monitor pain for increased frequency/intensity Rx: observation, reassurance, massage, heat,
stretching, OTC analgesics
DDx: osteoid osteoma, osteosarcoma, osteomyelitis --- sclerotic, cortical lesion with a central nidus of
lucency: osteoid osteoma
pain worse at night, unrelated to activity benign, bone-forming tumor
Rx: NSAIDS (suggestive of Dx); spontaneous resolution over several years
--- changing the cutoff point of a quantitative
diagnostic test inversely affects sensitivity &
specificity
lower the cutoff INCREASES sensitivity & decreases specificity (more true positives) raising the cutoff DECREASES sensitivity &
increases specificity (more true negatives) --- recurrent sinopulmonary infections, persistent
diarrhea, oral candidiasis, viral infections: SCID adenosine deaminase (ADA) deficiency
Dx: absent lymph nodes & tonsils, lymphopenia, absent thymic shadow on CXR, abnormal T, B, & natural killer cell count by flow cytometry ---
Bruton’s (X-linked) agammablobulinemia:
male infant, asymptomatic until age 6 – 9 months; recurrent pyogenic infections (S. pneumo, H.infl) o decreased IgG, IgA, IgM, IgE, &
absent/decreased B cells
o sinusitis, bronchitis, otitis media, Giardia
CVID presents similar to Bruton’s, but CVID has
less severe symptoms & later onset (age 15 – 35 yrs)
o normal circulating B cells
o decreased IgG, IgA, IgM, IgE
--- thrombocytopenia, eczema, recurrent infections:
Wiskott-Aldrich (“WAITER”)
XR, defective WASP gene
young boy with eczema, thrombocytopenia, recurrent encapsulated spp infections
o Strep pneumo, N. meningitidis, H. influenza @ birth: petechiae, bleeding from circumcision,
bruises, bloody stools
PLT production, small PLTs
low IgM, high IgA & IgE
---
Chronic granulomatous disease (CGD): defective
phagocytes due to NADPH oxidase dysfunction impaired oxidative metabolism within phagocytes;
defective intracellular killing
recurrent catalase-positive infections (S. aureus)
lymphadenitis, skin abscesses
Gram stain: neutrophils filled with bacteria Dx: nitro blue tetrazolium test
---
Chediak-Higashi: chemotaxis, degranulation,
& granulopoiesis
mild coagulopathy, pancytopenia
partial albinism, peripheral & cranial neuropathy,
hepatosplenomegaly, infections (S. aureus), progressive lymphoproliferative syndrome Dx: neutropenia, giant lysosomes in neutrophils Rx: daily TMP-SMX & ascorbic acid
---
Leukocyte adhesion defect (LAD): failure of
innate host defenses due to defective tethering, adhesion, & targeting of myeloid leukocytes to sites of microbial infection
o absence of neutrophils/pus at infection sites recurrent bacterial infections of skin & mucosal
surfaces, necrotic periodontitis, gingivitis, delayed umbilical cord separation (> 30 days) early loss of deciduous & permanent teeth leukocytosis with neutrophil predominance cultures: S. aureus, G-negative bacilli
--- increased gastric residual volume, vomiting, &
abdominal distension in a preterm neonate:
necrotizing enterocolitis (NEC)
risk factors: prematurity, very low birth weight gut immaturity & exposure to bacterial from
enteral feeds result in inflammation & damage to bowel wall
XR: pneumatosis intestinalis (intramural air with “train tracks”) & air in portal vein
leukocytosis, metabolic acidosis
Rx: decreased rates of NEC in premature infants who are breastfed
complications: pneumoperitoneum DDx: duodenal atresia, pyloric stenosis,
Hirschsprung
---
DDx of delayed passage of meconium
(within 48 hrs) level of meconium
obstruction consistency
Hirschsprung rectosigmoid normal
meconium ileus ileum inspissated
meconium ileus results in microcolon Dx: contrast enema
---
Hirschsprung disease should be suspected in a
newborn with failure to pass meconium within 48 hr, in the setting of Down syndrome
poor feeding, abdo distension, absent air in rectum failure of neural crest cell migration in the
rectosigmoid; positive “squirt sign” on exam Dx: rectal biopsy show absence of ganglion cells ---
C3 deficiency predisposes to encapsulated bacteria
C5 – C7 deficiency: recurrent Neisseria infections C1 esterase deficiency: hereditary angioedema --- anticholinesterase toxicity due to
