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85 Cards in this Set
- Front
- Back
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Mitral valve prolapse
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Asymptomatic mid systolic click usually seen in a woman
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Bicuspid Aortic valve
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Main cause of Aortic stenosis
Systolic murmur with an opening click |
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Congenital pulmonary stenosis
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Systolic murmur w/ opening click
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Tricuspid Regurgitation
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Systolic murmur that increases with inspiration
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Ruptured papillary muscle
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Systolic mitral regurg murmur that radiates to the axilla 5 days post RCA MI or endocarditis.
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ALL
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-Leukemia of kids(0-15)
-Check via tdt -Low platelets but leukocyte count is normal -Marrow is hypercellular w/ many blasts and needle shaped Auer rods |
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AML
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-Middle aged leukemia(15-40)
-Low platelets but leukocyte count is normal -Marrow is hypercellular w/ many blasts and needle shaped Auer rods |
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CML
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-Middle aged leukemia(40-60)
-Platelet count(N to high) but leukocyte count>500K -Philadelphia chromosome 9q to 22q balanced translocation(abl-bcr) -Marrow shows mature lymphocytes |
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Leukemoid reaction
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-Leukocytes elevate rapidly in response to infection(up to 50k)
-High leukocyte alkaline phosphatase differentiates this from CML/AML(where it is low) |
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Herniated disk
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L4-L5(L5)
-Groin & hip pain -Poor biceps femoris reflex L5-S1(S1): -sciatica(pain on straight leg raise) -Poor achilles reflex -Poor plantar flexion Tx: NSAID & bedrest x2days -If no improvement get MRI spine and do lumbar distectomy |
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SCID
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-No B or t-cells due to ADA deficiency
-No LN, tonsils, or thymic shadow |
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Ataxia telangiectasia
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multiple telangiectasias and ataxia
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di george
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-22q11 microdeletion causes failure of 3rd and 4th pharyngeal pouches to form.
-No thymus so get hypocalcemia(prolonged QT interval)and tetany,low set ears, T-cell deficiency |
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Selective IgA deficiency
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-B-cells do not differentiate so no IgA is made.
-Get anaphylactic transfusion reactions -Diagnose via serum electrophoresis |
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Bleomyacin AE
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Pulmonary fibrosis
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Cisplatin AE
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tinnitus,hearing loss, nephrotoxic
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Verapamil AE
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Headache and dizziness
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Mithramycin AE
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HUS(thrombocytopenia, ARF, Neuro changes and fever)
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Vincristine AE
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Peripheral neuropathy
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Microcytic anemia
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"TICS"
Thalessemia Iron def (TIBC up) Chronic disesae(Ferritin up) Sideroblastic(Fe/ferritin up) -lead: wrist drop, encephalopathy, epiphyseal deposition, serum protoporphyrin>35, basophillic strippling -INH -chloramphenicol |
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Actinic Keratosis
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-Precursor to SCC
-White scaly plaques at sunexposed areas. -Biopsy and find dysplasia that does not invade dermis |
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Squamous cell Cx
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Erythematous and crusting/ulcerating lesion.
Excisional Biopsy shows anaplasia invading dermis |
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Basal cell Cx
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Pearly & umbilicated
Excisional biopsy shows palisading cells |
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Melanoma
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Will morph quickly and just excise.
Diagnose via ABCD: asymmetrical border irregular color changes diameter>.6cm |
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Typical pneumonia in elderly or COPD
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Gram negative diplococci (moraxella cattharalis)
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Hepatitis types
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High Bili(jaundice)
ALT>AST Fever A&E: fecal to oral BCDEG: Parenteral A: Daycare vowel that hits the bowel B: Asia -HbsAg=chronic -Anti-Hbs Ab=vaccinated or had it previously -Anti Hbc=Acute C: Chronic, cirrhosis,Cx and dx via RIBA if strong clinical suspicion but ELISA is negative D: Dependent on HbSAg, Drugs(IV),Defective RNA E: Vowel hits bowel and expectant mother may die in burma,india,mexico G: Dialysis or IV drugs |
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Watery diarrhea
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E.coli: Activates cyclic AMP
Staph Aureus: custards or mayo Campylobacter B. Cereus: Fried rice V.Cholarae: Rice water stools |
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When to do further diarrhea workup and what
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If bloody, fever or >4 days.
