Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
641 Cards in this Set
- Front
- Back
- 3rd side (hint)
basilar skull fractures
|
raccoon eyes, rhinorrhea, otorrhea, ecchymosis behind ear
|
dx: CT/head/neck
|
|
Mullerian agenesis
|
blind vag, no uterus, XX
|
|
|
4mos
|
rolls front -> back
up on hands when prone LOLs |
|
|
screening for lipid d/os
|
men >35, 20-35 if increased risk
women > 45, 20-45 if increased risk |
|
|
• Tardive dyskinesia
|
involuntary movements of face/neck, chewing movements, tongue protrusions, grimacing
continual blockade of dopamine receptors upregulation of receptors hyperkinetic disorder |
tx: bzds, beta blockers
|
|
epidural hematoma
|
modest trauma
lucid interval fixed dilated pupil biconvex hematoma |
tx: craniotomy
|
|
Androgen insensitivity
|
XY w/ male internal, female external (testes make MIH), primary amenorrhea, blind vag pouch, elevated androgens
|
tx: gonadectomy after puberty (allow for complete growth) due to r/o testicular ca
|
|
6mos
|
sits w/ support, rolls back --> front
raking babbles stranger danger, looks to ground when drops toy introduce solid foods |
|
|
folate recommendations
|
400ug (0.4mg) for all women
4mg if h/o of NTD |
|
|
akathisia
|
restlessness
|
Tx: propanolol, benzos
|
|
subdural hematoma
|
semilunar crescent hematoma
more trauma not fully awake |
midline structures deviated --> craniotomy
no deviation --> prevent ICP elevation |
|
5a-reductase def
|
XY w/ female external that presents @ puberty, nl levels of androgens
|
|
|
9mos
|
sits independently
pincer grasp, use of cup mama/dada, responds to name, waves bye associates w/ no, peek-a-boo |
|
|
mammogram screening
|
50-74 q2yrs
|
|
|
dystonia
|
painful muscle spasms
opisthonos - neck/back spasm causing flexion torticollis - lateral neck flexion pleurothothonos - torso spasm |
Tx: diphenhydramine (benadryl), benzatropine given IM
|
|
car seats
|
<1yr or <20lbs --> Rear facing car seat
>1yr + 20-40lbs --> forward facing car seat >1yr + 40lbs --> booster seat |
|
|
chronic subdural hematoma
|
seen in old/etoh
tearing venous sinuses |
tx: surgical evacuation
|
|
PCOS
|
hyperandrogenism, LH/FSH >2, IR
|
tx: clomiphene (SERM) inhibits E-r in HT breaking NFB, aromatase inh, OCPs
|
|
12mos
|
walks +/- support
fine pincer grasp 1-3 words 1 step commands |
|
|
typical antipsychotics
|
• Ex: low potency: Chlorpromazine
• Ex: high potency: haldol, prolixin, stelazine |
AEs:
low potency: higher risk of anti-HAM, less of EPS, NMS, tardive dyskinesia high potency: lower risk of anti-HAM, more of EPS, NMS Haldol: QT prolongation OK to take when pregnant |
|
Brown-Sequard hemisection
|
paralysis + loss of proprioception ipsilaterally and distally
loss of P/T b/l no loss of vibratory/positional sense |
|
|
cluster headaches
|
s/s: unilateral stabbing pain, can cause ipsilateral Horner's
|
tx: O2 before sumatriptan,
prophylaxis: verapamil |
|
endometritis
|
MCC pp fever, uterine tenderness, foul smelling lochia, polymicrobial, plasma cells in bx, usu strep
|
tx: clinda/gent
if persists after abx --> CT for abscess or thrombophlebitis |
|
15mos
|
climbing
tower 2 cubes 4-6 wds points to body part |
|
|
NMS (neuroleptic malignant syndrome)
|
= potentially fatal rxn to neuroleptics
s/s: FEVER = fever, encephalopathy, vitals unstable, elevated enzymes, rigid muscles labs: SKY HIGH CPKs |
tx: stop antipsychotic, give dopamine agonists (bromocriptine), muscle relaxants (dantrolene)
|
|
central cord syndrome
|
from forced hyperextension of neck
paralysis/burning in UEs, no loss in LEs |
|
|
migraines
|
s/s: unilateral throbbing lasting up to 3d
, n/v, photo/phonophobia |
tx: NSAIDs, ACM, ergot, sumatriptan
prophylaxis: TCAs, BB |
|
Meig's tumor
|
ovarian fibroma causing
|
|
|
18mos
|
pushes/pulls large objects
tower of 4 cubes, uses spoon 7-20 wds points to 3 body parts, listens to story |
|
|
risperidone
|
atypical antipsychotic
most like typicals - CI for Parkinson's pts also blocks alpha1 |
• AEs: hyperprolactinemia, sedation, weight gain, orthostatic hypotension
|
|
rib fracture
|
pain --> hypoventilation --> atelectasis --> pneumonia
|
tx: local nerve block
|
|
Krukenberg
|
GI tumor met to ovary
|
|
|
2y
|
up/down stairs
tower of 6 cubes 2 wd sentences, 50% intelligible, me, I, you 2 step command |
|
|
mayo-related diarrhea
|
Shit Comes Everywhere
1-6h --> S.Aureus 12h --> C.perf 12-14h --> E.Coli |
|
|
Olanzapine
|
atypical antipsychotic
• AEs: weight gain, elevated serum glucose, TGs |
|
|
sucking chest wounds
|
tx: occlusive dressing w/ 3 sides taped to let air out but not in
|
|
|
endometriosis
|
dysmenorrhea, dyspareunia, painful defecation, fixed retroverted uterus, infertility
|
dx: laparoscopy
tx: OCPs, danazol (inhibits ovarian steroidogenesis), GnRH agonists (goal to prevent production of endogenous E), surgery/cautery, TAHBSO |
|
3y
|
tricycle
spoon/fork, copies circle, dresses self 3 word sentence knows name, age, sex |
|
|
IBS
|
s/s: recurrent ab pain 3d/wk for 3mos
|
|
|
Quetiapine
|
atypical antipsychotic
good for fast on/fast off in Parkinson's, Lewy Body dementia • Used off-label for insomnia, anxiety |
• AE: sedation, weight gain
|
|
viral conjunctivitis
|
tx: cold compress
|
|
|
flail chest
|
sensitive to fluid overload
can develop pulmonary/myocardial contusion w/in 48hrs |
tx: fluid restriction, colloids (plasma or albumin), diuretics
|
|
adenomyosis
|
endometriosis in uterine musculature, large boggy uterus
|
dx: d/c to r/o endo ca
tx: hysterectomy, GnRH agonists |
|
4y
|
balance on one foot, tiptoes
tower of 10 blocks, copies cross, draws person w/ 3 parts full sentences, 100% intelligible knows first/last name, colors, shapes |
|
|
Ziprasidone
|
atypical antipsychotic
|
• AE: QT prolongation arrhythmias
• Less likely to cause weight gain • More likely to cause sedation, orthostatic hypotension needs to be taken w/ food |
|
bacterial conjunctivitis
|
s/s - purulent d/c
tx: erythromycin, cipro |
|
|
aortic rupture
|
a/w deceleration injurie or broken bones that are hard to break (first rib, scapula, sternum)
variable presentation: WIDENING MEDIASTINUM, anxiety, tachy, htn (NOT hypotension) |
tx: PA CXR --> spiral CT
if don't show same result --> aortogram |
|
fibroids (leiomyoma)
|
dysmenorrhea, heavy menses, enlarged uterus, MC indication for hysterectomy, E-dependent
|
dx: d/c to r/o endo ca in >35
tx: surgery |
|
5y
|
bike w/ training wheels
pencil grasp, ties knot, copies square/triangle counts to 10 can follow simple directions |
|
|
Aripiprazole
|
atypical antipsychotic
• Serotonin antagonist • + partial D2 agonist = blocks receptor if overstimulated, stimulates receptor when needed |
AE: akithisia
|
|
AAA screening
|
US for smoking men 65-75
|
|
|
urethral injury
|
sensation of wanting to void but can't, high-riding prostate
anterior injuries (distal to UG diaphragm) a/w straddling posterior injuries (prostatic + membranous) a/w pelvic fractures |
dx: retrograde urethrogram
DO NOT INSERT FOLEY tx: anterior injury repaired, posterior injury drained suprapubically |
|
aromatase deficiency
|
nl internal genitalia, ambiguous external, elevated FSH & LH
|
|
|
clozapine
|
• first antipsychotic w/o EPS, TD, NMS
• no elevation in prolactin • blocks Serotonin and D2 and 9 other NTs • need slow titration to reach therapeutic level |
• AEs: sedation, weight gain, increased salivation, hyperglycemia, seizures, CPU arrest, AGRANULOCYTOSIS (reason why it’s not 1st line tx)
o Need to do weekly blood counts for first 6mo, biweekly from 6-12mo, and monthly monitoring after 1y need committed pts for this med o WBC must be =/>3000mm, neutrophils >1500/mm |
|
cervical ca screening
|
paps beginning @ 21
q2yrs in 20s q3yrs afterwards d/c @ 65 if had 3 consecutive neg. |
|
|
SCFE
|
fat kids, hip flexed, sole of foot points towards other foot, thigh externally rotated
|
dx: XR
tx: pinning of femoral head |
|
Kallmann syndrome
|
congenital hypogonadotropic hypogonadism w/ anosmia, low LH & FSH
|
|
|
SSRI
|
• First line txs bc easy to use
• All have similar efficacy and AEs • Risky during pregnancy • Doesn’t decrease side efx due to reuptake inhibition |
• AEs: sex dysfx, migraines, GI dysfx
• serotonin inhibits dopamine receptors 5HT2 in BG causes Parkinsonian features • serotonin stimulates dopamine receptors 5HT3 in BS causes nausea o tx w/ 5HT3 blocker |
|
CRC screening
|
• FOBT (q1) + sigmoidoscopy (q3-5), colonoscopy (q10) b/t 50-75 (if +FH, begin 10yr before dx)
If high-grade dysplasia, 3+ adenomas, villous adenomas, or adenoma >1cm 3yr f/u FAP: genetic testing @ 10 • + colectomy • - colonoscopy q1-2yrs HNPCC: genetic testing @ 21, if + colonoscopy q2yrs until 40 then q1yr |
|
|
circumferential burn
|
can cut off blood supply and cause edema
|
tx: escharotomy, fasciotomy if fails
|
|
McCune Albright
|
cafe au lait spots, polyostotic fibrous dysplasia, precocious puberty
|
|
|
trazodone
|
• = 5HT2 antagonist, alpha1 blocker
• short ½ life - requires divided doses • indications: insomnia |
• AE: priapism impotence, sedation, orthostatic htn, hepatotoxicity
no sex side efx |
|
pneumococcus vaccine
|
<65 if chronic dz + booster 5yrs later
x1 if >65 • Adult 23-valent vaccine has capsular polysaccharides T-cell-independent B cell response • Child 7-valent conjugated w/ protein T-cell dependent B cell response |
|
|
Anterior cord syndrome
|
seen in burst fracture of vertebral body
lose motor, PT b/l but keep vibratory/position |
|
|
chlamydia
|
r/o blindness, pneumonia
ABC --> MCC blindness WW D-K --> STD |
dx: NAAT
tx: po doxy or azithro |
|
Nefazodone
|
• = SRI, 5HT2 antagonist, alpha1 blocker
• doesn’t suppress REM sleep – can improve sleep architecture • short ½ life divided doses • indications: fibromyalgia, chronic pain, sleep disorders |
• AE: hepatotoxicity w/ specific brand, orthostatic htn
no sex side efx |
|
Central cord syndrome –
|
in elderly from hyperextension of neck
burning/paralysis in UEs |
Dx: MRI
tx: high dose CS |
|
hydatiform mole
|
pre-eclampsia before 3rd trimester, hCG that doesn't return after delivery, grape expulsion
complete - 46XX, all chromosomes from father, no fetal tissue incomplete - 69XXY, fetal tissue in tumor |
tx: d/c, follow hCG (if doesn't fall --> think chorioca --> tx: MTX)
|
|
optic neuritis
|
acute loss of vision w/ central scotoma, a/w MS, exacerbated by heat
|
tx: IV CS
|
|
Bupropion
|
• NDRI
• no sex/cardiac AEs smoking cessation, SAD, ADHD • good for sex dysfx caused by SSRIs • indications: for Parkinson’s pts CI for eating d/o |
• AEs: seizures
|
|
Cauda equina syndrome –
|
distended bladder, flaccid rectal sphincter, perineal saddle anesthesia
|
|
|
threatened abortion
|
hemorrhage <20wks w/ live fetus, closed cervix
|
tx: reassure
|
|
central retinal v. occlusion
|
optic disk swelling, retinal hemorrhage, dilated v., cotton wool spots
|
|
|
Venlafaxine
|
• SNRI, DA inh @ high doses
• Not a first line tx • Indications: severe, refractory depression, chronic pain |
• AEs: sedation, htn, withdrawal
|
|
skull fracture
|
linear --> wound closure
comminuted/depressed --> OR |
|
|
inevitable abortion
|
vag bleeding, lower ab cramps, u/s shows ruptured sac w/o fetal heart tones, can see POC through os
|
tx: suction + RhoGAM
|
|
central retinal a. occlusion
|
sudden, painless loss of vision in one eye, optic disk pallor, cherry red fovea, boxcar segmentation of blood in retinal v.