organophosphate poisoning
bradycardia, miosis, salivation Rx: atropine & pralidoxime
---
hazard ratio: ratio of an event rate occurring in
treatment vs. control group
ratio < 1 = treatment group has lower event rate ratio > 1 = treatment group has higher event rate ---
asymptomatic bacteriuria of pregnancy is
treated with ABX to prevent pyelonephritis, preterm birth, low birth weight, perinatal mortality risk of pyelonephritis is due to progesterone
causing smooth muscle relaxation, thus ureteral dilation
screen all pregos @ 12 – 16 wks gestation
Rx: amoxicillin, nitrofurantoin, cephalexin are safe C/I: tetracycline, fluoroquinolones, TMP-SMX
(interferes with folate metabolism in 1st trimester, & risk of kernicterus in 3rd trimester)
--- strongest indicator for future suicide attempt: Hx
of previous attempt(s)
---
β-blocker A/E: worsening of CHF, bradyarrhythmia,
---
loop diuretics can cause hearing loss &/or tinnitus
ototoxicity occur with high doses, renal failure, or
combo with other ototoxic drugs (aminoglycosides) ---
HCTZ/thiazides can cause photosensitivity,
orthostatic hypotension, hypercalcemia
--- HTN & hypokalemia: 10 hyperaldosteronism prone to diuretic-induced hypokalemia, resulting
in weakness & muscle cramps
also metabolic alkalosis, mild hypernatremia no peripheral edema due to spontaneous diuresis
(aldosterone escape)
screening: morning aldosterone:renin ratio o ratio > 20, with aldosterone > 15 ng/dL
suggests primary hyperaldosteronism confirm Dx: adrenal suppression testing after
oral saline load
positive result requires adrenal CT MCC: unilateral adenoma or B/L hyperplasia Dx: CT scan to confirm unilateral mass; equivocal
results require adrenal venous sampling U/L adenoma Rx: surgery (#1) or aldosterone
antagonist (spironolactone, eplerenone) B/L hyperplasia Rx: aldosterone antagonists ---
spironolactone: aldosterone/progesterone/androgen
Rc antagonist
A/E: libido, gynecomastia, breast tenderness, menstrual irregularities
eplerenone: selective mineralocorticoid antagonist
---
dehydration is a risk factor for venous thrombosis
due to hemoconcentration
sudden pleuritic chest pain, cough, dyspnea, hemoptysis: PE
also tachycardia, tachypnea, & hypoxemia chest CT: wedge shaped infarction contrast-enhanced CT: filling defects
CXR: “Hampton’s hump”, “Westermark” sign causes transudative & exudative pleural effusion DDx: TB, PCP, bacterial pneumonia, lung cancer ---
older patient with rapidly progressive dementia, myoclonus, akinetic mutism, behavior changes:
Creutzfeldt-Jakob disease (CJD)
triphasic sharp wave complexes on EEG, &/or 14-3-3 CSF proteins
Dx: brain biopsy show spongiform changes Rx: supportive; death within one year of onset DDx: ALS, Lewy body dementia, Alzheimer’s,
NPH, peudodementia
---
scheduled cholecystectomy is indicated for all
symptomatic gallstones (acute pancreatitis), once medically stable due to risk of recurrent episodes Rx poor surgical candidate: ursodeoxycholic acid
asymptomatic gallstones should not be treated,
except morbidly obese undergoing gastric bypass or presence of porcelain GB
---
genital HSV eruptions: painful vesicles on an
erythematous base that evolve to shallow, “punched-out” ulcerations/erosions
Hx of genital HSV: Rx prophylactic acyclovir or valacyclovir @ 36 wks to risk of outbreak during delivery
neonatal HSV risk factors: maternal infection,
vaginal delivery with active lesions
Rx: c-section for pregos with active genital lesions or prodromal symptoms (burning, pain)
vaginal delivery only in absence of active lesions --- burning, localized pain & regional hyperesthesia or
allodynia, in the context of recent cancer therapy:
herpes zoster (shingles)
pain may precede rash by several days
--- acute arthritis of right knee, fatigue, constipation,
polyuria: pseudogout
hyperparathyroidism predisposes to pseudogout
acute formation of calcium pyrophosphate dehydrate (CPPD) crystals, leading to
chondrocalcinosis (calcified articular cartilage)
