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Kaplan internal medicine pdf 2013

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You just clipped your first slide! GI Clinical signs could include: Gastrointestinal Physiology Chapter 1: Disorders of the Ear, Nose, and Throat. Embed Size px.

Acid - Base Disturbances. Acid-Base Disturbances. General Aspects of the Endocrine System. Hypothalamic-Anterior Pituitary System. Posterior Pituitary. Adrenal Cortex.

Kaplan Internal Medicine Lecture Notes, ( 2014)

Chapter 5: Adrenal Medulla. Chapter 6: Endocrine Pancreas. Chapter 7: Hormonal Control of Calcium and Phosphate. Chapter 8: Thyroid Hormones. Chapter 9: Growth, Growth Hormone and Puberty. Chapter Male Reproductive System. Female Reproductive System.

Gastrointestinal Physiology. The Notes were designed to be accompaniedby facultylectures-live, on video, or on the web.

Reading them without accessing the accompanying lectures is not an effective way to review for the USMLE. To maximize the effectiveness of these Notes, annotate them as you listen to lectures. To facilitate this process, we've created wide, blank margins. While these margins are occasionally punctuated by faculty high-yield "margin notes: Many students find that previewing the Notes prior to the lecture is a very effective way to prepare for class.

This allows you to anticipate the areas where you'll need to pay particular attention. This strategy works regardless of whether you're attending a live lecture or watching one on video or the web. Finally, we want to hear what you think. What do you like about the Notes?

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Internal 2013 pdf kaplan medicine

Please share your feedback by e-mailing us at medfeedback kaplan. Thank you for joining Kaplan Medical, and best of luck on your Step 1 exam! Figure This represents an isotonic fluid loss equal loss offluid and osmoles.

Possible causes are hemorrhage, isotonic urine, or the immediate consequences ofdiarrhea or vomiting. Patientshowsloss ofextracellularand intracellular volume with rise in osmolality. Thisrepresents a netloss ofwater greater loss ofwater than osmoles. Possiblecausesare inadequatewaterintakeor sweating. Pathologically, thiscould be hypotonic water loss from the urine resulting from diabetes insipidus. The rise in osmolality shifted water out ofthe cell.

This represents a net gain of solute increase in osmoles greater than increase in water. Colloids, e. Patient shows increase in extracellular and intracellular volumes with a decrease in osmolality. The fall in osmolality shifted water into the cell. Thus, this represents net gain of water more water than osmoles. Possible causes are drinking significant quantities of water could be pathologic primary polydipsia , drinking significant quantities of a hypotonic fluid, or a hypotonic fluid infusion saline, dextrose in water.

Pathologically this could be abnormal water retention such as that which occurs with syndrome ofinappropriate ADH. Patient shows increase in extracellular volume with no change in osmolality or intracellular volume.

Since extracellular osmolality didn't change, then intracellular volume is unaffected. This represents a net gain of isotonic fluid equal increase fluid and osmoles. Pathologically this could be the result of excess aldosterone.

Patient shows decrease in extracellular volume and osmolality with an increase in intracellular volume. The rise in intracellular volume is the result ofthe decreased osmolality.

This represents a net loss of hypertonic fluid more osmoles lost than fluid. The only cause to consider is the pathologic state ofadrenal insufficiency. Lack ofmineralcorticoids, e. In addition,ADH vasoconstricts arterioles V 1 receptor and thus can serve as a hormonal regulator of vascular tone. The 2 primary regulators of ADH are:. Although renin is an enzyme, not a hormone, it is important in this discussion because it catalyzes the conversion of angiotensinogen to angiotensin I, which in turn is converted to Ang II by angiotensin converting enzyme ACE.

This is the renin-angiotensin-aldosterone system RAAS. The 3 primary regulators of renm are:. Examining the function and regulation of these hormones one should see the feedback regulation. For example, aldosterone increases sodium reabsorption, which in turn increases extracellular volume. As indicated, these hormones are covered in more detail later in this book. Answers are provided below.

Decreased extracellular volume stimulates RAAS.