|
|
|
Mirtazepine
|
• 5HT2, 5HT3, NE, alpha2 antagnoist
• not a reuptake inhibitor indications: refractory depression |
AE: weight gain (Mirtazapine --> munchies), orthostatic htn, sedation
no sex side efx |
|
rupture of bronchi/trachea
|
tx: IR-guided intubation + surgery
|
|
|
placenta abruptio
|
hypertonic/tender uterus, ab/back pain, won't necessarily bleed, RFs: HTN, trauma
|
tx: c/s
|
|
otitis externa
|
ear pain, itching, staph/strep/pseudomonas
tx: topical abx |
|
|
Duloxetine (Cymbalta)
|
• = NE, SRI
• well tolerated • BID dosing also used for diabetic neuropathy |
• AE: nausea, sex dysfx
|
|
air embolism
|
from ventilator/central line
|
tx: cardiac massage w pt lying on L
prevention: Trendelenberg |
|
bronchiolitis
|
RIAP, fever
tx: O2, supportive |
|
|
Desvenlafaxine (Pristiq)
|
• = NE, 5HT, DA reuptake inh
• = metabolite of venlafaxine no advantage over other antidepressants except diff. manufacturer |
|
|
fat embolism
|
seen after polytrauma to long bones --> resp distress, upper body petechial rash, subconjunctival hemorrhage
|
dx: fat droplets in urine, intra-arterial fat globules on fundoscopy
tx: resp support |
|
croup
|
PAIR (pair of crews)
steeple sign, barking cough, stridor, caused by parainfluenza |
tx: CS, Epi
|
|
1. Lithium
|
Increases NO Decreases apoptosis susceptibility
Regulates Ca levels Increases neuroprotective genes Reduces glycogen synthase kinase reduces apoptosis and increases synaptic plasticity Given 1x/d narrow therapeutic index need to measure blood levels |
AEs: movement, nephrogenic DI, hypOth, preg probs, T-wave inversion
Li levels increased w/: dehydration, diuretics, Na deprivation, impaired renal fx, NSAIDs |
|
splenic rupture
|
MCC intraabdominal bleeding s/p blunt trauma (ex: rib fracture)
|
needs immunization against encapsulated (S.pneumo, HiB, Meningo)
|
|
epiglottitis
|
strep/staph/HiB
stridor (high pitched turbulence), drooling, tripod, thumb sign, muffled speech |
tx: oxacillin, AW management
|
|
2. Carbamazepine
|
• Better tolerated than Li
• No weight gain • Better for rapid mood swings • Can be used for PTSD • wide dosage range • induces metabolism of other drugs |
AE: leukopenia, hyponatremia, NT dfx, sedation, SIADH, agranulocytosis
• Routine CBCs are NOT PREDICTIVE b/c many have initial decline in WBC • Don’t combine w/ drugs that can depress marrow |
|
urethral injury
|
exclusively in men
sensation of wanting to void but can't high-riding prostate |
dx: RUG
tx: anterior surgeries surgically repaired, posterior drained suprapubically DO NOT INSERT FOLEY |
|
herpangina
|
vesicles/ulcers in post. pharynx
coxsackie/echo |
|
|
3. Valproate (Depakote)
|
+:
• 1 bedtime dose • anti-anxiety, anti-aggressive -: • not an anti-depressant |
AEs: weight gain, polycystic ovaries, hepatotoxicity, hair loss, pancreatitis, thrombocytopenia
|
|
scrotal hematoma
|
no intervention unless testicle ruptures
|
dx: US
|
|
pneumonia
|
CAP - SHM, s.pneumo --> rusty sputum --> tx: macrolide, doxy, new flouro
HAP - GNR, S.aureus, SHM + pseudomonas, Klebsiella, Acinetobacter, S.aureus --> tx: 3rd gen cephalosporin, fluoroquinolone neonates: GBS, E.Coli Children: RSV, Mycoplasma, Chlamydia, S.pneumo Adults: Mycoplasma, Chlamydia, S.pneumo, viruses, anaerobes Elderly: S.pneumo, influenza, anaerobes, GNR |
|
|
o Lamotrigine
|
= anticonvulsant w/ antidepressant properties = best for bipolar depression
best when combined w/ mood stabilizers |
AEs: sedation, CNS side efx, rash, SJ syndrome
|
|
crushing injuries
|
hyperkalemia, myoglobinemia/uria, renal failure, compartment syndrome
|
tx: IVF, diuretics, alkalinization, fasciotomy
|
|
COPD
|
Stage 1 (mild) – FEV1/FVC<0.7, FEV1>80% predicted SABAs
Stage 2 (moderate) – FEV1/FVC<0.7, FEV1 50-80% predicted LABAs Stage 3 (severe) – FEV1/FVC<0.7, FEV1 30-50% predicted ICS Stage 4 (very severe) or w/ signs of pulmonary htn – FEV1/FVC<0.7, FEV1 FEV<30%, , signs of hypoxemia (Pa)2 < 55mmHg or SaO2 </= 88% @ rest) O2 tx |
|
|
TCAs
|
Indications: migraines, when other drugs don’t work
Tertiary amines (ex: amitriptyline) inhibit reuptake of both Secondary amines (ex: nortriptyline) inhibit NE reuptake NOT FIRST LINE TXs due to AEs |
AEs: anticholinergic, postural hypotension, heart block, risk of SCD post-MI
LD50 = 1w = 50% of pts that OD will die |
|
extremity trauma
|
• No major vessels involved --> tetanus prophylaxis & clean
• Major vessels involved & asx --> arteriogram/Doppler • Sx --> surgical exploration/repair • stabilize bone, vascular, then nerve last --> prolonged ischemia can lead to compartment syndrome so might need fasciotomy |
|
|
asthma
|
Intermittent – sx <2x/wk, >80% FEV SABA
Mild persistent – sx >2x/wk, >80% FEV ICS + SABA Moderate persistent – daily sx, FEV 60-80% ICS + LABA + SABA Severe persistent – continual, FEV <60% ICS + LABA + omalizumab + SABA |
|
|
BZDs
|
indicated tx for acute anxiety, GAD, muscle spasm, seizures, sleeping d/os, EtOH w/drawal, anesthsia induction
long acting: chlordiazepoxide, diazepam, flurazepam (CDF clear da field goin long) intermediate acting: clonazepam, loreazepem, temazopram (TCL like MLBs) short: alprazolam, midazolam, oxezepam, trazolam (ATOM) lorazepam least metabolized by liver clonezepam also in acute mania, akisthisia, RLS and can be used in preg |
AE: sedation, resp depression, psychomotor impairment, w/drawal
|
|
dog bites
|
• Provoked dog bites only need rabies immunization if close to face, otherwise observe dog
• If dog wild or unprovoked --> kill dog! and give rabies vaccine |
|
|
chronic bronchitis
|
hypertrophy of mucus glands
cough/sputum for 3mos for 2 yrs, nl DLco |
|
|
antidepressant, anticonvulsant, buspirone
|
indicated for substance abusers, chronic anxiety, pts that can’t tolerate psychomotor impairment
|
|
|
snakebite
|
tx: type/cross, coag studies, LFTs, BUN/Cr, 5 vials of antivenin (regardless of size)
|
|
|
viral conjunctivitis
|
MC adeno
tx: cold compress |
|
|
propanolol
|
indicated for anxiety w/ autonomic features
|
AE: sedation, sex dysfx
|
|
black widow bite
|
muscle cramps
|
tx: IV Ca gluconate, muscle relaxants
|
|
bacterial conjunctivitis
|
MC staph, strep, hemophilus, moraxella, pseudomonas
tx: erythromycin |
|
|
buspirone, antidepressant
|
5HT agonist
indicated for anxiety in pulmonary pt, GAD does not potentiate CNS and EtOH depression |
|
|
brown recluse
|
skin ulcer w/ necrotic ctr and surrounding erythema
|
tx: excision
|
|
OA
|
relief w/ rest
tx: ACM, NSAIDs |
|
|
antidepressants, CBT
|
indicated in panic disorder
|
|
|
devo dysplasia of hip
|
@ birth, hips easily dislocated w/ jerk/click
RFs: white, f, first born, breech |
dx: US if <4mos, XR if >4mos
tx: abduction splinting w/ Pavlik harness for 6mos |
|
RA
|
improves w/ use
tx: MTX, NSAIDs, anti-TNFa, CS |
|
|
antidepressant
|
indicated for social anxiety
|
|
|
Legg-Perthes
|
avascular necrosis of capital femoral epiphysis, age 6, limping, decreased hip motion, antalgic
|
tx: casting/crutches
|
|
Female triad
|
amenorrhea, h/o stress fracture from minimal trauma, disordered eating
|
|
|
Ramelteon
|
melatonin agonist used as a BZD alternative
|
AE: hyperprolactin, galactorrhea
|
|
genu varum/valgus
|
varum - nl up to 3 --> no tx
valgus --> nl b/t 4-8 --> no tx |
|
|
patellofemoral syndrome
|
overuse, pain on posterior patella when sitting for too long, J sign (patella moves from medial to lateral when knee fully extended)
tx: stretch vastus medialis |
|
|
Buspirone
|
serotonin agonist used as a BZD alternative
|
|
|
Osgood-Schlatter
|
osteochondrosis of tibial tubercle
|
tx: immobilize knee in extension/cylinder cast for 4-6wks
|
|
cocaine
|
• blocks dopamine, NE, serotonin reuptake
• Can also block initiation/conduction of nerve impulses – anesthetic • Dopamine pleasure • Too much will lead to psychosis – delirium, hallucinations (ex: bugs crawling on skin) s/s – overactive SNS |
withdrawal: dysphoric, fatigue, hypersomnia, suicidal
• peaks in days but can last up to months • tx: benzos |
|
melanoma
|
superficial spreading - MC
lentigo maligna - elderly, sun-damaged acral lentiginous - blacks/azns, palms/soles nodular - most aggressive |
|
|
club foot
|
InAdEquate – inversion, adduction, equines (tiptoe)
|
tx: serial plaster casts going from adducted forefoot to hindfoot varus to equinus (moving from distal to proximal) 50% still require surgery
|
|
amphetamines
|
• Causes release of NE and dopamine and prevents reuptake
• Also acts as MAOi s/s: overactive SNS, increased alertness, decreased sleep/appetite, euphoria, self-confidence to point of aggression |
withdrawal: fatigue, hypersomnia, depression, suicidal
• peaks in days, resolves in a wk |
|
BCC
|
pearly papules, central ulceration, telangiectasia, bleed/itch, rarely mets
|
|
|
scoliosis
|
deformity progresses until skeletal maturity reached (2 yrs before onset of menses)
|
tx: bracing
|
|
Ecstasy
|
• s/s: increased intrapersonal insight
• afterglow afterwards = talkative phase • long term use depression due to serotonin depletion |
|
|
SCC
|
irregular, raised
actinic keratosis = precursor |
|
|
Supracondylar fracture of humerus
|
occurs w/ hyperextension of elbow --> high r/o compartment syndrome
|
|
|
crystal meth
|
• rock form of amphetamine
• = more fat soluble more BBB penetrating |
|
|
spinal stenosis
|
pain on walking/standing
relieved by flexion tx: NSAIDs, epidural CS |
|
|
radial head subluxation (nursemaid elbow)
|
from pulling child’s arm
|
tx: closed reduction - extend elbow, supinate forearm, hyperflex elbow w/ thumb over radial head to feel reduction
|
|
PCP
|
s/s: hallucinations, delirium, mania, disorientation, high pain threshold, nystagmus, agitation