attacks are precipitated by trauma, surgery, illness Dx: synovial fluid (rhomboid-shaped positively
birefringent crystals) DDx: gout, septic arthritis
---
hydroxyapatite: osteoarthritis
monosodium urate: gout
calcium oxalate: renal calculi
struvite: renal calculi; UTI of urease spp (Proteus)
---
osteoarthritis: non-inflammatory arthritis
age > 50, morning stiffness < 30 min
decreased ROM, stiffness after prolonged rest; anterior hip pain exacerbated by walking crepitus, no TTP, no warmth of joint
bony enlargement; Heberden & Bouchard nodes XR: joint space narrowing, osteophytes,
subchondral sclerosis & subchondral cysts Rx: weight loss slows OA progression
--- Rx mild/moderate OA pain: acetaminophen Rx OA exacerbation: NSAID, intra-articular steroid Rx OA refractory to NSAID & intra-articular steroid:
colchicine
--- recurrent hemarthrosis & skeletal muscle
hemorrhage after mild trauma: hemophilia A & B menorrhagia & mucosal bleeding is common in
women with von Willebrand disease (AD) --- MCC of nephrotic syndrome in children age < 10:
minimal change disease
periorbital edema in the AM, pretibial pitting, nephrotic range proteinuria, hypoalbuminemia
T-cell mediated injury to podocytes cause
increased permeability to albumin renal biopsy not required for Dx
Rx: empiric steroids upon suspicion of Dx o 90% have complete remission of proteinuria
renal biopsy indicated in age > 10, or if
unresponsive to steroid Rx; exclude other causes --- bradycardia, miosis, rhonchi, fasciculations,
salivation, lacrimation, urination, defecation:
organophosphate poisoning
Rx: removal of clothing & washing of the skin prevents transcutaneous absorption
--- TCA overdose Rx: sodium bicarbonate & EKG ---
bicuspid aortic valve, aortic coarctation, & aortic
root dilation; risk of aortic dissection: Turner’s ovarian dysgenesis; low estrogen & amenorrhea
results in a high FSH/LH & low inhibin normal GH levels
---
Social anxiety disorder (social phobia)
anxiety about ≥ 1 social situations, > 6 months fear of scrutiny, humiliation, embarrassment marked functional impairment
generalized social anxiety disorder
o Rx: SSRI (paroxetine) & CBT
performance-only social anxiety disorder
o Rx: propranolol 30 - 60 minutes prior & CBT o alt: benzodiazepine (avoid if substance abuse) Buspiron: Rx GAD only, not social anxiety ---
ischemic cardiac pain can be mistaken for
epigastric pain
SLE & chronic steroid use are risk factors for accelerated coronary atherosclerosis
exercise stress test without imaging if baseline
EKG is normal
o positive stress test coronary angiography ---
acute exacerbation of MS Rx: methylprednisone
(high-dose IV corticosteroid)
long-term steroid therapy provides no benefit & does not prevent future relapses
long-term Rx: beta-interferon can decrease frequency of acute exacerbations & relapses o also glatiramer acetate, IV Ig,
cyclophosphamide, or plasmapheresis --- MCC of constrictive pericarditis in developing
countries: TB
MCC in the US: viral pericarditis
pericardial scarring & thickening results in diastolic dysfunction; pericardial calcifications decreased cardiac output & venous overload
pericardial knock, pulsus paradoxus, Kussmaul sign, prominent x & y descents
--- CXR: parenchymal nodules (silicosis)
CXR: pleural plaques (asbestosis)
--- hard, irregular, fixed breast mass: malignancy rubbery, firm, freely mobile mass: fibroadenoma Hx of 1st-degree relative with breast cancer
requires diagnostic (vs. screening) breast imaging palpable breast mass age < 30: USS
palpable mass age > 30: mammogram, then USS simple cyst Rx: needle aspiration
complex cyst/solid mass: image-guided core Bx suspicious malignancy: core needle biopsy --- both folate & Vit B12 are involved in conversion
of homocysteine methionine, thus a deficiency in either results in homocysteine levels Vit B12 is involved in conversion of
methylmalonyl-CoA succinyl-CoA
Vit B12 deficiency results in methylmalonic acid ---
haptoglobin binds free Hb to form Hb-haptoglobin
complexes removed by the liver haptoglobin in hemolytic anemias
---
alpha-fetoprotein is elevated in HCC &