2013 medicine pdf kaplan internal

This drop in extracellular volume stimulates ADH, as does the rise osmolarity. This setting would be a strong stimulus for ADH. The rise in extracellular volume inhibits RAAS. These 4 forces are often referred to as Starling forces. Grouping the forces into those that favor filtration and those that oppose it, and taking into account the properties of the barrier to filtration, the formula for fluid exchangeis the following:.

The filtration coefficient depends upon a number of factors but for our purposes permeabilityis mostimportant As indicatedbelow,a variety of factors can increase permeability of the capillary resulting in a large flux of fluid from the capillary into the interstitial space.

In some tissues e. In other tissues, filtration may occur at the proximal end until the forces equilibrate. The lymphatics play a pivotal role in maintaining a low interstitial fluid volume and protein content.

The lymphatics also remove proteins from the interstitium. Given the following values, calculate a net pressure: Calculate a net pressure ifthe interstitial hydrostatic pressure is -2 mmHg.

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Edema is the accumulation of fluid in the interstitial space. It expresses itself in peripheral tissues in 2 different forms:. In this type of edema, pressing the affected area with a finger or thumb results in a visual indentation ofthe skin that persists for some time after the digit is removed.

This is the "classic;' most common type observed clinically. It generally responds well to diuretic therapy. As the name implies, a persistent visual indentation is absent when pressing the affected area.

This occurs when interstitial oncotic forces are elevated proteins for example. This type of edema does not respond well to diuretic therapy. Lymphedema see below can also increase 1trF. Circulating agents, e. Given that one function of the lymphatics is to clear interstitial proteins, lymphedema can produce a non-pitting edema because of the rise in 1t1p.

Edema in the interstitium ofthe lung can result in grave consequences. A low hydrostatic pressure in pulmonary capillaries and lymphatic drainage helps "protect" the lungs against edema.

Pdf kaplan internal 2013 medicine

Increased left atrial pressure, increases venous pressure, which in turn increases capillary pressure. First patient sign is often orthopnea dyspnea when supine , which can be relieved when sitting upright. Elevated pulmonary wedge pressure provides confirmation Treatment: Due to direct injury of the alveolar epithelium or after a primary injury to the capillary endothelium.

Most common causes are sepsis, bacterial pneumonia, trauma, and gastric aspirations.

Kaplan usmle step 2 ck lecture notes pdf download

The intracellular proteins have a negative charge. In order to understand and apply what governs the conductance of ions as it relates to the function of excitable tissue nerves and muscle , it is important to remember this relative difference in concentrations for these ions. In addition, it is imperative to understand the following 5 key principles. Membrane potential Em. This separation of charge means there is the potential to do work and is measured in volts.

Thus, Em represents the measured value. Electrochemical gradient. Electrochemical gradient indicates the combination of these 2 forces. If reached, the tendency for an ion to diffuse in one direction based upon the chemical gradient is countered by the electrical force in the opposite direction.

Ions move across the membrane via channels see below. Net force driving force. It is estimated by subtracting the ions equilibrium potential from the cell's membrane potential.

Free KAPLAN USMLE STEP 2 CK 2013 EDITION (Internal Medicine) PDF Download

In short, it quantitates how far a given ion is from equilibrium at any membrane potential. Figure 11 - 1 - 1. Basic Schematic of an Excitable Cell. Ions diffuse across the membrane via ion channels. There are 3 basic types ofion channels Figure II Figure 11 - 1 - 2. Immune-Mediated Disease. Disorders of the Eye. Disorders of the Ear, Nose, and Throat. Gastrointestinal Disease. Renal and Urologic Disorders.

Endocrine Disorders. Orthopedic Disorders. Rheumatic and Vasculitic Disorders. Infectious Disease. What is her Apgar score? Table What is the most likely diagnosis? C5—C6; cannot abduct shoulder; externally rotate and supinate forearm; Klumpke: It is clearly demarcated and does not fade into the surrounding skin. A newborn has a flat, salmon-colored lesion on the glabella, which becomes darker red when he cries. What is the best course of management?