mechanism: • NMDA antagonist • Also activates dopaminergic neurons psychosis |
Tx:
• Isolate and wait for PCP to clear • Benzos for agitation (but risk of resp. depression) • Antipsychotics for psychosis • Might need to restrain pt but risk of rhabdo forced acid diuresis w/ NH4Cl, vit C |
|
anserine bursitis
|
sharp pain @ anteromedial tibia just below knee, not aggravated by valgus
|
tx: RICE
|
|
osteosarcoma
|
MC primary malignant bone tumor, sunburst pattern, pain worse @ night, elevated ALP, periosteal elevation (Codman’s triangle)
|
|
|
• Hallucinogens
|
Mechanism: Serotonin agonist
s/s: changes in thought, feeling, perception, visual distortions, illusions, time perception altered, intense emotions, suggestibility, overactive SNS |
|
|
Behcet’s syndrome
|
recurring genital/oral ulcers, relapsing uveitis, cutaneous hypersensitivity, Japs/Koreans
|
|
|
Tarsal tunnel syndrome
|
entrapment of posterior tibial n --> pain on pronation of food, paresthesias in medial aspect of ankle/heel
|
|
|
Ewing's sarcoma
|
2nd MC primary malignant bone tumor, onion skinning
|
|
|
weed
|
decreases adenylate cyclase
s/s: euphoria, wellbeing, relaxation, perception enhancement of music, paranoia/anxiety, decreased intraocular pressure (used for glaucoma) |
|
|
intussusception
|
sausage mass, intermttent pain @ ileoecal jx leading to bowel necrosis
|
dx/tx: barium enema
|
|
multiple myeloma
|
hypercalcemia, renal failure, anemia, bone lesions, BJ protein in urine, abnl Igs in serum electrophoresis
|
tx: chemo, thalidomide
|
|
flumenazil
|
given in BZD OD
|
|
|
stress fracture of femoral neck
|
persistent groin pain
limited hip flexion/internal rotation |
|
|
soft tissue sarcoma
|
dx: MRI
tx: excision, radiation, chemo |
|
|
methadone
|
used to taper opioid addicts
|
|
|
iliotibial band syndrome
|
in runners
stinging pain over lateral femoral epicondyle |
|
|
clavicle fracture
|
tx: figure of 8 device for 4-6wks
|
|
|
schizophrenia
|
increased dopamine activity
mesocortical (neg sx), mesolimbic (pos sx), tuberoinfundibular (hyperPRL), nigrostriatal (increased Ach --> EPS) need 2+ for 1mo: delusions, hallucinations, disorganized speech, disorganized behavior, neg sx duration of illness for at least 6mos |
|
|
osteitis pubis
|
in runners
pain in anterior pelvis, tenderness over pubis |
|
|
anterior dislocation of shoulder
|
MC shoulder dislocation, pt holds arm close to body rotated as if shaking hands, numbness over deltoid from stretching of axillary n.
|
dx: AP/lateral XR
|
|
flouxetine
|
safe in preg
longest 1/2 life of SSRIs increases carbamazepine levels |
|
|
roseola (HHV6)
|
fever (MCC febrile infantile seizures) --> macular rash from trunk to extremities, sparing the face
no LAD |
|
|
posterior dislocation of shoulder
|
usu after seizure/burn, arm held close to body
|
dx: axillary/scapular lateral XR
|
|
duloxetine
|
also used for diabetic neuropathy
|
|
|
RMSF
|
palm/sole involvement starting @ wrists/ankles, myalgias
|
--> tx: doxy
|
|
Colles fracture
|
falling on outstretched hand, distal radius dorsally displaced & dorsally angulated fracture of distal radius
|
tx: closed reduction
|
|
paroxetine
|
short 1/2life --> fastest w/drawal syndromes
|
|
|
citalopram (celexa)
|
most 5HT specific
|
|
|
typhoid fever
|
maculopapular rash on lower chest, S. enterica
|
tx: quinolone
|
|
Scaphoid fracture
|
tx: thumb spica cast and repeat XR in 7-10d, if displaced/angulated --> ORIF
|
|
|
delusional d/o
|
nonbizarre delusions >1mo w/o impairment in daily fx
|
|
|
HS purpura
|
vasculitis causing leukocytoclastic arthritis + butt purpura + abdominal colic in kids (commonly due to intussusception)
nl CBC, complement |
tx: supportive
|
|
Metacarpal neck fracture (Boxer's fracture)
|
tx: mild – closed reduction/ulnar gutter splint, severe – Kirschner wire/plate fixation
|
|
|
dysthymia
|
rule of 2s: 2sx/2yrs, never asx for >2mos
|
|
|
erythema toxicum
|
red patches w/ overlying pustules
dx: eosinophils on scraping |
|
|
Intertrochanteric fractures
|
tx: ORIF, immobilization leads to high r/o DVT so needs anti coag
|
|
|
double depression
|
MDD + dysthymia
|
|
|
SSSS
|
+ Nikolsky's
no MM involvement |
|
|
Femoral shaft fracture
|
can bleed enough to cause shock, fat embolism
|
tx: intramedullary rod fixation
|
|
cyclothymia d/o
|
hypomania w/ mild depression for 2yrs usu w/ borderline pts
|
|
|
SJ syndrome
|
MM involvement
|
|
|
Posterior hip dislocation
|
ex: head on collision, leg shortened, adducted, internally rotated (broken hip externally rotated)
|
tx: emergency reduction for low vasculature of femoral head
|
|
rapid cycling
|
4+ mood d/os in 1yr
|
|
|
pernio
|
red/purple plaques in extremities while in cold
|
|
|
Gas gangrene
|
from deep, penetrating wounds
|
tx: IV pen, debridement, hyperbaric O2 (to kill C.perf)
|
|
schizophrenia
|
delusions, hallucinations, disorganized speech, disorganized behavior, neg sx - need 2+ for >1mo w/ a 6mo duration of overall illness (includes prodromal, psychotic, residual stages)
elevated dopa, 5HT, NE reduced GABA cortical atrophy, ventriculomegaly |
|
|
Radial n. injury
|
from oblique fractures of middle-distal 1/3 of humerus
|
If after reduction, able to dorsiflex no surgery
If still paralysis after reduction nerve entrapped and needs surgery |
|
Cow's milk
|
lacks vit E, Fe, essential FAs
|
|
|
GAD
|
increased NE in locus ceruleus
reduced GABA, 5HT |
tx: BZDs, SSRIs, buspirone, venlafaxine
|
|
Dequervain tenosynovitis
|
seen in mothers carrying baby from wrist flexion/thumb extension, pain reproducible from putting thumb in closed fist and ulnar deviating
|
tx: steroid injection
|
|
TTP
|
inhibition of ADAMS13 --> platelets aggregate --> clots shear cells --> schistocytes, hemolytic anemia, thrombocytopenia, renal failure, AMS, fever
tx: plasmapheresis |
|
|
panic d/o
|
a/w depression, substance abuse, social phobias
|
tx: acute - BZDs, chronic - SSRIs
|
|
Dupuytren contracture
|
palmar contracture, palmar fascial nodules
|
tx: surgery
|
|
DIC
|
increased PT/PTT
|
|
|
agoraphobia
|
fear of being alone in public places w/o escape
|
tx: SSRI
|
|
Venostasis ulcers
|
edematous, indurated, hyperpigmented above medial malleolus
|
tx: stockings, vein stripping
|
|
non-seminomatous germ cell tumors
|
elevated hCG, AFP
|
|
|
OCD
|
reduced 5HT
egodystonic (unlike OCPD = egosyntonic) |
tx: SSRI, clomipramine (TCA)
|
|
Marjolin ulcer
|
SCC of skin developing into leg ulcer from many years of healing/breaking down (ex: 3rd deg burn)
|
dx: bx
tx: wide local excision + skin grafting |
|
tumor lysis syndrome
|
hyperPO4, hyperK, hyperuric (intracellular)
hypoCa (PO4 binds up Ca) |
|
|
ASD
|
sx < 1mo
event occurred <1mo ago |
tx: SSRIs, clonidine
|
|
Morton neuroma
|
inflammation of common digital n. b/t 3rd-4th toes usu from pointed shoes
|
tx: change shoes
|
|
mets to brain
|
Lung Bone Skin Kidney GI
|
|
|
adjustment d/o
|
sx begin w/in 3mos of non-life threatening stressor
sxs end w/in 6mos (ex: breaking up w/ gf) required impairment in fxing |
tx: psychotx
|
|
hyperkalemia
|
Slow devo from renal failure unable to excrete, ACEi
Fast devo from crushing injuries |
tx: HD, NG suction, insulin + glucose, IV Ca to neutralize cellular membrane, NaHCO3 (stimulates Na/H exchanger stimulates Na/K ATPase), kayexelate
|
|
mets to liver
|
Colon Stomach Pancreas Breast Lung
|
|
|
drug dependence
|
1) tolerance
2) w/drawal 3) overuse of substance 4) desire/unsuccessful efforts to cut down 5) sig amt of time involved 6) decreased social activities b/c of substance 7) continued use despite physical/psych prbs 3 of these sx for 12+mos |
|
|
post-op fever
|
Day 1: Wind (atelectasis) incentive spirometer, elevate head of bed
Day 3: Water Day 5: Walking dx: Doppler tx: heparin Day 7: Wound |
|
|
mets to bone
|
Prostate Thyroid Breast Lung Kidney
|
|
|
social phobia
|
fear of social situations
|
tx: assertiveness training + fluoxetine
|
|
cholangitis
|
RUQ pain + jaundice + fever (Charcot's triad)
|
|
|
ARDS
|
b/l pulmonary infiltrates, hypoxia, often a/w sepsis
|
tx: PEEP
|
|
specific phobia
|
tx: BZDs, propanolol
|
|
|
IBS
|
recurrent ab pain for 3d/mo for past 3mos a/w improvement on poop, change in frequency/form of stool
|
|
|
hyponatremia
|
neuro instability, coma
For every >100mg/dl glu Na decreases by 1.6mEq/L Quick changes careful hypertonic NS Slow changes over days from GI loss isotonic fluids if alkalotic, LR if acidotic Slow changes over weeks h2o restriction |
Hypovolemic hyponatremia tx: expand intravascular vol w/ NS
Hypervolemic hyponatremia tx: h2o trestriction Euvolemic hyponatremia SIADH tx: fluid restriction, demeclocycline (ADH antagonist) |
|
etoh w/drawal
|
autonomic instability, seizures, hallucinations beginning b/t 6h-7d
|
tx: BZDs, MgSO4 for seizures
|
|
hemochromatosis
|
s/s: cirrhosis, CHF, DM, joints, conduction block, hepatocellular ca
/o Listeria, Yersinia, Vibrio (Fe-lovin bacteria) heart dysfx can be reversed |
|
|
hypernatremia
|
neuro instability, coma
Every 3mEq/L > 140 represents 1L water lost Quick changes give D5W b/c brain hasn’t compensated yet Slow changes replace w/ D51/2NS b/c brain has compensated |
Hypovolemic hypernatremia (ex: diarrhea) tx: NS
Euvolemic hypernatremia (ex: DI) tx: DDAVP, D5W Hypervolemic hypernatremia (ex: Conn’s) tx: diurese |
|
etoh abuse
|
increased GABA
Cut down, Annoy, Guilt, Eye opener (2+) |
tx: thiamine, naloxone, folate, glucose
|
|
Zn deficiency
|
alopecia, skin lesions, abnl taste, impaired healing
|
|
|
hypokalemia
|
muscle weakness, myalgia, arrhythmia
Slow development from GI loss or urine loss (diuretics) Fast from DKA correction |
|
|
etoh dependence
|