testicular germ cell tumors
--- low-grade fever & leukocytosis are common
during the first 24 hr postpartum
intrapartum & postpartum chills are common
lochia rubra (bloody discharge) is characteristic
postpartum; after 3 – 4 days lochia serosa (pale) lochia alba (white/yellow)
foul-smelling lochia suggests endometritis fever & elevated WBCs beyond 24 – 48 hr requires UTI work-up: U/A, blood cultures --- blunt deceleration trauma (MVA, fall from > 10 ft),
must rule out blunt aortic injury high mortality rate
Dx: CXR widened mediastinum
DDx: myocardial contusion (tachycardia) --- ipsilateral ataxia, nystagmus, intention tremor,
loss of coordination: cerebellar tumor patient falls/sway TOWARD the lesion side --- age > 40, personality change, dementia, chorea:
Huntington’s
wide-based gait, steppage gait: Tabes dorsalis affected arm adducted, affected leg extended; leg
is swung out in a semicircle: hemiparesis/stroke waddling gait: muscular dystrophy
--- risk factor for cervical insufficiency: Hx of
maternal OB trauma, prior GYN surgery (LEEP, cone Bx), multiple gestation, Hx preterm birth, or 2nd trimester abortion
o Dx: transvaginal USS
risk factors for placental abruption: chronic HTN,
smoking, cocaine use, Hx of maternal trauma, Hx of external cephalic version
risk factors for uterine rupture: multiparity, Hx
of c-section or myomectomy, adv maternal age, fetal macrosomia
--- abdo pain that refers to one or both shoulders
suggests subdiaphragmatic peritonitis due to irritation of subdiaphragmatic parietal peritoneum blunt traumatic bladder injuries, bladder dome
is the only region covered by peritoneum, most susceptible to rupture
MC site of extraperitoneal bladder rupture:
bladder neck
---
unfractionated heparin is preferred over
enoxaparin (LMWH), fondaparinux, & rivaroxaban for severe renal insufficiency reduced renal clearance anti-Xa levels,
thus bleeding risk
monitor unfractionated heparin with aPTT once therapeutic, initiate warfarin
o warfarin takes 5 – 7 days to be therapeutic; must bridge with heparin
Rivaroxaban has immediate onset of action, does
not require bridging with heparin; but no antidote --- upper GI bleeding, depressed consciousness level,
& ongoing hematemesis due to esophageal variceal hemorrhage should first be intubated Rx: endoscopic band ligation or sclerotherapy
after patient is stabilized & intubated
---
Acute intoxication
Marijuana appetite, dry mouth,
conjunctival injection,
tachycardia, slow reaction time, euphoria/dysphoria/paranoia, psychomotor impairment (days)
gynecomastia (chronic use)
phencyclidin e
P C P
violent behavior, impulsivity, hallucinations, amnesia, dissociation, vertical nystagmus, mydriasis, ataxia LSD visual hallucinations, mydriasis, euphoria/dysphoria/panic, perceptual intensification, tachycardia/palpitations/HTN, Cocaine euphoria, agitation,
formication (“cocaine bugs”)
chest pain, stroke, MI, seizures
tachycardia, HTN, mydriasis
Meth violent behavior, tooth decay
diaphoresis, tachycardia, HTN, choreiform movements, psychosis
Heroin
(opioid) euphoria, miosis,respiratory depression, depressed mental state,
constipation, hypotension, hypothermia, & bradycardia amphetamin
e agitation, paranoia, delirium, palpitations, tachycardia, HTN, diaphoresis, mydriasis, seizures, hyperthermia, intracerebral hemorrhage Alcohol slurred speech, unsteady gait,
disinhibition, nystagmus
best predictor of opioid intoxication: RR Rx of severe psychomotor agitation a/w PCP
intoxication: benzo
---
cocaine withdrawal: dysphoria, appetite,
hypersomnia, difficulty concentrating
opioid withdrawal: yawning, mydriasis,
lacrimation, rhinorrhea, diaphoresis, N/V, diarrhea, arthralgia, muscle spasms
--- recurrent fractures, hearing loss, opalescent teeth,
blue sclerae: osteogenesis imperfecta (AD) normal intelligence, osteopenia
--- pain, followed by well-demarcated lesions & bullae
with skin necrosis: warfarin-induced necrosis MC @ breasts, buttocks, thighs, abdomen a/w protein C deficiency
