Instability The triangular fibrocartilage complex (TFCC) is the meniscus of the wrist - a shock-absorbing and stabilizing structure on the ulnar side. It connects the distal radius to the ulnar styloid and stabilizes the distal radioulnar joint (DRUJ). Injuries cause ulnar-sided w...","sourceLabel":"Section in Hand Surgery"},"3684":{"title":"Metacarpal & Phalangeal Fractures","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#s7","snippet":"Metacarpal & Phalangeal Fractures Metacarpal Fractures Figure 10 - Metacarpal Anatomy and Fracture Assessment. Clinical photograph illustrating the dorsal anatomy of the hand and metacarpal region. Assessment of the knuckle cascade and rotational alignment are critical in evaluating metacarpal fract...","sourceLabel":"Section in Hand Surgery"},"3685":{"title":"Tendon Injuries (Flexor & Extensor)","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#s8","snippet":"Tendon Injuries (Flexor & Extensor) Flexor Tendon Zones (Verdan) Figure 11 - Flexor Tendon Zones of Injury. Zones I-V for the fingers and TI-TV for the thumb. Zone II (\"no man's land\") extends from the A1 pulley to the FDS insertion and is the most challenging zone for flexor tendon repair. Flexor t...","sourceLabel":"Section in Hand Surgery"},"3686":{"title":"Stenosing Tenosynovitis","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#s9","snippet":"Stenosing Tenosynovitis Trigger Finger Figure 14 - Trigger Finger Pathomechanism. Schematic diagram illustrating the A1 pulley and its relationship to the flexor tendon sheath. In trigger finger, stenosis of the A1 pulley creates a size mismatch with the flexor tendon, causing mechanical catching an...","sourceLabel":"Section in Hand Surgery"},"3687":{"title":"Compressive Neuropathies of the Upper Extremity","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#s10","snippet":"Compressive Neuropathies of the Upper Extremity Carpal Tunnel Syndrome (CTS) Figure 16 - Carpal Tunnel Contents. Cross-section at the distal carpal tunnel level demonstrating the median nerve (most superficial and radial), nine flexor tendons, and the transverse carpal ligament forming the roof of t...","sourceLabel":"Section in Hand Surgery"},"3688":{"title":"Peripheral Nerve Injuries & Brachial Plexus","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#s11","snippet":"Peripheral Nerve Injuries & Brachial Plexus Nerve injuries are graded with the Seddon and Sunderland classifications: Seddon Sunderland Injury Recovery Neurapraxia I Myelin injury, axon intact Days to weeks, complete Axonotmesis II Axon disrupted, endoneurium intact 1 mm/day regeneration III Endoneu...","sourceLabel":"Section in Hand Surgery"},"3689":{"title":"Dupuytren Contracture","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#s12","snippet":"Dupuytren Contracture A progressive fibroproliferative disease of the palmar and digital fascia producing cords and nodules that pull the fingers (especially ring and small) into flexion contracture. Northern European ancestry, diabetes, smoking, alcohol use, and male sex are risk factors (the so-ca...","sourceLabel":"Section in Hand Surgery"},"3690":{"title":"Hand & Wrist Masses / Tumors","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#s13","snippet":"Hand & Wrist Masses / Tumors Ganglion cyst : the most common hand mass (60-70%). Mucinous fluid from a joint or tendon sheath. Dorsal wrist ganglia (70%) arise from the scapholunate ligament; volar wrist ganglia arise from the radiocarpal or STT joint and are adjacent to the radial artery; retinacul...","sourceLabel":"Section in Hand Surgery"},"3691":{"title":"Hand Infections","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#s14","snippet":"Hand Infections Kanavel Signs - Pyogenic Flexor Tenosynovitis The four cardinal signs described by Allen Kanavel: (1) fusiform (sausage-shaped) swelling of the digit; (2) finger held in slight flexion at rest; (3) tenderness along the flexor tendon sheath; (4) severe pain with passive extension of t...","sourceLabel":"Section in Hand Surgery"},"3692":{"title":"Arthritis of the Hand & Wrist","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#s15","snippet":"Arthritis of the Hand & Wrist Thumb CMC (Basal Joint) Arthritis Figure 20 - SLAC Wrist Radiographic Appearance. PA radiograph showing scapholunate advanced collapse with widened SL interval, radioscaphoid joint space narrowing, and progressive degenerative changes following the predictable SLAC patt...","sourceLabel":"Section in Hand Surgery"},"3693":{"title":"Fingertip, Nail Bed & Amputation Injuries","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#s16","snippet":"Fingertip, Nail Bed & Amputation Injuries Fingertip injuries are the most common hand injury seen in the ED. Management depends on tissue loss, bone exposure, and the angle/geometry of the defect. Figure 21 - Fingertip Amputation Zones and Digital Anatomy. Classification diagram of the fingertip sho...","sourceLabel":"Section in Hand Surgery"},"3694":{"title":"Congenital Hand Anomalies","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#s17","snippet":"Congenital Hand Anomalies Congenital hand differences are classified by the Oberg-Manske-Tonkin (OMT) system, which replaced the older Swanson classification. Common entities: Syndactyly : webbing of adjacent digits. Simple (skin only) vs complex (bony fusion). Most commonly between the long and rin...","sourceLabel":"Section in Hand Surgery"},"3695":{"title":"Hand Surgery Procedures - A to Z","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#s18","snippet":"Hand Surgery Procedures - A to Z Procedure Description / Indication ORIF distal radius (volar locking plate) Standard operative repair of displaced/unstable distal radius fractures External fixation, distal radius Severely comminuted or open fractures Dorsal bridge plating Highly comminuted distal r...","sourceLabel":"Section in Hand Surgery"},"3696":{"title":"Imaging & Diagnostics","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#s19","snippet":"Imaging & Diagnostics Plain radiographs : PA, lateral, oblique; dedicated scaphoid view; stress views; clenched fist view for SL gap. CT : fracture characterization, occult scaphoid fractures, intra-articular step-off, malunion/nonunion evaluation. MRI : TFCC tears, ligament injuries, occult fractur...","sourceLabel":"Section in Hand Surgery"},"3697":{"title":"Medications You Must Know","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#s20","snippet":"Medications You Must Know Class / Name Brand Use Notes Cephalexin Keflex Cellulitis, paronychia 500 mg PO QID x 7 d Dicloxacillin - Staph skin infection Alternative to cephalexin Amoxicillin-clavulanate Augmentin Bite wounds (human/animal) Covers Pasteurella, Eikenella, oral anaerobes TMP-SMX Bactri...","sourceLabel":"Section in Hand Surgery"},"3698":{"title":"Classification Systems","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#s21","snippet":"Classification Systems All major classifications used in hand surgery are enumerated within their respective condition sections above. Key references include: Frykman - distal radius fractures (Section 03) Mayo - scaphoid fractures (Section 04) Mayfield - perilunate injury progression (Section 05) L...","sourceLabel":"Section in Hand Surgery"},"3699":{"title":"Physical Exam - The Hand Exam","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#s22","snippet":"Physical Exam - The Hand Exam Hand Exam Template Inspection: Resting posture, cascade, swelling, ecchymosis, deformity, scars, nail changes, thenar/hypothenar bulk. Palpation: Snuffbox, scaphoid tubercle, Lister tubercle, radial/ulnar styloid, DRUJ, CMC, MCP, PIP, DIP joints, A1 pulley, first dorsal...","sourceLabel":"Section in Hand Surgery"},"3700":{"title":"Abbreviations Master List","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#s23","snippet":"Abbreviations Master List APB - abductor pollicis brevis APL - abductor pollicis longus AIN - anterior interosseous nerve CMC - carpometacarpal CRPS - complex regional pain syndrome CRPP - closed reduction percutaneous pinning CTR - carpal tunnel release (OCTR/ECTR) CTS - carpal tunnel syndrome DIP ...","sourceLabel":"Section in Hand Surgery"},"3701":{"title":"Sample HPI Templates","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#s24","snippet":"Sample HPI Templates HPI 1 - Distal Radius Fracture 68-year-old right-hand-dominant retired teacher with history of osteoporosis, hypertension, and hypothyroidism who presents as a transfer from outside ED for evaluation of a left distal radius fracture. She was walking her dog yesterday when she tr...","sourceLabel":"Section in Hand Surgery"},"3702":{"title":"References & Sources","pageTitle":"Hand Surgery","pageUrl":"/scribe-guides/hand-surgery","url":"/scribe-guides/hand-surgery#references","snippet":"References & Sources Clinical Practice Guidelines American Academy of Orthopaedic Surgeons. Management of Distal Radius Fractures: Clinical Practice Guideline. 2020. American Academy of Orthopaedic Surgeons. Management of Carpal Tunnel Syndrome: Evidence-Based Clinical Practice Guideline. JBJS. 2016...","sourceLabel":"Section in Hand Surgery"},"3703":{"title":"OB/GYN","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn","snippet":"OB/GYN - Complete Reference Every obstetric and gynecologic diagnosis, procedure, medication, classification, and documentation framework you need to succeed on day one and beyond."},"3704":{"title":"Female Reproductive Anatomy - Essentials","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s1","snippet":"Female Reproductive Anatomy - Essentials OB/GYN covers both obstetrics (pregnancy, labor, delivery, and the postpartum period) and gynecology (the female reproductive tract across the lifespan). A scribe must understand pelvic anatomy cold because virtually every note, exam, ultrasound, and operativ...","sourceLabel":"Section in OB/GYN"},"3705":{"title":"Scribe Documentation Framework (OB vs GYN)","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s2","snippet":"Scribe Documentation Framework (OB vs GYN) OB/GYN notes split into two very different documentation patterns. An OB note centers on the pregnancy - gestational age, fetal status, and any maternal complications. A GYN note behaves more like a general medicine/surgery visit focused on the chief compla...","sourceLabel":"Section in OB/GYN"},"3706":{"title":"Prenatal Care & Routine Obstetric Visits","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s3","snippet":"Prenatal Care & Routine Obstetric Visits Standard uncomplicated prenatal care consists of a visit schedule from the initial OB intake through delivery. The cadence is approximately every 4 weeks until 28 weeks, every 2 weeks from 28 to 36 weeks, and weekly from 36 weeks to delivery. Each visit has p...","sourceLabel":"Section in OB/GYN"},"3707":{"title":"Hypertensive Disorders of Pregnancy","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s4","snippet":"Hypertensive Disorders of Pregnancy Hypertensive disorders complicate 5-10% of pregnancies and are a leading cause of maternal morbidity. ACOG Practice Bulletin 222 on gestational hypertension and preeclampsia is the governing guideline and defines four overlapping categories. Hypertensive Disorders...","sourceLabel":"Section in OB/GYN"},"3708":{"title":"Gestational Diabetes Mellitus (GDM)","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s5","snippet":"Gestational Diabetes Mellitus (GDM) GDM is glucose intolerance first recognized in pregnancy and affects roughly 6-9% of pregnancies. It increases risk of macrosomia, shoulder dystocia, neonatal hypoglycemia, and future type 2 diabetes per ACOG Practice Bulletin 190 . Screening is universal at 24-28...","sourceLabel":"Section in OB/GYN"},"3709":{"title":"Hyperemesis Gravidarum & Intrahepatic Cholestasis","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s6","snippet":"Hyperemesis Gravidarum & Intrahepatic Cholestasis Hyperemesis gravidarum is severe nausea and vomiting of pregnancy causing dehydration, electrolyte disturbance, ketonuria, and > 5% weight loss. Stepwise therapy: vitamin B6 (pyridoxine) &rarr; add doxylamine &rarr; add metoclopramide or promethazine...","sourceLabel":"Section in OB/GYN"},"3710":{"title":"Fetal Growth Disorders & Amniotic Fluid Abnormalities","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s7","snippet":"Fetal Growth Disorders & Amniotic Fluid Abnormalities Intrauterine growth restriction (IUGR / FGR) is estimated fetal weight < 10th percentile with evidence of pathologic restriction; small for gestational age (SGA) is EFW < 10th percentile (may be constitutional). Large for gestational age (LGA) is...","sourceLabel":"Section in OB/GYN"},"3711":{"title":"Antepartum Bleeding - Previa, Abruption, Vasa Previa","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s8","snippet":"Antepartum Bleeding - Previa, Abruption, Vasa Previa Third-Trimester Bleeding - Emergency Differential Placenta previa: painless bright red bleeding; placenta covers or is within 2 cm of internal cervical os. NO vaginal exam until previa is excluded by US. Cesarean delivery is mandatory. Placental a...","sourceLabel":"Section in OB/GYN"},"3712":{"title":"Early Pregnancy Loss, Ectopic, and Molar Pregnancy","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s9","snippet":"Early Pregnancy Loss, Ectopic, and Molar Pregnancy Miscarriage Types Type Cervix Features Threatened Closed Bleeding, viable IUP on US Inevitable Open Bleeding, POC still in uterus Incomplete Open Partial passage of POC Complete Closed All POC passed, empty uterus on US Missed Closed Nonviable pregn...","sourceLabel":"Section in OB/GYN"},"3713":{"title":"Preterm Labor, PROM/PPROM & Chorioamnionitis","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s10","snippet":"Preterm Labor, PROM/PPROM & Chorioamnionitis Preterm labor is regular contractions with cervical change before 37 weeks. PROM is rupture of membranes before labor; PPROM is PROM before 37 weeks. Diagnosis uses pooling of fluid in the posterior fornix, ferning on slide, nitrazine positive (blue), or ...","sourceLabel":"Section in OB/GYN"},"3714":{"title":"Labor, Delivery & Intrapartum Complications","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s11","snippet":"Labor, Delivery & Intrapartum Complications Stages of Labor Stage 1 - Latent: onset of regular contractions to 6 cm dilation Stage 1 - Active: 6 cm to complete dilation (10 cm) Stage 2: complete dilation to delivery of the infant Stage 3: delivery of the infant to delivery of the placenta Stage 4: f...","sourceLabel":"Section in OB/GYN"},"3715":{"title":"Postpartum Care & Complications","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s12","snippet":"Postpartum Care & Complications Postpartum Hemorrhage (PPH) Defined as cumulative blood loss &ge; 1000 mL or blood loss with signs of hypovolemia within 24 hours of birth. Causes follow the Four T's : Tone (uterine atony - 70% of cases), Trauma (lacerations, hematoma), Tissue (retained placenta), Th...","sourceLabel":"Section in OB/GYN"},"3716":{"title":"Abnormal Uterine Bleeding (PALM-COEIN)","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s13","snippet":"Abnormal Uterine Bleeding (PALM-COEIN) Per FIGO and ACOG PALM-COEIN classification , abnormal uterine bleeding in reproductive-age women is categorized by structural (PALM) and non-structural (COEIN) causes. PALM-COEIN Structural (PALM) Non-structural (COEIN) P - Polyp C - Coagulopathy A - Adenomyos...","sourceLabel":"Section in OB/GYN"},"3717":{"title":"Contraception - Every Method","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s14","snippet":"Contraception - Every Method Contraception counseling uses the tiered effectiveness framework from the CDC US Medical Eligibility Criteria . LARCs (IUDs, implant) are the most effective reversible methods. Figure 14 - Cervical Anatomy Relevant to IUD Placement. Diagram of the cervix illustrating the...","sourceLabel":"Section in OB/GYN"},"3718":{"title":"PCOS, Endometriosis, Adenomyosis & Fibroids","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s15","snippet":"PCOS, Endometriosis, Adenomyosis & Fibroids Polycystic Ovary Syndrome (PCOS) A heterogeneous endocrine disorder affecting 6-12% of reproductive-age women. Diagnosis uses the Rotterdam criteria : 2 of 3 of (1) oligo/anovulation, (2) clinical or biochemical hyperandrogenism, (3) polycystic ovaries on ...","sourceLabel":"Section in OB/GYN"},"3719":{"title":"Ovarian Cysts, Torsion & PID","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s16","snippet":"Ovarian Cysts, Torsion & PID Physiologic cysts (follicular, corpus luteum) resolve spontaneously. Hemorrhagic cysts present with acute unilateral pain. Pathologic cysts include endometriomas (\"chocolate cysts\"), dermoids (mature cystic teratomas), and cystadenomas. Simple cysts < 5 cm in premenopaus...","sourceLabel":"Section in OB/GYN"},"3720":{"title":"Vaginitis, Cervicitis & Vulvar Disorders","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s17","snippet":"Vaginitis, Cervicitis & Vulvar Disorders Condition Discharge pH Microscopy Treatment Bacterial vaginosis (BV) Thin gray, fishy odor > 4.5 Clue cells, positive whiff test Metronidazole PO/gel or clindamycin Candidiasis Thick white \"cottage cheese\" < 4.5 Pseudohyphae, budding yeast Fluconazole 150 mg ...","sourceLabel":"Section in OB/GYN"},"3721":{"title":"Cervical, Endometrial & Ovarian Cancer","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s18","snippet":"Cervical, Endometrial & Ovarian Cancer Cervical Cancer & Screening Essentially all cervical cancer is caused by persistent high-risk HPV infection (especially 16 and 18). Screening per USPSTF cervical cancer screening and ASCCP 2019 risk-based management guidelines : Ages 21-29: cytology every 3 yea...","sourceLabel":"Section in OB/GYN"},"3722":{"title":"Pelvic Organ Prolapse & Urinary Incontinence","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s19","snippet":"Pelvic Organ Prolapse & Urinary Incontinence Pelvic organ prolapse (POP) is descent of pelvic organs into the vaginal canal: cystocele (bladder), rectocele (rectum), enterocele (small bowel), uterine prolapse, and vaginal vault prolapse. Quantified by the POP-Q system. Symptoms: vaginal bulge, press...","sourceLabel":"Section in OB/GYN"},"3723":{"title":"Menopause, HRT & Infertility Workup","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s20","snippet":"Menopause, HRT & Infertility Workup Menopause is defined as 12 months of amenorrhea, average age 51. Symptoms include vasomotor (hot flashes, night sweats), genitourinary syndrome of menopause (vaginal dryness, dyspareunia, urinary urgency), sleep disturbance, and mood changes. FSH is elevated but i...","sourceLabel":"Section in OB/GYN"},"3724":{"title":"OB/GYN Procedures - A to Z","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s21","snippet":"OB/GYN Procedures - A to Z Procedure Description / Indication Cervical cytology (Pap) Sampling of ectocervix + endocervical canal for cytology/HPV testing Colposcopy Magnified cervical exam with acetic acid/Lugol's; directed biopsies of abnormal areas LEEP / cone biopsy Electrosurgical or cold-knife...","sourceLabel":"Section in OB/GYN"},"3725":{"title":"Labs, Imaging & Screening","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s22","snippet":"Labs, Imaging & Screening OB-Specific Labs & Tests Quantitative &beta;-hCG: detects pregnancy at ~8-10 days post-conception. In a viable IUP, hCG rises by at least 53% every 48 hours in early pregnancy. Plateau or slow rise raises concern for ectopic or nonviable IUP. Discriminatory zone: &beta;-hCG...","sourceLabel":"Section in OB/GYN"},"3726":{"title":"Medications You Must Know","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s23","snippet":"Medications You Must Know Class / Indication Generic (Brand) Notes Prenatal vitamin PNV with folic acid 400-800 mcg 4 mg in prior NTD history Iron Ferrous sulfate, ferrous gluconate, IV iron sucrose For anemia of pregnancy Antiemetic (N/V of pregnancy) Vit B6 + doxylamine (Diclegis), ondansetron, pr...","sourceLabel":"Section in OB/GYN"},"3727":{"title":"Classification Systems & Physical Exam","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s24","snippet":"Classification Systems & Physical Exam Key Classification Systems (Full Enumeration) All of the following are fully enumerated in the sections where they first appear: PALM-COEIN (Section 13), Bishop score (Section 11), FIGO cervical/endometrial/ovarian staging (Section 18), Rotterdam criteria for P...","sourceLabel":"Section in OB/GYN"},"3728":{"title":"Abbreviations Master List","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s25","snippet":"Abbreviations Master List Obstetrics GA Gestational age EDD / EDC Estimated due date / date of confinement LMP Last menstrual period G / P / TPAL Gravidity / parity / term-preterm-abortion-living IUP Intrauterine pregnancy SAB / TAB Spontaneous / therapeutic abortion EPL Early pregnancy loss FHT / F...","sourceLabel":"Section in OB/GYN"},"3729":{"title":"Sample HPI Templates","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s26","snippet":"Sample HPI Templates These templates show the kind of documentation expected in OB/GYN clinic and L&D. Use them as frameworks to internalize the rhythm and content of a good OB or GYN HPI. Sample HPI - New OB Intake \"Ms. [Name] is a 29-year-old G2P1001 at 9w2d by LMP c/w 8w6d TVUS presenting for ini...","sourceLabel":"Section in OB/GYN"},"3730":{"title":"References & Sources","pageTitle":"OB/GYN","pageUrl":"/scribe-guides/obgyn","url":"/scribe-guides/obgyn#s27","snippet":"References & Sources Clinical Practice Guidelines ACOG Practice Bulletin 222. Gestational Hypertension and Preeclampsia. Obstet Gynecol. 2020. ACOG Practice Bulletin 190. Gestational Diabetes Mellitus. Obstet Gynecol. 2018. ACOG Practice Bulletin 183. Postpartum Hemorrhage. Obstet Gynecol. 2017. ACO...","sourceLabel":"Section in OB/GYN"},"3731":{"title":"Urology","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology","snippet":"Urology - Complete Reference Every diagnosis, condition, procedure, medication, abbreviation, and documentation framework you need to succeed on day one and beyond."},"3732":{"title":"The Genitourinary System - Anatomy Essentials","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology#s1","snippet":"The Genitourinary System - Anatomy Essentials Urology covers the entire urinary tract in both sexes and the male reproductive system. That means kidneys, ureters, bladder, urethra, prostate, seminal vesicles, vas deferens, epididymis, testes, penis, and scrotum. Female reproductive organs belong to ...","sourceLabel":"Section in Urology"},"3733":{"title":"Scribe Documentation Framework","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology#s2","snippet":"Scribe Documentation Framework The Urology Visit Urology visits cluster around a handful of chief complaints: LUTS/BPH, hematuria, cancer follow-up, stones, incontinence, ED, scrotal problems, and UTIs. Notes are SOAP-formatted, but the urologic HPI has specific elements that must be captured every ...","sourceLabel":"Section in Urology"},"3734":{"title":"Prostate Cancer","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology#s3","snippet":"Prostate Cancer Prostate cancer is the most common non-skin cancer in men and the second leading cause of male cancer death in the US. The vast majority are adenocarcinomas arising in the peripheral zone. Most are indolent; a minority are aggressive and metastasize to regional lymph nodes and bone. ...","sourceLabel":"Section in Urology"},"3735":{"title":"Benign Prostatic Hyperplasia & LUTS","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology#s4","snippet":"Benign Prostatic Hyperplasia & LUTS BPH is the non-cancerous enlargement of the prostatic transition zone. It is nearly universal in aging men - histologic BPH is present in > 80% of men by age 80. BPH causes lower urinary tract symptoms (LUTS) by compressing the prostatic urethra and by altering bl...","sourceLabel":"Section in Urology"},"3736":{"title":"Prostatitis & Chronic Pelvic Pain","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology#s5","snippet":"Prostatitis & Chronic Pelvic Pain The NIH classification of prostatitis has four categories: Category I - acute bacterial prostatitis (acute febrile illness with dysuria and perineal pain, boggy tender prostate on DRE - vigorous DRE contraindicated due to bacteremia risk; treat with fluoroquinolone ...","sourceLabel":"Section in Urology"},"3737":{"title":"Kidney Cancer (RCC & Upper Tract)","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology#s6","snippet":"Kidney Cancer (RCC & Upper Tract) Renal cell carcinoma (RCC) is the most common primary kidney cancer in adults. Clear cell RCC is the most common subtype (~75%), followed by papillary (types 1 and 2) and chromophobe. RCC classically presents incidentally on imaging obtained for another indication -...","sourceLabel":"Section in Urology"},"3738":{"title":"Bladder Cancer (NMIBC & MIBC)","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology#s7","snippet":"Bladder Cancer (NMIBC & MIBC) The overwhelming majority of bladder cancers are urothelial (transitional cell) carcinomas. Squamous cell (associated with chronic inflammation, schistosomiasis) and adenocarcinoma (urachal remnant) are uncommon. The dominant risk factor is smoking - document pack-years...","sourceLabel":"Section in Urology"},"3739":{"title":"Testicular & Penile Cancer","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology#s8","snippet":"Testicular & Penile Cancer Testicular Cancer Testicular cancer is the most common solid malignancy in men aged 15-35 and one of the most curable. Germ cell tumors account for > 95% and are divided into seminoma and non-seminomatous germ cell tumors (NSGCT - embryonal, yolk sac, choriocarcinoma, tera...","sourceLabel":"Section in Urology"},"3740":{"title":"Nephrolithiasis (Kidney Stones)","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology#s9","snippet":"Nephrolithiasis (Kidney Stones) Kidney stones are among the most common urologic emergencies and clinic visits. Lifetime prevalence approaches 10%. Recurrence rates are high (50% within 5-10 years), so medical prevention is as important as acute management. Figure 11 - Renal Caliceal Anatomy for Sto...","sourceLabel":"Section in Urology"},"3741":{"title":"Hematuria Evaluation","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology#s10","snippet":"Hematuria Evaluation Hematuria is blood in the urine. It is divided into gross hematuria (visible) and microscopic hematuria (&ge; 3 RBC/HPF on microscopic UA in the absence of obvious benign cause). Gross hematuria in an adult is bladder cancer until proven otherwise. Microscopic hematuria requires...","sourceLabel":"Section in Urology"},"3742":{"title":"Urinary Tract Infection & Pyelonephritis","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology#s11","snippet":"Urinary Tract Infection & Pyelonephritis Urinary tract infections range from uncomplicated cystitis in healthy women to life-threatening urosepsis. Classification drives management: UTI Classification Uncomplicated: healthy non-pregnant premenopausal woman, normal GU tract. Complicated: any UTI in a...","sourceLabel":"Section in Urology"},"3743":{"title":"Scrotal Pain & Testicular Emergencies","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology#s12","snippet":"Scrotal Pain & Testicular Emergencies Testicular Torsion - Time-Sensitive Emergency Twisting of the spermatic cord cuts off blood supply to the testis. Peak incidence in adolescents. Presents with sudden severe unilateral scrotal pain, often with nausea/vomiting, high-riding testis with a horizontal...","sourceLabel":"Section in Urology"},"3744":{"title":"Male Sexual Health (ED, Peyronie, Hypogonadism, Infertility)","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology#s13","snippet":"Male Sexual Health (ED, Peyronie, Hypogonadism, Infertility) Erectile dysfunction (ED) is the consistent inability to achieve or maintain an erection adequate for satisfactory sexual activity. Etiology is overwhelmingly vascular (endothelial dysfunction shares risk factors with CAD - ED is often a s...","sourceLabel":"Section in Urology"},"3745":{"title":"Urinary Incontinence & Female Urology","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology#s14","snippet":"Urinary Incontinence & Female Urology ICS Types of Incontinence Stress (SUI): involuntary leakage with effort, cough, sneeze, or exercise - due to urethral hypermobility or intrinsic sphincter deficiency. Urgency (UUI): involuntary leakage accompanied by a sudden compelling desire to void - a compon...","sourceLabel":"Section in Urology"},"3746":{"title":"Neurogenic Bladder & Urinary Retention","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology#s15","snippet":"Neurogenic Bladder & Urinary Retention Neurogenic bladder is any bladder dysfunction caused by nervous system injury: spinal cord injury, multiple sclerosis, Parkinson disease, stroke, diabetic neuropathy, spina bifida. Manifestations include detrusor overactivity, detrusor-sphincter dyssynergia (DS...","sourceLabel":"Section in Urology"},"3747":{"title":"Obstructive Uropathy, Strictures & Hydronephrosis","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology#s16","snippet":"Obstructive Uropathy, Strictures & Hydronephrosis Hydronephrosis is dilation of the renal collecting system, usually from obstruction but also from reflux or congenital anomaly. Graded on ultrasound: Figure 19 - UPJ Obstruction with Hydronephrosis. Renal ultrasound demonstrating significant hydronep...","sourceLabel":"Section in Urology"},"3748":{"title":"Pediatric Urology","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology#s17","snippet":"Pediatric Urology Vesicoureteral reflux (VUR) is retrograde flow of urine from bladder to ureter/kidney, predisposing to pyelonephritis and renal scarring. Diagnosed by voiding cystourethrogram (VCUG). Graded I-V: Figure 22 - Hypospadias Classification. Diagram illustrating the classification of hyp...","sourceLabel":"Section in Urology"},"3749":{"title":"Genitourinary Trauma & Urologic Emergencies","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology#s18","snippet":"Genitourinary Trauma & Urologic Emergencies Renal trauma is most commonly blunt (MVC, fall). Graded by the AAST Renal Injury Scale I-V: Figure 24 - Fournier Gangrene Fascial Spread. CT scan demonstrating the extent of fascial involvement in necrotizing fasciitis, illustrating the tip-of-the-iceberg ...","sourceLabel":"Section in Urology"},"3750":{"title":"Urologic Procedures - A to Z","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology#s19","snippet":"Urologic Procedures - A to Z Procedure What It Is Key Indications Flexible cystoscopy Office-based bladder/urethral inspection with a flexible scope Hematuria workup, surveillance, LUTS evaluation, catheter placement Rigid cystoscopy OR-based bladder inspection allowing larger working channel Stone ...","sourceLabel":"Section in Urology"},"3751":{"title":"Urologic Imaging & Diagnostics","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology#s20","snippet":"Urologic Imaging & Diagnostics Ultrasound: Renal US shows hydronephrosis, stones, masses, cysts. Scrotal US with Doppler is the go-to for testicular pain, mass, or trauma - reports intratesticular flow. Bladder US measures volume and PVR. Transrectal US (TRUS) evaluates the prostate for biopsy guida...","sourceLabel":"Section in Urology"},"3752":{"title":"Medications You Must Know","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology#s21","snippet":"Medications You Must Know Alpha Blockers (BPH, MET) Generic Brand Dose Notes Tamsulosin Flomax 0.4 mg qHS Most common; intraoperative floppy iris syndrome (IFIS) - flag before cataract surgery Alfuzosin Uroxatral 10 mg daily QT prolongation caution Silodosin Rapaflo 8 mg daily Most uroselective; ret...","sourceLabel":"Section in Urology"},"3753":{"title":"Classification & Staging Systems","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology#s22","snippet":"Classification & Staging Systems This section collects classifications referenced throughout the guide that are not already fully enumerated in their disease sections. Stone, bladder cancer, VUR, hydronephrosis, renal injury, and Bosniak systems are listed in their respective sections above. AUA Sym...","sourceLabel":"Section in Urology"},"3754":{"title":"Physical Exam, Abbreviations & Risk Factors","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology#s23","snippet":"Physical Exam, Abbreviations & Risk Factors The Urologic Physical Exam Male GU Exam Template Abd: soft, NT, ND; no CVA tenderness; no palpable bladder Penis: circumcised, meatus normal, no lesions Testes: descended bilaterally, normal size, non-tender, no masses Epididymis/cord: non-tender, no varic...","sourceLabel":"Section in Urology"},"3755":{"title":"Sample HPI Templates & References","pageTitle":"Urology","pageUrl":"/scribe-guides/urology","url":"/scribe-guides/urology#s24","snippet":"Sample HPI Templates & References These templates show the rhythm and content expected in a real urology clinic note. Use them as frameworks during your first weeks. Sample HPI - BPH / LUTS New Consult \"Mr. [Name] is a 68-year-old male with hypertension and type 2 diabetes who presents for evaluatio...","sourceLabel":"Section in Urology"},"3756":{"title":"Otolaryngology (ENT)","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent","snippet":"Otolaryngology (ENT) - Complete Reference Every diagnosis, condition, procedure, medication, abbreviation, and documentation framework you need to succeed on day one and beyond in otolaryngology head & neck surgery."},"3757":{"title":"Head & Neck Anatomy Essentials","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#s1","snippet":"Head & Neck Anatomy Essentials Otolaryngology - head and neck surgery covers the ear, nose, throat, larynx, salivary glands, thyroid/parathyroid, skull base, and all soft-tissue structures of the face and neck above the clavicles (excluding the brain, eyes, and cervical spine). A scribe must underst...","sourceLabel":"Section in Otolaryngology (ENT)"},"3758":{"title":"Scribe Documentation Framework","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#s2","snippet":"Scribe Documentation Framework ENT encounters move fast. A busy general otolaryngologist may see 30-50 patients per day, each requiring a focused exam of ear, nose, throat, and often flexible laryngoscopy. The scribe's job is to capture a complete, billable note in real time without slowing the clin...","sourceLabel":"Section in Otolaryngology (ENT)"},"3759":{"title":"Otology - Ear Diseases","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#s3","snippet":"Otology - Ear Diseases Otitis Externa (OE) Infection of the external auditory canal, often called \"swimmer's ear.\" Pseudomonas and Staph aureus are the most common organisms. Patients present with otalgia, otorrhea, and tenderness on manipulation of the tragus or pinna. On otoscopy the canal is edem...","sourceLabel":"Section in Otolaryngology (ENT)"},"3760":{"title":"Hearing Loss & Audiology","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#s4","snippet":"Hearing Loss & Audiology Hearing loss is categorized by type and severity. Conductive hearing loss (CHL) is caused by pathology of the outer or middle ear (cerumen impaction, TM perforation, effusion, ossicular disruption, otosclerosis). Sensorineural hearing loss (SNHL) arises from the cochlea or C...","sourceLabel":"Section in Otolaryngology (ENT)"},"3761":{"title":"Vestibular Disorders","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#s5","snippet":"Vestibular Disorders Benign Paroxysmal Positional Vertigo (BPPV) The most common cause of vertigo. Caused by displaced otoconia (calcium carbonate crystals) from the utricle into a semicircular canal, most commonly the posterior canal. Presents with brief (< 1 minute) episodes of spinning triggered ...","sourceLabel":"Section in Otolaryngology (ENT)"},"3762":{"title":"Facial Nerve Disorders","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#s6","snippet":"Facial Nerve Disorders Bell Palsy Idiopathic (likely HSV-reactivation-related) lower-motor-neuron facial nerve paralysis, presenting with acute unilateral facial weakness including the forehead (distinguishing it from a central lesion, which spares the forehead). Associated symptoms: decreased teari...","sourceLabel":"Section in Otolaryngology (ENT)"},"3763":{"title":"Rhinology - Nose & Sinus Disease","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#s7","snippet":"Rhinology - Nose & Sinus Disease Acute Rhinosinusitis (ARS) Inflammation of the nasal cavity and paranasal sinuses lasting < 4 weeks. Most cases are viral. Acute bacterial rhinosinusitis (ABRS) is diagnosed per the AAO-HNS adult sinusitis CPG when any one of: (1) symptoms persist > 10 days without i...","sourceLabel":"Section in Otolaryngology (ENT)"},"3764":{"title":"Epistaxis & Nasal Trauma","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#s8","snippet":"Epistaxis & Nasal Trauma Epistaxis is overwhelmingly anterior (90%), arising from Kiesselbach's plexus at the anterior septum (Little's area), where the anterior ethmoid, superior labial, greater palatine, and sphenopalatine arteries anastomose. Posterior epistaxis originates from the sphenopalatine...","sourceLabel":"Section in Otolaryngology (ENT)"},"3765":{"title":"Laryngology - Voice & Airway","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#s9","snippet":"Laryngology - Voice & Airway Persistent hoarseness (dysphonia) lasting > 3 weeks, or any hoarseness in a smoker, requires laryngoscopy per the AAO-HNS dysphonia/hoarseness CPG . Vocal Fold Lesions Vocal fold nodules are bilateral, symmetric, callus-like thickenings at the junction of the anterior an...","sourceLabel":"Section in Otolaryngology (ENT)"},"3766":{"title":"Dysphagia Evaluation","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#s10","snippet":"Dysphagia Evaluation Dysphagia workup is guided by the AAO-HNS dysphagia evidence statements . Distinguish oropharyngeal dysphagia (transfer failure, coughing with meals, aspiration) from esophageal dysphagia (food sticking after swallowing). Common otolaryngology evaluations: Test What It Shows Use...","sourceLabel":"Section in Otolaryngology (ENT)"},"3767":{"title":"Head & Neck Oncology","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#s11","snippet":"Head & Neck Oncology Over 90% of head and neck cancers are squamous cell carcinoma (SCC) . Risk factors: tobacco, alcohol (synergistic with tobacco), HPV (especially HPV-16 for oropharyngeal SCC), betel nut, radiation, and poor dentition. Staging follows AJCC 8th edition and is managed per NCCN Head...","sourceLabel":"Section in Otolaryngology (ENT)"},"3768":{"title":"Salivary Gland Disease","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#s12","snippet":"Salivary Gland Disease The major salivary glands are the parotid, submandibular, and sublingual. Parotid tumors are most common and the majority (~80%) are benign; the smaller the gland the higher the probability of malignancy (sublingual tumors are ~80% malignant). The facial nerve runs through the...","sourceLabel":"Section in Otolaryngology (ENT)"},"3769":{"title":"Neck Masses & Congenital Lesions","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#s13","snippet":"Neck Masses & Congenital Lesions The age of the patient guides the differential. In children : reactive lymphadenopathy (most common), congenital cysts (thyroglossal duct, branchial cleft), lymphatic malformations, and lymphoma. In young adults : reactive/infectious, lymphoma, thyroid nodules. In ad...","sourceLabel":"Section in Otolaryngology (ENT)"},"3770":{"title":"Sleep-Disordered Breathing & OSA","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#s14","snippet":"Sleep-Disordered Breathing & OSA Obstructive sleep apnea (OSA) is recurrent collapse of the upper airway during sleep. ENT is often consulted for surgical management when CPAP fails. Evaluation includes polysomnography (AHI: mild 5-14, moderate 15-29, severe &ge; 30), Mallampati score, tonsil size, ...","sourceLabel":"Section in Otolaryngology (ENT)"},"3771":{"title":"Pediatric ENT","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#s15","snippet":"Pediatric ENT Recurrent AOM & Otitis Media with Effusion (OME) Recurrent AOM (3 episodes in 6 months or 4 in 12 months with at least one in the past 6 months) and chronic OME with hearing loss are common indications for tympanostomy tube (T-tube) placement . Per the AAO-HNS tympanostomy tubes CPG , ...","sourceLabel":"Section in Otolaryngology (ENT)"},"3772":{"title":"Deep Neck Space Infections","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#s16","snippet":"Deep Neck Space Infections Airway Emergencies Deep neck infections can rapidly compromise the airway, spread to the mediastinum (descending necrotizing mediastinitis), or cause septic thrombophlebitis of the internal jugular vein (Lemierre syndrome). Any patient with trismus, drooling, muffled \"hot ...","sourceLabel":"Section in Otolaryngology (ENT)"},"3773":{"title":"Facial Plastics & Reconstruction","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#s17","snippet":"Facial Plastics & Reconstruction Facial plastic & reconstructive surgery encompasses cosmetic and functional procedures of the face and neck. Common procedures performed or comanaged by ENT: rhinoplasty (cosmetic and functional - often combined with septoplasty as septorhinoplasty), otoplasty (ear p...","sourceLabel":"Section in Otolaryngology (ENT)"},"3774":{"title":"ENT Procedures - A to Z","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#s18","snippet":"ENT Procedures - A to Z Procedure Description / Indication Tympanostomy tube placement Myringotomy + PE tube for OME, rAOM Myringotomy Incision of TM for drainage Tympanoplasty Repair of TM perforation with fascia/cartilage graft Stapedectomy / stapedotomy Prosthetic replacement of stapes for otoscl...","sourceLabel":"Section in Otolaryngology (ENT)"},"3775":{"title":"ENT Imaging & Diagnostics","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#s19","snippet":"ENT Imaging & Diagnostics Study Key Uses CT sinus (without contrast) Chronic rhinosinusitis, preoperative FESS planning; scored by Lund-Mackay CT neck with contrast Neck mass workup, abscess, head and neck cancer staging CT temporal bone Cholesteatoma, temporal bone fracture, malignant OE MRI IAC wi...","sourceLabel":"Section in Otolaryngology (ENT)"},"3776":{"title":"Medications You Must Know","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#s20","snippet":"Medications You Must Know Antibiotics Drug Typical Use in ENT Amoxicillin (high-dose) First-line AOM in children Amoxicillin-clavulanate (Augmentin) ABRS, recurrent AOM, peritonsillar abscess, sialadenitis Cefdinir / cefpodoxime AOM/ABRS in non-anaphylactic PCN allergy Ceftriaxone IM AOM failure, se...","sourceLabel":"Section in Otolaryngology (ENT)"},"3777":{"title":"Classification Systems","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#s21","snippet":"Classification Systems AAO-HNS Adult Sinusitis Diagnostic Criteria (Acute Bacterial Rhinosinusitis) Diagnose ABRS when a patient has signs/symptoms of ARS AND any one of the following: Persistent symptoms lasting &ge; 10 days without improvement Severe onset - high fever (&ge; 39&deg;C) with purulen...","sourceLabel":"Section in Otolaryngology (ENT)"},"3778":{"title":"Physical Exam - The ENT Exam","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#s22","snippet":"Physical Exam - The ENT Exam The ENT exam is fast, focused, and repeats on every patient. A complete exam has ear, nose, oral cavity/oropharynx, neck, and cranial nerve components; most encounters add flexible laryngoscopy. Standard ENT Exam Template Ears: Auricles normal. EACs patent without debris...","sourceLabel":"Section in Otolaryngology (ENT)"},"3779":{"title":"Abbreviations Master List","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#s23","snippet":"Abbreviations Master List Anatomy EAC External auditory canal TM Tympanic membrane ME Middle ear IAC Internal auditory canal ET Eustachian tube OMC Ostiomeatal complex NP Nasopharynx OP Oropharynx HP Hypopharynx BOT Base of tongue FOM Floor of mouth TVF True vocal fold RLN Recurrent laryngeal nerve ...","sourceLabel":"Section in Otolaryngology (ENT)"},"3780":{"title":"Sample HPI Templates","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#s24","snippet":"Sample HPI Templates Sample HPI - Chronic Otitis Media with Cholesteatoma \"Mr. [Name] is a 42-year-old male with a longstanding history of right ear drainage and gradually worsening hearing, presenting for otology evaluation. He reports approximately 15 years of intermittent foul-smelling right otor...","sourceLabel":"Section in Otolaryngology (ENT)"},"3781":{"title":"References & Sources","pageTitle":"Otolaryngology (ENT)","pageUrl":"/scribe-guides/ent","url":"/scribe-guides/ent#references","snippet":"References & Sources Clinical Practice Guidelines Rosenfeld RM et al. Clinical Practice Guideline (Update): Adult Sinusitis. AAO-HNSF. Otolaryngol Head Neck Surg. 2015. Lieberthal AS et al. The Diagnosis and Management of Acute Otitis Media. AAP/AAO-HNS. Pediatrics. 2013. Rosenfeld RM et al. Clinica...","sourceLabel":"Section in Otolaryngology (ENT)"},"3782":{"title":"Ophthalmology","pageTitle":"Ophthalmology","pageUrl":"/scribe-guides/ophthalmology","url":"/scribe-guides/ophthalmology","snippet":"Ophthalmology - Complete Reference Every diagnosis, condition, procedure, medication, abbreviation, and documentation framework you need to succeed on day one in an eye clinic or OR."},"3783":{"title":"Ocular Anatomy Essentials","pageTitle":"Ophthalmology","pageUrl":"/scribe-guides/ophthalmology","url":"/scribe-guides/ophthalmology#s1","snippet":"Ocular Anatomy Essentials Ophthalmology is an optical system grafted onto a nervous system. Light travels through a precisely ordered series of structures - tear film, cornea, aqueous, pupil, lens, vitreous, retina - and is transduced into neural signals that exit the eye via the optic nerve. Every ...","sourceLabel":"Section in Ophthalmology"},"3784":{"title":"Scribe Documentation Framework (Eye-Specific)","pageTitle":"Ophthalmology","pageUrl":"/scribe-guides/ophthalmology","url":"/scribe-guides/ophthalmology#s2","snippet":"Scribe Documentation Framework (Eye-Specific) Ophthalmology notes do not look like general medical notes. The structure is heavily templated around a repeatable data set: visual acuity, IOP, pupils, motility, confrontation fields, slit-lamp exam, and dilated fundus exam. The HPI is usually short, th...","sourceLabel":"Section in Ophthalmology"},"3785":{"title":"Refractive Error","pageTitle":"Ophthalmology","pageUrl":"/scribe-guides/ophthalmology","url":"/scribe-guides/ophthalmology#s3","snippet":"Refractive Error Refractive error is the single most common reason people see an eye care provider. It is an optical mismatch between the length of the eye and the focusing power of the cornea and lens. Refractive error is not a disease - it is a property that glasses, contact lenses, or surgery can...","sourceLabel":"Section in Ophthalmology"},"3786":{"title":"Cataracts","pageTitle":"Ophthalmology","pageUrl":"/scribe-guides/ophthalmology","url":"/scribe-guides/ophthalmology#s4","snippet":"Cataracts Cataract is a clouding of the crystalline lens and is the leading cause of reversible blindness worldwide. It is the most common surgical diagnosis in ophthalmology: cataract surgery is the highest-volume surgical procedure performed in the United States. Every comprehensive ophthalmology ...","sourceLabel":"Section in Ophthalmology"},"3787":{"title":"Glaucoma","pageTitle":"Ophthalmology","pageUrl":"/scribe-guides/ophthalmology","url":"/scribe-guides/ophthalmology#s5","snippet":"Glaucoma Glaucoma is an optic neuropathy characterized by progressive retinal ganglion cell loss, optic nerve head cupping, and corresponding visual field defects. It is the leading cause of irreversible blindness worldwide. Elevated IOP is the most important modifiable risk factor, but glaucoma can...","sourceLabel":"Section in Ophthalmology"},"3788":{"title":"Diabetic Retinopathy & DME","pageTitle":"Ophthalmology","pageUrl":"/scribe-guides/ophthalmology","url":"/scribe-guides/ophthalmology#s6","snippet":"Diabetic Retinopathy & DME Diabetic retinopathy (DR) is a microvascular complication of diabetes and a leading cause of blindness in working-age adults. Every diabetic patient needs a yearly dilated fundus exam. Duration of diabetes and glycemic control are the dominant risk factors. Figure 11 - Dia...","sourceLabel":"Section in Ophthalmology"},"3789":{"title":"Age-Related Macular Degeneration","pageTitle":"Ophthalmology","pageUrl":"/scribe-guides/ophthalmology","url":"/scribe-guides/ophthalmology#s7","snippet":"Age-Related Macular Degeneration AMD is the leading cause of severe central vision loss in adults over 60 in developed countries. It affects the macula - the cone-rich central retina - producing central scotomas and metamorphopsia while sparing peripheral vision. The two forms are dry (non-neovascul...","sourceLabel":"Section in Ophthalmology"},"3790":{"title":"Retinal Detachment & Vitreoretinal Interface","pageTitle":"Ophthalmology","pageUrl":"/scribe-guides/ophthalmology","url":"/scribe-guides/ophthalmology#s8","snippet":"Retinal Detachment & Vitreoretinal Interface Retinal detachment is a surgical emergency - the neurosensory retina separates from the RPE, cutting off outer retinal nutrition. Untreated, it leads to permanent vision loss. Figure 14 - Types of Retinal Detachment. Schematic comparing rhegmatogenous (re...","sourceLabel":"Section in Ophthalmology"},"3791":{"title":"Vascular Occlusions (RVO, RAO)","pageTitle":"Ophthalmology","pageUrl":"/scribe-guides/ophthalmology","url":"/scribe-guides/ophthalmology#s9","snippet":"Vascular Occlusions (RVO, RAO) Sudden, painless vision loss in an older patient with vasculopathic risk factors should immediately raise concern for a retinal vascular occlusion. Figure 16 - Retinal Vascular Imaging with OCT Angiography. OCTA demonstrating capillary non-perfusion zones, microaneurys...","sourceLabel":"Section in Ophthalmology"},"3792":{"title":"Uveitis","pageTitle":"Ophthalmology","pageUrl":"/scribe-guides/ophthalmology","url":"/scribe-guides/ophthalmology#s10","snippet":"Uveitis Uveitis is inflammation of the uveal tract. It is classified anatomically by the primary site of inflammation - a schema that drives both workup and treatment. Figure 17 - Keratic Precipitates in Anterior Uveitis. Slit lamp photograph demonstrating keratic precipitates (KPs) deposited on the...","sourceLabel":"Section in Ophthalmology"},"3793":{"title":"Cornea, Conjunctiva & External Disease","pageTitle":"Ophthalmology","pageUrl":"/scribe-guides/ophthalmology","url":"/scribe-guides/ophthalmology#s11","snippet":"Cornea, Conjunctiva & External Disease Conjunctivitis Type Discharge Key Features Viral (adenovirus) Watery Often bilateral, preauricular lymphadenopathy, starts unilateral; highly contagious; follicular reaction Bacterial Purulent Crusting lids, mucopurulent discharge; hyperacute discharge suggests...","sourceLabel":"Section in Ophthalmology"},"3794":{"title":"Eyelid, Lacrimal & Orbital Disease","pageTitle":"Ophthalmology","pageUrl":"/scribe-guides/ophthalmology","url":"/scribe-guides/ophthalmology#s12","snippet":"Eyelid, Lacrimal & Orbital Disease Ptosis: drooping of the upper eyelid. Aponeurotic (age-related stretching of levator aponeurosis) is most common; other causes include myogenic (myasthenia gravis, CPEO), neurogenic (CN III palsy, Horner syndrome), mechanical, and congenital. Measure MRD1 (margin r...","sourceLabel":"Section in Ophthalmology"},"3795":{"title":"Neuro-Ophthalmology","pageTitle":"Ophthalmology","pageUrl":"/scribe-guides/ophthalmology","url":"/scribe-guides/ophthalmology#s13","snippet":"Neuro-Ophthalmology Optic neuritis: inflammation of the optic nerve, most commonly demyelinating (multiple sclerosis, NMO-SD, MOG-AD). Young patients with unilateral subacute vision loss, eye pain worse with movement, dyschromatopsia (especially red desaturation), and a relative afferent pupillary d...","sourceLabel":"Section in Ophthalmology"},"3796":{"title":"Pediatric Ophthalmology & Strabismus","pageTitle":"Ophthalmology","pageUrl":"/scribe-guides/ophthalmology","url":"/scribe-guides/ophthalmology#s14","snippet":"Pediatric Ophthalmology & Strabismus Amblyopia (\"lazy eye\"): reduced best-corrected vision in an otherwise structurally normal eye from abnormal visual development in childhood. Causes: strabismic, refractive (anisometropic or isoametropic), and deprivational (congenital cataract, ptosis). Treated w...","sourceLabel":"Section in Ophthalmology"},"3797":{"title":"Ocular Trauma & Emergencies","pageTitle":"Ophthalmology","pageUrl":"/scribe-guides/ophthalmology","url":"/scribe-guides/ophthalmology#s15","snippet":"Ocular Trauma & Emergencies Chemical Injury - Immediate Alkali burns are worse than acid (saponification and deeper penetration). Irrigate first, ask questions later: copious irrigation with saline or LR until pH normalizes (7.0-7.4). Check pH with litmus paper every 30 minutes. Classify severity us...","sourceLabel":"Section in Ophthalmology"},"3798":{"title":"Ophthalmic Procedures - A to Z","pageTitle":"Ophthalmology","pageUrl":"/scribe-guides/ophthalmology","url":"/scribe-guides/ophthalmology#s16","snippet":"Ophthalmic Procedures - A to Z Procedure Description Typical Indication Phacoemulsification + IOL Ultrasonic lens removal through clear corneal incision with foldable IOL implantation Visually significant cataract YAG capsulotomy Nd:YAG laser opening of opacified posterior capsule Posterior capsular...","sourceLabel":"Section in Ophthalmology"},"3799":{"title":"Ophthalmic Imaging & Diagnostics","pageTitle":"Ophthalmology","pageUrl":"/scribe-guides/ophthalmology","url":"/scribe-guides/ophthalmology#s17","snippet":"Ophthalmic Imaging & Diagnostics Core Ophthalmic Tests Optical coherence tomography (OCT): non-contact cross-sectional imaging of the retina and optic nerve. Macular OCT: detects DME, AMD (drusen, SRF/IRF, PED), ERM, macular hole. Optic nerve OCT (RNFL, ganglion cell complex): tracks glaucoma progre...","sourceLabel":"Section in Ophthalmology"},"3800":{"title":"Medications You Must Know","pageTitle":"Ophthalmology","pageUrl":"/scribe-guides/ophthalmology","url":"/scribe-guides/ophthalmology#s18","snippet":"Medications You Must Know Glaucoma Drops by Class Class Examples (Generic / Brand) Mechanism Key Notes Prostaglandin analogs (PGA) Latanoprost (Xalatan), travoprost (Travatan Z), bimatoprost (Lumigan), tafluprost (Zioptan), latanoprostene bunod (Vyzulta) &uarr; uveoscleral outflow First-line; qhs do...","sourceLabel":"Section in Ophthalmology"},"3801":{"title":"Classification Systems","pageTitle":"Ophthalmology","pageUrl":"/scribe-guides/ophthalmology","url":"/scribe-guides/ophthalmology#s19","snippet":"Classification Systems Snellen Visual Acuity & ETDRS The Snellen chart uses letters of decreasing size at 20 feet; acuity is recorded as a fraction (20/20 is normal). The ETDRS chart (Early Treatment Diabetic Retinopathy Study) is the research standard: 5 letters per line, logMAR spacing, used in cl...","sourceLabel":"Section in Ophthalmology"},"3802":{"title":"The Eye Exam","pageTitle":"Ophthalmology","pageUrl":"/scribe-guides/ophthalmology","url":"/scribe-guides/ophthalmology#s20","snippet":"The Eye Exam The eye exam is the most specialized part of ophthalmology documentation. The provider moves fast; you must keep up. Here is the standard order and what each component captures. The Standard Exam Flow 1. Visual acuity (distance VAsc / VAcc, pinhole if reduced; near if indicated). 