tx: AA, disulfiram, naltrexone (decreases cravings), SSRIs, psychotx
|
|
|
urinary retention
|
6h in-n-out straight cath
2d indwelling Foley |
|
|
PCOS
|
hyperandrogenism + IR
|
tx: weight loss, clomiphene (SERM), aromatase inh, OCPs
|
|
Wernicke-Korsakoff
|
ataxia, confusion, eye probs
amnesia, confabulation, hallucinations |
|
|
Ogilvie’s syndrome
|
paralytic ileus of colon in absence of obstruction
|
tx: colonoscopy to decompress, rectal tube
|
|
cocaine intoxication
|
reduces dopamine reuptake
sympathetomimetic, dilated pupils |
tx: BZDs (mild), Haldol (severe)
|
|
GERD
|
dx: pH monitoring, if long-standing hx endoscopy/bx
• If uncontrolled w/ med management laparoscopic Nissen fundoplication • If + dysplasia resection |
|
|
cocaine dependence
|
tx: psychotx, TCAs, dopamine agonists (amantidine, bromocriptine)
|
|
|
achalasia
|
incomplete LES relaxation, more difficulty w/ liquids than solids
|
dx: barium swallow, manometry tx: repeated dilations, Heller myotomy
|
|
Paps
|
ASCUS+ --> repeat pap 4-6mos, colp, or HPV testing
+HPV --> colp -HPV --> repeat pap LSIL --> colp CIN --> paps +/- colp q6mos until 3 neg. results |
|
|
cocaine w/drawal
|
dysphoric crash, dreams, constipated
|
|
|
esophageal ca
|
progressive dysphagia from solids to liquids
• SCC – black men w/ h/o smoking/drinking • Adenoca – a/w GERD |
• Dx: barium swallow, endoscopy/bx
|
|
Candida vaginitis
|
s/s: white d/c, pruritis, vaginal pH>4.5
|
|
|
amphetamines
|
classic: release dopa
designer: release dopa, 5HT |
tx: BZDs, haldol
|
|
MW tear
|
dx: endoscopy
|
tx: photocoag
|
|
ATN
|
muddy brown casts, renal tubular epithelium on UA
|
|
|
sedatives/hypnotics
|
BZDs - increase freq of Cl channel opening
Barbs - increase duration of Cl channel opening |
BZD OD tx: flumenazil
barb OD tx: alkalize urine w/ NaHCO3 to promote excretion |
|
MALTOMA
|
tx: H.pylori eradication
|
|
|
acute GN
|
dysmorphic RBCs, RBC casts on UA
|
|
|
bzd w/drawal
|
autonomic hyperactivity (like EtOH)
seizures LIFE-THREATENING |
tx: long acting BZD (chlordiazepoxide, diazepam), carb/valproate for seizures
|
|
varices
|
• bleeding tx: sclerotherapy, banding
• non-bleeding tx: propanolol reduces r/o bleeding (no effect on formation) |
|
|
AIN
|
WBC casts
|
|
|
opiates intox
|
reduce autonomic activity, constricted pupils
|
intox tx: naloxone
dependence tx: methadone |
|
Carcinoid syndrome
|
seen w/ SB carcinoid tumor w/ liver mets, diarrhea, flushing, wheezing, RHF
|
dx: 24h URINARY collection of 5HIAA (blood levels only elevated during attack)
|
|
PIGN
|
EM: subepithelial immune complex humps, periorbital swelling, hematuria, oliguria, reduced C3
|
|
|
opiate w/drawal
|
rhinorrhea, piloerection, flu-like sx, GI, cramping
|
tx: clonidine, buprenorphine, methodone if severe
|
|
R colon ca
|
presents w/ hidden anemia, less likely to obstruct b/ larger
|
dx: colonoscopy + bx
tx: R hemicolectomy |
|
RPGN
|
LM: crescent moon
|
|
|
caffeine
|
increase cAMP
w/drawl - headache |
|
|
L colon ca
|
presents w/ bloody BM
|
dx: flex sig + bx, colonoscopy tx: surgery, pre-op radiation and chemo
|
|
DPGN
|
wire looping capillaries, a/w SLE, subendothelial DNA ICs
|
|
|
nicotine
|
stimulates nAch and potentiates dopamine
|
|
|
Pseudomembranous colitis
|
dx: C. dif toxin in stool
tx: colectomy if med management fails, WBC >50k, or lactate > 5 |
|
|
Berger's IgA nephropathy
|
MC glomerulonephritis in adults
after URI/gastroenteritis a/w HS purpura nl complement levels |
|
|
alzheimer's
|
reduced Ach
aphasia - can't speak, understand phrases apraxia - can't remember practiced movements agnosia - can't recognize things previously known |
tx: NMDA antagonists (memantine), AchE inh. (tacrine, donepezil, Rivastigmine)
|
|
hemorrhoids
|
• internal bleed tx: rubber band ligation
o can become painful if prolapse • external pain tx: surgery if conservative tx fails |
|
|
MGN
|
LM: diffuse capillary & GBM thickening, spike/dome, AT3 lost
a/w renal v. thrombosis, HBV |
|
|
Parkinson's
|
reduced dopamine in BG --> increased Ach
Tremor resting Rigidity cogwheel Akinesia Postural instability |
tx: Bromocriptine, Amantidine, Levodopa/carbidopa, Selegiline, Anticholinergics
|
|
Lower GI bleed
|
o If > 2mL/min angiogram
o If < 0.5mL/min wait til bleeding stops and do colonoscopy o If b/t tagged RBC study (slow test!) Puddling arteriogram No puddling colonoscopy |
|
|
minimal change dz
|
LM: nl glomeruli
EM: foot process effacement selective loss of albumin MC nephrotic syndrome in children a/w Hodgkin's |
tx: prednisone
|
|
NPH
|
gait disturbance, urinary incontinence, dementia
|
|
|
Volvulus
|
seen in old, parrot beak w/ air-loop in RUQ tapering towards LLQ w/ twisting @ sigmoid
|
dx: XR
tx: proctosigmoidoscopic w/ decompression, rectal tube recurrence needs sigmoid resection |
|
amyloidosis
|
LM: congo-red stain, apple-green birefringence
a/w RA, renal/hepatomegaly --> proteinuria, liver damage, restrictive CM caused by MM or chronic inflammatory states |
|
|
Wilson's
|
Asterixis
BG degeneration Corneal deposits Dementia |
tx: penicillamine
|
|
FSGS
|
LM: sclerosis, hyalinosis
MCC nephrotic syndrome, also highly prevalent w/ HIV, obesity, heroin, nigs |
|
|
Hepatic adenoma
|
from b/c pills, r/o bleeding
|
dx: CT
tx: emergent surg |
|
grief
|
nl sx resolve in 1yr
abnl sx >1yr |
|
|
MPGN
|
LM: tram-track appearance from GBM splitting
type I a/w HBV, HCV type II a/w elevaed C3 (IgG against C3 convertase) - persistent complement activation, kidney damage |
|
|
acalculous cholecystitis
|
occurs in ICU pts due to cholestasis and gallbladder ischemia
|
|
|
sleep change w/ age
|
increase REM cycles, stages 1, 2
decrease REM duration, stages, 3, 4 |
|
|
RCC
|
flank pain + hematuria + palpable mass
varicocele that fails to empty when recumbent RFs: smoking, obesity, VHL syndrome |
dx: CT ab
|
|
Diaphragmatic hernia
|
NG tube seen in pulmonary cavity, more common on L side b/c R side protected by liver, high r/o strangulation
|
|
|
Tourette's
|
coprolalia - cussing
copropraxia - obscene gesturing coprophagia - eat shit need both motor and vocal tics tics qd for >1yr w/ no tic free period for 3mos elevated dopamine |
tx: haldol, pimozide (dopa blocker), clonidine (for tics)
|
|
cystinuria
|
s/s: recurrent stone formation, hexagonal crystals, radioopaque, alkalinize urine
pathogenesis: defect in renal transportation of dibasic AAs |
dx: CN-nitroprusside --> breaks SH groups and determines amt of cysteine in urine
tx: acetazolamide |
|
intraductal papilloma
|
young, BLOODY d/c
|
dx: galactogram
tx: resection |
|
enuresis
|
2x/wk for 3mos
|
tx: behavior tx, DDAVP, TCAs
|
|
RTA1
|
distal, inability to secrete H when challegned
causes: MM, nephrocalcinosis, cisplatin, amphoB, Sjogren's |
|
|
infiltrating ductal ca
|
MC type of breast ca
|
|
|
encopresis
|
1x/mo for 3mos
|
tx: behavioral, stool softeners
|
|
RTA2
|
proximal, HCO3 lost in urine, elevaetd Cl, reduced K
causes: Fanconi's, MM, topiramate, acetazolamide |
|
|
inflammatory breast ca
|
worst prognosis, orange peel
|
|
|
anorexia
|
body weight <85% of expected weight
amenorrhea (3 consecutive missed periods) hypoCl, hypoK, alkalosis --> seizures hypercholesterolemia reduced resting E expenditure, serum E/T increased BUN good appetite but starves self IUGR osteoporosis |
|
|
RTA4
|
reduction in aldo, inability to convert glu --> NH3, elevated K, Cl
causes: DM, analgesic nephropathy, ACEi, K-sparing diuretics |
|
|
thyroid nodules
|
low r/o ca
dx: FNA o if malignant/indeterminate lobectomy o follicular ca – total thyroidectomy so can use radioactive I for any mets o hot nodules rarely malignant |
|
|
bulimia
|
binging/purging 2x/wk for 3mos
nl weight egodystonic --> more likely to seek help than anorexics dental erosion salivary gland hypertrophy |
|
|
sick euthyroid syndrome
|
low T3
nl T4 |
|
|
Nesidioblastosis
|
hypersecretion of insulin in newborn
|
tx: pancreatectomy
|
|
binge eating
|
2x/wk for 6mos
|
tx: stimulants to suppress appetite
Orlistate - inhibits pancreatic lipase --> reduces absorption |
|
thyroid ca
|
papillary: MC, best prognosis, "ground-glass nuclei" = Orphan Annie, psammoma bodies, increased r/w childhood radiation
follicular: MC in I deficient areas medullary: a/w MEN2A, 2B, parafollicular cells producing calcitonin anaplastic - worst |
|
|
glucagonoma
|
migratory necrolytic dermatitis, anemia, glossitis, stomatitis
|
|
|
primary insomnia
|
3x/wk for 1mo
|
|
|
glitazones
|
increase insulin sensitivity
AEs: weight gain, edema --> CHF |
|
|
Primary hyperaldo
|
hypokalemia w/o diuretics, low renin
Hyperplasia – appropriate response to postural change (increased aldo when upright) Adenoma if inappropriate response |
|
|
narcolepsy
|
for 3mos
|
tx: ritalin, modafinil (sympathetomimetic)
|
|
exenatide (GLP1 agonstis)
|
increase insulin release
AE: n/v |
|
|
Aortic coarctation
|
dx: CXR shows rib scalloping (erosion from intercostals collaterals), spiral CT, MRI angio tx: surgery
|
|
|
nightmare d/o
|
occurs during REM
can remember them when awake (unlike night terrors, somnoambulism) |
tx: TCAs which reduce REM
|
|
gliptins
|
DPP4 inhibitors --> increases GLP1 --> increases insulin release
|
|
|
esophageal atresia
|
excessive salivation after birth, fistula b/t lower esophagus and trachea, a/w VACTER (vertebral, anal, cardiac, tracheal, esophageal, renal, radial anomalies)
|
tx: surgery, g-tube to prevent aspiration
|
|
informed consent
|
Name of tx
Alternatives Risks/benefits Consequences of refusing Capacity |
|
|
insulins
|
rapid: lispro, aspart, regular
intermediate: NPH, Lente long: glargine (Lantus), detemir, ultralente |
|
|
congenital diaphragmatic hernia
|