Rx: vitamin K; discontinue warfarin if lesions progress, maintain anticoagulation with heparin --- worsening renal function, HTN, & distal ischemia
following an invasive arterial procedure:
cholesterol embolization
livedo reticularis on skin exam
---
plantar warts are due to HPV infection
painful hyperkeratotic papules on the soles common in young adults & immunocompromised --- scaly, erythematous, ulcerated skin lesion that is
slow-growing, non-resolving with irregular growth on sun-exposed area: squamous cell ca
--- suspected appendicitis with delayed presentation
(> 5 days) after onset of symptoms: appendiceal
abscess (contained, perforated abscess = phlegmon)
Dx: CT scan
if stable, Rx: hydration & IV ABX, bowel rest, elective appendectomy
--- anemia, constipation, weight loss: colon cancer fever, dysuria, flank pain: pyelonephritis ---
esophageal perforation MC occurs following
instrumentation of the esophagus o less commonly due to Boerhaave’s
retrosternal pain & crepitus @ suprasternal notch due to pneumomediastinum
DDx: Mallory-Weiss (self-limited hematemesis) ---
cat bites: prophylactic augmentin for 5 days
Pasteurella multocida
---
fluoroquinolones is a/w tendon rupture in children
--- large thymic silhouette in the anterior mediastinum
is a normal finding on CXR in age < 3 yrs triangular shape, “sail sign”, scalloped border residual thymic tissue can undergo malignant
transformation into a thymoma DDx: lymphoma
---
home O2 therapy & smoking cessation have
been shown to decrease mortality in COPD --- hyperpigmentation of palmar creases, anorexia,
fatigue, GI complains, weight loss, hypotension: primary adrenal insufficiency (Addison’s)
hyponatremia, hyperkalemia
hyponatremia is due to volume contraction
(aldosterone deficiency) & increased vasopressin (lack of cortisol suppression)
mild hyperchloremic acidosis
--- hypernatremia, hypokalemia: Cushing’s
---
Wolff-Parkinson-White: accessory pathway
that bypasses AV node; atrioventricular reentrant tachycardia (AVRT)
persistent a-fib with rapid ventricular response can deteriorate to v-fib
Rx hemodynamically unstable: cardioversion Rx hemodynamically stable: procainamide AV nodal blockers (adenosine, β-blocker, CCB,
digoxin) can accessory pathway conduction, thus worsen WPW
AV nodal reentry tachycardia (AVNRT) 2 separate conducting pathways (slow/fast) within AV node sudden onset & termination, absent P, narrow QRS --- abrupt onset of sharply-demarcated, edematous,
erythematous, tender skin lesion with raised border, & fever: erysipelas
inflammation of superficial dermis legs most common, or face MCC: Group A strep
---
Todd’s paralysis: focal neurologic deficit
following a seizure
--- muscle weakness & dry mouth: Lambert-Eaton a/w lung small cell carcinoma & Hodgkin’s antibodies against presynaptic voltage-gated Ca++
channels in motor nerves
muscle response to motor nerve stimulation increases with repetitive stimulation
diminished/absent DTRs
Rx: plasmapheresis & immunosuppressants ---
Myasthenia crisis can be exacerbated by RTI
diplopia, ptosis, proximal muscle weakness, & weakness of bulbar muscles & diaphragm can lead to respiratory distress
Rx MG with respiratory failure: intubation, then corticosteroids + IV Ig or plasmapheresis (preferred) ---
Myasthenic crisis: exacerbation of symptoms due
to undermedication of AChE-ases or infection Rx: withhold AChE-ase inhibitors
(pyridostigmine), remove respiratory secretions
Cholinergic crisis: exacerbation of symptoms due
to overmedication with AChE-ases
Rx: atropine (anticholinergic, prevents A/E of AChE inhibitor therapy)
Dx: edrophonium (Tensilon) test (short-acting AChE-inhibitor)
o myasthenic crisis improves muscle strength o MG cholinergic crisis worsens weakness --- polyuria & polydipsia are classic for new-onset
Type I DM
bimodal onset: age 4 – 6 yrs or early puberty
nocturnal enuresis can be a presenting
symptom in toddlers
DDx: UTI, maturational delay of sphincter, psychological stress, nephrogenic DI
---
enuresis: urinary incontinence in age ≥ 5 yrs
primary enuresis: never achieved dryness
secondary enuresis: return of incontinence after