2. Pup...","sourceLabel":"Section in Ophthalmology"},"3803":{"title":"Abbreviations Master List","pageTitle":"Ophthalmology","pageUrl":"/scribe-guides/ophthalmology","url":"/scribe-guides/ophthalmology#s21","snippet":"Abbreviations Master List Laterality & Basic Terms OD Oculus dexter - right eye OS Oculus sinister - left eye OU Oculus uterque - both eyes VA Visual acuity VAsc / sc Visual acuity without correction VAcc / cc Visual acuity with correction PH Pinhole BCVA Best-corrected visual acuity CF / HM / LP / ...","sourceLabel":"Section in Ophthalmology"},"3804":{"title":"Sample HPI Templates","pageTitle":"Ophthalmology","pageUrl":"/scribe-guides/ophthalmology","url":"/scribe-guides/ophthalmology#s22","snippet":"Sample HPI Templates The following HPIs show the density and style expected in real ophthalmology clinic notes. Pattern-match off these during your first weeks. Sample HPI - Cataract Evaluation \"Mrs. [Name] is a 72-year-old female with a history of hypertension and type 2 diabetes (last A1C 6.8%) wh...","sourceLabel":"Section in Ophthalmology"},"3805":{"title":"References & Sources","pageTitle":"Ophthalmology","pageUrl":"/scribe-guides/ophthalmology","url":"/scribe-guides/ophthalmology#s23","snippet":"References & Sources Clinical Practice Guidelines AAO Primary Open-Angle Glaucoma Preferred Practice Pattern. Ophthalmology. 2021. AAO Cataract in the Adult Eye Preferred Practice Pattern. Ophthalmology. 2022. AAO Diabetic Retinopathy Preferred Practice Pattern. Ophthalmology. 2020. AAO Retinal Deta...","sourceLabel":"Section in Ophthalmology"},"3806":{"title":"Maternal-Fetal Medicine","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine","snippet":"Maternal-Fetal Medicine - Complete Reference Every high-risk obstetric diagnosis, procedure, medication, classification, and documentation framework a scribe needs in the MFM clinic, antepartum unit, and labor floor."},"3807":{"title":"Maternal Physiology & Pregnancy Essentials","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#s1","snippet":"Maternal Physiology & Pregnancy Essentials Maternal-fetal medicine (MFM), also called perinatology, is the obstetric subspecialty focused on high-risk pregnancy . MFM physicians manage pregnancies complicated by maternal medical disease (diabetes, hypertension, lupus, cardiac disease), obstetric com...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3808":{"title":"Scribe Documentation Framework in MFM","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#s2","snippet":"Scribe Documentation Framework in MFM The MFM Consultation Note MFM encounters are usually consultations from a general OB or primary care provider. The note structure is: reason for consult, pregnancy history (GTPAL, EDD, dating method), current pregnancy course, PMH/PSH, medications, allergies, fa...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3809":{"title":"Chronic Medical Conditions in Pregnancy","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#s3","snippet":"Chronic Medical Conditions in Pregnancy A large portion of MFM consults are for pregestational (chronic) medical disease. Pregnancy changes the pharmacokinetics, disease activity, and fetal risk profile of nearly every chronic condition. Pregestational Diabetes (Type 1 & Type 2) Pregestational DM ca...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3810":{"title":"Gestational Diabetes Mellitus (GDM)","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#s4","snippet":"Gestational Diabetes Mellitus (GDM) GDM is glucose intolerance first recognized in pregnancy, driven by placental insulin resistance. It affects roughly 6-10% of US pregnancies. Untreated GDM causes macrosomia, shoulder dystocia, birth trauma, neonatal hypoglycemia, polycythemia, hyperbilirubinemia,...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3811":{"title":"Hypertensive Disorders of Pregnancy","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#s5","snippet":"Hypertensive Disorders of Pregnancy Hypertensive disorders complicate 10-15% of pregnancies and remain a leading cause of maternal mortality globally. The four categories: Figure 19 - Spiral Artery Remodeling in Preeclampsia vs Normal. Comparison of normal spiral artery transformation versus failed ...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3812":{"title":"Preeclampsia, Eclampsia & HELLP","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#s6","snippet":"Preeclampsia, Eclampsia & HELLP Preeclampsia is a multisystem disorder of pregnancy characterized by new-onset hypertension and end-organ dysfunction after 20 weeks. Pathophysiology centers on abnormal placentation : shallow trophoblastic invasion of the spiral arteries leads to placental hypoperfus...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3813":{"title":"Intrahepatic Cholestasis & Hyperemesis Gravidarum","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#s7","snippet":"Intrahepatic Cholestasis & Hyperemesis Gravidarum Intrahepatic Cholestasis of Pregnancy (ICP) A third-trimester hepatic disorder presenting with generalized pruritus (especially palms and soles, worse at night) without a rash. Diagnosis: elevated total serum bile acids (&ge;10 &micro;mol/L; severe &...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3814":{"title":"Placental Disorders","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#s8","snippet":"Placental Disorders Placenta Previa The placenta covers or approaches the internal cervical os. Classic presentation: painless, bright-red vaginal bleeding in the second or third trimester. No digital exam - transvaginal ultrasound is the diagnostic modality. Many previas diagnosed at anatomy scan r...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3815":{"title":"VTE in Pregnancy","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#s9","snippet":"VTE in Pregnancy Pregnancy is a hypercoagulable state; VTE risk is 4-5&times; baseline and highest in the postpartum period. PE remains a leading cause of maternal mortality. DVT in pregnancy preferentially involves the left iliofemoral veins (right iliac artery compresses the left iliac vein). Figu...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3816":{"title":"Fetal Growth Restriction & LGA","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#s10","snippet":"Fetal Growth Restriction & LGA Fetal Growth Restriction (FGR / IUGR) Defined as estimated fetal weight (EFW) or abdominal circumference (AC) <10th percentile for gestational age. Severe FGR is <3rd percentile. FGR is further categorized as early-onset (<32 weeks; usually placental insufficiency; hig...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3817":{"title":"Amniotic Fluid Disorders","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#s11","snippet":"Amniotic Fluid Disorders Amniotic fluid is measured on ultrasound by the amniotic fluid index (AFI) - the sum of the deepest vertical pocket in each of four uterine quadrants - or by the single deepest pocket (SDP / MVP) . Amniotic Fluid Volume Definitions Condition AFI Single Deepest Pocket Oligohy...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3818":{"title":"Multiple Gestation","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#s12","snippet":"Multiple Gestation Multiple gestation is a core MFM domain. Outcomes depend on chorionicity (number of placentas) and amnionicity (number of sacs), which are determined by the timing of embryo splitting and must be assigned in the first trimester. Figure 9 - Monozygotic Twin Chorionicity Based on Ti...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3819":{"title":"Cervical Insufficiency, Preterm Labor & PPROM","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#s13","snippet":"Cervical Insufficiency, Preterm Labor & PPROM Cervical Insufficiency & Cerclage Painless cervical dilation in the second trimester leading to recurrent pregnancy loss or extreme preterm birth. Indications for cerclage: history-indicated (&ge;1 prior second-trimester loss or preterm birth; placed 12-...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3820":{"title":"Fetal Demise & Recurrent Pregnancy Loss","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#s14","snippet":"Fetal Demise & Recurrent Pregnancy Loss Intrauterine Fetal Demise (IUFD / Stillbirth) Fetal death &ge;20 weeks. Workup after delivery: fetal autopsy, placental pathology, karyotype/microarray, Kleihauer-Betke (fetomaternal hemorrhage), antiphospholipid antibodies, screening for hereditary thrombophi...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3821":{"title":"Fetal Anomalies, Isoimmunization & Hydrops","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#s15","snippet":"Fetal Anomalies, Isoimmunization & Hydrops Aneuploidy Screening & Diagnostic Testing First-trimester screening combines nuchal translucency (NT) ultrasound at 11w0d-13w6d with serum PAPP-A and free &beta;-hCG. Cell-free DNA (cfDNA) / NIPT tests maternal blood for fetal chromosomal aneuploidy (trisom...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3822":{"title":"Congenital Infections (TORCH, GBS, HSV, HIV)","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#s16","snippet":"Congenital Infections (TORCH, GBS, HSV, HIV) The TORCH acronym catches perinatal infections that cause fetal injury: T oxoplasmosis, O ther (syphilis, parvovirus, varicella, Zika, listeria), R ubella, C MV, H SV. Figure 17 - Congenital CMV Infection on Prenatal Ultrasound. Prenatal ultrasound demons...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3823":{"title":"Substance Use & Severe Maternal Morbidity","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#s17","snippet":"Substance Use & Severe Maternal Morbidity Substance Use in Pregnancy Universal screening with validated tools (4P's, NIDA, SURP-P). Opioid use disorder is treated with medication-assisted therapy - buprenorphine or methadone (both safer than withdrawal, which increases fetal loss). Neonatal abstinen...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3824":{"title":"MFM Procedures - A to Z","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#s18","snippet":"MFM Procedures - A to Z Procedure Description & Indications Amniocentesis Transabdominal needle aspiration of amniotic fluid under US guidance; &ge;15w0d. Indications: aneuploidy diagnosis, fetal infection PCR, lung maturity (rare), fluid reduction. Loss rate ~1/900-1/1600. Chorionic Villus Sampling...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3825":{"title":"Fetal Assessment & Imaging","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#s19","snippet":"Fetal Assessment & Imaging Nonstress Test (NST) External fetal monitoring for at least 20 minutes. Reactive NST (&ge;32w): &ge;2 accelerations of &ge;15 bpm lasting &ge;15 seconds in 20 minutes. Before 32 weeks: &ge;2 accelerations of &ge;10 bpm for &ge;10 seconds. Nonreactive NSTs prompt BPP or fur...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3826":{"title":"Medications You Must Know","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#s20","snippet":"Medications You Must Know Antihypertensives Drug Use Notes Labetalol Chronic + acute severe HTN IV 10-20 mg q10 min up to 300 mg; oral 100-1200 mg/day divided Nifedipine ER Chronic HTN 30-120 mg daily; immediate-release used for acute severe HTN Hydralazine Acute severe HTN IV 5-10 mg q20 min; refle...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3827":{"title":"Classification Systems & Criteria","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#s21","snippet":"Classification Systems & Criteria Bishop Score (Cervical Readiness for Induction) Bishop Score Factor 0 1 2 3 Dilation (cm) Closed 1-2 3-4 &ge;5 Effacement (%) 0-30 40-50 60-70 &ge;80 Station -3 -2 -1/0 +1/+2 Consistency Firm Medium Soft - Position Posterior Mid Anterior - Score &le;6 = unfavorable ...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3828":{"title":"Obstetric Physical Exam","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#s22","snippet":"Obstetric Physical Exam The MFM physical exam is focused and standardized. Every visit includes: Standard OB Exam Template Vitals: BP (document both arms in hypertensive patients), HR, RR, SpO 2 , weight, BMI General: Well-appearing, in NAD, comfortable HEENT: No facial edema, no scleral icterus, or...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3829":{"title":"Abbreviations Master List","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#s23","snippet":"Abbreviations Master List Pregnancy & Anatomy GA gestational age EDD estimated due date LMP last menstrual period EGA estimated gestational age GTPAL gravidity/term/preterm/abortions/living CRL crown-rump length BPD biparietal diameter HC head circumference AC abdominal circumference FL femur length...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3830":{"title":"Sample HPI Templates","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#s24","snippet":"Sample HPI Templates HPI 1 - Preeclampsia Consultation 34 y/o G2P1001 at 31w3d by first-trimester US with a dichorionic singleton pregnancy, presenting for MFM consultation for suspected preeclampsia. Prenatal course complicated by chronic hypertension on labetalol 200 mg BID and baseline proteinuri...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3831":{"title":"References & Sources","pageTitle":"Maternal-Fetal Medicine","pageUrl":"/scribe-guides/maternal-fetal-medicine","url":"/scribe-guides/maternal-fetal-medicine#references","snippet":"References & Sources Clinical Practice Guidelines ACOG Practice Bulletin 222: Gestational Hypertension and Preeclampsia. Obstet Gynecol. 2020. ACOG Practice Bulletin 190: Gestational Diabetes Mellitus. Obstet Gynecol. 2018. ACOG Practice Bulletin 201: Pregestational Diabetes Mellitus. Obstet Gynecol...","sourceLabel":"Section in Maternal-Fetal Medicine"},"3832":{"title":"Reproductive Endocrinology","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology","snippet":"Reproductive Endocrinology & Infertility - Complete Reference Every diagnosis, ART procedure, medication, classification system, abbreviation, and documentation framework a new REI scribe needs to succeed."},"3833":{"title":"Reproductive Physiology - HPG Axis & the Menstrual Cycle","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#s1","snippet":"Reproductive Physiology - HPG Axis & the Menstrual Cycle Reproductive endocrinology and infertility (REI) is the subspecialty of obstetrics and gynecology that manages disorders of the reproductive hormonal axis, infertility, and assisted reproductive technology (ART). An REI scribe must understand ...","sourceLabel":"Section in Reproductive Endocrinology"},"3834":{"title":"Scribe Documentation Framework in REI","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#s2","snippet":"Scribe Documentation Framework in REI REI notes blend an OB/GYN-style gynecologic history with a fertility-specific narrative. A new consult can easily take 45 minutes and generates a dense multi-page note. Follow-ups during active ART cycles are short, number-heavy, and follow a repeating template....","sourceLabel":"Section in Reproductive Endocrinology"},"3835":{"title":"The Infertility Workup - Female & Male","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#s3","snippet":"The Infertility Workup - Female & Male The standard infertility workup evaluates four functional domains: ovulation, ovarian reserve, tubal patency, and sperm . Uterine cavity evaluation is added when indicated. ASRM Practice Committee: Fertility evaluation of infertile women (2021) defines the base...","sourceLabel":"Section in Reproductive Endocrinology"},"3836":{"title":"Ovulatory & Anovulatory Disorders","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#s4","snippet":"Ovulatory & Anovulatory Disorders Anovulation and oligo-ovulation account for roughly 25% of female infertility. The WHO classification, adopted by REI practice, divides anovulation into three groups: Figure 5 - Two-Cell, Two-Gonadotropin Model of Ovarian Steroidogenesis. Diagram illustrating how LH...","sourceLabel":"Section in Reproductive Endocrinology"},"3837":{"title":"Polycystic Ovary Syndrome (PCOS)","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#s5","snippet":"Polycystic Ovary Syndrome (PCOS) PCOS is the most common endocrine disorder in reproductive-age women (8-13% prevalence) and the single most common cause of anovulatory infertility. It is a syndrome - meaning it is diagnosed by a constellation of features rather than a single test. Pathophysiology P...","sourceLabel":"Section in Reproductive Endocrinology"},"3838":{"title":"Diminished Ovarian Reserve & Premature Ovarian Insufficiency","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#s6","snippet":"Diminished Ovarian Reserve & Premature Ovarian Insufficiency Diminished ovarian reserve (DOR) describes a quantitative and/or qualitative reduction in the remaining oocyte pool for age. It is not a disease per se but a prognostic finding associated with reduced response to stimulation and lower cycl...","sourceLabel":"Section in Reproductive Endocrinology"},"3839":{"title":"Hypogonadotropic Hypogonadism & Hypothalamic Amenorrhea","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#s7","snippet":"Hypogonadotropic Hypogonadism & Hypothalamic Amenorrhea Hypogonadotropic hypogonadism is the hypothalamic or pituitary failure to stimulate the ovaries - low FSH, low LH, low estradiol. The most common REI presentation is functional hypothalamic amenorrhea (FHA) from low body weight, excessive exerc...","sourceLabel":"Section in Reproductive Endocrinology"},"3840":{"title":"Hyperprolactinemia & Pituitary Disorders","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#s8","snippet":"Hyperprolactinemia & Pituitary Disorders Prolactin suppresses GnRH pulsatility, producing oligomenorrhea/amenorrhea, anovulation, galactorrhea, and infertility. Causes include pregnancy (always exclude first), medications (antipsychotics, metoclopramide, SSRIs, methyldopa, verapamil), hypothyroidism...","sourceLabel":"Section in Reproductive Endocrinology"},"3841":{"title":"Endometriosis & Adenomyosis","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#s9","snippet":"Endometriosis & Adenomyosis Endometriosis is the presence of endometrial-like glands and stroma outside the uterine cavity, most commonly on the peritoneum, ovaries (endometriomas / \"chocolate cysts\"), pelvic ligaments, and bowel/bladder serosa. It affects 6-10% of reproductive-age women and up to 3...","sourceLabel":"Section in Reproductive Endocrinology"},"3842":{"title":"Uterine Fibroids, Polyps & Intrauterine Adhesions","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#s10","snippet":"Uterine Fibroids, Polyps & Intrauterine Adhesions Uterine Fibroids (Leiomyomas) Benign smooth-muscle tumors of the uterus, extremely common (up to 70% lifetime prevalence). Classified by location - submucosal (protruding into the cavity, highest fertility impact), intramural , and subserosal . The F...","sourceLabel":"Section in Reproductive Endocrinology"},"3843":{"title":"Tubal Factor, Hydrosalpinx & Congenital Uterine Anomalies","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#s11","snippet":"Tubal Factor, Hydrosalpinx & Congenital Uterine Anomalies Tubal Factor Infertility Accounts for ~25-35% of female infertility. Causes include prior pelvic inflammatory disease (chlamydia, gonorrhea), tubal surgery, prior ectopic pregnancy, endometriosis, tuberculosis, and prior tubal ligation. Diagn...","sourceLabel":"Section in Reproductive Endocrinology"},"3844":{"title":"Male Factor Infertility","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#s12","snippet":"Male Factor Infertility Male factor contributes to ~40-50% of infertility (as sole or contributing factor). The semen analysis is the cornerstone of evaluation. WHO 2021 (6th edition) reference lower limits define the common abnormalities: Figure 14 - Varicocele Etiology and Formation. Anatomical di...","sourceLabel":"Section in Reproductive Endocrinology"},"3845":{"title":"Recurrent Pregnancy Loss (RPL)","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#s13","snippet":"Recurrent Pregnancy Loss (RPL) ASRM defines recurrent pregnancy loss as two or more failed clinical pregnancies documented by ultrasound or histology (ESHRE definition allows biochemical losses). Only ~50% of RPL workups identify a definitive cause. ASRM Practice Committee: Evaluation of RPL (2012) ...","sourceLabel":"Section in Reproductive Endocrinology"},"3846":{"title":"Unexplained & Secondary Infertility","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#s14","snippet":"Unexplained & Secondary Infertility Unexplained infertility is a diagnosis of exclusion - ovulatory cycles, normal semen analysis, patent tubes, and a normal uterine cavity after a complete workup. It accounts for ~15-30% of couples. Management ladder: expectant management (younger women), ovulation...","sourceLabel":"Section in Reproductive Endocrinology"},"3847":{"title":"Fertility Preservation & Oncofertility","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#s15","snippet":"Fertility Preservation & Oncofertility Fertility preservation covers patients facing gonadotoxic therapy (chemotherapy, pelvic radiation, bilateral oophorectomy or orchiectomy), those with a gender identity transition plan, and those pursuing elective (\"social\") preservation. ASCO Fertility Preserva...","sourceLabel":"Section in Reproductive Endocrinology"},"3848":{"title":"Third-Party Reproduction & Donor Gametes","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#s16","snippet":"Third-Party Reproduction & Donor Gametes Third-party reproduction involves donor eggs, donor sperm, donor embryos, or a gestational carrier. REI clinics perform extensive screening, counseling, and psychological evaluation before these cycles. Figure 18 - Surgical Sperm Retrieval Decision Algorithm....","sourceLabel":"Section in Reproductive Endocrinology"},"3849":{"title":"Assisted Reproductive Technology (ART) Procedures","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#s17","snippet":"Assisted Reproductive Technology (ART) Procedures Ovulation Induction (OI) Letrozole (Femara) 2.5-7.5 mg days 3-7 - an aromatase inhibitor; first-line in PCOS and unexplained infertility per PPCOS II . Clomiphene (Clomid) 50-150 mg days 3-7 or 5-9 - a SERM blocking hypothalamic estrogen feedback, ra...","sourceLabel":"Section in Reproductive Endocrinology"},"3850":{"title":"OHSS & Other ART Complications","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#s18","snippet":"OHSS & Other ART Complications Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of ovarian stimulation driven by VEGF-mediated capillary leak in hCG-exposed, hyperstimulated ovaries. Presents 3-10 days after trigger (early) or after pregnancy establishes (late). High-risk featu...","sourceLabel":"Section in Reproductive Endocrinology"},"3851":{"title":"Imaging, Labs & Diagnostics","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#s19","snippet":"Imaging, Labs & Diagnostics Transvaginal Ultrasound (TVUS) The workhorse of REI. Used for baseline ovarian and uterine assessment, AFC, follicle tracking during stim, endometrial measurement, cyst characterization, and embryo transfer guidance. You will document: ovarian volumes, follicle number by ...","sourceLabel":"Section in Reproductive Endocrinology"},"3852":{"title":"Medications You Must Know","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#s20","snippet":"Medications You Must Know Ovulation Induction & Stimulation Drug (Generic) Brand Mechanism / Use Letrozole Femara Aromatase inhibitor; first-line OI, especially PCOS Clomiphene citrate Clomid, Serophene SERM; blocks hypothalamic estrogen feedback, raises FSH Follitropin alfa/beta Gonal-F, Follistim ...","sourceLabel":"Section in Reproductive Endocrinology"},"3853":{"title":"Classification Systems & Criteria","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#s21","snippet":"Classification Systems & Criteria Most classifications referenced in REI notes are already enumerated above in their condition sections - Rotterdam (PCOS), rASRM (endometriosis), FIGO (fibroids), WHO (anovulation), ASRM (M&uuml;llerian), WHO 2021 (semen), OHSS severity. Two more are worth memorizing...","sourceLabel":"Section in Reproductive Endocrinology"},"3854":{"title":"Physical Exam & Pelvic Exam in REI","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#s22","snippet":"Physical Exam & Pelvic Exam in REI The REI physical exam is focused and targeted. Full exams happen at the new consult; subsequent monitoring visits are usually a TVUS only. REI New-Consult Exam Template General: BMI, body habitus, signs of androgen excess (hirsutism, acne, alopecia, acanthosis nigr...","sourceLabel":"Section in Reproductive Endocrinology"},"3855":{"title":"Abbreviations Master List","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#s23","snippet":"Abbreviations Master List Cycle & Physiology HPG Hypothalamic-pituitary-gonadal axis GnRH Gonadotropin-releasing hormone FSH Follicle-stimulating hormone LH Luteinizing hormone E2 Estradiol P4 Progesterone hCG Human chorionic gonadotropin hMG Human menopausal gonadotropin AMH Anti-M&uuml;llerian hor...","sourceLabel":"Section in Reproductive Endocrinology"},"3856":{"title":"Sample HPI Templates","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#s24","snippet":"Sample HPI Templates These templates reflect the typical rhythm, content, and terminology of an REI clinic note. Use them as scaffolds. Sample HPI - New Infertility Consult \"Ms. [Name] is a 34-year-old G0 female presenting with her 36-year-old male partner for initial evaluation of primary infertili...","sourceLabel":"Section in Reproductive Endocrinology"},"3857":{"title":"References & Sources","pageTitle":"Reproductive Endocrinology","pageUrl":"/scribe-guides/reproductive-endocrinology","url":"/scribe-guides/reproductive-endocrinology#references","snippet":"References & Sources Clinical Practice Guidelines ASRM Practice Committee. Fertility evaluation of infertile women: a committee opinion. Fertil Steril. 