located on L, hypoplastic lung has fetal circulation so need to allow few days for maturation
|
dx: US before birth
tx: might need ECMO (extracorporeal membrane oxygenation) |
|
capacity
|
1) can communicate choice
2) understand relevant info 3) appreciates situation 4) can manipulate situation to make rational conclusion |
|
|
presbycusis
|
age related sensorineural hearing loss, symmetric high freq loss, loss of speech discrimination
|
|
|
gastroschisis
|
cord normal, no protective membrane covering bowel
|
|
|
to stand trial
|
1) understand charges
2) have ability to work w/ attorney 3) understand consequences 4) able to testify |
|
|
AMD
|
leading cause of severe central vision loss in elderly
RFs: smoking, HTN exudative (wet) - rare, sudden vision loss non-exudative (dry) - atrophy/degeneration of central retina |
tx: ranibizumab intraocular injection
|
|
omphalocele
|
membrane covers bowel
|
tx: large defects need silastic “silo” to house/protect bowel
|
|
malpractice
|
Dereliction (negligence)
Duty Direct Damage |
|
|
post-MI
|
1-5d --> arrhythmia
5-10d --> free wall rupture, tamponade, papillary muscle/septum rupture 7wks --> ventricular aneurysm |
|
|
exstrophy of urinary bladder
|
ab wall defect over pubis
|
tx: repair done w/in first 2d
|
|
paliperidone
|
titanium shell to allow medicine to be released throughout entire GI tract and capsule shitted out
|
|
|
WPW
|
tx: 1a, 1c antiarrhythmics
|
|
|
Meconium ileus
|
a/w CF, dilated loops in SB, ground-glass in lower ab
|
dx/tx: gastrografin enema (hypertonic to draw fluid in to dissolve pellets of meconium)
|
|
murmurs
|
R sided increase w/ inspiration
L sided increase w/ expiration valsalva reduces all murmurs except HCM and MVP handgrip increases all murmurs except HC |
|
|
Biliary atresia
|
dx: HIDA scan 1wk after phenobarb (liver stimulant)
tx: surg (1/3 success, 1/3 need transplant immediately after, 1/3 eventually need transplant) |
|
|
transplant
|
hyperacute (mins) - type2 rxn preformed anti-donor abs
acute (week) - Ts against foreign MHCs chronic (mos) - Ts and abs vascular damage GVHD - donor Ts --> maculopapular rash, HSM, diarrhea |
|
|
Hirschsprung
|
chronic constipation, explosive stool
|
dx: XR w/ distended proximal colon, normal distal is aganglionic, full thickness bx of mucosa
|
|
gingko
|
a/w intracerebral bleeding
|
|
|
Intussusception
|
currant jelly stools, Usu hooks onto LN, viral illness in kids, lymphoma in adults
|
dx/tx: barium/air enema
|
|
kava
|
a/w GI, skin rashes
used for GAD |
|
|
Vascular rings
|
causes stridor and crowing respiration when baby neck in hyperextended, difficulty breathing/swallowing
|
dx: barium swallow, bronchoscopy to r/u tracheomalacia
tx: surgery to divide the smaller of two aortic arches |
|
echinacea
|
used for URI prophylaxis
|
|
|
AS
|
angina, exertional syncope, harsh midsystolic murmur
|
tx: valve replacement if gradient >50mmHg, CHF, angina, or syncope
|
|
DTRs
|
increased w/ hypoCa
decreased w/ hypoMg |
|
|
MS
|
a/w h/o RF, dyspnea on exertion, PND, hemoptysis, low pitched rumbling diastolic murmur, AF
|
tx: commissurotomy/valvotomy
|
|
preventions
|
1 - target @ risk (ex: vaccines)
2 - screenings 3 - limit complications in dz'd |
|
|
MR
|
MC caused by prolapse, exertional dyspnea, AF, high pitched holosystolic murmur
|
tx: annuloplasty (valve replacement)
|
|
amaurosis fugax
|
vision loss from carotid atherosclerosis emboli, "curtain coming down"
|
|
|
Coronary dz
|
o Progressive unstable disabling angina that’s unresponsive to med management cath
o >70% stenosis revascularization o simple problem (single vessel involvement that’s NOT L main/LAD) angioplasty + stent o complex problem (multiple vessel involvement or L main/LAD) CABG |
|
|
optic neuritis
|
acute painful loss of vision, central scotoma, a/w MS, marked changes in color perception
|
|
|
Central lung lesions
|
dx: bronchoscopy + bx, thoracotomy + wedge resection tx: pneumonectomy (whole lung)
|
|
|
anterior uveitis
|
red/painful eye w/o eyelid involvement
|
|
|
Peripheral lung lesions
|
dx: percutaneous bx, thoracotomy + wedge resection tx: lobectomy but need minimum of FEV 800
|
|
|
cavernous sinus thrombosis
|
periorbital edema, exopthalamos, papilledema, bilateral sx, ptosis, cranial n palsies
|
|
|
SCLC
|
tx: chemo/radiation
|
|
|
orbital cellulitis
|
swollen eye, pain w/ movement, fever, proptosis
|
|
|
NSCLC
|
tx: surgery
|
|
|
vitreous hemorrhage
|
loss of vision, floaters, MCC DM
|
|
|
hilar v. nodal mets
|
• Hilar mets tx: removed w/ pneumonectomy
• Nodal mets (carina/mediastinum) no surg |
|
|
spared eye injury
|
damage to one eye after trauma to other side, patho: uncovering of "hidden ags"
|
|
|
Subclavian steal syndrome
|
not enough blood flow + posterior neuro signs (visual, equilibrium) when arm exercised
|
dx: arteriogram tx: bypass
|
|
HPV vaccine
|
3 shots given over 6mos before onset of sex of <26
|
|
|
AAA
|
usu asx, if tender, high r/o rupture, excruciating back pain means already ruptured
|
dx: US
tx: <4cm observe, 5-6cm surgery |
|
central retinal v. occlusion
|
optic disk swelling, retinal hemorrhage, dilated cotton wool spots
|
|
|
Intermittent claudication
|
• Rest pain is worst stage – pain in leg when trying to sleep, dangling leg helps pain but turns purple, shiny atrophic, no peripheral pulses
|
dx: Doppler, if significant do arteriorgram
tx: smoking cessation, cilostazol (PDEi), surgery if disabling |
|
central retinal a. occlusion
|
sudden painless loss of vision in one eye, cherry red fovea, boxcar segmentation of blood
|
tx: ocular massage, O2
|
|
Aortic dissection
|
tearing chest pain radiating to back, widened mediastinum, uneven pulses
|
dx: spiral CT
tx: surg. |
|
BCC
|
raised, waxy, non-healing ulcer, upper part of face, doesn’t met
|
tx: local excision w/ 1mm borders
|
|
subconjunctival hemorrhage
|
valsalva causing rupture of vessels, benign
|
|
|
SCC
|
nonhealing ulcer, lower lip, mets
|
tx: excise w/ 2cm borders
|
|
sympathetic opthalmia (spared eye injury)
|
damage to one eye after trauma to opposite side
path: uncovering of hidden ags |
|
|
Melanoma
|
originates from pigmented lesion from UV exposure in childhood, ABCDE (asymmetry, borders, color, diameter, evolution), depth determines prognosis, lesions >4mm terrible, 1-4mm benefit from aggressive tx
• Mets to weird places, no predictable timetable, can recur after many years of nothing |
tx: wide excision, IFNa
|
|
blepharitis
|
eyelid inflammation
|
|
|
amblyopia
|
suppression of 2 overlapping images permanent blindness of one eye
|
tx: immediate correction
|
|
dacrocystitis
|
lacrimal sac inflammation
s.aureus, beta strep |
|
|
strabismus
|
reflection of light comes off uneven b/l, leads to amblyopia
|
|
|
presbyopia
|
age-related decrease in lens elasticity --> difficulty w/ near-vision
|
|
|
Acute angle closure glaucoma
|
severe eye pain, frontal headache in evening after pupils dilated for long, halos, eyeball hard as rock
|
tx: CA inh (diamox), topical bb, a2 agonists, mannitol
|
|
AMD
|
leading cause of central vision loss in elderly, straight lines appear wavy, pigment accumulation in retina,
RFs: smoking, HTN wet --> sudden vision loss dry --> chronic degeneration of retina |
tx: ranibizumab, laser anti-coag
|
|
Orbital cellulitis
|
eyelids hot, febrile, eyelids pried open showing dilated/fixed pupil, limited motion, pus in orbit
|
dx: CT
tx: drainage |
|
corneal abrasion
|
dx: flourescein + wood lamp
|
|
|
malignant otitis externa
|
pseudomonas infection of DM ear pain, drainage, granulation tissue can progress to osteomyelitis
|
tx: cipro to cover pseudomonas
|
|
Retinal detachment
|
flashes of light, floaters
|
tx: laser spot welding
|
|
mucormycosis
|
low grade fever, bloody nasal d/c, nasal congestion, chemosis/proptosis/diplopia, Rhizopus infection a/w DM
|
tx: surgical debridement + ampho B
|
|
Central retinal a. occlusion
|
sudden LOV in one eye
|
tx: breathe into paper bag, ASA, massage eye to try to dislodge embolus
|
|
pertussis
|
tx: erythro 14d or azithro 5d
only reduces transmission |
|
|
Ischemic stroke
|
sudden onset w/o HA
neuro deficits >24h |
dx: CT to r/o extensive infarct and presence of hemorrhage tx: tPA if <3h (best <90min) before sx begin
|
|
herpangina
|
vesicles in posterior pharynx
due to coxsackie, echovirus |
|
|
TIA
|
sudden onset w/o HA
MC >70% stenosis of IC or ulcerated plaque @ carotid bifurcation |
dx: duplex
tx: endarterectomy to PREVENT strokes |
|
NSCLC
|
tx: surgery
|
|
|
SAH
|
sudden onset w/ HA
worst headache every, can come back w/ even worse one (first one = “sentinel bleed”) |
dx: CT, arteriogram to locate aneurysm
tx: clipping |
|
SCLC
|
a/w ectopic ACTH/ADH, Lambert-Eaton
tx: chemo b/c metastasizes |
|
|
brain tumor
|
Progressively increasing HA for months, papilledema, projectile vomiting
|
dx: MRI
tx: high-dose steroids (dexamethasone aka Decadron) |
|
Lofgren's syndrome
|
b/l hilar lymphadenopathy, high grade fever, erythema nodosum (red raised lesions which resolve spontaneously)
~acute sarcoidosis |
|
|
Frontal lobe brain tumor
|
inappropriate behavior, optic n. atrophy ipsilaterally, papilledema contralaterally, anosmia
|
|
|
Hypertrophic osteoarthropathy
|
COPD causing digital clubbing and acute onset arthropathy often a/w lung ca
|
|
|
Craniopharyngioma
|
kids, bitemporal hemianopsia, calcified lesion above sella
|
|
|
adenoca
|
LC of non-smokers, peripheral
|
|
|
Prolactinoma
|
amenorrhea, galactorrhea
|
dx: r/o preg, hypoTH, get PRL level, MRI of sella
tx: bromocriptine (dopa agonist inhibits PRL), trans-sphenoidal surgery for those that want to get preg or fail med management |
|
conductive hearing loss
|
difficulty hearing low freq.
