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641 Cards in this Set

  • Front
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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