2021. Schlegel PN et al. Diagnosis and treatment of infertility in men: AUA/ASRM guideline. J Urol / Fertil Steril. 2021. Teede HJ et al. Recommenda...","sourceLabel":"Section in Reproductive Endocrinology"},"3858":{"title":"Psychiatry","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main","snippet":"Psychiatry - Complete Reference Every diagnosis, condition, procedure, medication, abbreviation, and documentation framework you need to succeed on day one and beyond."},"3859":{"title":"Neuroanatomy & Neurotransmitter Essentials","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main#s1","snippet":"Neuroanatomy & Neurotransmitter Essentials Psychiatry is the medicine of thought, mood, perception, cognition, and behavior. Unlike surgical specialties, psychiatry has no radiographic lesion or palpable mass to diagnose. The \"anatomy\" of psychiatry is the brain's functional circuitry and its chemic...","sourceLabel":"Section in Psychiatry"},"3860":{"title":"Scribe Documentation Framework & the MSE","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main#s2","snippet":"Scribe Documentation Framework & the MSE The Psychiatric SOAP Note Psychiatric notes follow SOAP structure but replace the traditional physical exam with a Mental Status Examination (MSE) . The assessment often includes a diagnostic formulation and, always, a documented risk assessment. Subjective C...","sourceLabel":"Section in Psychiatry"},"3861":{"title":"Depressive Disorders","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main#s3","snippet":"Depressive Disorders Depressive disorders are the highest-frequency diagnosis in outpatient psychiatry. The unifying feature is low mood or anhedonia with functional impairment. Depression is common (lifetime prevalence ~20%), disabling, and treatable - and it is the leading psychiatric risk factor ...","sourceLabel":"Section in Psychiatry"},"3862":{"title":"Bipolar & Related Disorders","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main#s4","snippet":"Bipolar & Related Disorders Bipolar disorders are episodic mood disorders defined by the presence of at least one manic (Bipolar I) or hypomanic (Bipolar II) episode, typically interspersed with depressive episodes. Lifetime prevalence is about 1-2%. Bipolar disorder is notoriously underrecognized i...","sourceLabel":"Section in Psychiatry"},"3863":{"title":"Anxiety Disorders","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main#s5","snippet":"Anxiety Disorders Anxiety disorders are the most prevalent class of psychiatric conditions (~30% lifetime prevalence). They share a core feature of excessive fear/worry and behavioral avoidance disproportionate to actual threat. DSM-5-TR groups them by the trigger and phenomenology. Figure 8 - Neura...","sourceLabel":"Section in Psychiatry"},"3864":{"title":"OCD & Related Disorders","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main#s6","snippet":"OCD & Related Disorders DSM-5-TR separated OCD and related disorders from the anxiety chapter, reflecting distinct neurobiology (cortico-striato-thalamo-cortical circuit dysfunction). Figure 10 - OCD Subtypes and Overlap. Venn diagram illustrating the heterogeneous subtypes of early-onset obsessive-...","sourceLabel":"Section in Psychiatry"},"3865":{"title":"Trauma & Stressor-Related Disorders","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main#s7","snippet":"Trauma & Stressor-Related Disorders Posttraumatic Stress Disorder (PTSD) Requires exposure to actual or threatened death, serious injury, or sexual violence (Criterion A), followed by four symptom clusters persisting >1 month: intrusion (flashbacks, nightmares, distressing memories), avoidance (of t...","sourceLabel":"Section in Psychiatry"},"3866":{"title":"Schizophrenia Spectrum & Other Psychotic Disorders","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main#s8","snippet":"Schizophrenia Spectrum & Other Psychotic Disorders Psychotic disorders share the feature of disturbances in reality testing: hallucinations, delusions, disorganized thought, disorganized or abnormal motor behavior, and negative symptoms. These are among the most disabling conditions in medicine. Fig...","sourceLabel":"Section in Psychiatry"},"3867":{"title":"Substance-Related & Addictive Disorders","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main#s9","snippet":"Substance-Related & Addictive Disorders DSM-5-TR consolidated abuse and dependence into single substance use disorders (SUDs) rated mild (2-3 criteria), moderate (4-5), or severe (6+) of 11 criteria covering impaired control, social impairment, risky use, and pharmacologic features (tolerance, withd...","sourceLabel":"Section in Psychiatry"},"3868":{"title":"Feeding & Eating Disorders","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main#s10","snippet":"Feeding & Eating Disorders Anorexia Nervosa Restriction of energy intake leading to significantly low body weight, intense fear of weight gain, disturbance in body image. Subtypes: restricting or binge-eating/purging. Highest mortality of any psychiatric disorder. Medical complications: bradycardia,...","sourceLabel":"Section in Psychiatry"},"3869":{"title":"Neurodevelopmental Disorders","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main#s11","snippet":"Neurodevelopmental Disorders Attention-Deficit/Hyperactivity Disorder (ADHD) Persistent pattern of inattention and/or hyperactivity-impulsivity present before age 12, across multiple settings, for at least 6 months. Requires 6 of 9 symptoms in each domain (5 for adults &ge;17). Three presentations: ...","sourceLabel":"Section in Psychiatry"},"3870":{"title":"Disruptive, Impulse-Control, & Conduct Disorders","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main#s12","snippet":"Disruptive, Impulse-Control, & Conduct Disorders Oppositional Defiant Disorder (ODD) Pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting &ge;6 months, with at least 4 symptoms from these domains. Common precursor to conduct disorder. Conduct Disorder Repetitive...","sourceLabel":"Section in Psychiatry"},"3871":{"title":"Personality Disorders","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main#s13","snippet":"Personality Disorders Personality disorders are enduring, pervasive, inflexible patterns of inner experience and behavior deviating from cultural expectations, stable over time, with onset in adolescence or early adulthood and causing distress/impairment. DSM-5-TR groups the 10 PDs into three cluste...","sourceLabel":"Section in Psychiatry"},"3872":{"title":"Somatic, Dissociative, Sexual & Gender-Related Disorders","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main#s14","snippet":"Somatic, Dissociative, Sexual & Gender-Related Disorders Somatic Symptom & Related Disorders Somatic Symptom Disorder - distressing somatic symptoms with excessive thoughts, feelings, or behaviors related to the symptom. Illness Anxiety Disorder - preoccupation with having/acquiring a serious illnes...","sourceLabel":"Section in Psychiatry"},"3873":{"title":"Sleep-Wake & Neurocognitive Disorders (Overlap)","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main#s15","snippet":"Sleep-Wake & Neurocognitive Disorders (Overlap) Insomnia Disorder Dissatisfaction with sleep quantity/quality with difficulty initiating, maintaining, or early-morning awakening, &ge;3 nights/week for &ge;3 months. CBT-I is first-line treatment. Pharmacologic options include zolpidem, eszopiclone, z...","sourceLabel":"Section in Psychiatry"},"3874":{"title":"Psychiatric Emergencies & Safety Assessment","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main#s16","snippet":"Psychiatric Emergencies & Safety Assessment Every psychiatric encounter includes a risk assessment. Some encounters are the emergency. Figure 19 - Allostatic Load and Stress Response Patterns. Four patterns of allostatic overload compared with a normal stress response. Repeated stressor exposure, fa...","sourceLabel":"Section in Psychiatry"},"3875":{"title":"Psychiatric Procedures & Neuromodulation","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main#s17","snippet":"Psychiatric Procedures & Neuromodulation Electroconvulsive Therapy (ECT) The most effective treatment for severe depression and catatonia, and an effective treatment for treatment-resistant mania and psychotic depression. Electrical stimulus induces a therapeutic generalized seizure lasting 15-60 se...","sourceLabel":"Section in Psychiatry"},"3876":{"title":"Medications You Must Know","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main#s18","snippet":"Medications You Must Know SSRIs (Selective Serotonin Reuptake Inhibitors) Generic Brand Notes Fluoxetine Prozac Longest half-life (no taper needed); activating; pediatric MDD approved Sertraline Zoloft Broad indications; GI side effects; PTSD/OCD approved Paroxetine Paxil Most anticholinergic; short...","sourceLabel":"Section in Psychiatry"},"3877":{"title":"Rating Scales & Classification Systems","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main#s19","snippet":"Rating Scales & Classification Systems PHQ-9 (Patient Health Questionnaire-9) - Depression 9 items, each 0-3 (past 2 weeks). Total 0-27. 0-4 none, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe. Q9 screens SI. GAD-7 - Generalized Anxiety 7 items, 0-3 each. Total 0-21. 0-4 none, 5-9 ...","sourceLabel":"Section in Psychiatry"},"3878":{"title":"Medication Monitoring & Lab Work","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main#s20","snippet":"Medication Monitoring & Lab Work Medication Baseline Ongoing Lithium BMP, TSH, Ca, urine SG, EKG if >40 or cardiac hx, pregnancy test Level 5 days after dose change then every 3-6 months; TSH, BMP, Ca every 6-12 months Valproate LFTs, CBC, pregnancy test Level, LFTs, CBC every 6 months Carbamazepine...","sourceLabel":"Section in Psychiatry"},"3879":{"title":"Abbreviations Master List","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main#s21","snippet":"Abbreviations Master List Diagnoses & Symptoms MDD Major depressive disorder PDD Persistent depressive disorder (dysthymia) PMDD Premenstrual dysphoric disorder SAD Seasonal affective disorder / social anxiety disorder (context) BPAD Bipolar affective disorder GAD Generalized anxiety disorder OCD Ob...","sourceLabel":"Section in Psychiatry"},"3880":{"title":"Mental Status Exam & Risk Documentation","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main#s22","snippet":"Mental Status Exam & Risk Documentation MSE Documentation Template Appearance: well-groomed, casually dressed, appears stated age Behavior/Psychomotor: cooperative, calm, good eye contact, no abnormal movements Speech: normal rate, rhythm, volume, and prosody Mood: \"depressed\" (patient's words) Affe...","sourceLabel":"Section in Psychiatry"},"3881":{"title":"Sample HPI Templates","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main#s23","snippet":"Sample HPI Templates These templates show the kind of documentation expected in psychiatric clinic notes. Use them as frameworks to internalize the rhythm and content of a good psychiatric HPI. Sample HPI - New MDD Presentation \"Ms. [Name] is a 34-year-old female with no prior psychiatric history wh...","sourceLabel":"Section in Psychiatry"},"3882":{"title":"References & Sources","pageTitle":"Psychiatry","pageUrl":"/scribe-guides/psychiatry-main","url":"/scribe-guides/psychiatry-main#s24","snippet":"References & Sources Clinical Practice Guidelines American Psychiatric Association. Practice Guideline for the Treatment of Patients with Major Depressive Disorder, 3rd ed. Am J Psychiatry. 2010. American Psychiatric Association. Practice Guideline for the Treatment of Patients with Bipolar Disorder...","sourceLabel":"Section in Psychiatry"},"3883":{"title":"Child & Adolescent Psychiatry","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry","snippet":"Child & Adolescent Psychiatry - Complete Reference Every diagnosis, developmental milestone, rating scale, medication, abbreviation, and documentation framework you need to scribe in child & adolescent psychiatry."},"3884":{"title":"Child Psychiatry Foundations & Normal Development","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry#s1","snippet":"Child Psychiatry Foundations & Normal Development Child and adolescent psychiatry is the medical specialty that evaluates and treats mental, emotional, developmental, and behavioral disorders in patients from infancy through young adulthood (roughly 0-21, though some clinics extend to 25 for transit...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"3885":{"title":"Scribe Documentation Framework (SOAP, HPI, MSE)","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry#s2","snippet":"Scribe Documentation Framework (SOAP, HPI, MSE) Child psychiatry notes have three peculiarities: (1) the history is obtained from multiple informants (parent, child, teacher, prior therapist, pediatrician); (2) the mental status exam replaces the physical exam as the central objective finding; and (...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"3886":{"title":"Attention-Deficit/Hyperactivity Disorder (ADHD)","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry#s3","snippet":"Attention-Deficit/Hyperactivity Disorder (ADHD) ADHD is the single most common diagnosis in child psychiatry, affecting ~9% of children in the US. It is a neurodevelopmental disorder of inattention, hyperactivity, and impulsivity that begins before age 12, persists >6 months, is present in 2+ settin...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"3887":{"title":"Autism Spectrum Disorder (ASD)","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry#s4","snippet":"Autism Spectrum Disorder (ASD) Autism spectrum disorder is a neurodevelopmental disorder characterized by persistent deficits in social communication and restricted, repetitive behaviors. Prevalence is ~1 in 36 per the CDC's ADDM network. DSM-5-TR eliminated prior subtypes (Asperger, PDD-NOS) in fav...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"3888":{"title":"Intellectual, Learning & Communication Disorders","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry#s5","snippet":"Intellectual, Learning & Communication Disorders Intellectual Developmental Disorder (Intellectual Disability) Defined by deficits in both intellectual functioning (reasoning, problem-solving, abstract thinking) and adaptive functioning (conceptual, social, practical) with onset during the developme...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"3889":{"title":"Motor & Tic Disorders","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry#s6","snippet":"Motor & Tic Disorders Developmental Coordination Disorder (DCD) Acquisition and execution of coordinated motor skills substantially below expectation for age (clumsy, slow, inaccurate motor performance), interfering with ADLs and academics. Onset in early developmental period. Managed with OT. Stere...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"3890":{"title":"Disruptive, Impulse-Control & Conduct Disorders","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry#s7","snippet":"Disruptive, Impulse-Control & Conduct Disorders Oppositional Defiant Disorder (ODD) Pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting &ge;6 months and involving &ge;4 symptoms from these categories (for children <5: on most days; &ge;5: at least weekly). Symp...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"3891":{"title":"Mood Disorders in Children & Adolescents","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry#s8","snippet":"Mood Disorders in Children & Adolescents Major Depressive Disorder (MDD) DSM-5-TR criteria in youth mirror adults but with key differences: in children and adolescents, mood may be irritable rather than sad, and failure to make expected weight gain can substitute for weight loss. &ge;5 of 9 SIGECAPS...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"3892":{"title":"Anxiety Disorders in Youth","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry#s9","snippet":"Anxiety Disorders in Youth Anxiety disorders are the most common psychiatric disorders in children (~1 in 12). They share a pattern of developmentally inappropriate, persistent, impairing anxiety. Figure 15 - Neural Circuitry of the Fear Response. The fear response is mediated by a circuit involving...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"3893":{"title":"OCD & Related Disorders in Youth","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry#s10","snippet":"OCD & Related Disorders in Youth OCD affects ~1-3% of children; onset is bimodal with peaks around ages 10 and early 20s. Obsessions are intrusive, unwanted thoughts/urges/images causing distress; compulsions are repetitive behaviors/mental acts performed to reduce distress. Symptoms must consume >1...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"3894":{"title":"Trauma, Stress & Attachment Disorders","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry#s11","snippet":"Trauma, Stress & Attachment Disorders PTSD in Children & Adolescents Exposure to actual/threatened death, serious injury, or sexual violence (directly, witnessed, learned about a loved one, or repeated exposure). Symptoms: intrusion (memories, nightmares, flashbacks, dissociation, distress at cues),...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"3895":{"title":"Feeding & Eating Disorders","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry#s12","snippet":"Feeding & Eating Disorders Eating disorders in youth are high-mortality psychiatric conditions and must be caught early. The pediatric psychiatrist works closely with adolescent medicine, nutrition, and medical stabilization teams. Figure 20 - HPA Axis Dysregulation in Eating Disorders. Anorexia ner...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"3896":{"title":"Elimination & Pediatric Sleep-Wake Disorders","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry#s13","snippet":"Elimination & Pediatric Sleep-Wake Disorders Enuresis Repeated involuntary voiding (age &ge;5 or developmental equivalent), &ge;2&times;/week for 3 months. Subtypes: nocturnal only (most common), diurnal, both. Rule out UTI, diabetes, structural abnormalities. Treatment: bedwetting alarms first-line...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"3897":{"title":"Gender Dysphoria & Somatic Symptom Disorders","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry#s14","snippet":"Gender Dysphoria & Somatic Symptom Disorders Gender Dysphoria in Children & Adolescents Marked incongruence between experienced/expressed gender and assigned gender, associated with clinically significant distress/impairment, lasting &ge;6 months. Children's criteria emphasize strong desire to be an...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"3898":{"title":"Early-Onset Psychosis & Adolescent Substance Use","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry#s15","snippet":"Early-Onset Psychosis & Adolescent Substance Use Early-Onset Schizophrenia Schizophrenia with onset before age 18 (childhood-onset: before 13). Criteria are identical to adult schizophrenia: &ge;2 of 5 symptoms (delusions, hallucinations, disorganized speech, grossly disorganized/catatonic behavior,...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"3899":{"title":"Suicidality, Self-Injury & Safety Assessment","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry#s16","snippet":"Suicidality, Self-Injury & Safety Assessment Suicide is a leading cause of death in adolescents. Every child psychiatry note must contain a documented suicide risk assessment. NSSI (non-suicidal self-injury) - cutting, burning, scratching - is distinct from suicidal behavior but is a risk factor for...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"3900":{"title":"Screening Tools & Rating Scales","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry#s17","snippet":"Screening Tools & Rating Scales Scale Purpose Age Key Cutoff/Notes ASQ-3 / SWYC Developmental screen 1 mo-5.5 y Used at well-child visits; <cutoff triggers referral M-CHAT-R/F Autism screen 16-30 mo 0-2 low, 3-7 medium, 8-20 high ADOS-2 / ADI-R Autism diagnostic Toddler-adult Gold standard; psycholo...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"3901":{"title":"Therapeutic Procedures & Interventions","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry#s18","snippet":"Therapeutic Procedures & Interventions Child psychiatry \"procedures\" are psychotherapy modalities, system-level interventions, and medication management visits. The scribe must recognize each by name and know its evidence base and target diagnosis. Figure 22 - The CBT Cognitive Triangle. The foundat...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"3902":{"title":"Pediatric Psychopharmacology","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry#s19","snippet":"Pediatric Psychopharmacology Pediatric psychopharmacology is dose- and weight-sensitive, requires baseline and follow-up monitoring, and carries unique safety concerns (growth suppression, metabolic syndrome, suicidality, extrapyramidal symptoms). Always document weight, height, BMI percentile, and ...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"3903":{"title":"Classification Systems & Developmental Benchmarks","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry#s20","snippet":"Classification Systems & Developmental Benchmarks DSM-5-TR Diagnostic Categories Relevant to Youth Neurodevelopmental Disorders (ADHD, ASD, ID, SLD, communication, motor/tic) Schizophrenia Spectrum and Other Psychotic Disorders Bipolar and Related Disorders Depressive Disorders (incl. DMDD) Anxiety ...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"3904":{"title":"Mental Status Exam in Children","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry#s21","snippet":"Mental Status Exam in Children The pediatric MSE replaces the physical exam as the primary objective assessment. It must be developmentally calibrated - you do not expect the same organized, goal-directed speech from a 4-year-old as from a 16-year-old. Pediatric MSE Template Appearance: age-appropri...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"3905":{"title":"Abbreviations Master List","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry#s22","snippet":"Abbreviations Master List Diagnoses ADHD Attention-deficit/hyperactivity disorder ASD Autism spectrum disorder ID Intellectual disability (IDD = intellectual developmental disorder) GDD Global developmental delay SLD Specific learning disorder DCD Developmental coordination disorder ODD Oppositional...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"3906":{"title":"Sample HPI Templates","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry#s23","snippet":"Sample HPI Templates These templates show the kind of documentation expected in a child & adolescent psychiatry clinic note. Use them as frameworks to internalize the rhythm of a good pediatric psychiatric HPI. Sample HPI - ADHD Evaluation \"Ethan is an 8y 3m old male brought by his mother for evalua...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"3907":{"title":"References & Sources","pageTitle":"Child & Adolescent Psychiatry","pageUrl":"/scribe-guides/child-psychiatry","url":"/scribe-guides/child-psychiatry#s24","snippet":"References & Sources Clinical Practice Guidelines Wolraich ML et al. AAP Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of ADHD in Children and Adolescents. Pediatrics. 2019. AACAP Practice Parameter for the Assessment and Treatment of ADHD. JAACAP. 2007. Hyman SL et al. AA...","sourceLabel":"Section in Child & Adolescent Psychiatry"},"3908":{"title":"Addiction Medicine","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine","snippet":"Addiction Medicine - Complete Reference Every substance use disorder, withdrawal syndrome, medication, screening instrument, and documentation framework you need to succeed on day one and beyond."