BC>AC Weber lateralizes to affected side |
|
|
acromegaly
|
htn, DM, big hands/feet/tongue/jaw from pit adenoma
|
dx: somatomedin C, pit MRI levels
tx: surg, radiation |
|
sensorineural hearing loss
|
difficulty hearing high freq.
AC>BC Weber lateralizes to unaffected side |
|
|
Pit apoplexy
|
destruction of pit from bleeding from pit tumor, stupor/hypotension
|
dx: MRI
tx: steroids |
|
Felty syndrome
|
RA + splenomegaly + granulocytopenia (Felt a big spleen and low neutrophils)
|
|
|
Pineal tumor
|
loss of upper gaze, downward gaze
|
|
|
polymyalgia rheumatica
|
needs b/l shoulder/hip stiffness for 1mo for dx, does not respond to NSAIDs, morning stiffness, ESR >40, a/w TA
seen in elderly ladies, point tenderness |
tx: low dose CS
|
|
Spinal stenosis
|
pain on walking, relieved by rest/hunching over, position-dependent (vascular claudication is NOT position-dependent), nl pulses
|
dx: MRI
tx: pain specialist for nerve block |
|
medial epicondylitis
|
overuse of flexor pronator, exacerbated by wrist flexion
|
|
|
Autonomic dysreflexia
|
seen in paraplegics w/ high transection, usu brought on by bladder distention, extreme htn
|
tx: VD, Ca blockers
|
|
Dequervain
|
pain w/ pinch gripping from inflammation of abductor pollicis longus, extensor pollicis
|
tx: thumb spica splint, NSAIDs
|
|
Reflex sympathetic dystrophy (causalgia)
|
occurs after crushing injury, slight stim causes severe pain, cold/cyanotic/moist, unresponsive to analgesics
|
dx: successful sympathetic block tx: surgical sympathetectomy
|
|
frozen shoulder syndrome (adhesive capsulitis)
|
Idiopathic, night pain, RF: DM, not relieved by CS injection
|
|
|
Torsion
|
young adolescents, high-rising, cord NOT TENDER, loss of cremasteric reflex
|
tx: orchiopexy to fix testicle to scrotum
|
|
Patellofemoral syndrome
|
overuse injury, pain on posterior patella when sitting for too long, popping/catching/stiffness, J sign (patella moves from medial to lateral position when knee fully extended)
|
tx: stretch vastus medialis
|
|
epididymitis
|
fever, pyuria, testis in nl position, cord TENDER, pain relieved when lifting testicle (Prehn's sign)
|
dx: U/S to r/o torsion
tx: abx (azithro/ceftriaxone to cover GC) |
|
Peutz-Jegher's
|
multiple benign hamartomas + hyperpigmentation, increased r/o CRC
|
|
|
Posterior urethral valves
|
MC reason for male to fail to void in first day
|
dx: VCUG
tx: Foley to void, endoscopic fulguration (electric current to destroy tissue) to remove valves |
|
Cowden syndrome
|
GI hamartomas + breast/thyroid ca + gingival hyperplasia
|
|
|
vesicoureteral reflux
|
dx: IVP, VCG
tx: long term abx until self-resolves |
|
|
Cronkhite-Canada
|
juvenile polyps + skin changes
|
|
|
Low ureter implantation
|
normal need to void, voids nl, but constantly dripping b/c ureter below sphincter
|
dx: IVP
tx: surgery |
|
diverticulitis
|
dx: CT w/ contrast
|
tx: cipro, metro, augmentin for anaerobes
|
|
Ureteropelvic jx obstruction
|
pee normally but not when large diuresis (ex: college student beer binge first time), colicky flank pain
|
dx: US
|
|
diverticulosis
|
dx: barium enema
|
|
|
RCC
|
hematuria, flank pain, flank mass
|
dx: CT to see growth into renal v., IVC
tx: surgery |
|
pancreatitis
|
dx: CT abdomen
|
|
|
bladder ca
|
a/w smoking, presents w/ hematuria
|
dx: IVP, cystoscopy
tx: surgery, intravesical BCG |
|
nephrotic syndrome
|
fatty casts
|
|
|
prostate ca
|
dx: transrectal needle bx
tx: surgery, radiation, androgen ablation if bone mets, orchiectomy, meds (LHRH agonists, flutamide antiandrogen) |
|
|
CRF
|
brown/waxy casts
|
|
|
testicular ca
|
painless testicular mass, often malignant
|
dx: bx done w/ radical orchiectomy by inguinal route, AFP, bHCG tx: radiation, chemo (platinums)
|
|
contrast nephropathy
|
use low/isomolar contrast media and hydrate w/ isotonic HCO3 + N-acetylcysteine before procedure
|
|
|
Stress incontinence
|
in women w/ multiple deliveries, neck of urethra in vagina outside of the high pressure of abdomen, weakened pelvic floor
|
tx: Kegels, surgery if large cystocele
|
|
uric acid stones
|
radiolucent, seen in leukemia (high turnover)
|
dx: CT or IVP
Tx: potassium citrate or KHCO3 to alkalinize urine |
|
kidney stones
|
• Small stones (<3mm) @ ureterovesical jx have 70% chance of passing spontaneously
• Larger stones (>7mm) tx: lithotripsy |
lithotripsy o CI for preg, bleeding d/o, staghorn stone
|
|
cryoglobulinemia
|
proteins in blood that become insoluble @ low temps
palpable purpura, proteinuria, hematuria, a/w HCV |
|
|
hyperacute rejection
|
occurs in minutes, caused by preformed abs, prevented by ABO mismatching so not seen clinically
|
|
|
fibromuscular dysplasia
|
causes arterial stenosis, MCC of 2ndary HTN in kids, CVA bruit, angio reveals string of beads
|
|
|
acute rejection
|
occurs up to 3mos, organ dysfx
• liver transplant rejection usu due to technical problems rather than immunologic, difficult surgery b/c many anastomoses dx: U/S to r/o biliary obstruction, doppler to r/o vascular thrombosis • heart requires frequent ventricular bx b/c if show signs of rejection, too late |
dx: bx tx: steroid boluses
|
|
choledochal cyst
|
congenital dilation of biliary ducts --> ab pain, recurrent pancreatitis --> cholangiocarcinoma
dx: CT/MRI |
|
|
HCM
|
AD
murmur increases w/ valsalva, S4 best heard w/ pt in L lateral decub |
tx: bb, ccb to improve filling
|
|
chronic hep C
|
waxing/waning of LFTs
can lead to arthralgias, cryoglobulinemia, porphyria cutanea tarda, glomerulonephritis |
tx: IFNa, ribavirin
|
|
HIT
|
heparin binds to F4 --> ab activating platelets --> thrombocytopenic + hypercoagulable
elevated aPTT |
tx: stop heparin and give thrombin inh
|
|
erythema multiforme
|
target lesions
HSV, mycoplasma |
|
|
gallstones
|
dx: U/S
|
tx: laparoscopic cholecystectomy, lithotripsy, ursodeoxycholic acid
|
|
cholesteatoma
|
hearing loss, ear d/c despite abx, granulation tissue,
|
|
|
lactose intolerance
|
+H breath test
+stool test for reducing substances acidic stool increased stool osmotic gap |
|
|
Sheehan's syndrome
|
postpartum pituitary necrosis --> failure to lactate
|
|
|
AIHA
|
warm: SLE, Methyl dopa, CLL
cold: Mycoplasma, EBV, CLL |
tx: warm - steroids
cold - supportive |
|
folate deficiency
|
can be caused by phenytoin, MTX, TMP
|
|
|
Howell-Jolly bodies
|
basophilic remnant of HgB
sign of splenic dysfx |
need to protect against encapsulated: strep, klebsiella, hib, neisseria, salmonella, gbs
|
|
TTP
|
schistocytes, hemolytic anemia, thrombocytopenia, renal failure, AMS, fever
|
tx: plasmapheresis
|
|
HIT
|
abs activating platelets
thrombocytopenic + hypercoagulable elevated aPTT |
|
|
DIC
|
thrombocytopenia, thrombosis, bleeding
|
|
|
paroxysmal noctural hemoglobinuria
|
abnormal GP1 which normally binds CD55, CD59 --> RBCs lack this --> get attacked by complement
|
|
|
hereditary angioedema
|
C1 esterase deficiency
|
|
|
cyclosporine
|
IL2 inh
|
AEs: nephrotoxic, hyperkalemia, HTN, tremor, hirsutism, gingival hyperplasia
|
|
cholangitis
|
RUQ pain, jaundic, fever
|
dx/tx: ERCP
|
|
diverticulitis
|
LLQ pain w/ n/f
|
tx: CT w/ contrast
tx: cipro/metro |
|
primary biliary cirrhosis
|
destruction of intra-hepatic ducts, a/w autoimmune dz, pruritis, elevated conjugated BR
|
dx: anti-mito abs
tx: ursodeoxycholic acid |
|
primary sclerosing cholangitis
|
onion-skin bile duct fibrosis, beading of bile-ducts, a/w hyper IgM, pANCA, u/c
|
dx: ERCP
|
|
celiac dz
|
blunting/destruction of villi
|
|
|
laxative abuse
|
dx: bx colon for dark brown pigmentation in macrophages in LP & lymphoid follicles
|
|
|
GC
|
disseminated --> seen w/ terminal complement deficiency --> skin lesions w/ tenosynovitis
|
tx: ceftriaxone + azithromycine
|
|
chlamydia
|
cause of lymphogranuloma venerum
no bacturia |
tx: azithro 1g or doxy 100mg qd 1wk
|
|
PID
|
tx: ceftriaxone + doxy
|
|
|
long qt
|
tx: bb
|
|
|
AS repair indications
|
pulsus parvus (decreased amplitude), pulsus tardus (delayed upstroke)
1) sx 2) undergoing CABG 3) mean AV gradient >50mmHg or AV area <0.6cm2 |
|
|
AAA surgery indications
|
1) sx
2) diameter >5cm |
|
|
Marfan's
|
predisposes to MVP, AR
|
|
|
acute endocarditis
|
S. aureus on nl heart valves
|
|
|
subacute endocarditis
|
S. viridans, enterococcus on damaged heart valves
|
|
|
digoxin
|
increases inotropy and slows HR
used for CHF in NYHA4 |
|
|
adenosine
|
abolishes SVTs
|
|
|
pseudohypoPTH
|
unresponsive to elevated PTH, hypoCa shortened 4th-5th digits, short stature
