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Lofgren syndrome is an acute form of sarcoidosis that presents with fever, erythema nodosum, bilateral hilar LAD, and migratory arthritis #Rheumatology

Heerfordt-Waldenström syndrome is a subacute variant of sarcoidosis characterized by parotid enlargement + facial nerve palsy + anterior uveitis (photophobia) ± joint pain #Rheumatology

The Topical Steroid Ladder Mild = Class 6 & 7 Intermediate = Class 4 & 5 Potent = Class 2 & 3 Very potent = Class 1 #Dermatology

Layers of the epidermis #mnemonic Come Let's Get SunBurned. 😎 Stratum Corneum Stratum Lucida Stratum Granulosum Stratum Spinosum Stratum Basale #Dermatology

Secondary skin lesions #Dermatology

Primary skin lesions Macule - Flat lesion < 1 cm in diameter Patch - Flat lesion > 1 cm in diameter Papule - Elevated lesion < 1 cm in diameter Nodule - Solid, round, raised dermal lesion that extends deeper into the dermis than a papule Plaque - Elevated lesion > 1 cm in diameter (diameter is usually greater than depth) Vesicle - Fluid containing lesion < 1 cm Bullae - Fluid containing lesion > 1 cm Pustule - Vesicle containing purulent fluid #Dermatology

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Cognition and judgement Cognition is usually not extensively reported and can be inferred from the interview or reported as ‘intact’ • If indicated a miniCog can be done – Orientation – 3 word recall – Concentration: serial 7s • If impairment is suspected a Mini Mental State Examination should be performed. Judgement: During interview one can assess/infer many aspects of the patient’s capability for social judgment • Does the patient understand the likely outcome of his or her behavior, and is he or she influenced by this understanding? • Can the patient predict what he or she would do in imaginary situations (e.g., smelling smoke in a crowded movie theater)? • If impaired, then it is a safety issue.

Insight Patient's degree of awareness and understanding about being ill. Levels of insight: 1. Complete denial of illness 2. Slight awareness of being sick and needing help, but denying it at the same time 3. Awareness of being sick but blaming it on others, on external factors, or on organic factors 4. Awareness that illness is caused by something unknown in the patient 5. Intellectual insight: admission that the patient is ill and that symptoms or failures in social adjustment are caused by the patient's own particular irrational feelings or disturbances without applying this knowledge to future experiences 6. True emotional insight: emotional awareness of the motives and feelings within the patient and the important persons in his or her life, which can lead to basic changes in behavior.

Thought (process and content)  • Process refers to the way in which a person puts together ideas and associations, the form in which a person thinks. • Process or form of thought can be logical and coherent or completely illogical and even incomprehensible. • Content refers to what a person is actually thinking about: ideas, beliefs, preoccupations, obsessions

Perceptions Perceptual disturbances, such as hallucinations and illusions, can be experienced in reference to the self or the environment. Inferred from patient's behavior. Depersonalization and Derealization are also included here.

Emotions (mood and affect): Mood Patient's self-reported emotion. Statements about the patient's mood should include depth, intensity, duration, and fluctuations. Affect Patient's present emotional responsiveness. Inferred from the patient's facial expression, including the amount and the range of expressive behavior. • Quality: Dysphoric in depression, Euthymic (normal) or Elevated/Euphoric in mania, Flat in Schizophrenia or labile (all over the place), or irritable  • Congruency: Affect may or may not be congruent with mood.  • Range: Affect can be described as within normal range, constricted, blunted, or flat.   In the normal range of affect can be variation in facial expression, tone of voice, use of hands, and body movements.   Full range > constricted > blunted > flat. Also mention the appropriateness of the patient's emotional responses in the context of the subject the patient is discussing. (e.g. Patient talking about death without sadness is inappropriate)

Speech: Speech can be described in terms of its quantity, rate of production, and quality. Speech can be rapid or slow, pressured (hard to interrupt the pt), hesitant, emotional, dramatic, monotonous, loud, whispered, slurred, staccato, or mumbled. • Speech impairments, such as stuttering and any unusual rhythms (termed dysprosody) or accent should be noted.

Behavior: - Mannerisms - tics - gestures - twitches - stereotyped behavior - echopraxia - hyperactivity - agitation - combativeness - flexibility - rigidity - gait - agility • Take note of movements which can result due to drug side effects eg. TD or EPS or tremors • Describe restlessness, wringing of hands, pacing, and other physical manifestations. • Note psychomotor retardation or generalized slowing of body movements. • Describe any aimless, purposeless activity.

Appearance: - body type - posture - poise - clothes - grooming - hair, and nails - looks older/younger than stated age - signs of anxiety (moist hands, perspiring forehead, tense posture and wide eyes)

Remember the components of psychiatric examination with the word: ASEPTIC - Appearance and behaviour - Speech - Emotion (mood and affect) - Perception - Thought content and process - Insight and judgment - Cognition #Psychiatry #mnemonic

Personality disorders: Cluster A (Weird): Schizoid Schizotypical Paranoid Cluster B (Wild): Antisocial Borderline Histrionic Narcissistic Cluster C (Wacky): Avoidant Obsessive-compulsive Dependent #Psychiatry

Duration of symptoms require to make diagnosis of psychiatric disorders #Psychiatry

Other Conditions That Can Confused With Asthma: ~ Eosiniphilic granulomatosis with polyangitis -- Clues to diagnosis: other organs involved such as colon (colitis), nerves (sensory loss), upper airway (otitis media, sinusitis, rhinitis), or skin (palpable purpura) -- CXR: will show migratory or transient interstitial infiltrates ~ Chronic Eosiniphilic Pneumonia -- Clues to diagnosis: Flu-like syndrome, weight loss, night sweats, ...etc. -- CXR: Infiltrates with peripheral or pleural-based distribution ~ Allergic Bronchopulmonary Aspergillosis -- Clues to diagnosis: increasing severity of asthma or COPD with thick-brownish phlegm production -- CXR: Upper zone opacities, findings of bronchiectasis, atelectasis due to mucoid impaction #Respiratory

#DDx of Hemoptysis #mnemonic: B²ATTLE CA³MP - Bronchitis - Bronchiectasis - Aspergilloma - Tumor - TB - Lung abscess - pulmonary Embolism - Coagulopathy - Autoimmune disorders - AV malformations - Alveolar hemorrhage - Mitral Stenosis - Pneumonia #Respiratory