},"3909":{"title":"Neurobiology of Addiction - Foundations","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#s1","snippet":"Neurobiology of Addiction - Foundations Addiction medicine treats a chronic, relapsing brain disorder characterized by compulsive substance use despite harmful consequences. Before you can document an encounter intelligently, you need to understand that addiction is not a moral failing or a lack of ...","sourceLabel":"Section in Addiction Medicine"},"3910":{"title":"Scribe Documentation Framework","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#s2","snippet":"Scribe Documentation Framework The Addiction Medicine SOAP Note Addiction medicine encounters blend medical and psychiatric documentation. You will write a SOAP note, but the HPI is substance-focused, the exam includes a mental status exam (MSE), and the assessment frequently references DSM-5-TR cri...","sourceLabel":"Section in Addiction Medicine"},"3911":{"title":"DSM-5-TR Substance Use Disorder Criteria","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#s3","snippet":"DSM-5-TR Substance Use Disorder Criteria Every SUD in DSM-5-TR shares the same 11-item criterion set, grouped into four clusters. A diagnosis requires at least 2 criteria within a 12-month period . Severity is graded by count: mild (2-3) , moderate (4-5) , severe (6 or more) . You will document thes...","sourceLabel":"Section in Addiction Medicine"},"3912":{"title":"Screening, Brief Intervention & Referral (SBIRT)","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#s4","snippet":"Screening, Brief Intervention & Referral (SBIRT) Universal screening for unhealthy substance use is endorsed for adults in primary care settings by the USPSTF unhealthy alcohol use screening & brief counseling recommendation and, for drug use, by the USPSTF illicit drug use screening recommendation ...","sourceLabel":"Section in Addiction Medicine"},"3913":{"title":"Alcohol Use Disorder (AUD)","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#s5","snippet":"Alcohol Use Disorder (AUD) AUD is the most common SUD in the United States and a top-five cause of preventable death. Alcohol is a CNS depressant that potentiates GABA-A receptors and antagonizes NMDA receptors. Chronic exposure downregulates GABA and upregulates glutamate, setting the stage for the...","sourceLabel":"Section in Addiction Medicine"},"3914":{"title":"Alcohol Withdrawal & CIWA-Ar","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#s6","snippet":"Alcohol Withdrawal & CIWA-Ar Alcohol withdrawal is a potentially lethal syndrome driven by the unmasking of upregulated glutamatergic tone when alcohol (a GABA agonist) is removed. Symptoms begin 6-12 hours after the last drink and follow a predictable progression. Figure 9 - Neurochemical Seesaw in...","sourceLabel":"Section in Addiction Medicine"},"3915":{"title":"Opioid Use Disorder (OUD)","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#s7","snippet":"Opioid Use Disorder (OUD) OUD is the driving force behind the overdose epidemic. Illicit opioids today are overwhelmingly fentanyl and its analogs, not heroin. Prescription OUD (oxycodone, hydrocodone, morphine, hydromorphone, methadone diverted) remains common. The ASAM National Practice Guideline ...","sourceLabel":"Section in Addiction Medicine"},"3916":{"title":"Opioid Withdrawal & COWS","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#s8","snippet":"Opioid Withdrawal & COWS Figure 13 - Descending Opioid Pain Modulation Pathways. Opioid receptors in the periaqueductal gray and rostral ventromedial medulla activate descending inhibitory pathways to the spinal cord dorsal horn. Chronic opioid use disrupts these endogenous pain modulation systems, ...","sourceLabel":"Section in Addiction Medicine"},"3917":{"title":"Stimulant Use Disorder","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#s9","snippet":"Stimulant Use Disorder Stimulant use disorder covers cocaine, amphetamines, and methamphetamine. All block or reverse monoamine transporters to flood the synapse with dopamine and norepinephrine. There is no FDA-approved pharmacotherapy for any stimulant use disorder - contingency management is the ...","sourceLabel":"Section in Addiction Medicine"},"3918":{"title":"Sedative-Hypnotic Use Disorder","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#s10","snippet":"Sedative-Hypnotic Use Disorder Covers benzodiazepines, barbiturates, and Z-drugs (zolpidem, zaleplon, eszopiclone). All are GABA-A positive allosteric modulators. Patients often develop physiologic dependence on legitimately prescribed benzodiazepines; recognize this is not synonymous with SUD - it ...","sourceLabel":"Section in Addiction Medicine"},"3919":{"title":"Cannabis Use Disorder","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#s11","snippet":"Cannabis Use Disorder Cannabis is the most commonly used illicit drug in the US; high-potency products (concentrates, edibles, vape cartridges) have dramatically increased THC exposure since the 1990s. Approximately 9% of users develop a cannabis use disorder; risk rises to ~17% for those starting i...","sourceLabel":"Section in Addiction Medicine"},"3920":{"title":"Hallucinogens, Dissociatives & MDMA","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#s12","snippet":"Hallucinogens, Dissociatives & MDMA Classic Hallucinogens (LSD, Psilocybin, DMT, Mescaline) 5-HT2A receptor agonists. Produce perceptual distortions, synesthesia, depersonalization, altered sense of time, and emotional intensification. Minimal reward pathway activation - low addiction liability, no ...","sourceLabel":"Section in Addiction Medicine"},"3921":{"title":"Inhalants, Nicotine, Caffeine & Behavioral Addictions","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#s13","snippet":"Inhalants, Nicotine, Caffeine & Behavioral Addictions Inhalants Volatile solvents (glue, paint thinner, gasoline), aerosols, nitrites (\"poppers\"), and nitrous oxide. Rapid onset via lipid-soluble CNS penetration. Associated with sudden sniffing death syndrome (cardiac arrhythmia), hypoxia, and, for ...","sourceLabel":"Section in Addiction Medicine"},"3922":{"title":"Dual Diagnosis & Substance-Induced Conditions","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#s14","snippet":"Dual Diagnosis & Substance-Induced Conditions The co-occurrence of a substance use disorder with another psychiatric condition is the rule, not the exception. Roughly half of adults with any SUD have a co-occurring mental illness. Every note should explicitly address both. The distinction between a ...","sourceLabel":"Section in Addiction Medicine"},"3923":{"title":"Medication-Assisted Treatment (MAT / MOUD)","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#s15","snippet":"Medication-Assisted Treatment (MAT / MOUD) MAT (the umbrella term) and MOUD (specifically medications for OUD) represent the single highest-impact intervention in addiction medicine. The FDA and ASAM both endorse buprenorphine, methadone, and naltrexone . Following the 2023 elimination of the X-waiv...","sourceLabel":"Section in Addiction Medicine"},"3924":{"title":"Psychosocial Treatments & Harm Reduction","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#s16","snippet":"Psychosocial Treatments & Harm Reduction Psychotherapies Motivational interviewing (MI) is a collaborative, goal-oriented style of communication for strengthening motivation and commitment to change. Core principles are partnership, acceptance, compassion, and evocation. Cognitive-behavioral therapy...","sourceLabel":"Section in Addiction Medicine"},"3925":{"title":"Addiction Procedures & Office Workflows","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#s17","snippet":"Addiction Procedures & Office Workflows Addiction medicine is less procedure-heavy than surgical specialties, but there are many office-based clinical workflows that function as \"procedures\" for documentation purposes. Workflow Description Scribe Documentation SBIRT session Screening + brief interve...","sourceLabel":"Section in Addiction Medicine"},"3926":{"title":"Drug Testing & Laboratory Interpretation","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#s18","snippet":"Drug Testing & Laboratory Interpretation Urine Drug Screens (UDS) Immunoassay-based point-of-care or lab UDS panels are the workhorse. Standard panels detect amphetamines, benzodiazepines, cocaine (detects the metabolite benzoylecgonine), opiates, PCP, and THC. Critical pitfalls: a standard \"opiate\"...","sourceLabel":"Section in Addiction Medicine"},"3927":{"title":"Medications You Must Know","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#s19","snippet":"Medications You Must Know Alcohol Use Disorder Generic Brand Mechanism Dose Notes Naltrexone (oral) ReVia Mu-opioid antagonist 50 mg PO daily Avoid with active opioid use; hepatotoxicity (rare) Naltrexone XR Vivitrol Mu-opioid antagonist 380 mg IM q4 weeks Gluteal injection Acamprosate Campral NMDA/...","sourceLabel":"Section in Addiction Medicine"},"3928":{"title":"ASAM Criteria & Classification Systems","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#s20","snippet":"ASAM Criteria & Classification Systems The Six ASAM Dimensions Every ASAM assessment evaluates the patient across six dimensions. Each is scored for severity, and the composite determines the recommended level of care. ASAM Six Dimensions Dimension 1: Acute intoxication and/or withdrawal potential. ...","sourceLabel":"Section in Addiction Medicine"},"3929":{"title":"Special Populations","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#s21","snippet":"Special Populations Pregnancy MOUD - buprenorphine or methadone - is the standard of care for OUD in pregnancy. Detoxification is not recommended due to high relapse and fetal risk. Historically methadone was the default; buprenorphine (particularly the mono product) is now considered equivalent and...","sourceLabel":"Section in Addiction Medicine"},"3930":{"title":"Physical Exam & Mental Status in Addiction","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#s22","snippet":"Physical Exam & Mental Status in Addiction Focused Physical Exam Template GEN: appearance, nutrition, hygiene, in/no distress VS: T / BP / HR / RR / SpO2 / pain HEENT: pupils (size, reactivity), nystagmus, nasal septum, oral mucosa, dentition NECK: lymphadenopathy, thyromegaly, JVD CV: rate, rhythm,...","sourceLabel":"Section in Addiction Medicine"},"3931":{"title":"Abbreviations Master List","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#s23","snippet":"Abbreviations Master List Disorders & Syndromes SUD Substance use disorder AUD Alcohol use disorder OUD Opioid use disorder StUD Stimulant use disorder TUD Tobacco use disorder CUD Cannabis use disorder DTs Delirium tremens WKS Wernicke-Korsakoff syndrome NAS / NOWS Neonatal abstinence / opioid with...","sourceLabel":"Section in Addiction Medicine"},"3932":{"title":"Sample HPI Templates","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#s24","snippet":"Sample HPI Templates These sample HPIs reflect the rhythm and content of real addiction medicine clinic notes. Quantify everything, document the timeline, and always address the key diagnostic criteria. Sample HPI - New Alcohol Use Disorder Consult \"Mr. [Name] is a 54-year-old male self-referred for...","sourceLabel":"Section in Addiction Medicine"},"3933":{"title":"References & Sources","pageTitle":"Addiction Medicine","pageUrl":"/scribe-guides/addiction-medicine","url":"/scribe-guides/addiction-medicine#references","snippet":"References & Sources Clinical Practice Guidelines ASAM. The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update. J Addict Med. 2020. ASAM. Clinical Practice Guideline on Alcohol Withdrawal Management. J Addict Med. 2020. SAMHSA TIP 63: Medications for Opioi...","sourceLabel":"Section in Addiction Medicine"},"3934":{"title":"Hospitalist Medicine","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine","snippet":"Hospitalist Medicine - Complete Reference Every admission diagnosis, inpatient workflow, procedure, medication, classification, and documentation framework a hospital medicine scribe needs to succeed on day one and beyond."},"3935":{"title":"Hospital Medicine - The Systems You Must Know","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s1","snippet":"Hospital Medicine - The Systems You Must Know Hospital medicine (hospitalist medicine) is the specialty of inpatient adult general medicine. Hospitalists admit, manage, and discharge patients on the medical wards, run rapid responses and code blues, co-manage surgical patients, coordinate transition...","sourceLabel":"Section in Hospitalist Medicine"},"3936":{"title":"Scribe Documentation Framework (H&P, Progress, Discharge)","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s2","snippet":"Scribe Documentation Framework (H&P, Progress, Discharge) Hospital medicine generates three core note types every single day: the admission history and physical (H&P) , the daily progress note (SOAP) , and the discharge summary . Consultation notes, procedure notes, and event notes (rapid response, ...","sourceLabel":"Section in Hospitalist Medicine"},"3937":{"title":"Community-Acquired & Hospital-Acquired Pneumonia","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s3","snippet":"Community-Acquired & Hospital-Acquired Pneumonia Pneumonia is infection of the lung parenchyma. It is one of the top three reasons for medical admission. Classification is by where it was acquired: CAP (community-acquired), HAP (hospital-acquired, &ge;48 hours after admission), VAP (ventilator-assoc...","sourceLabel":"Section in Hospitalist Medicine"},"3938":{"title":"COPD Exacerbation","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s4","snippet":"COPD Exacerbation COPD exacerbation (AECOPD) is an acute worsening of baseline dyspnea, cough, or sputum production beyond normal day-to-day variation. It is triggered most commonly by viral or bacterial lower respiratory infections (H. influenzae, M. catarrhalis, S. pneumoniae, Pseudomonas in advan...","sourceLabel":"Section in Hospitalist Medicine"},"3939":{"title":"Acute Heart Failure (ADHF)","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s5","snippet":"Acute Heart Failure (ADHF) Acute decompensated heart failure is a clinical syndrome of congestion and/or hypoperfusion in a patient with underlying structural or functional cardiac disease. It is subclassified by ejection fraction into HFrEF (EF &le; 40%), HFmrEF (41-49%), and HFpEF (&ge; 50%). Figu...","sourceLabel":"Section in Hospitalist Medicine"},"3940":{"title":"Sepsis & Septic Shock","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s6","snippet":"Sepsis & Septic Shock Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection (Sepsis-3 definition). Septic shock is sepsis with circulatory and cellular/metabolic dysfunction requiring vasopressors to maintain MAP &ge; 65 mmHg AND lactate > 2 mmol/L despite ...","sourceLabel":"Section in Hospitalist Medicine"},"3941":{"title":"Acute Kidney Injury (AKI)","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s7","snippet":"Acute Kidney Injury (AKI) AKI is an abrupt decline in kidney function. Causes are classified as prerenal (hypoperfusion - volume depletion, hypotension, HF, cirrhosis, NSAIDs, ACEi/ARB), intrinsic (ATN from ischemia or nephrotoxins, AIN, glomerulonephritis, rhabdomyolysis), and postrenal (obstructio...","sourceLabel":"Section in Hospitalist Medicine"},"3942":{"title":"Hyperglycemic Crises (DKA / HHS) & Inpatient Glucose","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s8","snippet":"Hyperglycemic Crises (DKA / HHS) & Inpatient Glucose Diabetic ketoacidosis (DKA) : insulin deficiency produces hyperglycemia, ketogenesis, and an anion-gap metabolic acidosis. Classic triad: glucose > 250, pH < 7.30 or bicarb < 18, positive serum or urine ketones. Hyperosmolar hyperglycemic state (H...","sourceLabel":"Section in Hospitalist Medicine"},"3943":{"title":"Gastrointestinal Bleeding (Upper & Lower)","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s9","snippet":"Gastrointestinal Bleeding (Upper & Lower) Upper GIB (proximal to the ligament of Treitz): peptic ulcer disease, gastritis, esophagitis, variceal hemorrhage, Mallory-Weiss tear, Dieulafoy lesion, malignancy. Lower GIB : diverticulosis, angiodysplasia, colitis (ischemic, infectious, IBD), hemorrhoids,...","sourceLabel":"Section in Hospitalist Medicine"},"3944":{"title":"Atrial Fibrillation with RVR & Inpatient Arrhythmias","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s10","snippet":"Atrial Fibrillation with RVR & Inpatient Arrhythmias Atrial fibrillation is an irregularly irregular supraventricular arrhythmia without discrete P waves. \"RVR\" means rapid ventricular response (HR typically > 110). Triggers in the hospital include sepsis, hypovolemia, anemia, pain, withdrawal, hypo...","sourceLabel":"Section in Hospitalist Medicine"},"3945":{"title":"Syncope & Inpatient Falls","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s11","snippet":"Syncope & Inpatient Falls Syncope is transient loss of consciousness from global cerebral hypoperfusion. Categories: reflex (vasovagal, situational, carotid sinus), orthostatic (volume depletion, meds, autonomic), and cardiac (arrhythmia, structural, outflow obstruction, PE). Cardiac syncope carries...","sourceLabel":"Section in Hospitalist Medicine"},"3946":{"title":"Cellulitis, SSTI & Bone/Joint Infection","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s12","snippet":"Cellulitis, SSTI & Bone/Joint Infection Cellulitis is a non-purulent skin and soft tissue infection usually caused by beta-hemolytic streptococci. Purulent SSTI (abscess, furuncle, carbuncle) is most often Staphylococcus aureus , including MRSA. Always consider necrotizing fasciitis as a red-flag di...","sourceLabel":"Section in Hospitalist Medicine"},"3947":{"title":"UTI & Pyelonephritis","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s13","snippet":"UTI & Pyelonephritis Cystitis: dysuria, frequency, urgency, suprapubic pain. Pyelonephritis: adds flank pain, fever, rigors, nausea, vomiting. Most common pathogens: E. coli , Klebsiella , Proteus , Enterococcus . Catheter-associated UTI (CAUTI) is a hospital-acquired condition and is reported to CM...","sourceLabel":"Section in Hospitalist Medicine"},"3948":{"title":"Electrolyte Abnormalities","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s14","snippet":"Electrolyte Abnormalities The hospitalist manages electrolyte derangements all day. Know the thresholds and the replacement protocols. Figure 12 - Diagnostic Algorithm for Hyponatremia. Systematic approach to the differential diagnosis of hyponatremia, beginning with serum osmolality to exclude pseu...","sourceLabel":"Section in Hospitalist Medicine"},"3949":{"title":"Encephalopathy & Altered Mental Status","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s15","snippet":"Encephalopathy & Altered Mental Status Altered mental status is a symptom, not a diagnosis. The differential is vast: metabolic (hypoglycemia, hyponatremia, uremia, hepatic encephalopathy, hypercapnia), infectious (sepsis, meningitis, encephalitis, UTI in elderly), toxic (alcohol, drugs, meds, antic...","sourceLabel":"Section in Hospitalist Medicine"},"3950":{"title":"Alcohol & Opioid Withdrawal","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s16","snippet":"Alcohol & Opioid Withdrawal Alcohol withdrawal : autonomic hyperactivity, tremor, anxiety, nausea, insomnia, agitation, seizures (6-48h), hallucinosis (12-48h), delirium tremens (48-96h, mortality up to 5% untreated). Screen every admission with AUDIT-C. CIWA-Ar (Clinical Institute Withdrawal Assess...","sourceLabel":"Section in Hospitalist Medicine"},"3951":{"title":"VTE - DVT and Pulmonary Embolism","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s17","snippet":"VTE - DVT and Pulmonary Embolism DVT is deep venous thrombosis, most commonly in the lower extremity (proximal: iliac, femoral, popliteal; distal: calf veins). PE is pulmonary embolism - thrombus in the pulmonary arterial tree, usually embolized from a lower-extremity DVT. Figure 14 - Compression Ul...","sourceLabel":"Section in Hospitalist Medicine"},"3952":{"title":"Chest Pain Rule-Out & ACS on the Floor","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s18","snippet":"Chest Pain Rule-Out & ACS on the Floor Chest pain on a hospitalist service is usually a rule-out. Know the can't-miss differential: ACS, PE, aortic dissection, tension pneumothorax, esophageal rupture, pericardial tamponade. Workup EKG within 10 minutes, high-sensitivity troponin at presentation and...","sourceLabel":"Section in Hospitalist Medicine"},"3953":{"title":"Rapid Response, Code Blue & Post-Op Complications","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s19","snippet":"Rapid Response, Code Blue & Post-Op Complications A rapid response is activated when a patient deteriorates acutely - meeting institutional triggers such as HR > 130, SBP < 90, RR > 28, SpO 2 < 90, new altered mental status, or nursing concern. A code blue is activated for cardiopulmonary arrest. Sc...","sourceLabel":"Section in Hospitalist Medicine"},"3954":{"title":"Perioperative Medicine & Palliative Care Consults","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s20","snippet":"Perioperative Medicine & Palliative Care Consults Cardiac Risk Assessment The Revised Cardiac Risk Index (RCRI) and newer NSQIP MICA or Gupta calculators estimate perioperative cardiac risk. RCRI components: high-risk surgery, ischemic heart disease, CHF, cerebrovascular disease, insulin-dependent d...","sourceLabel":"Section in Hospitalist Medicine"},"3955":{"title":"Bedside Procedures on the Floor","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s21","snippet":"Bedside Procedures on the Floor Figure 18 - Central Venous Catheter Anatomy. Anatomical relationship of the internal jugular, subclavian, and brachiocephalic veins converging into the superior vena cava. Understanding this anatomy is essential for proper catheter tip positioning at the cavoatrial ju...","sourceLabel":"Section in Hospitalist Medicine"},"3956":{"title":"Labs, Imaging & Telemetry on the Wards","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s22","snippet":"Labs, Imaging & Telemetry on the Wards Labs - Daily Bread CBC: WBC (differential matters - bandemia suggests acute infection), hemoglobin/hematocrit, platelets. BMP: Na, K, Cl, CO 2 , BUN, Cr, glucose. Calculate anion gap (Na &minus; Cl &minus; HCO 3 ; normal 8-12). CMP adds LFTs and albumin. Coags:...","sourceLabel":"Section in Hospitalist Medicine"},"3957":{"title":"Inpatient Medications You Must Know","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s23","snippet":"Inpatient Medications You Must Know IV Antibiotics - Core Formulary Drug Typical Dose Use Case Ceftriaxone 1-2 g IV q24h CAP, UTI/pyelo, meningitis (2 g q12h), SBP Cefepime 1-2 g IV q8-12h Pseudomonal coverage, HAP, febrile neutropenia Piperacillin-tazobactam (Zosyn) 3.375-4.5 g IV q6-8h Broad-spect...","sourceLabel":"Section in Hospitalist Medicine"},"3958":{"title":"Classification & Risk Scores","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s24","snippet":"Classification & Risk Scores Hospitalists live inside risk scores. Every one listed below should be familiar enough that you can capture the components when the clinician references them. Figure 21 - Hospital Quality Metrics and SEP-1 Compliance Rates. Post-intervention compliance rates for the CMS ...","sourceLabel":"Section in Hospitalist Medicine"},"3959":{"title":"Physical Exam & Abbreviations","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s25","snippet":"Physical Exam & Abbreviations The Hospitalist Exam - Head to Toe General: alert, oriented, NAD vs ill-appearing, body habitus. HEENT: PERRL, EOMI, conjunctivae, oropharynx (moist, erythema, thrush), JVP (measured in cm above sternal angle). Neck: supple, lymphadenopathy, thyromegaly, bruits. Cardiac...","sourceLabel":"Section in Hospitalist Medicine"},"3960":{"title":"Sample HPIs & Hospital Course Templates","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#s26","snippet":"Sample HPIs & Hospital Course Templates These templates show the rhythm of real hospitalist documentation. Use them as frameworks when you are building a note in real time. Sample HPI - Sepsis Admission (Urinary Source) \"Mrs. [Name] is a 78-year-old female with a history of hypertension, type 2 diab...","sourceLabel":"Section in Hospitalist Medicine"},"3961":{"title":"References & Sources","pageTitle":"Hospitalist Medicine","pageUrl":"/scribe-guides/hospitalist-medicine","url":"/scribe-guides/hospitalist-medicine#references","snippet":"References & Sources Clinical Practice Guidelines Metlay JP et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. ATS/IDSA. Am J Respir Crit Care Med. 2019. Kalil AC et al. Management of Adults with Hospital-acquired and Ventilator-associated Pneumonia. IDSA/ATS. Clin Infect Di...","sourceLabel":"Section in Hospitalist Medicine"},"3962":{"title":"Urgent Care","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care","snippet":"Urgent Care - Complete Reference Every diagnosis, low-acuity presentation, procedure, medication, and documentation framework a scribe needs to work confidently in an urgent care clinic."