|
|
|
MEN1
|
pit, pancreas, PT
|
|
|
MEN2A
|
PT, pheo, medullary thyroid
|
|
|
MEN2B
|
pheo, medullary thyroid, gangliomatosis
|
|
|
adrenoleukodystrophy
|
accumulation of VLCFAs
|
|
|
hyperkalemia
|
tx: CBIGK
ca gluconate bb insulin glucose kayexelate |
|
|
hyperkalemia
|
tx: CBIGK
ca gluconate bb insulin glucose kayexelate |
|
|
choriocarcinoma
|
elevated hCG tumor
|
|
|
seminoma
|
elevated hCG tumor, MC testicular ca, +ALP, fried egg pathology
|
|
|
yolk-sac tumor
|
elevated AFP tumor
|
|
|
Bartter syndrome
|
polyuria, polydipsia, growth/mental retardation
defective NaCl reabsorption in TAL --> RAS activation, hypokalemia, high Ucl, metabolic alkalosis |
|
|
legionella
|
atypical pneumonia + GI sx + mild LFT elevation + hyponatremia
|
tx: quinolones
|
|
wegener's (granulomatous vasculitis)
|
vasculitis, lung granulomatous inflammation, glomerulonephritis
|
tx: cyclophosphamide, steroids
|
|
addison's
|
weight loss, hyperpigmentation, hypotensive
causes: autoimmune, TB, mets, post-steroid tx, CMV, mets, fungal infection |
dx: cosyntropin (ACTH) stim test
tx: IV hydrocortisone |
|
toxic MC
|
dilated colon, fever, tachy, leukocytosis, vol depletion, AMS, hypotension, altered electrolytes
|
dx: AXR
tx: bowel rest, NG, IVF, cipro/metro |
|
indinavir (protease inh)
|
HIV med causing crystal-induced nephropathy
|
|
|
NRTIs
|
HIV meds causing lactic acidosis, SJ syndrome
|
|
|
abacavir (NRTI)
|
HIV med causing hypersensitivity
|
|
|
nevirapine (NNRTI)
|
HIV med causing hepatotoxicity
|
|
|
cyclophosphamide
|
immunosuppressant r/o hemorrhagic cystitis, bladder ca
|
|
|
tacrolimus
|
immunosuppressant w/ AE nephrotoxicity
|
|
|
azathiopine
|
purine analog w/ AE diarrhea, leukopenia, hepatotoxicity, pancreatitis
|
|
|
mycophenolat
|
immunosuppressant w/ AE marrow suppression
|
|
|
nocardia
|
aerobic G+ acid-fast branching rods
|
tx: TMPSMX
|
|
actinomyces
|
anaerobic G+ branching bacteria, yellow sulfur granules
|
tx: IV pen
|
|
urge incontinence
|
can't make it to bathroom in time, spastic contractions of bladder
|
tx: TCAs, anticholinergics (oxybutynin), behavioral tx (frequent voiding)
|
|
stress incontinence
|
incontinence due to pelvic weakness
|
tx: Kegels, pessary
urethropexy (urethral support) indicated if swab in urethra moves >30deg w/ intraabdominal pressure indicating urethral hypermobility |
|
overflow incontinence
|
>100mL post-void from obstruction or inadequate contraction
|
tx: self-catheterization, cholinergics to increase bladder contraction, a-blockers to reduce spinchter contraction
|
|
neurogenic
|
constant leakage
|
tx: urination schedule
|
|
acyclovir
|
antiviral w/ AE of crystalline nephropathy
|
need to ppx w/ IV hydration
|
|
threatened abortion
|
hemorhage <20wks w/ living fetus, closed cervix
|
tx: reassure
|
|
inevitable abortion
|
vag bleeding, lower ab cramps, u/s shows ruptured sac w/o fetal heart tones
|
tx: suction evacuation
|
|
missed abortion
|
dead fetus retained, disappearance of n/v
|
tx: d/c is <14wks, deliver if >14wks
|
|
complete abortion
|
expulsion of all POC
|
tx: serial hCG to make sure goes to zero
|
|
A-M
|
bb that are cardioselective
|
|
|
colloid
|
IVF containing albumin
used in burns/hypoproteinemia |
|
|
crystalloid
|
IVF not containing albumin (ex: NS)
|
|
|
cholesteatoma
|
hearing loss, ear d/c despite abx, granulation tissue, skin debris
= epidermal cyst |
tx: mastoidectomy
|
|
ehrlicosis
|
tick borne dz causing leukopenia, thrombocytopenia, elevated LFTs
"spotless RMSF" |
tx: doxy
|
|
measles (rubeola)
|
Koplik spots, paramyxovirus, maculopapular rash from forehead down, fever, malaise
|
tx: supportive, vit A
|
|
fibromyalgia
|
nl ESR/EMG
point tenderness over muscles |
tx: antidepressants, NSAIDs
|
|
polymyositis
|
ESR/EMG abnl
|
tx: CS
|
|
polymyalgia rheumatica
|
muscle weakness in elderly women
extremely elevated ESR a/w TA |
tx: CS
|
|
Beckwith-Wiedmann
|
infant w/ macrosomia, macroglossia, visceromegaly, omphalocele, hypoglycmeia, hyperinsulinemia
|
|
|
congenital hypothyroidism
|
infant w/ hypotonia, macroglossia, macrocephaly, umbilical hernia
MCC thyroid dysgenesis |
|
|
maternal diabetes
|
infant w/ caudal regression, TGA, duodenal atresia, NTDs
|
|
|
WAGR
|
infant w/ Wilm's tumor, aniridia (absence of iris), GU anomaly, retard
|
|
|
Fragile X
|
large head, long face, prominent forehead, protruding ears, joint laxity, big balls
CGG repeats from FMR mutation |
|
|
FAS
|
retard, hypoplastic maxilla, long philtrum, microcephaly
|
|
|
tricuspid atresia
|
infant w/ LVH, a/w VSD, hypoplastic RV
|
tx: PG to keep PDA, arterial septoplasty to keep ASD open
|
|
Ebstein's anomaly
|
infant w/ enlarged RA, downward displaced tricuspid
|
|
|
neonatal abstinence to opiates
|
newborn w/ irritability, high-pitched cry, poor sleeping, tremors, seizures, sweating sneezing, tachypnea, poor feeding, vomiting/diarrhea
|
tx: morphine
|
|
neonatal exposure to phenytoin (fetal hydantoin syndrome)
|
neonate w/ nail/digit hypoplasia, dysmorphic facies, MR
|
|
|
spondylolisthesis
|
fwd slip of vetebrae in pre-adolsecent --> back pain, neuro dysfx, step off @ lumbosacral area
|
|
|
IgA deficiency
|
MC primary immunodeficiency, anaphylaxis after Ig exposure (ex: tranfusion)
recurrent Giardia infections |
|
|
Bruton's agammaglobulinemia
|
XLR, B cell deficiency, recurrent lung/sinus infections
|
dx: decreased IgG, A, M, E
|
|
DiGeorge's
|
microdeletion of Chr 22q11, hypoplasia of 3rd/4th pharyngeal pouches (thymus, PTs), cyanotic heart dz
recurrent viral/fungal infections |
|
|
SCID
|
adenosine deaminase deficiency, B&T cell deficiency --> viral/fungal/bacterial infections
|
|
|
WA
|
XLR, infections, thrombocytopenia, eczema
|
|
|
Chediak-Higashi
|
MT defect, albinism
giant lysosomes in neutrophils |
tx: daily TMPSMX, Vit C
|
|
CGD
|
NADPH oxidase defect --> recurrent infections w/ catalase + (S.aureus, Pseudomonas)
|
dx: +NBT dye reduction = lack respiratory burst
|
|
chronic mucocutaneous candidiasis
|
candida infections to scalp/skin, a/w hypo TH
|
|
|
Hyper IgE (Jobs)
|
recurrent staph infections, fair skin, red hair, eczema, eosinophilia
|
|
|
Von Gierke' (G6phosphatase def.)
|
deficient G6phosphatase --> hypoglycemia, lactic acidosis, hyperuricemia, hyperlipidemia, doll-like face, thin extremities, protuberant abdomen
|
|
|
Pompe's (acid maltase def.)
|
floppy baby, hepatomegaly, macroglossia, heart failure
|
|
|
Glycogen debranching enzyme def.
|
hepatomegaly, hypoglycemia, hyperlipidemia, growth retardation, elevated LFTs, fasting ketosis, nl blood lactate
|
|
|
milk protein intolerance
|
neonate w/ bloody diarrhea, eosinophils in stool, FH of atopy
|
|
|
constrictive pericarditis
|
impaired diastolic fx --> elevated JVP
due to viruses, radiation, TB sharp x, y descents on CVP |
|
|
chronic hepC
|
waxing/waning of LFTs, arthralgias, cryoglobulinemia, porphyria cutanea tarda, glomerulonephritis
|
tx: IFNa, ribavirin
|
|
LAD
|
neutrophilia w/o PMNs in infected tissue
delayed umbilical cord separation, loss of teeth |
|
|
breastfeeding failure jaundice
|
neonatal jaundice within 1st week due to insufficient intake
|
tx: support good breast feeding
|
|
breast milk jaundice
|
neonatal jaundice extending into 3rd month from breast milk causes increase in enterohepatic ciculation
|
tx: temporarily stop breast feeding
|
|
transient synovitis
|
yellow/clear aspirate from joint after viral infection, pain on internal rotation, nl CBC/ESR
|
tx: NSAIDs
|
|
myotonic muscular dystrophy
|
afx all muscles, progressive muscle wasting, temporal wasting, upper lip V, delayed muscle relaxation, testicular atrophy, baldness
AD |
|
|
congenital syphilis
|
newborn w/ cutaenous lesions, jaundice, anemia, rhinorrhea, saber shins, Hutchinson teeth, saddle-nose deformity
|
|
|
bacillary angiomatosis
|
exophytic angioma caused by Bartonella
seen in immunocompromised |
tx: erythromycin
|
|
GBS
|
ascending muscle paralysis after viral infection
= autoimmune dz against myelin elevated protein in CSF a/w campylobacter |
tx: resp support (monitor w/ bedside VC), plasmapheresis, IVIg
|
|
frontal lobe lesion
|
apathy, inattention, disinhibition, labile affect
|
|
|
temporal lobe lesion
|
memory impairment, hyperaggression, hypersexuality
|
|
|
dominant parietal lobe lesion
|
inability to read/write/name/math
|
|
|
nondominant parietal lobe lesion
|
ignoring one side of body, trouble w/ dressing
|
|
|
Kallman's syndrome
|
hypogonadism + anosmia
|
|
|
Vit E def.