≥ 6 months of dryness
--- immune-mediated muscle inflammation:
polymyositis
multicentric CNS inflammation & demyelination:
MS
--- infertility: inability to conceive for > 1 yr
infertility for women age > 35: > 6 months o MCC of fertility in the 4th decade who are
menstruating: age-related decreased
ovarian reserve
Dx: early follicular phase FSH level, clomiphene challenge test, or inhibin-B level
DDx: premature ovarian failure (amenorrhea & menopause before age 40)
--- rapid & massive increase in transaminases with
modest elevations in total bilirubin & ALP in the setting of hypotension (septic shock, heart failure):
ischemic hepatic injury
DDx: alcoholic liver disease (AST rarely >300), acute hepatitis (significant hyperbilirubinemia), TB, sarcoidosis, acalculous cholecystitis, autoimmune hepatitis (elevated bilirubin) --- if suspicion for subarachnoid hemorrhage is high,
but head CT is negative lumbar puncture --- sudden & unexpected travel, confusion about
personal identity, inability to remember the past:
dissociative fugue
episodes of inability to recall important personal info; related to a traumatic or stressful event:
dissociative amnesia
two or more distinct identities that alternatively assume control behavior: dissociative identity
disorder (multiple personality disorder)
persistent/recurrent feelings of detachment from one’s own physical or mental processes, with intact sense of reality; significant impairment:
depersonalization disorder
experiencing familiar persons & surroundings as if strange or unreal: derealization disorder --- proximal DVT of lower extremities; MCC of PE o continue warfarin for 3 months for patients
with reversible risk factors
o continue warfarin for 6 – 12 months for
idiopathic DVT
--- glucose-6-phosphatase deficiency (Von-Gierkes’):
Type I glycogen storage disease affects liver, kidneys, intestinal mucosa
@ age 3 – 4 months, hypoglycemia, lactic acidosis, hyperuricemia, hyperlipidemia
doll-like face (fat cheeks), thin extremities, protuberant abdomen, short stature
hypoglycemic seizures
--- Acid maltase deficiency (Pompe’s): Type II
glycogen storage disease
“floppy baby” with feeding difficulties, macroglossia, cardiomegaly, hepatomegaly --- glycogen debranching enzyme deficiency: Type
III glycogen storage disease
elevated liver transaminases, fasting ketosis, normal blood lactate & uric acid levels
--- branching enzyme deficiency: Type IV glycogen
storage disease (amylopectinosis)
age 18 months, hepatosplenomegaly, failure to thrive, progressive liver cirrhosis
--- new onset neurologic deficits (confusion),
occipital headaches, Hx of HTN & a-fib & vascular disease, on warfarin: stroke Dx: non-contrast head CT
o hemorrhagic stroke white hyperdense regions --- all patients with B/L carpal tunnel syndrome
(CTS) should be screened with TSH
CTS 2/2 hypothyroidism is a/w deposition of mucopolysaccharide protein complexes within perineurium & endoneurium of median nerve;
commonly B/L, more severe
--- accumulation of fluid can cause CTS in pregos amyloid fibril deposition causes CTS in systemic
amyloidosis (ESRD, chronic hemodialysis)
soft-tissue enlargement due to synovial edema & tendon hyperplasia causes CTS in acromegaly inflammation of tendon & synovial sheaths cause
CTS in RA
--- severe hypovolemic hypernatremia Rx: isotonic
normal saline or lactated Ringer’s
hypernatremia causes weakness, lethargy, irritability, altered mental status, seizures, muscle cramps & decreased DTRs
--- periodic abdo pain, multiple duodenal ulcers & a
jejunal ulcer: Zollinger-Ellison syndrome
steatorrhea due to pancreatic enzyme inactivation
--- pancreatic enzyme deficiency: chronic pancreatitis reduced bile salt absorption: ileal resection
---
hyperventilation decreases CO2 concentration
promotes vasoconstriction syncope
---
brief psychotic
disorder > 1 day, < 1 month; sudden onset, return to full function
Schizophreniform > 1 month, < 6 months;
functional decline not required
Schizophrenia at least 6 months;
functional decline required
Schizoaffective at least 2 week Hx of psychotic