},"3963":{"title":"Urgent Care Scope & Triage Principles","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#s1","snippet":"Urgent Care Scope & Triage Principles Urgent care sits between the primary care office and the emergency department. Patients walk in (or register online) for problems that need same-day attention but are not immediately life threatening. A scribe in urgent care must learn to recognize the full rang...","sourceLabel":"Section in Urgent Care"},"3964":{"title":"Scribe Documentation Framework","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#s2","snippet":"Scribe Documentation Framework Urgent care notes are short, focused, and problem-oriented. The chief complaint drives everything: the HPI, the ROS, the exam, and the plan all orbit a single reason for the visit. Unlike primary care, you are not documenting a comprehensive wellness review - you are c...","sourceLabel":"Section in Urgent Care"},"3965":{"title":"Upper Respiratory Infections (URI, Influenza, COVID)","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#s3","snippet":"Upper Respiratory Infections (URI, Influenza, COVID) Viral URI is the single most common presentation in urgent care. Patients arrive with cough, congestion, sore throat, and low-grade fever. The scribe's job is to document a thorough respiratory and ENT exam, capture the correct POC test results, a...","sourceLabel":"Section in Urgent Care"},"3966":{"title":"Streptococcal Pharyngitis & Mononucleosis","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#s4","snippet":"Streptococcal Pharyngitis & Mononucleosis Sore throat is one of the top three urgent care chief complaints. The scribe must help distinguish Group A Streptococcus (treat with antibiotics to prevent rheumatic fever) from viral pharyngitis (no antibiotics), and recognize mononucleosis, which looks sim...","sourceLabel":"Section in Urgent Care"},"3967":{"title":"Sinusitis, Otitis Media & Otitis Externa","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#s5","snippet":"Sinusitis, Otitis Media & Otitis Externa Acute Rhinosinusitis Inflammation of the paranasal sinuses, usually viral. Symptoms: facial pain/pressure, purulent rhinorrhea, nasal congestion, decreased smell, maxillary tooth pain. The key question: viral or bacterial? Per the IDSA sinusitis guideline , a...","sourceLabel":"Section in Urgent Care"},"3968":{"title":"Conjunctivitis, Allergic Rhinitis & Eye Complaints","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#s6","snippet":"Conjunctivitis, Allergic Rhinitis & Eye Complaints Conjunctivitis Viral: Watery discharge, usually starts in one eye and spreads, often with URI symptoms. Highly contagious. Treatment: cool compresses, artificial tears, meticulous hand hygiene. Figure 7 - Corneal Abrasion with Fluorescein Staining. ...","sourceLabel":"Section in Urgent Care"},"3969":{"title":"Bronchitis, Pneumonia & Asthma/COPD Exacerbations","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#s7","snippet":"Bronchitis, Pneumonia & Asthma/COPD Exacerbations Acute Bronchitis Cough &plusmn; sputum production, usually post-URI. Duration can be up to 3 weeks. Almost always viral. Do not prescribe antibiotics. Treatment: symptomatic (dextromethorphan, guaifenesin, honey, bronchodilator if wheezing). Communit...","sourceLabel":"Section in Urgent Care"},"3970":{"title":"UTI, Vaginitis & STIs","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#s8","snippet":"UTI, Vaginitis & STIs Uncomplicated Cystitis Dysuria, frequency, urgency, suprapubic pain in an otherwise healthy non-pregnant woman. UA: +LE, +nitrite, +blood. Per IDSA uncomplicated UTI guidelines , first-line therapy is nitrofurantoin 100 mg BID x 5 days, TMP-SMX DS BID x 3 days (if local resista...","sourceLabel":"Section in Urgent Care"},"3971":{"title":"GI Complaints","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#s9","snippet":"GI Complaints Acute Gastroenteritis Nausea, vomiting, diarrhea, &plusmn; cramping, usually viral (norovirus, rotavirus). Assess hydration: mucous membranes, skin turgor, capillary refill, orthostatic vitals. Treatment: oral rehydration (Pedialyte, Gatorade), BRAT-like diet as tolerated, ondansetron ...","sourceLabel":"Section in Urgent Care"},"3972":{"title":"Headache, Dizziness, Syncope & Weakness","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#s10","snippet":"Headache, Dizziness, Syncope & Weakness Non-Emergent Headache Tension-type, migraine, medication overuse. Always ask about red flags: sudden \"thunderclap,\" worst headache of life, focal deficit, fever with neck stiffness, new headache after age 50, headache with trauma, immunocompromised, anticoagul...","sourceLabel":"Section in Urgent Care"},"3973":{"title":"Back Pain, Sprains, Strains & Simple Fractures","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#s11","snippet":"Back Pain, Sprains, Strains & Simple Fractures Acute Low Back Pain Most commonly mechanical/musculoligamentous. Red flags: saddle anesthesia, bowel/bladder incontinence (cauda equina), IV drug use/fever (epidural abscess), history of cancer, trauma, progressive neuro deficit, severe night pain. Any ...","sourceLabel":"Section in Urgent Care"},"3974":{"title":"Lacerations, Abscess, Cellulitis & Bites","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#s12","snippet":"Lacerations, Abscess, Cellulitis & Bites Laceration Repair Document: mechanism, time of injury (ideally closed < 12 h for trunk/extremity, < 24 h for face), contamination, foreign body, neurovascular and tendon exam distal to the wound, tetanus status. Irrigate copiously (100-200 mL per cm of wound)...","sourceLabel":"Section in Urgent Care"},"3975":{"title":"Dermatology (Rashes, Shingles, Tinea, Scabies, Warts)","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#s13","snippet":"Dermatology (Rashes, Shingles, Tinea, Scabies, Warts) Contact Dermatitis (Poison Ivy, Nickel, Soaps) Pruritic, erythematous, vesicular rash in linear streaks (classic for plant contact). Treatment: topical mid-high potency steroid (triamcinolone, clobetasol for limited severe areas), oral antihistam...","sourceLabel":"Section in Urgent Care"},"3976":{"title":"Burns, Foreign Bodies, Nail & Eye Injuries","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#s14","snippet":"Burns, Foreign Bodies, Nail & Eye Injuries Minor Burns First-degree: erythema only, painful. Superficial partial-thickness (2nd degree): blisters, wet, very painful. Treatment: cool water irrigation, cleanse, debride ruptured blisters, apply bacitracin or silver sulfadiazine (avoid on face), non-adh...","sourceLabel":"Section in Urgent Care"},"3977":{"title":"Chest Pain Workup & Low-Risk Cardiac Presentations","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#s15","snippet":"Chest Pain Workup & Low-Risk Cardiac Presentations Chest pain is the highest-liability urgent care presentation. Your job as a scribe is to document thoroughly so the provider's reasoning is clear. The provider will typically risk-stratify using clinical impression plus EKG and, in some clinics, poi...","sourceLabel":"Section in Urgent Care"},"3978":{"title":"Allergic Reactions & Anaphylaxis","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#s16","snippet":"Allergic Reactions & Anaphylaxis Mild allergic reactions (hives, itching, mild facial swelling without airway involvement) are common. Treatment: diphenhydramine 25-50 mg, cetirizine 10 mg, famotidine 20 mg, consider prednisone 40-60 mg x 3-5 days, observe 1-2 hours. Figure 23 - Anaphylaxis Manageme...","sourceLabel":"Section in Urgent Care"},"3979":{"title":"Occupational Medicine, Physicals & Work Injuries","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#s17","snippet":"Occupational Medicine, Physicals & Work Injuries Urgent care is the primary site for occupational health services. Scribes should know these documentation patterns cold because they are highly structured and time sensitive. Figure 24 - Nursemaid's Elbow - Ultrasound Findings. High-frequency ultrasou...","sourceLabel":"Section in Urgent Care"},"3980":{"title":"Urgent Care Procedures A to Z","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#s18","snippet":"Urgent Care Procedures A to Z Figure 25 - Epistaxis Management Algorithm. Stepwise approach to epistaxis management in urgent care. Initial treatment begins with direct pressure and topical vasoconstrictors, progressing to silver nitrate cautery if a bleeding source is identified, and anterior nasal...","sourceLabel":"Section in Urgent Care"},"3981":{"title":"Labs, POC Testing & Imaging","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#s19","snippet":"Labs, POC Testing & Imaging Point-of-Care Tests Test Turnaround Notes Rapid strep (GAS) 5-10 min Throat swab; negatives in children should reflex to culture Rapid influenza A/B 10-15 min Nasal swab; sensitivity ~60-80% COVID-19 antigen 15 min Nasal swab; confirm with PCR if high clinical suspicion M...","sourceLabel":"Section in Urgent Care"},"3982":{"title":"Medications You Must Know","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#s20","snippet":"Medications You Must Know Oral Antibiotics Drug Class Common Use Amoxicillin Aminopenicillin Strep throat, AOM, CAP, sinusitis Amoxicillin-clavulanate (Augmentin) Beta-lactam + inhibitor Sinusitis, bite wounds, CAP Cephalexin (Keflex) 1st-gen cephalosporin Non-purulent cellulitis, strep Azithromycin...","sourceLabel":"Section in Urgent Care"},"3983":{"title":"Classification & Decision Rules","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#s21","snippet":"Classification & Decision Rules CURB-65 - Pneumonia Severity (Full Enumeration) 1 point each: C onfusion, U rea (BUN) > 19 mg/dL, R espiratory rate &ge; 30, B lood pressure < 90/60, age &ge; 65 . 0-1: outpatient. 2: consider short admission. &ge; 3: inpatient, consider ICU. Wells Score for DVT Activ...","sourceLabel":"Section in Urgent Care"},"3984":{"title":"Physical Exam & Abbreviations Master List","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#s22","snippet":"Physical Exam & Abbreviations Master List Focused Exam by Chief Complaint In urgent care, a focused problem-oriented exam is standard. For a sore throat: general appearance, vitals, HEENT (tonsils, exudates, cervical nodes, TMs, nares), neck (lymphadenopathy, meningismus), respiratory. For an ankle ...","sourceLabel":"Section in Urgent Care"},"3985":{"title":"ED Transfer Criteria & Red Flags","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#s23","snippet":"ED Transfer Criteria & Red Flags Knowing when to transfer is the single most important safety skill in urgent care. The following list is not exhaustive but covers the most common clean hand-offs. Transfer Immediately by EMS Chest pain with red flags (pressure, diaphoresis, radiation, ECG changes) S...","sourceLabel":"Section in Urgent Care"},"3986":{"title":"Sample HPI Templates & Closing Note","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#s24","snippet":"Sample HPI Templates & Closing Note These templates model the rhythm of a real urgent care note - short, focused, and specific. Use them as pattern matching for your first weeks on the job. Sample HPI - Viral URI \"Mr. [Name] is a 34-year-old male with no significant PMH presenting with 4 days of nas...","sourceLabel":"Section in Urgent Care"},"3987":{"title":"References & Sources","pageTitle":"Urgent Care","pageUrl":"/scribe-guides/urgent-care","url":"/scribe-guides/urgent-care#references","snippet":"References & Sources Clinical Practice Guidelines Shulman ST et al. IDSA Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis. Clin Infect Dis. 2012. Chow AW et al. IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults...","sourceLabel":"Section in Urgent Care"},"3988":{"title":"Critical Care / ICU","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care","snippet":"Critical Care / ICU - Complete Reference Every diagnosis, procedure, ventilator mode, vasoactive drug, and documentation framework you need to survive week one in the ICU and beyond."},"3989":{"title":"ICU Principles & Organ-System Foundations","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care#s1","snippet":"ICU Principles & Organ-System Foundations The intensive care unit is where physiology that is normally invisible becomes the story of the chart. Every ICU patient is defined by which of their organ systems is failing and which are at risk of failing next. A competent ICU scribe learns to think in sy...","sourceLabel":"Section in Critical Care / ICU"},"3990":{"title":"Scribe Documentation Framework (ICU Note Structure)","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care#s2","snippet":"Scribe Documentation Framework (ICU Note Structure) ICU progress notes differ from outpatient SOAP notes in one critical way: they are written by system , not by problem. A typical ICU attending will round at the bedside and dictate a note that reads: \"Neuro - intubated, sedated on propofol, RASS &m...","sourceLabel":"Section in Critical Care / ICU"},"3991":{"title":"Shock - Overview & Classification","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care#s3","snippet":"Shock - Overview & Classification Shock is a state of inadequate tissue oxygen delivery leading to cellular dysfunction and, if untreated, death. Shock is not defined by a specific blood pressure - a patient with a MAP of 70 who is oliguric, obtunded, and lactic is in shock. Clinically, ICU teams cl...","sourceLabel":"Section in Critical Care / ICU"},"3992":{"title":"Sepsis & Septic Shock INFECTIOUS","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care#s4","snippet":"Sepsis & Septic Shock INFECTIOUS Sepsis (Sepsis-3 definition) is life-threatening organ dysfunction caused by a dysregulated host response to infection, identified clinically by a rise in the SOFA score of 2 or more points. Septic shock is sepsis plus persistent hypotension requiring vasopressors to...","sourceLabel":"Section in Critical Care / ICU"},"3993":{"title":"Cardiogenic Shock & Acute Heart Failure CARDIAC","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care#s5","snippet":"Cardiogenic Shock & Acute Heart Failure CARDIAC Cardiogenic shock is low cardiac output shock from pump failure. SBP < 90 for > 30 min or requiring pressors to maintain, cardiac index < 2.2 L/min/m&sup2;, and elevated filling pressures (PCWP > 15). The most common cause is acute MI with LV dysfuncti...","sourceLabel":"Section in Critical Care / ICU"},"3994":{"title":"Hypovolemic, Obstructive & Distributive Shock CIRCULATORY","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care#s6","snippet":"Hypovolemic, Obstructive & Distributive Shock CIRCULATORY Hypovolemic Shock Volume loss - hemorrhage (trauma, GI bleed, ruptured AAA, ectopic pregnancy, post-partum) or fluid losses (severe diarrhea, DKA, burns). Classic physiology: low CVP, low CO, high SVR, narrow pulse pressure, orthostatic vital...","sourceLabel":"Section in Critical Care / ICU"},"3995":{"title":"Acute Respiratory Failure & ARDS PULMONARY","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care#s7","snippet":"Acute Respiratory Failure & ARDS PULMONARY Acute respiratory failure is classified as Type 1 (hypoxemic, PaO2 < 60) or Type 2 (hypercapnic, PaCO2 > 50 with acidosis). Type 1 reflects a problem with oxygenation (V/Q mismatch, shunt, diffusion impairment). Type 2 reflects ventilation failure (airway o...","sourceLabel":"Section in Critical Care / ICU"},"3996":{"title":"Mechanical Ventilation - Modes, Settings & Weaning PULMONARY","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care#s8","snippet":"Mechanical Ventilation - Modes, Settings & Weaning PULMONARY The ventilator is the most important piece of equipment in the ICU. Scribes must learn to read and document ventilator settings with the same fluency as vital signs. Figure 10 - Ventilator Pressure and Flow Waveforms. Representative airway...","sourceLabel":"Section in Critical Care / ICU"},"3997":{"title":"Status Asthmaticus & COPD Exacerbation PULMONARY","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care#s9","snippet":"Status Asthmaticus & COPD Exacerbation PULMONARY Status asthmaticus is a severe asthma exacerbation unresponsive to initial bronchodilators, progressing toward respiratory failure. Clinical features: severe dyspnea, accessory muscle use, silent chest (ominous), tachycardia, pulsus paradoxus, altered...","sourceLabel":"Section in Critical Care / ICU"},"3998":{"title":"Cardiac Arrest, Post-Arrest Care & TTM CARDIAC","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care#s10","snippet":"Cardiac Arrest, Post-Arrest Care & TTM CARDIAC Cardiac arrest care follows the AHA 2020 ACLS guidelines . Shockable rhythms (VF/pulseless VT) are treated with immediate defibrillation, high-quality CPR (100-120/min, depth &ge; 2 inches), epinephrine 1 mg every 3-5 min, amiodarone 300 mg after 3 shoc...","sourceLabel":"Section in Critical Care / ICU"},"3999":{"title":"STEMI, Malignant Arrhythmias & ECMO CARDIAC","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care#s11","snippet":"STEMI, Malignant Arrhythmias & ECMO CARDIAC STEMI (ST-elevation MI) requires emergent reperfusion: primary PCI within 90 minutes (door-to-balloon), thrombolytics if PCI unavailable. Standard meds: aspirin 325 mg chewed, P2Y12 inhibitor (ticagrelor, prasugrel, or clopidogrel), anticoagulation (hepari...","sourceLabel":"Section in Critical Care / ICU"},"4000":{"title":"AKI, CRRT & Electrolyte Emergencies RENAL","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care#s12","snippet":"AKI, CRRT & Electrolyte Emergencies RENAL Acute kidney injury (AKI) is defined by the KDIGO criteria : rise in creatinine &ge; 0.3 mg/dL within 48 h, or 1.5&times; baseline within 7 days, or UOP < 0.5 mL/kg/hr &times; 6 h. Three physiologic categories: prerenal (hypovolemia, sepsis, cardiorenal - Fe...","sourceLabel":"Section in Critical Care / ICU"},"4001":{"title":"DKA, HHS & Endocrine Emergencies ENDOCRINE","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care#s13","snippet":"DKA, HHS & Endocrine Emergencies ENDOCRINE DKA Diabetic ketoacidosis : glucose > 250, anion gap acidosis (pH < 7.3, HCO3 < 18), ketonemia/ketonuria. Presents with Kussmaul breathing, fruity breath, abdominal pain, altered mental status. Management: IV fluids (normal saline 1-2 L bolus, then maintena...","sourceLabel":"Section in Critical Care / ICU"},"4002":{"title":"GI Bleeding & Hepatic Emergencies GI/HEPATIC","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care#s14","snippet":"GI Bleeding & Hepatic Emergencies GI/HEPATIC Upper GI bleed: hematemesis, melena, coffee-ground emesis. Causes: peptic ulcer (most common), variceal bleeding (cirrhosis), Mallory-Weiss tear, gastritis, AVMs, malignancy. Management: 2 large-bore IVs, type and cross, resuscitate (crystalloid then bloo...","sourceLabel":"Section in Critical Care / ICU"},"4003":{"title":"Neurologic Emergencies NEURO","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care#s15","snippet":"Neurologic Emergencies NEURO Intracerebral Hemorrhage (ICH) Spontaneous bleed (often hypertensive) or secondary (AVM, aneurysm, tumor, anticoagulant). Treatment: aggressive BP control (target SBP 140 per INTERACT-2), reverse anticoagulation (PCC for warfarin, idarucizumab for dabigatran, andexanet o...","sourceLabel":"Section in Critical Care / ICU"},"4004":{"title":"Toxicology - Overdose & Withdrawal TOX","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care#s16","snippet":"Toxicology - Overdose & Withdrawal TOX Acetaminophen overdose: stages I (6-24 h, nonspecific), II (24-72 h, RUQ pain, LFTs rising), III (72-96 h, fulminant hepatic failure), IV (recovery or transplant/death). Rumack-Matthew nomogram guides treatment. N-acetylcysteine (NAC) IV 150 mg/kg loading, or P...","sourceLabel":"Section in Critical Care / ICU"},"4005":{"title":"Toxidromes & Temperature Emergencies TOX","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care#s17","snippet":"Toxidromes & Temperature Emergencies TOX Key Toxidromes Syndrome Cause Features Treatment NMS Neuroleptics (antipsychotics) Hyperthermia, lead-pipe rigidity, AMS, autonomic instability, &uarr;CK Stop agent, cooling, dantrolene, bromocriptine Serotonin syndrome SSRIs, MAOIs, linezolid, tramadol Clonu...","sourceLabel":"Section in Critical Care / ICU"},"4006":{"title":"ICU Procedures - Airway, Access & Bedside","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care#s18","snippet":"ICU Procedures - Airway, Access & Bedside Figure 19 - Ultrasound-Guided Central Venous Catheter Placement. Six-step approach to ultrasound-guided central venous access demonstrating systematic probe positioning for vessel identification, short-axis and long-axis needle visualization techniques, guid...","sourceLabel":"Section in Critical Care / ICU"},"4007":{"title":"Hemodynamic Monitoring & POCUS","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care#s19","snippet":"Hemodynamic Monitoring & POCUS Arterial line waveform: dicrotic notch reflects aortic valve closure. Underdamped (whip) = overestimates SBP; overdamped = underestimates SBP. MAP is the most reliable number. Figure 20 - Pulmonary Artery Catheter Waveforms During Insertion. Sequential pressure wavefor...","sourceLabel":"Section in Critical Care / ICU"},"4008":{"title":"ICU Medications - Sedation, Pressors & Prophylaxis","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care#s20","snippet":"ICU Medications - Sedation, Pressors & Prophylaxis Sedation & Analgesia Figure 22 - ICU Sedation and Analgesia Agent Comparison. Pharmacokinetic and pharmacodynamic profiles of commonly used ICU sedation agents, including onset and offset characteristics, receptor mechanisms, and clinical considerat...","sourceLabel":"Section in Critical Care / ICU"},"4009":{"title":"Classification Systems & Scoring","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care#s21","snippet":"Classification Systems & Scoring Glasgow Coma Scale (GCS) - Range 3-15 Component Score Finding Eye 4 Spontaneous 3 To voice 2 To pain 1 None Verbal 5 Oriented 4 Confused 3 Inappropriate words 2 Incomprehensible sounds 1 None Motor 6 Obeys commands 5 Localizes pain 4 Withdraws from pain 3 Flexion (de...","sourceLabel":"Section in Critical Care / ICU"},"4010":{"title":"Physical Exam & Daily ICU Rounds","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care#s22","snippet":"Physical Exam & Daily ICU Rounds The ICU exam is focused and repetitive: you document the same elements every day, looking for interval change. General appearance: sedated, awake, in distress, comfortable. HEENT: pupils (size, reactivity), ETT position, NG tube. Neck: central line, tracheostomy, JVD...","sourceLabel":"Section in Critical Care / ICU"},"4011":{"title":"Abbreviations Master List","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care#s23","snippet":"Abbreviations Master List Organ Systems & Syndromes ARDS - acute respiratory distress syndrome AKI - acute kidney injury ATN - acute tubular necrosis AMS - altered mental status CHF - congestive heart failure COPD - chronic obstructive pulmonary disease DIC - disseminated intravascular coagulation D...","sourceLabel":"Section in Critical Care / ICU"},"4012":{"title":"Sample HPI Templates & References","pageTitle":"Critical Care / ICU","pageUrl":"/scribe-guides/critical-care","url":"/scribe-guides/critical-care#s24","snippet":"Sample HPI Templates & References These sample HPIs represent the kinds of admissions and progress notes you will draft in the ICU. Internalize the rhythm: one-sentence identification, presenting event, objective data at presentation, interventions, and current status. Sample HPI - Septic Shock from...","sourceLabel":"Section in Critical Care / ICU"},"4013":{"title":"Pain Management","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management","snippet":"Pain Management - Complete Reference Every pain syndrome, interventional procedure, medication, classification, and documentation framework you need to succeed on day one and beyond."},"4014":{"title":"Pain Neurobiology - Pathways & Mechanisms","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management#s1","snippet":"Pain Neurobiology - Pathways & Mechanisms Pain medicine is a multidisciplinary specialty that manages acute, chronic, cancer, and interventional pain. Unlike most fields where \"the diagnosis\" drives care, pain medicine is organized around mechanisms of pain. A single patient with low back pain may s...","sourceLabel":"Section in Pain Management"},"4015":{"title":"Scribe Documentation Framework","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management#s2","snippet":"Scribe Documentation Framework Pain encounters fall into four templates: new consultation , medication follow-up , procedure visit , and post-procedure follow-up . Each has its own required elements, and you will learn to toggle between them fluidly. Pain-Specific HPI Elements (PQRSTU+) P rovokes/Pa...","sourceLabel":"Section in Pain Management"},"4016":{"title":"Chronic Low Back Pain","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management#s3","snippet":"Chronic Low Back Pain Chronic low back pain (CLBP) is the single highest-volume diagnosis in any pain clinic. Low back pain lasting > 12 weeks is considered chronic. The scribe's job is to classify it by the suspected pain generator because management diverges dramatically. Figure 5 - Lumbosacral De...","sourceLabel":"Section in Pain Management"},"4017":{"title":"Failed Back Surgery / Post-Laminectomy Syndrome","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management#s4","snippet":"Failed Back Surgery / Post-Laminectomy Syndrome Also called post-laminectomy syndrome or persistent spinal pain syndrome type 2 , FBSS refers to persistent or recurrent low back and/or leg pain after one or more lumbar spine surgeries. Estimated to affect 20-40% of post-lumbar-surgery patients. The ...","sourceLabel":"Section in Pain Management"},"4018":{"title":"Facet Arthropathy & Sacroiliac Joint Dysfunction","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management#s5","snippet":"Facet Arthropathy & Sacroiliac Joint Dysfunction Facet (Zygapophyseal) Joint Pain Facet joints are paired synovial joints at each spinal level. Degenerative arthropathy produces axial pain that worsens with extension and rotation, is typically unilateral or bilateral paraspinal, and may refer into t...","sourceLabel":"Section in Pain Management"},"4019":{"title":"Disc Herniation & Radiculopathy","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management#s6","snippet":"Disc Herniation & Radiculopathy Intervertebral disc herniation - protrusion, extrusion, or sequestration of the nucleus pulposus through the annulus fibrosus - compresses or inflames an exiting nerve root producing radicular pain in a dermatomal distribution. In the lumbar spine, the most common lev...","sourceLabel":"Section in Pain Management"},"4020":{"title":"Spinal Stenosis & Neurogenic Claudication","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management#s7","snippet":"Spinal Stenosis & Neurogenic Claudication Central, lateral recess, or foraminal narrowing of the spinal canal from degenerative changes (hypertrophied ligamentum flavum, facet hypertrophy, disc bulge, spondylolisthesis). Lumbar spinal stenosis presents with neurogenic claudication; cervical spinal s...","sourceLabel":"Section in Pain Management"},"4021":{"title":"Headache & Craniofacial Pain Syndromes","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management#s8","snippet":"Headache & Craniofacial Pain Syndromes Headache disorders are frequently co-managed with neurology, but pain medicine handles interventional treatment and many refractory cases. Figure 9 - Occipital Nerve Anatomy. The greater occipital nerve (C2 dorsal ramus medial branch) and lesser occipital nerve...","sourceLabel":"Section in Pain Management"},"4022":{"title":"Neuropathic Pain Syndromes","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management#s9","snippet":"Neuropathic Pain Syndromes Neuropathic pain arises from lesion of the somatosensory nervous system. Evaluation tools include the DN4 questionnaire and painDETECT. The IASP NeuPSIG treatment recommendations form the backbone of pharmacologic management. Figure 10 - Neuropathic Pain Treatment Algorith...","sourceLabel":"Section in Pain Management"},"4023":{"title":"Complex Regional Pain Syndrome","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management#s10","snippet":"Complex Regional Pain Syndrome CRPS is a disproportionate pain syndrome following injury or surgery, characterized by regional sensory, motor, autonomic, and trophic disturbances. CRPS Type I (formerly reflex sympathetic dystrophy) has no identifiable nerve lesion; Type II (formerly causalgia) follo...","sourceLabel":"Section in Pain Management"},"4024":{"title":"Myofascial, Fibromyalgia & Nociplastic Pain","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management#s11","snippet":"Myofascial, Fibromyalgia & Nociplastic Pain Figure 13 - Trigger Point Anatomy. Schematic of the anatomy of a taut band and myofascial trigger point. Hyperirritable contraction knots within skeletal muscle produce local tenderness and characteristic referred pain patterns. Treatment involves mechanic...","sourceLabel":"Section in Pain Management"},"4025":{"title":"Cancer, Visceral & Pelvic Pain","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management#s12","snippet":"Cancer, Visceral & Pelvic Pain Cancer pain is typically mixed - nociceptive (bone metastasis, soft tissue invasion), neuropathic (nerve compression, chemotherapy), and visceral (organ capsule stretch, obstruction). The WHO analgesic ladder remains the global framework. Figure 15 - WHO Analgesic Ladd...","sourceLabel":"Section in Pain Management"},"4026":{"title":"Post-Surgical & Post-Thoracotomy Pain","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management#s13","snippet":"Post-Surgical & Post-Thoracotomy Pain Chronic post-surgical pain (CPSP) develops after 10-50% of major surgeries. Recognized syndromes include post-thoracotomy pain syndrome (intercostal nerve injury), post-mastectomy pain syndrome (intercostobrachial neuralgia), post-inguinal herniorrhaphy pain (il...","sourceLabel":"Section in Pain Management"},"4027":{"title":"Interventional