|
vitamin deficiency causing reduced proprioception/vibratory sensation, areflexia, ataxia, gaze palsy
|
|
|
Werdnig-Hoffman (infantile spinal muscular dystrophy)
|
floppy baby, degeneration of anterior horn cells
AR |
|
|
galactosemia
|
FTT, b/l cataracts, jaundice, hypoglycemia
due to G1P uridyl transferase deficiency |
tx: remove galactose/lactose from diet
|
|
HUS
|
mild hemolytic anemia, thrombocytopenia, renal failure, AMS, fever after 5-10d course of diarrhea
|
dx: schistocytes on smear
|
|
Gaucher's
|
b-glucosidase deficiency, chronic fatigue, ez bruisability, bone pain, pathologic fractures, HSM, anemia, leukopenia, thrombocytopenia
|
dx: flask deformity of distal femur, Gaucher cells in marrow (tissue paper)
|
|
Niemann-Pick
|
sphingomyelinase deficiency, FTT, HSM, protruding abdomen, cherry fovea
|
|
|
Tay Sachs
|
hexosaminidase ef., accumulation of GM2, cherry red fovea, MR, seizures
|
|
|
Farbers
|
ceramidase deficiency, bone pain, joint swellin
|
|
|
hypervitaminosis D
|
vitamin toxicity leading nausea, polyuria, polydipsia, hyperCa
|
|
|
Dandy-Walker
|
non-communicating hydrocephalus
cystic expansion of 4th ventricle |
|
|
Arnold-Chiari
|
non-communicating hydrocephalus
protrusion of posterior fossa through foramen magnum |
|
|
Friedrich's ataxia
|
spinocerebellar ataxia due to trinucleotide repeats, degeneration of cardiac muscle fibers, hammer toes, scoliosis
MCC COD cardiomyopathy |
|
|
thecal sac compression
|
cancer + incontinence + LBP
|
tx: GC before MRI
dx: MRI |
|
physiologic jaundice
|
jaundice occuring after first 24hr of birth
|
|
|
esophageal atresia
|
choking/regurg after first feed, gastric distention from air
|
|
|
TGA
|
cyanotic congenital heart dz, single loud S2, kept alive by AS/VSD/PDA/PFO
|
tx: PGE --> surgery
|
|
posterior limb of internal capsule
|
stroke causing pure motor hemiparesis
|
|
|
VPN thalamus (thalamic pain phenomenon)
|
stroke causing pure sensory deficit/pain
can present w/ hemiparesis/ballistic movements as well |
|
|
abruptio placenta
|
3rd trimester painful bleeding, ab/back pain, hypertonic/tender uterus, MIGHT NOT BLEED
RFs: HTN, trauma |
tx: deliver
|
|
laryngomalacia
|
floppy larynx, chronic inspiratory noise
|
tx: upright after feeds
|
|
Erb-Duchenne
|
C5-6 brachial palsy of newborn, lack of moro reflex, intact grasp of affected arm
waiter's tip |
|
|
Klumpke Paralysis
|
newborrn hand paralysis + ipsilateral Horner's
involvement of C8-T1 |
|
|
dysphagia due to motility problem
|
dysphagia w/ solids & liquids
|
dx: barium swallow
|
|
dysphagia due to obstruction
|
dysphagia w/ just solids
|
|
|
leprosy
|
hypopigmented anesthetized skin, peripheral n. damage causing atrophy
|
|
|
McCune Albright
|
precocious puberty, pigmentation cafe au lait, polyosteotic fibrous dysplasia
|
|
|
tuberous sclerosis
|
hypopigmented macules, seizures, MR, CNS hamartomas, increased r/o cardiac rhabdomyoma & renal angiomyolipoma
|
|
|
SIADH
|
euvolemic hyponatremia
|
tx: fluid restriction, demeclocycline
|
|
DI
|
euvolemic hypernatremia
|
tx: DDAVP, d5w
|
|
hypokalemia
|
electrolyte abnl causing muscle weakness, arrhythmia, T-wave flattening
|
tx: IV KCl, check Mg
|
|
hyperkalemia
|
electrolyte abnl causing, T-wave peaking
|
tx: IVF, Ca gluconate, NaHCO3, glucose, insulin
|
|
hypocalcemia
|
electrolyte abnl causing tetany
|
tx: check albumin (1g/dL drop in albumin --> 0.8mg/dL drop in Ca), give Ca gluconate
|
|
hypercalcemia
|
electrolyte abnl causing stones, bones, moans, groans
|
tx: IVF, furosemide (causes hypoca)
|
|
caput succeedanum
|
neonatal cerebral edema crossing suture lines
|
tx: reassure
|
|
cephalohematoma
|
neonatal cerebral edema that doesn't cross midline
|
tx: CT to r/o fracture, reassure
|
|
RU486
|
P antagonist, single dose effective after 72h, causes endometial degeneration and separation of trophoblast
|
|
|
Plan B (progesterone) = Levonorgestrel
|
2 high dose progesteron within 120hr of fucking
|
|
|
Ramsey-Hunt syndrome
|
zoster causing Bell's palsy
|
|
|
partial seizure w/ 2ndary generalization
|
focal seizure w/ LOC + tonic-clonic
|
|
|
complex partial seizure
|
focal seizure w/ just LOC
|
|
|
simple partial seizure
|
focal seizure w/o LOC
|
|
|
Calcium oxalate stones
|
most common stones, envelope shaped, can be caused by ethylene glycol
|
tx: hydration (>2L/d), thiazides, decrease protein/uric acid/Na
stones <5mm tend to pass spontaneously w/ conservative mgmt |
|
ammonium MgPO4 (struvite) stones
|
caused by urease positive bugs (Proteus, Staph, Klebsiella), staghorn calculi
|
|
|
CVID
|
nl # Bs but rduced IgG, A, M, E
|
|
|
medial medullary syndrome
|
contralateral hemiparesis, contralateral loss of proprioception, ipsilateral paralysis of hypoglossal n.
afx ASA |
|
|
lateral medullary syndrome (Wallenberg)
|
contralateral loss of p/t, ipsilateral Horner's (CN3 sympathetics), ipsilateral facial pain (CN5)
afx PICA |
|
|
riboflavin deficiency
|
vitamin deficiency affecting mucus membranes, photophobia, anemia
|
|
|
sick sinus syndrome
|
SA node dysfx
|
|
|
Kawasaki's
|
fever, conjunctivitis, inflamed/fissured lips, conjunctivitis, strawberry tongue, desquamative rash on palms/soles
leads to HF and coronary aneurysms suspect in any kid w/ MI necrotizing vasculitis |
tx: IVIg, ASA
|
|
Scarlet Fever
|
exudative pharngitis w/ fever, sandpaper rash, strawberry tongue
|
tx: pen
|
|
homocystinuria
|
cystathione synthase deficiency
Marfan's, MR, thromboembolic, downward dislocation of lens |
tx: B6
|
|
Krabbe's
|
b-galactosidase def., myelin abscence, MR, blind, deaf, paralysis
|
|
|
Fabry's
|
reduced a-galactosidease, angiokeratomas, peripheral neuropathy, corneal dystrophy
|
|
|
ichthyosis vulgaris
|
dry, rough skin w/ horny plates over extensor surfaces
lizard skin! |
|
|
Diamond-Blackfan syndrome
|
congenital macrocytic RBC aplasia, short stature, webbed neck, cleft lip, shielded chest, triphalangeal thumbs
|
tx: CS, transfusion
|
|
Fanconi's anemia
|
AR, congenital marrow failure, macrocytic anemia, poor growth, abnl morphology, cafe-au lait, from chromosomal breaks
|
|
|
Waterhouse-Friedrichsen
|
infantile meningococcemia, vasomotor collapse, skin rash from adrenal hemorrhage
|
|
|
hemi-neglect syndrome
|
lesion to R (non-dominant) parietal lobe responsible for spatial organization
|
|
|
Pinzmetal's angina
|
CP @ rest due to coronary vasospasm
a/w smoking |
tx: CCBs
|
|
Paget's dz
|
increase in osteoblastic/osteoclastic activity --> abnl bone remodeling, increase ALP w/ nl Ca/PO4, elevated Uhydroxyproline, mosaic bone pattern, increase hat size, deafness, increase r/o osteosarcoma
|
tx: asx nothing
bisphosphonates to prevent osteoclastic activity if sx |
|
serum-sickness syndrome
|
fever, hives, rash, polyarthralgia, LAD 1wk after pen or amoxicillin
not a true drug allergy |
|
|
constrictive pericarditis
|
sharp x, y descents on central venous tracing
only impaired diastolic filling caused by viruses, radiation, TB |
|
|
ecthyma gangrenosum
|
nontender nodules w/ central necrosis seen in immunocompromised
Pseudomonas |
|
|
HSV encephalitis
|
~ meningitis, temporal lobe involvement
CSF: increased WBC, protein, RBC |
tx: aciclovir before cx
|
|
pemphigus vulgaris
|
mucosal involvement, IgG against desmosomes, +Nikolsky's, paraneoplastic
|
tx: azathioprine
|
|
bullous pemphigoid
|
IgGs against hemidesmosomes, - Nikolsky's, spares oral mucosa
|
tx: CS
|
|
secondary hyperPTism
|
increased PTH from reduced Ca caused by CRF
|
|
|
scleroderma
|
anti-centromere, anti-topo, anti-Scl-70
|
|
|
drug-induced SLE
|
anti-histone
|
|
|
PBC
|
anti-mito abs
|
|
|
autoimmune hepatitis
|
anti-SM abs
|
|
|
atopic dermatitis
|
erythematous, scaly rash
found on flexural surfaces |
tx: antihistamines, topical steroids
|
|
dyshydrotic eczema
|
pinhead sized vesicles in pts that wash hands frequently
|
|
|
nummular eczema
|
coin shaped eczema on back & lower extremities
|
|
|
psoriasis
|
silvery scaly plaques
|
tx: topical CS
|
|
Fe toxicity
|
GI hemorrhage, shock, metabolic acidosis, hepatic failure from OD
|
|
|
vascular dementia
|
sudden onset dementia, stepwise loss
|
|
|
Lennox-Gastaut seizures
|
childhood seizures < 7, slow spikes of EEG
|
|
|
Juvenile Myoclonic Epilepsy
|
teenager seizures, usu when waking up, worsened by sleep deprivation
|
|
|
myelodysplasic d/o
|
macrocytic anemia, thrombocytopenia, leukopenia
|
|
|
bullous impetigo
|
honey crusted skin lesions, S.aureus/GAS
|
tx: mupirocin, bactrim
|
|
HS
|
AD, splenomegaly, pigmented gall stones, elevated MCHC, negative Coombs
|
dx: osmotic fragility
tx: FA supplementation to prevent parvo infection, splenectomy (need daily pen ppx for 5yrs after splenectomy) |
|
placenta previa
|
painles 3rd trimester bleeding
RFs: multiparity, advanced maternal age |
dx: U/S
tx: c/s |
|
placenta abruptio
|
PAINFUL (ab/back) 3rd trimester bleeding (might not bleed), hypertonic/tender uterus
RFs; HTN, trauma |
tx: deliver
|
|
Bartholin gland abscess
|
pain @ 4&8 o'clock of vag
|
tx: I/d
|
|
posterior uveitis
|
eye redness, photophobia, pain, inflammation of choroid, can result in retinal detachment
|
|
|
langerhans cell histiocytosis
|
single lytic bone lesion + hyperca w/ pain & swelling
|
tx: conservative
|
|
Shy-Drager (multiple system atrophy)
|
Parkinson's + autonomic insufficiency
|
tx: intravascular expansion w/ fludrocortisone, salt, alpha agonists
|
|
Riley-Day syndrome
|
familial dysautonomia
|
|
|
pulmonary contusion
|
patchy alveolar infiltrate (white out) s/p chest trauma
hypoxemia worsened by volume expansion |
|
|
Fe intoxication
|
intoxication causing GI hemorrhage, shock, metabolic acidosis, hepatic failure
radioopaque on XR |
|
|
myocardial contusion
|
a/w sternal fractures, elevated PCWP after fluid bolus, + cardiac enzymes
|
dx: get EKG for r/o arrhythmia
|
|
digoxin toxicity
|
toxicity causing blurred vision, disturbed color perception, headache, ab pain
|
tx: stop dig, normalize K, lidocaine, anti-dig Fab frags
|
|
TIA
|
focal neuro deficit lasting <24h
|
prevention: ASA
|
|
fat necrosis of breast
|
benign foamy macrophages/globules on path, skin retraction, calcification on mamo
|
dx: bx
tx: none |
|
Edward's syndrome
|
trisomy 18, rocker bottom feet, VSD, closed fists, index overlapping 3rd&4th, mcirongathia, microcephaly
|
|
|
Patau's syndrome
|
trisomy 13, hypotelorism, polydactyly, scalp dfx
|
|
|
suppurative hidradenitis
|
chronic folliculitis of groin/axilla
|
|
|
Bowen's dz
|
SCC insitu of skin
|
|
|
histo
|
palatal ulcers, HSM, pancytopenia
along Missouri/Ohio r., bat exposure |
dx: serum/urine ag
tx: itraconazole |
|
blasto
|
soil/rotting wood east of Mississippi R., skin/bone lesions
|
|
|
NF2
|
cafe au lait spots, acoustic neuroma
|
dx: MRI w/ gadolinium
|
|
ASA intoxication
|
intoxication of fever, tinnitus, tachypnea, metabolic acidosis, resp alkalosis
|
|
|
erysipelas
|
butterfly swelling of face of abrupt onset, well demarcated, caused by GAS
|
tx: diclox
|
|
acute mediastinitis
|
widening of mediastinum after cardiac surgery, fever, CP, leukocytosis
|
tx: debridement + abx
|
|
pseudotumor cerebri
|
pulsatile headache/tinnitus, worse when lying flat, r/o blindness, mimics tumor, exacerbated by vit A, some have empty sella
|
dx: neuroimaging to r/o mass, MRA to r/o sinus thrombosis, LP to r/o infection (elevated opening pressure)
tx: LPs, shunt |
|
Paget's dz
|
infiltrating breast dz directly under areola affecting skin/lymphatics, ezcema of nipple
|
|