Get x-ray first for surgical planning. No treatment needed if good blood supply. Physical exam reveals a baby with eczema and a musty odor. Which screening test would most likely be abnormal? Some examples: GI Physical exam reveals a large plethoric infant who is tremulous. A murmur is heard. Blood sugar is low. Follow glucose carefully in infant after delivery. Anemia, Other: Infectious Metabolic Neurologic Respiratory distress syndrome RDS Shortly after birth, a week gestation infant develops tachypnea, nasal flaring, and grunting and requires intubation.

Chest radiograph shows a hazy, ground-glass appearance of the lungs. Surgical resection of necrotic bowel may be necessary.

Jaundice A 2-day-old infant is noticed to be jaundiced. He is nursing and stooling well. Indirect bilirubin is Physical exam is unremarkable except for visible jaundice. DOL, day of life. Note Work up for possible pathologic hyperbilirubinemia when: This is frequent in first-time breast-feeding mothers.

The infant may become dehydrated; however, it is lack of calories that causes the jaundice. The treatment is to obtain a lactation consultation and rehydrate the baby. The jaundice occurs in the first days of life.

Breast-milk jaundice occurs due to a glucoronidase present in some breast milk. Infants become jaundiced in week 2 of life. Diagnosis and treatment is phototherapy if needed. Although the bilirubin may rise again, it will not rise to the previous level. The baby may then be safely breast fed. Problem gone by 2—3 months. Chapter 1 l The Newborn and Resuscitation 11 Table Physical examination reveals a bulging fontanel, delayed capillary refill, and grunting. CBC, differential and platelets, blood culture, urine anal- ysis and culture, chest radiograph Note: Lumbar puncture not routinely performed unless there is a likelihood of meningitis, e.

Most infants have IUGR. Ingestion of water or food with oocytes that have been excret- ed by infected cats fecal contamination most common form of transmission in the United States. Chapter 1 l The Newborn and Resuscitation 15 — Treat with VZIG varicella zoster immune globulin , if mother develops vari- cella 5 days before to 2 days after delivery. A low-grade fever is reported, as well as diarrhea. Maternal history is positive for heroin use.

Meconium toxicology can detect opioid and cocaine exposure after the first trimester. Urine drug screening provides maternal drug use data for only a few days prior to delivery. Should regain or surpass BW by 2 weeks. Their average peak is Growth and Nutrition 3 GI Chapter 3 l Growth and Nutrition 27 GI For causes of decreased linear growth, length decreases first or at the same time as weight e. Skeletal maturity is linked more to sexual maturity than chronologic age. Breast milk has less iron than most formu- las, but has higher bioavailability.

Formula feeding is used as a substitute for or to supplement breast milk. Most commercial formulas are cow-milk—based with modifications to approxi- mate breast milk. Specialty formulas soy, lactose- free, premature, elemental are modified to meet specific needs. Suspect craniopharyngioma if short stature and vision problems. The child has been very healthy. He is below the fifth percentile for height and has been all his life. Physical exam is normal.

Father is 6 foot 3; mother is 5 foot Differential diagnosis: Chapter 3 l Growth and Nutrition 35 Weight Organic failure to thrive A baby weighs 16 pounds at 1 year of age. Birth weight was 8 pounds. Parents state that the baby feeds well. Physical exam reveals a baby with little subcutaneous fat, long dirty fingernails, impetigo, and a flat occiput. Thacher, M. Figure USMLE Step 2 l Pediatrics 36 Non-organic failure to thrive A 4-month-old infant presents to the emergency department because of upper respiratory symptoms.

He is 3. Birth weight was 4. The mother states that the patient takes 16 oz of infant formula per day with cereal added. What age is most appropriate for this baby? Chapter 4 l Development 39 Table Do this until chronological age 2 years, then consider delays to be true. While all babies receive hearing testing within the first month of life, that is for congenital sen- sorineural hearing loss. Over the first year of life, conductive hearing loss may occur from repeated ear infections.