Procedures - A to Z","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management#s14","snippet":"Interventional Procedures - A to Z Interventional pain procedures form the backbone of any pain clinic's revenue and clinical value. You will document dozens of these per week. Each procedure has specific consent language, fluoroscopy or ultrasound guidance, injectate composition, and post-procedure...","sourceLabel":"Section in Pain Management"},"4028":{"title":"Neuromodulation & Implantable Devices","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management#s15","snippet":"Neuromodulation & Implantable Devices Neuromodulation is the fastest-growing segment of interventional pain medicine. Figure 20 - Spinal Cord Stimulator Anatomy. Components of a spinal cord stimulation system including percutaneous electrode leads placed in the posterior epidural space over the dors...","sourceLabel":"Section in Pain Management"},"4029":{"title":"Post-Procedure Care & Complications","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management#s16","snippet":"Post-Procedure Care & Complications Every procedure visit includes structured post-procedure documentation: vitals pre/post, sedation level (most pain procedures are done awake or with minimal sedation), immediate pain score change, neurologic exam unchanged, and return precautions. Red-Flag Post-Pr...","sourceLabel":"Section in Pain Management"},"4030":{"title":"Imaging & Diagnostics","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management#s17","snippet":"Imaging & Diagnostics Pain physicians rely on MRI, CT, X-ray, EMG/NCS, and diagnostic nerve blocks to identify the pain generator and justify intervention. Figure 22 - Spinal Bone Metastases MRI. Sagittal T1-weighted and STIR MR images showing diffuse marrow signal abnormality from metastatic diseas...","sourceLabel":"Section in Pain Management"},"4031":{"title":"Medications - Multimodal Analgesia","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management#s18","snippet":"Medications - Multimodal Analgesia Multimodal analgesia layers agents with different mechanisms to maximize relief and minimize opioid exposure. Figure 23 - COX-Prostaglandin Pathway. The cyclooxygenase enzymes COX-1 (constitutive) and COX-2 (inducible) convert arachidonic acid to prostaglandins and...","sourceLabel":"Section in Pain Management"},"4032":{"title":"Opioid Stewardship & Risk Mitigation","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management#s19","snippet":"Opioid Stewardship & Risk Mitigation The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain replaced the 2016 version and emphasizes individualized, non-restrictive care while retaining the core principles of caution, multimodality, and risk mitigation. Figure 24 - Opioid Receptor...","sourceLabel":"Section in Pain Management"},"4033":{"title":"Classification & Assessment Systems","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management#s20","snippet":"Classification & Assessment Systems Pain Intensity Scales Pain Intensity Instruments Numeric Rating Scale (NRS 0-10): 0 = no pain, 10 = worst imaginable. Default in most U.S. pain clinics. Document current, average (past week), worst, and least. Visual Analog Scale (VAS): 100 mm line marked by the p...","sourceLabel":"Section in Pain Management"},"4034":{"title":"Physical Exam - The Pain Exam","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management#s21","snippet":"Physical Exam - The Pain Exam The pain-specific exam blends musculoskeletal, neurologic, and observational components. Chart it in the same order every time. Figure 25 - Complex Pain Pathways. Comprehensive diagram of pain signal transmission from peripheral nociceptive nerve endings in joints, musc...","sourceLabel":"Section in Pain Management"},"4035":{"title":"Abbreviations Master List","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management#s22","snippet":"Abbreviations Master List Diagnoses & Syndromes CLBP chronic low back pain FBSS failed back surgery syndrome PSPS persistent spinal pain syndrome CRPS complex regional pain syndrome RSD reflex sympathetic dystrophy (old term) DPN diabetic peripheral neuropathy PHN post-herpetic neuralgia TN trigemin...","sourceLabel":"Section in Pain Management"},"4036":{"title":"Sample HPI Templates","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management#s23","snippet":"Sample HPI Templates The following HPIs represent the most common encounter types in a pain clinic. Study them until the rhythm is automatic. Sample HPI - Chronic Low Back Pain (New Consult) \"Mr. [Name] is a 54-year-old male with a history of type 2 diabetes, hypertension, obesity (BMI 34), and a re...","sourceLabel":"Section in Pain Management"},"4037":{"title":"References & Sources","pageTitle":"Pain Management","pageUrl":"/scribe-guides/pain-management","url":"/scribe-guides/pain-management#s24","snippet":"References & Sources Clinical Practice Guidelines Dowell D et al. CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022. MMWR Recomm Rep. 2022. Qaseem A et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: ACP Clinical Practice Guideline. Ann...","sourceLabel":"Section in Pain Management"},"4038":{"title":"Sleep Medicine","pageTitle":"Sleep Medicine","pageUrl":"/scribe-guides/sleep-medicine","url":"/scribe-guides/sleep-medicine","snippet":"Sleep Medicine - Complete Reference Every diagnosis, sleep study, PAP device, medication, abbreviation, and documentation framework you need to scribe competently in a sleep clinic or sleep lab."},"4039":{"title":"Sleep Neurophysiology - Essentials","pageTitle":"Sleep Medicine","pageUrl":"/scribe-guides/sleep-medicine","url":"/scribe-guides/sleep-medicine#s1","snippet":"Sleep Neurophysiology - Essentials Sleep medicine sits at the intersection of pulmonology, neurology, otolaryngology, and psychiatry. To chart competently, a scribe must understand how normal sleep is organized, what physiologic signals are recorded during a sleep study, and what happens to the airw...","sourceLabel":"Section in Sleep Medicine"},"4040":{"title":"Scribe Documentation Framework","pageTitle":"Sleep Medicine","pageUrl":"/scribe-guides/sleep-medicine","url":"/scribe-guides/sleep-medicine#s2","snippet":"Scribe Documentation Framework Sleep medicine encounters fall into a handful of predictable buckets: new consultations for snoring/witnessed apneas/daytime sleepiness, insomnia evaluations, restless legs, narcolepsy or hypersomnia workups, parasomnia visits, and follow-ups centered on PAP compliance...","sourceLabel":"Section in Sleep Medicine"},"4041":{"title":"Obstructive Sleep Apnea (OSA)","pageTitle":"Sleep Medicine","pageUrl":"/scribe-guides/sleep-medicine","url":"/scribe-guides/sleep-medicine#s3","snippet":"Obstructive Sleep Apnea (OSA) Obstructive sleep apnea is repetitive partial or complete collapse of the upper airway during sleep despite ongoing respiratory effort. It is the single most common diagnosis in a sleep clinic, affecting an estimated 10-30% of middle-aged adults, and the majority of you...","sourceLabel":"Section in Sleep Medicine"},"4042":{"title":"Central Sleep Apnea (CSA)","pageTitle":"Sleep Medicine","pageUrl":"/scribe-guides/sleep-medicine","url":"/scribe-guides/sleep-medicine#s4","snippet":"Central Sleep Apnea (CSA) Central sleep apnea is a cessation of airflow caused by loss of ventilatory drive - there is no respiratory effort during the event, unlike OSA. CSA is far less common than OSA and usually occurs in specific clinical contexts. Figure 9 - Loop Gain and Central Sleep Apnea. E...","sourceLabel":"Section in Sleep Medicine"},"4043":{"title":"Obesity Hypoventilation Syndrome (OHS)","pageTitle":"Sleep Medicine","pageUrl":"/scribe-guides/sleep-medicine","url":"/scribe-guides/sleep-medicine#s5","snippet":"Obesity Hypoventilation Syndrome (OHS) Obesity hypoventilation syndrome (Pickwickian syndrome) is defined by obesity (BMI &ge; 30), awake chronic hypercapnia (PaCO 2 > 45 mmHg), and sleep-disordered breathing, with no alternative cause of hypoventilation. Roughly 90% of OHS patients also have OSA. U...","sourceLabel":"Section in Sleep Medicine"},"4044":{"title":"Complex / Mixed Apneas, UARS & Snoring","pageTitle":"Sleep Medicine","pageUrl":"/scribe-guides/sleep-medicine","url":"/scribe-guides/sleep-medicine#s6","snippet":"Complex / Mixed Apneas, UARS & Snoring Mixed apnea: An event that starts as a central apnea (no effort) and transitions into an obstructive apnea as effort returns against a collapsed airway. Scored as obstructive by AASM convention. Complex sleep apnea = treatment-emergent CSA (see Section 4). Uppe...","sourceLabel":"Section in Sleep Medicine"},"4045":{"title":"Insomnia Disorders","pageTitle":"Sleep Medicine","pageUrl":"/scribe-guides/sleep-medicine","url":"/scribe-guides/sleep-medicine#s7","snippet":"Insomnia Disorders Insomnia disorder is defined by dissatisfaction with sleep quantity or quality associated with difficulty initiating sleep, maintaining sleep, or early-morning awakening, occurring despite adequate opportunity for sleep, with daytime impairment. Chronic insomnia requires symptoms ...","sourceLabel":"Section in Sleep Medicine"},"4046":{"title":"Narcolepsy & Central Disorders of Hypersomnolence","pageTitle":"Sleep Medicine","pageUrl":"/scribe-guides/sleep-medicine","url":"/scribe-guides/sleep-medicine#s8","snippet":"Narcolepsy & Central Disorders of Hypersomnolence Narcolepsy is a chronic neurologic disorder of sleep-wake state instability, classically presenting with excessive daytime sleepiness and intrusion of REM phenomena into wakefulness. Narcolepsy Type 1 (with cataplexy) Caused by autoimmune loss of hyp...","sourceLabel":"Section in Sleep Medicine"},"4047":{"title":"Restless Legs Syndrome & PLMD","pageTitle":"Sleep Medicine","pageUrl":"/scribe-guides/sleep-medicine","url":"/scribe-guides/sleep-medicine#s9","snippet":"Restless Legs Syndrome & PLMD Restless legs syndrome (RLS / Willis-Ekbom disease) is a sensorimotor disorder defined by the IRLSSG criteria: (1) an urge to move the legs, usually accompanied by uncomfortable sensations; (2) worse at rest; (3) relieved by movement; (4) worse in the evening or night; ...","sourceLabel":"Section in Sleep Medicine"},"4048":{"title":"REM Sleep Behavior Disorder & NREM Parasomnias","pageTitle":"Sleep Medicine","pageUrl":"/scribe-guides/sleep-medicine","url":"/scribe-guides/sleep-medicine#s10","snippet":"REM Sleep Behavior Disorder & NREM Parasomnias REM Sleep Behavior Disorder (RBD) RBD is loss of the normal REM atonia, allowing patients to physically enact their dreams - punching, kicking, jumping out of bed, and injuring themselves or bed partners. Dreams are typically action-packed and confronta...","sourceLabel":"Section in Sleep Medicine"},"4049":{"title":"Other Parasomnias & Sleep-Related Movement Disorders","pageTitle":"Sleep Medicine","pageUrl":"/scribe-guides/sleep-medicine","url":"/scribe-guides/sleep-medicine#s11","snippet":"Other Parasomnias & Sleep-Related Movement Disorders Nightmare disorder: Recurrent, well-remembered disturbing dreams in REM sleep; treat with image rehearsal therapy (IRT) and prazosin, especially for PTSD-associated nightmares. Sleep-related hallucinations: Hypnagogic (falling asleep) or hypnopomp...","sourceLabel":"Section in Sleep Medicine"},"4050":{"title":"Circadian Rhythm Sleep-Wake Disorders","pageTitle":"Sleep Medicine","pageUrl":"/scribe-guides/sleep-medicine","url":"/scribe-guides/sleep-medicine#s12","snippet":"Circadian Rhythm Sleep-Wake Disorders Circadian rhythm disorders are misalignments between the endogenous circadian clock and the desired or required sleep-wake schedule. Total sleep quality is often normal when the patient sleeps on their own schedule ; problems arise from external demands. Managem...","sourceLabel":"Section in Sleep Medicine"},"4051":{"title":"Sleep Studies - PSG, HSAT, MSLT, MWT","pageTitle":"Sleep Medicine","pageUrl":"/scribe-guides/sleep-medicine","url":"/scribe-guides/sleep-medicine#s13","snippet":"Sleep Studies - PSG, HSAT, MSLT, MWT Sleep studies are the procedural heart of sleep medicine. A scribe must know what each study measures, when it is ordered, and what the report says. Figure 22 - Standard Polysomnography Montage. A representative full-night PSG recording illustrating the standard ...","sourceLabel":"Section in Sleep Medicine"},"4052":{"title":"PAP Therapy - CPAP, BiPAP, ASV, AVAPS","pageTitle":"Sleep Medicine","pageUrl":"/scribe-guides/sleep-medicine","url":"/scribe-guides/sleep-medicine#s14","snippet":"PAP Therapy - CPAP, BiPAP, ASV, AVAPS Positive airway pressure pneumatically splints the upper airway open. The device, mode, pressures, interface, and humidification are all scribe-charted fields. Figure 24 - Implanted Nerve Stimulation Devices for Sleep Apnea. Chest radiograph demonstrating dual i...","sourceLabel":"Section in Sleep Medicine"},"4053":{"title":"Surgical & Device Procedures for OSA","pageTitle":"Sleep Medicine","pageUrl":"/scribe-guides/sleep-medicine","url":"/scribe-guides/sleep-medicine#s15","snippet":"Surgical & Device Procedures for OSA Procedure Reference Procedure Description Indication Drug-induced sleep endoscopy (DISE) Flexible endoscopy during propofol sedation to map airway collapse (VOTE: velum, oropharynx, tongue base, epiglottis) Planning Inspire or surgical candidacy Upper airway stim...","sourceLabel":"Section in Sleep Medicine"},"4054":{"title":"Medications You Must Know","pageTitle":"Sleep Medicine","pageUrl":"/scribe-guides/sleep-medicine","url":"/scribe-guides/sleep-medicine#s16","snippet":"Medications You Must Know Hypnotics - for Insomnia Drug Class Generic (Brand) Mechanism / Notes Z-drugs Zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta) Selective GABA-A (BZ1) agonists. Sleep-driving, complex sleep behaviors (FDA boxed warning). Shorter acting for sleep onset, eszopiclone...","sourceLabel":"Section in Sleep Medicine"},"4055":{"title":"Classification Systems & Severity Scales","pageTitle":"Sleep Medicine","pageUrl":"/scribe-guides/sleep-medicine","url":"/scribe-guides/sleep-medicine#s17","snippet":"Classification Systems & Severity Scales Epworth Sleepiness Scale (ESS) Eight situations, each scored 0 (would never doze) to 3 (high chance of dozing). Total 0-24. Total Interpretation 0-5 Lower normal daytime sleepiness 6-10 Higher normal daytime sleepiness 11-12 Mild excessive daytime sleepiness ...","sourceLabel":"Section in Sleep Medicine"},"4056":{"title":"Physical Exam - The Sleep Exam","pageTitle":"Sleep Medicine","pageUrl":"/scribe-guides/sleep-medicine","url":"/scribe-guides/sleep-medicine#s18","snippet":"Physical Exam - The Sleep Exam The sleep exam is focused and repetitive - you will document essentially the same elements every visit. Capture them efficiently. Sleep Physical Exam Template Vitals: BP ___/___, HR ___, SpO2 ___%, BMI ___, Neck circumference ___ in General: Alert, NAD, [body habitus] ...","sourceLabel":"Section in Sleep Medicine"},"4057":{"title":"Risk Factors & Comorbidities","pageTitle":"Sleep Medicine","pageUrl":"/scribe-guides/sleep-medicine","url":"/scribe-guides/sleep-medicine#s19","snippet":"Risk Factors & Comorbidities Figure 25 - Risk Factors Linking OSA to Cardiovascular Disease. Multiple pathophysiologic pathways connect obstructive sleep apnea to cardiovascular morbidity including intermittent hypoxia-reoxygenation injury, sympathetic activation, systemic inflammation, oxidative st...","sourceLabel":"Section in Sleep Medicine"},"4058":{"title":"Abbreviations Master List","pageTitle":"Sleep Medicine","pageUrl":"/scribe-guides/sleep-medicine","url":"/scribe-guides/sleep-medicine#s20","snippet":"Abbreviations Master List Diagnoses & Phenomena OSA Obstructive sleep apnea CSA Central sleep apnea OHS Obesity hypoventilation syndrome SDB Sleep-disordered breathing UARS Upper airway resistance syndrome CSR Cheyne-Stokes respiration EDS Excessive daytime sleepiness RLS Restless legs syndrome (Wil...","sourceLabel":"Section in Sleep Medicine"},"4059":{"title":"Sample HPI Templates","pageTitle":"Sleep Medicine","pageUrl":"/scribe-guides/sleep-medicine","url":"/scribe-guides/sleep-medicine#s21","snippet":"Sample HPI Templates These templates show the rhythm and content of a good sleep-medicine HPI. Pattern-match off them during your first week. Sample HPI - Snoring / Suspected OSA (New Consult) \"Mr. [Name] is a 54-year-old male with hypertension, hyperlipidemia, and BMI 34 referred by his PCP for eva...","sourceLabel":"Section in Sleep Medicine"},"4060":{"title":"References & Sources","pageTitle":"Sleep Medicine","pageUrl":"/scribe-guides/sleep-medicine","url":"/scribe-guides/sleep-medicine#s22","snippet":"References & Sources Clinical Practice Guidelines Kapur VK, et al. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea. AASM. J Clin Sleep Med. 2017. Patil SP, et al. Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure. AASM Clinical Practice Gui...","sourceLabel":"Section in Sleep Medicine"},"4061":{"title":"Wound Care","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care","snippet":"Wound Care - Complete Reference Every wound type, dressing, procedure, classification, and documentation pattern a wound care scribe needs on day one and beyond."},"4062":{"title":"Skin Anatomy & Wound Healing Physiology","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s1","snippet":"Skin Anatomy & Wound Healing Physiology Wound care as a specialty sits at the intersection of dermatology, vascular surgery, plastic surgery, endocrinology, infectious disease, and rehabilitation medicine. Before a scribe can document a wound encounter intelligently, they need a working knowledge of...","sourceLabel":"Section in Wound Care"},"4063":{"title":"Scribe Documentation Framework","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s2","snippet":"Scribe Documentation Framework Wound clinic notes are usually SOAP-formatted, but the Objective section is unusually dense compared with most specialties because every wound requires precise measurement, description, and staging at every visit. The note must answer three questions: (1) What does thi...","sourceLabel":"Section in Wound Care"},"4064":{"title":"Wound Assessment & the TIME Framework","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s3","snippet":"Wound Assessment & the TIME Framework The TIME framework, endorsed by the Wound Healing Society and the World Union of Wound Healing Societies, is the universal mental model wound care physicians use when assessing any chronic wound. Every assessment you document should implicitly address all four d...","sourceLabel":"Section in Wound Care"},"4065":{"title":"Pressure Injuries","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s4","snippet":"Pressure Injuries A pressure injury (the term \"pressure ulcer\" was officially retired by the National Pressure Injury Advisory Panel in 2016) is localized damage to the skin and/or underlying soft tissue, usually over a bony prominence or related to a medical device, resulting from intense and/or pr...","sourceLabel":"Section in Wound Care"},"4066":{"title":"Diabetic Foot Ulcers (DFU)","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s5","snippet":"Diabetic Foot Ulcers (DFU) Diabetic foot ulcers are the single highest-volume diagnosis in most multidisciplinary wound clinics. Approximately 15-25% of patients with diabetes develop a foot ulcer in their lifetime, and DFU precedes roughly 85% of all diabetes-related lower-extremity amputations. Th...","sourceLabel":"Section in Wound Care"},"4067":{"title":"Venous Leg Ulcers (VLU)","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s6","snippet":"Venous Leg Ulcers (VLU) Venous leg ulcers account for the majority of lower extremity ulcers (~70%) and are the end-stage manifestation of chronic venous insufficiency (CVI). They are characteristically located in the gaiter area - the region between the mid-calf and the ankle, most commonly over th...","sourceLabel":"Section in Wound Care"},"4068":{"title":"Arterial & Mixed Arterial-Venous Ulcers","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s7","snippet":"Arterial & Mixed Arterial-Venous Ulcers Arterial ulcers result from inadequate arterial perfusion - almost always from atherosclerotic PAD, less commonly from thromboembolism, vasculitis, or Buerger disease. They are typically located at the most distal points of perfusion (toes, heels, lateral mall...","sourceLabel":"Section in Wound Care"},"4069":{"title":"Surgical Wound Dehiscence","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s8","snippet":"Surgical Wound Dehiscence Dehiscence is partial or complete separation of a previously approximated surgical incision. It usually occurs between postoperative days 5 and 14. Risk factors include obesity, diabetes, malnutrition, chronic cough, steroid use, smoking, infection, hematoma, and increased ...","sourceLabel":"Section in Wound Care"},"4070":{"title":"Traumatic Wounds & Skin Tears","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s9","snippet":"Traumatic Wounds & Skin Tears Traumatic wounds include lacerations, abrasions, avulsions, crush injuries, and bites. In the wound clinic, the most common traumatic presentation is the skin tear - a separation of skin layers usually in elderly or corticosteroid-using patients whose fragile skin shear...","sourceLabel":"Section in Wound Care"},"4071":{"title":"Burns (Acute and Chronic)","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s10","snippet":"Burns (Acute and Chronic) Although acute major burns are managed at burn centers, outpatient wound clinics see small superficial burns, healed burns with contractures, and chronic burn-related wounds. Burns are classified by depth: Depth Prior Name Features Superficial First-degree Epidermis only. R...","sourceLabel":"Section in Wound Care"},"4072":{"title":"Atypical & Inflammatory Wounds","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s11","snippet":"Atypical & Inflammatory Wounds Any wound that fails to respond to standard care, has unusual morphology, or arises in an atypical location should raise suspicion for an atypical etiology. Biopsy is indicated when a wound does not respond to 4-6 weeks of appropriate therapy. Pyoderma Gangrenosum (PG)...","sourceLabel":"Section in Wound Care"},"4073":{"title":"Infected Wounds, Biofilm & Osteomyelitis","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s12","snippet":"Infected Wounds, Biofilm & Osteomyelitis Every chronic wound is colonized with bacteria; not every colonized wound is infected . The distinction matters clinically and drives antibiotic decisions. Figure 16 - Wound Managed with Hydrofiber Dressing. A wound with moderate exudate managed using a hydro...","sourceLabel":"Section in Wound Care"},"4074":{"title":"Moisture-Associated Skin Damage (MASD)","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s13","snippet":"Moisture-Associated Skin Damage (MASD) MASD is inflammation and erosion of the skin from prolonged exposure to urine, stool, sweat, wound drainage, or ostomy effluent. It is frequently mistaken for pressure injury but differs in mechanism and treatment. The four MASD subtypes: Type Cause Key Feature...","sourceLabel":"Section in Wound Care"},"4075":{"title":"Lymphedema & Other Chronic Wound Settings","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s14","snippet":"Lymphedema & Other Chronic Wound Settings Lymphedema - protein-rich interstitial edema from impaired lymphatic drainage - is a major contributor to non-healing lower extremity wounds. Primary lymphedema is congenital; secondary lymphedema follows lymph node dissection, radiation, filariasis, recurre...","sourceLabel":"Section in Wound Care"},"4076":{"title":"Debridement Techniques","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s15","snippet":"Debridement Techniques Debridement - the removal of non-viable tissue, debris, biofilm, and senescent cells - is the single most important wound clinic procedure. It converts a chronic wound into an acute-appearing wound and restores the proliferative phase. Debridement is billed by technique, depth...","sourceLabel":"Section in Wound Care"},"4077":{"title":"Negative Pressure Wound Therapy (NPWT)","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s16","snippet":"Negative Pressure Wound Therapy (NPWT) Negative pressure wound therapy (NPWT; also called vacuum-assisted closure, \"wound vac,\" KCI V.A.C., PICO) applies sub-atmospheric pressure to a sealed wound via an open-pore foam or gauze filler connected to a canister through tubing. Typical settings are &min...","sourceLabel":"Section in Wound Care"},"4078":{"title":"Advanced Therapies & Skin Substitutes","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s17","snippet":"Advanced Therapies & Skin Substitutes When a wound has failed 4-6 weeks of standard care (debridement, offloading/compression, moisture balance, infection control), advanced therapies are considered. These are generally billed under Medicare as cellular and/or tissue-based products (CTPs) or bioengi...","sourceLabel":"Section in Wound Care"},"4079":{"title":"Offloading & Compression Therapy","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s18","snippet":"Offloading & Compression Therapy Offloading (DFU & Pressure Injury) Device Use Notes Total contact cast (TCC) Gold standard for plantar neuropathic DFU Non-removable. Changed weekly. Contraindicated with active infection or significant ischemia. Removable cast walker (RCW) Alternative to TCC when no...","sourceLabel":"Section in Wound Care"},"4080":{"title":"Dressings - A to Z","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s19","snippet":"Dressings - A to Z The dressing decision is driven by the wound bed (dry vs wet), depth, infection status, and patient factors. The universal principle, articulated by Winter in 1962 and endorsed by every modern guideline, is that a moist wound bed heals faster than a dry one . Match the dressing to...","sourceLabel":"Section in Wound Care"},"4081":{"title":"Imaging, Labs & Diagnostics","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s20","snippet":"Imaging, Labs & Diagnostics Vascular Assessment Every lower extremity wound needs a vascular assessment. Pulses (DP, PT), ankle-brachial index (ABI) , toe-brachial index (TBI) (for diabetics/CKD with non-compressible vessels), transcutaneous oxygen measurement (TcPO2) (a TcPO2 < 40 mmHg predicts poo...","sourceLabel":"Section in Wound Care"},"4082":{"title":"Medications You Must Know","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s21","snippet":"Medications You Must Know Systemic Antibiotics Agent Class Use Case Cephalexin (Keflex) First-gen cephalosporin Mild cellulitis (non-MRSA coverage). Dicloxacillin Antistaph penicillin Mild cellulitis (MSSA). TMP-SMX (Bactrim) Sulfonamide MRSA-suspected mild cellulitis; oral MRSA coverage. Doxycyclin...","sourceLabel":"Section in Wound Care"},"4083":{"title":"Classification Systems","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s22","snippet":"Classification Systems This section consolidates every grading and classification system referenced throughout the guide. Fully enumerated scales appear in their condition sections; this is a quick-reference map. Figure 22 - Stage 4 Pressure Injury Classification. Full-thickness skin and tissue loss...","sourceLabel":"Section in Wound Care"},"4084":{"title":"Physical Exam - The Wound Exam","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s23","snippet":"Physical Exam - The Wound Exam The wound-focused physical exam is performed at every visit and its findings populate discrete fields in the wound flow sheet. It is the most structured exam in clinical practice - essentially a checklist. Wound Exam Template Location: [precise anatomic site, lateralit...","sourceLabel":"Section in Wound Care"},"4085":{"title":"Abbreviations Master List","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s24","snippet":"Abbreviations Master List Wound Types & Assessment DFU Diabetic foot ulcer VLU Venous leg ulcer PU / PI Pressure ulcer / pressure injury DTI Deep tissue injury CLTI Chronic limb-threatening ischemia CVI Chronic venous insufficiency PAD Peripheral arterial disease DFI Diabetic foot infection MASD Moi...","sourceLabel":"Section in Wound Care"},"4086":{"title":"Sample HPI Templates","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#s25","snippet":"Sample HPI Templates These templates demonstrate the rhythm and content of a strong wound clinic HPI. Pattern-match off them during your first weeks. Sample HPI - New Diabetic Foot Ulcer \"Mr. [Name] is a 62-year-old male with type 2 diabetes mellitus (A1C 9.4), diabetic peripheral neuropathy, hypert...","sourceLabel":"Section in Wound Care"},"4087":{"title":"References & Sources","pageTitle":"Wound Care","pageUrl":"/scribe-guides/wound-care","url":"/scribe-guides/wound-care#references","snippet":"References & Sources Clinical Practice Guidelines Edsberg LE et al. Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System. J Wound Ostomy Continence Nurs. 2016. NPIAP/EPUAP/PPPIA. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. 2019. Sennevi...","sourceLabel":"Section in Wound Care"},"4088":{"title":"Podiatry","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry","snippet":"Podiatry - Complete Reference Every diagnosis, deformity, procedure, medication, classification, and documentation pattern you need to run a podiatry clinic note from day one."},"4089":{"title":"Foot & Ankle Anatomy and Biomechanics","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#s1","snippet":"Foot & Ankle Anatomy and Biomechanics Podiatry is the medical and surgical specialty of the foot, ankle, and related lower extremity structures. To document intelligently, you must know the bony architecture, the joints that move the foot, the tendons that drive them, the nerve territories that expl...","sourceLabel":"Section in Podiatry"},"4090":{"title":"Scribe Documentation Framework","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#s2","snippet":"Scribe Documentation Framework A podiatry clinic note is structured as a SOAP but with specialty-specific detail at every level. The HPI always captures laterality (right vs. left foot), location (hindfoot, midfoot, forefoot, specific joint), shoe wear, activity, prior treatments tried (NSAIDs, orth...","sourceLabel":"Section in Podiatry"},"4091":{"title":"Hallux Valgus (Bunion) & Tailor's Bunion","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#s3","snippet":"Hallux Valgus (Bunion) & Tailor's Bunion Hallux valgus is a progressive triplanar deformity of the first ray characterized by lateral deviation of the hallux at the first MTP joint, medial prominence of the first metatarsal head (the visible \"bunion bump\"), and pronation of the great toe. It is the ...","sourceLabel":"Section in Podiatry"},"4092":{"title":"Hallux Rigidus & First MTP Arthritis","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#s4","snippet":"Hallux Rigidus & First MTP Arthritis Hallux rigidus is osteoarthritis of the first MTP joint producing progressive loss of dorsiflexion, dorsal osteophyte formation, and pain with push-off. It is the second most common condition of the great toe after hallux valgus. Distinguishing hallux rigidus fro...","sourceLabel":"Section in Podiatry"},"4093":{"title":"Lesser Toe Deformities","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#s5","snippet":"Lesser Toe Deformities Three related deformities affect the lesser toes and are frequently confused. Know the distinction cold: Figure 6 - Medial Ankle and Foot Structure. Diagram of the medial ankle structures relevant to lesser toe deformity assessment. Intrinsic muscle imbalance from motor neurop...","sourceLabel":"Section in Podiatry"},"4094":{"title":"Morton Neuroma & Forefoot Pain","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#s6","snippet":"Morton Neuroma & Forefoot Pain Morton neuroma is not a true neuroma - it is perineural fibrosis of a common digital nerve, most commonly in the third webspace (between 3rd and 4th metatarsal heads), where the medial and lateral plantar nerves converge and the nerve is tethered by the intermetatarsal...","sourceLabel":"Section in Podiatry"},"4095":{"title":"Plantar Fasciitis & Heel Pain Syndromes","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#s7","snippet":"Plantar Fasciitis & Heel Pain Syndromes Plantar fasciitis is the most common cause of adult heel pain. It is a degenerative fasciosis (not purely inflammatory) of the plantar aponeurosis at its calcaneal origin. Classic presentation: sharp medial heel pain with the first steps in the morning or afte...","sourceLabel":"Section in Podiatry"},"4096":{"title":"Achilles Tendinopathy & Rupture","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#s8","snippet":"Achilles Tendinopathy & Rupture Achilles pathology is split anatomically into insertional (at the calcaneal attachment, within 2 cm of insertion) and midportion/noninsertional (2-6 cm above insertion, the zone of relative hypovascularity). Both represent degenerative tendinosis, not true inflammatio...","sourceLabel":"Section in Podiatry"},"4097":{"title":"Posterior Tibial Tendon Dysfunction & Adult Flatfoot","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#s9","snippet":"Posterior Tibial Tendon Dysfunction & Adult Flatfoot Posterior tibial tendon dysfunction (PTTD) , now called adult-acquired flatfoot deformity (AAFD) or the newer term progressive collapsing foot deformity (PCFD) , is the most common cause of acquired flatfoot in adults. The posterior tibial tendon ...","sourceLabel":"Section in Podiatry"},"4098":{"title":"Peroneal Tendon Disorders","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#s10","snippet":"Peroneal Tendon Disorders The peroneus longus and brevis tendons share a common sheath behind the lateral malleolus. Disorders include tendinopathy/tenosynovitis , longitudinal tears (most often in peroneus brevis, which becomes \"split\" as it is compressed between the fibula and peroneus longus), an...","sourceLabel":"Section in Podiatry"},"4099":{"title":"Ankle Sprains & Chronic Instability","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#s11","snippet":"Ankle Sprains & Chronic Instability Ankle sprains are extremely common. Understand the three distinct types: Figure 11 - ATFL Dual-Band Configuration. The anterior talofibular ligament often consists of two distinct bands. This anatomy is relevant during Brostrom repair for chronic instability, wher...","sourceLabel":"Section in Podiatry"},"4100":{"title":"Ankle Arthritis, Impingement & Osteochondral Lesions","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#s12","snippet":"Ankle Arthritis, Impingement & Osteochondral Lesions Ankle osteoarthritis is predominantly post-traumatic (in contrast to hip and knee OA, which are primary). Presents with deep anterior ankle pain, morning stiffness, reduced dorsiflexion, and gradual loss of function. Figure 12 - Ankle Joint Anatom...","sourceLabel":"Section in Podiatry"},"4101":{"title":"Foot & Ankle Fractures","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#s13","snippet":"Foot & Ankle Fractures Know these specific fracture patterns cold: Figure 13 - Lisfranc Injury Radiograph. Weight-bearing anteroposterior radiograph demonstrating diastasis between the first and second metatarsal bases, loss of normal alignment at the tarsometatarsal joint complex, and a fleck sign ...","sourceLabel":"Section in Podiatry"},"4102":{"title":"Turf Toe, Sesamoiditis & First Ray Injuries","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#s14","snippet":"Turf Toe, Sesamoiditis & First Ray Injuries Turf toe is a sprain of the plantar plate and capsule of the first MTP joint from hyperdorsiflexion of the great toe, classically in football players on artificial turf. Graded I-III. Management: grade I in stiff-sole shoe with taping; grade III with plant...","sourceLabel":"Section in Podiatry"},"4103":{"title":"Nail & Skin Pathology","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#s15","snippet":"Nail & Skin Pathology Onychocryptosis (ingrown toenail) is among the most common office procedures in podiatry. The nail border penetrates the soft tissue of the nail fold producing pain, erythema, and often infection with granulation tissue. Figure 15 - Distal Lateral Subungual Onychomycosis (DLSO)...","sourceLabel":"Section in Podiatry"},"4104":{"title":"Diabetic Foot Disease & Charcot Neuroarthropathy","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#s16","snippet":"Diabetic Foot Disease & Charcot Neuroarthropathy Diabetic foot disease is the single highest-stakes domain in podiatry. It is the leading cause of non-traumatic lower extremity amputation worldwide. The pathogenic triad is neuropathy (loss of protective sensation), ischemia (PAD reducing perfusion a...","sourceLabel":"Section in Podiatry"},"4105":{"title":"Peripheral Arterial Disease & the Dysvascular Foot","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#s17","snippet":"Peripheral Arterial Disease & the Dysvascular Foot Podiatry and vascular surgery overlap extensively. A podiatrist cannot heal a wound in an ischemic foot - revascularization comes first. Every new diabetic foot patient, every non-healing wound patient, and every chronic rest pain patient needs a va...","sourceLabel":"Section in Podiatry"},"4106":{"title":"Nerve Entrapments & Neuropathic Foot Pain","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#s18","snippet":"Nerve Entrapments & Neuropathic Foot Pain Nerve entrapments of the foot and ankle are under-recognized causes of chronic pain and often masquerade as tendinopathy or fasciitis. Always consider a nerve etiology when pain is burning, electric, or associated with numbness. Tarsal tunnel syndrome is com...","sourceLabel":"Section in Podiatry"},"4107":{"title":"Pediatric & Congenital Foot Conditions","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#s19","snippet":"Pediatric & Congenital Foot Conditions Figure 21 - Bilateral Clubfoot (Talipes Equinovarus). Clinical photographs of bilateral congenital talipes equinovarus demonstrating the CAVE components: cavus (high arch), adductus (forefoot medially deviated), varus (hindfoot inverted), and equinus (ankle pla...","sourceLabel":"Section in Podiatry"},"4108":{"title":"Podiatric Procedures - A to Z","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#s20","snippet":"Podiatric Procedures - A to Z The core podiatric procedural repertoire. Know these by name; the surgeon will dictate them in shorthand. Figure 22 - Midfoot Beaming Reconstruction. Radiograph of midfoot Charcot reconstruction using intramedullary beaming with plantar plates and bolts. This technique ...","sourceLabel":"Section in Podiatry"},"4109":{"title":"Imaging & Diagnostics","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#s21","snippet":"Imaging & Diagnostics Weight-bearing X-rays are the cornerstone of podiatric imaging. Non-weight-bearing films miss deformity, undersell arch collapse, and hide Lisfranc injuries. Standard views: AP (DP), lateral, and oblique for the foot; AP, mortise, and lateral for the ankle; sesamoid axial for f...","sourceLabel":"Section in Podiatry"},"4110":{"title":"Medications You Must Know","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#s22","snippet":"Medications You Must Know Class Drugs (Generic / Brand) Use / Notes NSAIDs Ibuprofen, naproxen, meloxicam, diclofenac (PO/topical Voltaren gel) First-line analgesia; topical for localized tendinopathy/OA Corticosteroid injections Triamcinolone (Kenalog) 10-40 mg, methylprednisolone (Depo-Medrol), de...","sourceLabel":"Section in Podiatry"},"4111":{"title":"Classification Systems","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#s23","snippet":"Classification Systems Podiatric practice leans heavily on classification systems. The surgeon will name-drop these and you must chart them correctly. Weber Ankle Fracture Classification Weber A: Fibular fracture below the syndesmosis. Syndesmosis intact. Usually stable. Non-operative. Weber B: Fibu...","sourceLabel":"Section in Podiatry"},"4112":{"title":"Physical Exam, Abbreviations & Sample HPIs","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#s24","snippet":"Physical Exam, Abbreviations & Sample HPIs Physical Exam Template Podiatric Exam Documentation Vascular: DP 2+/2+, PT 2+/2+, cap refill < 3 sec, no dependent rubor, no edema Neuro: Protective sensation intact to 10-g monofilament at all 5 plantar sites bilaterally Vibratory sense intact with 128-Hz ...","sourceLabel":"Section in Podiatry"},"4113":{"title":"References & Sources","pageTitle":"Podiatry","pageUrl":"/scribe-guides/podiatry","url":"/scribe-guides/podiatry#references","snippet":"References & Sources Clinical Practice Guidelines Lipsky BA et al. IDSA Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections. Clin Infect Dis. 2012. Bus SA et al. IWGDF Guidelines on Offloading Foot Ulcers in Persons with Diabetes. Diabetes Metab Res Rev. 2020. Sch...","sourceLabel":"Section in Podiatry"},"4114":{"title":"Occupational & Environmental Medicine","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine","snippet":"Occupational Medicine - Complete Reference Every workplace exposure, regulatory framework, evaluation, diagnosis, procedure, medication, and documentation template you need to succeed in an occupational and environmental medicine clinic."},"4115":{"title":"Occupational Medicine - Principles & Regulatory Framework","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#s1","snippet":"Occupational Medicine - Principles & Regulatory Framework Occupational and environmental medicine (OEM) is the medical specialty devoted to the prevention, diagnosis, and treatment of work-related illness and injury, and the promotion of fitness-for-work and return-to-work. Unlike most clinical spec...","sourceLabel":"Section in Occupational & Environmental Medicine"},"4116":{"title":"Scribe Documentation Framework (DOT, FCE, IME, RTW)","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#s2","snippet":"Scribe Documentation Framework (DOT, FCE, IME, RTW) Occupational medicine notes differ from general practice notes because the documentation often serves a legal or regulatory function. You will write several distinct note types, each with its own required elements. The Work Injury Note Work Injury ...","sourceLabel":"Section in Occupational & Environmental Medicine"},"4117":{"title":"Occupational Lung Disease & Pneumoconioses","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#s3","snippet":"Occupational Lung Disease & Pneumoconioses Inhaled occupational dusts, fibers, fumes, and gases cause a spectrum of lung disease that includes pneumoconioses (fibrotic lung diseases from mineral dusts), hypersensitivity pneumonitis, occupational asthma, and occupational lung cancers. These diseases ...","sourceLabel":"Section in Occupational & Environmental Medicine"},"4118":{"title":"Occupational Asthma & Airway Disorders","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#s4","snippet":"Occupational Asthma & Airway Disorders Occupational asthma (OA) is asthma caused or triggered by workplace exposures, and is the most common occupational lung disease in developed economies. There are two major categories: sensitizer-induced OA (after a latency period of weeks to years, an IgE- or n...","sourceLabel":"Section in Occupational & Environmental Medicine"},"4119":{"title":"Occupational Cancers","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#s5","snippet":"Occupational Cancers Occupational exposures account for an estimated 4% to 10% of all cancers. The IARC Monographs are the authoritative reference for carcinogen classification and you will see them cited on every workers' comp cancer claim. Cancer Classic Occupational Exposure Industries Mesothelio...","sourceLabel":"Section in Occupational & Environmental Medicine"},"4120":{"title":"Noise-Induced Hearing Loss & Audiometry","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#s6","snippet":"Noise-Induced Hearing Loss & Audiometry Noise-induced hearing loss (NIHL) is the most common preventable occupational illness. Chronic exposure to noise > 85 dBA causes a characteristic bilateral, symmetric, sensorineural hearing loss with a notch at 4000 Hz on audiometry. With continued exposure, t...","sourceLabel":"Section in Occupational & Environmental Medicine"},"4121":{"title":"Occupational Dermatoses","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#s7","snippet":"Occupational Dermatoses Skin disease is the second-most-reported category of occupational illness after MSK injuries. The major entities you will document are irritant contact dermatitis, allergic contact dermatitis, contact urticaria, occupational acne (including chloracne), latex allergy, and occu...","sourceLabel":"Section in Occupational & Environmental Medicine"},"4122":{"title":"Work-Related Musculoskeletal Disorders (WMSDs)","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#s8","snippet":"Work-Related Musculoskeletal Disorders (WMSDs) Work-related musculoskeletal disorders are the largest single category of occupational illness and workers' compensation claims in the United States. They include acute traumatic injuries (lumbar strains from lifting, fractures from falls) and chronic c...","sourceLabel":"Section in Occupational & Environmental Medicine"},"4123":{"title":"Heat Illness & Cold Injury","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#s9","snippet":"Heat Illness & Cold Injury Heat-Related Illness Heat illness forms a spectrum: heat rash (miliaria) , heat cramps , heat syncope , heat exhaustion , and heat stroke . Heat exhaustion presents with core temperature 37-40&deg;C (100-104&deg;F), profuse sweating, tachycardia, headache, nausea, and pres...","sourceLabel":"Section in Occupational & Environmental Medicine"},"4124":{"title":"High-Altitude Illness & Decompression Sickness","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#s10","snippet":"High-Altitude Illness & Decompression Sickness High-altitude illness includes Acute Mountain Sickness (AMS) , High-Altitude Pulmonary Edema (HAPE) , and High-Altitude Cerebral Edema (HACE) . AMS presents > 2500 m with headache plus nausea, fatigue, dizziness, or sleep disturbance; treat with descent...","sourceLabel":"Section in Occupational & Environmental Medicine"},"4125":{"title":"Vibration Injury & Ergonomic Hazards","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#s11","snippet":"Vibration Injury & Ergonomic Hazards Hand-Arm Vibration Syndrome (HAVS) , previously called vibration white finger, results from prolonged use of vibrating hand tools (chainsaws, jackhammers, grinders, chipping hammers). The syndrome has three components: vascular (episodic blanching of fingers on c...","sourceLabel":"Section in Occupational & Environmental Medicine"},"4126":{"title":"Radiation Exposure (Acute & Chronic)","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#s12","snippet":"Radiation Exposure (Acute & Chronic) Radiation exposures in the workplace include ionizing radiation (X-ray, gamma, alpha, beta, neutron) in nuclear, medical, dental, industrial radiography, and research settings, and non-ionizing radiation (UV, microwave, RF, laser). OSHA and NRC set dose limits: t...","sourceLabel":"Section in Occupational & Environmental Medicine"},"4127":{"title":"Heavy Metal & Chemical Toxicology","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#s13","snippet":"Heavy Metal & Chemical Toxicology Lead Lead exposure occurs in battery manufacturing, lead smelting, radiator repair, construction (lead paint abatement, bridge painting, demolition), and firing ranges. Inorganic lead causes abdominal colic, constipation, anemia (basophilic stippling, microcytic), p...","sourceLabel":"Section in Occupational & Environmental Medicine"},"4128":{"title":"Asphyxiants, CO & H 2 S Exposures","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#s14","snippet":"Asphyxiants, CO & H 2 S Exposures Simple asphyxiants (nitrogen, methane, CO 2 , propane, argon) displace oxygen in enclosed spaces. Confined space deaths follow a classic pattern: the first worker collapses, and rescuers without SCBA enter and also die. Chemical asphyxiants interfere with oxygen tra...","sourceLabel":"Section in Occupational & Environmental Medicine"},"4129":{"title":"Occupational Infectious Disease & Bloodborne Pathogens","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#s15","snippet":"Occupational Infectious Disease & Bloodborne Pathogens Healthcare workers, laboratory workers, first responders, and agricultural workers face occupational infectious exposures. The OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030) governs HCW protection including hepatitis B vaccination, PPE, s...","sourceLabel":"Section in Occupational & Environmental Medicine"},"4130":{"title":"Traumatic, Agricultural & Eye Injuries","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#s16","snippet":"Traumatic, Agricultural & Eye Injuries Agricultural work is one of the most dangerous occupations in the United States. Hazards include tractor rollovers (ROPS reduce mortality), grain engulfment, power take-off entanglement, pesticide exposure, livestock injury, and zoonotic disease. Fatality rates...","sourceLabel":"Section in Occupational & Environmental Medicine"},"4131":{"title":"Mental Health, Stress, Shift Work & Reproductive Hazards","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#s17","snippet":"Mental Health, Stress, Shift Work & Reproductive Hazards Workplace Stress & Burnout Occupational burnout is recognized by the WHO as an occupational phenomenon (ICD-11) with three dimensions: exhaustion, cynicism/depersonalization, and reduced professional efficacy. PTSD in first responders, veteran...","sourceLabel":"Section in Occupational & Environmental Medicine"},"4132":{"title":"Evaluations & Procedures (Physicals, FCE, IME, Surveillance)","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#s18","snippet":"Evaluations & Procedures (Physicals, FCE, IME, Surveillance) Occupational medicine is evaluation-heavy. Most \"procedures\" are structured assessments that produce documented determinations rather than interventional acts. Evaluation Purpose / Key Elements Pre-placement physical Performed after condit...","sourceLabel":"Section in Occupational & Environmental Medicine"},"4133":{"title":"Laboratory, Imaging & Biological Monitoring","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#s19","snippet":"Laboratory, Imaging & Biological Monitoring Biological Exposure Indices (BEIs) ACGIH publishes Biological Exposure Indices (BEIs) alongside TLVs - reference values for the concentration of a chemical or metabolite in blood, urine, or exhaled air that corresponds to air exposure at the TLV. Exposure ...","sourceLabel":"Section in Occupational & Environmental Medicine"},"4134":{"title":"Medications & Antidotes","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#s20","snippet":"Medications & Antidotes Medication Use in OEM Key Notes Ibuprofen, naproxen (NSAIDs) MSK injury, lateral epicondylitis, low back strain Caution in CKD, ulcer disease Acetaminophen Analgesia when NSAIDs contraindicated &le; 3 g/day in liver disease Cyclobenzaprine, methocarbamol Acute muscle spasm Se...","sourceLabel":"Section in Occupational & Environmental Medicine"},"4135":{"title":"Classification Systems (AMA Guides, ILO, DOT, FAA, TLVs)","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#s21","snippet":"Classification Systems (AMA Guides, ILO, DOT, FAA, TLVs) ACGIH TLV Categories TLV-TWA (Time-Weighted Average): Average airborne concentration for a conventional 8-hour workday, 40-hour workweek, to which nearly all workers may be repeatedly exposed without adverse effect. TLV-STEL (Short-Term Exposu...","sourceLabel":"Section in Occupational & Environmental Medicine"},"4136":{"title":"Physical Exam - The Occupational Exam","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#s22","snippet":"Physical Exam - The Occupational Exam The occupational exam varies enormously by visit type, but these components appear across most encounters: Core Occupational Exam Components General: Vital signs including BP in the correct cuff size (large adult cuff if upper-arm circumference > 32 cm) seated a...","sourceLabel":"Section in Occupational & Environmental Medicine"},"4137":{"title":"Abbreviations Master List","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#s23","snippet":"Abbreviations Master List Regulatory & Agencies OSHA Occupational Safety and Health Administration NIOSH National Institute for Occupational Safety and Health ACGIH American Conference of Governmental Industrial Hygienists ACOEM American College of Occupational and Environmental Medicine AAOHN Ameri...","sourceLabel":"Section in Occupational & Environmental Medicine"},"4138":{"title":"Sample HPI Templates","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#s24","snippet":"Sample HPI Templates These templates show the documentation rhythm expected in a busy occupational medicine clinic. Each one combines mechanism-specific detail with the regulatory/administrative elements that distinguish OEM notes from general practice. Sample HPI - Acute Work Injury (Lumbar Strain)...","sourceLabel":"Section in Occupational & Environmental Medicine"},"4139":{"title":"References & Sources","pageTitle":"Occupational & Environmental Medicine","pageUrl":"/scribe-guides/occupational-medicine","url":"/scribe-guides/occupational-medicine#references","snippet":"References & Sources Clinical Practice Guidelines ACOEM Practice Guidelines. American College of Occupational and Environmental Medicine. Qaseem A, et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann...","sourceLabel":"Section in Occupational & Environmental 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