Examine stool for: -O&P -Culture -Leukocytes -C.dificile toxin |
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Bloody diarrhea
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Salmonella/Shigella
E.coli/ Yersinia enterolytica Campylobacter jejeni Entamoeba Histolytica |
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EKG & how to tx
-hyperkalemia -hypokalemia -Hypercalcemia -Hypocalcemia -Ischemia |
High K+= T-waves=Ca gluconate
Low K+= U waves=Oral K+ High Ca: Short QT Low Ca: Long QT Ischemia: ST depression, inverted t-wave, st elevation |
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Cluster headache
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-Multiple Periorbital attacks at night.
-Get conjunctival injection and lacrimation. -Tx w/ oxygen & sumatriptan |
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Migraine headache
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Unilateral with photophobia and last for hours.
Tx: Sumatriptam |
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Tension headache
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Tight band around the head that is most tense at the back of the skull
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Sarcoidosis
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-20-40 black
-b/l hilar adenopathy w/ non-caseating granulomas -Erythema nodosum @ shins, arthritis Tx: Prednisone |
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Berger disease
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IgA Nephropathy
Get micrscopic hematuria after URI. -Have elevated IgA in body that binds to mesangium. -HSP is similar but it has arthritis, abd pain and LE rash |
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Goodpasture syndrome
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TYPE II HS(Ab mediated)
Hemoptysis and hematuria with a linear pattern of anti collagen Ab seen on IF of GBM. -Have IDA and sputum w/ hemosiderin laden macrophages -Tx is plasmapheresis and steroids |
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Wegeners
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Necrotizing-granulomatous vasculitis
-c-ANCA(anti proteinase 3Ab) -Like Goodpasture(hematuria & hemoptysis & nosebleeds) Tx: Give cyclophosphamide or steroids |
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Post infectious Glomerulonephritis
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Post strep sore throat get hematuria(coca cola), edema & htn
C3 Low ASO high Lumpy bupy IF pattern Tx: Supportive |
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Causes of nephritic syndrome
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Wegener/Goodpasture
Post infectious GN Bergers |
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Minimal change disease
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Lose -ve charge on GBM and get nephrotic syndrome, edema and high lipids.
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Allopecia Arreata
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Loss of hair in sporadic areas secondary to AI disease -Hashimoto
-Pernicious anemia, -Addisons Get lymphocytic infiltrate around hair shaft. Treat with topical corticosteroids |
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Trichotillomania
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Get psych consult and will have unilateral missing hair and it will be trying to grow back
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Diverticulitis
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LHS appendicitis
Tx: NPO or liquid diet + cephalexin. Barium or Colonoscopy in 2 weeks to confirm diverticula. Surgery if necessary. |
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Visual Pathway defects
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hemianopsia: optic glioma or optic neuritis(seen in MS) or Retinal A occlusion.
Bitemporal hemianopsia: pit adenoma or craniopharyngioma homonomous hemianopsia: Occipital: Spare macula Parietal: Lose Lower quarter Temporal:Lose upper(T for top)quarter |
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H.pylori
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Gram negative that can cause gastritis, PUD, gastric lymphoma, gastric cx
Detect with serum IgG & igA or urease test on gastric mucosal biopsy eradicate w/ clarithromyacin, metronidazole,omeprazole Make sure it is gone with urea breath test |
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ALS
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Lower motor neuron degeneration of middle ages(40-50)
-muscles waste and fasciculate -foot drop, wrist clumsiness -Get dysphagia, dysarthria later Dx: Biopsy see denervation,renervation **In kids called werdnig hoffman(spinal muscular atrophy) and can move EOM and sphincter only** |
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Guillian Barre
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AI peripheral nerve demyelination seen 1 week after URI or immunization.
Ascending paralysis & weakness(LE then UE) CSF norm but has high protein Tx: plasmaphoresis |
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Myasthenia gravis
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Anti Ach receptor Ab in women 20-40.
Biopsy normal Get weak at end of day,ptosis and diplopia. Erdophonium/tensilon test(short acting AchE inhibitor) and should get better. Tx: Pyridostigmine(long acting AchE inhibitor) & removal of thymus(get thymomas). |
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Charcot marie tooth
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LE wasting and distal muscle weakness w/o fasciculations
Kid disease and into 20's |
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Coartation of Aorta
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UE HTN, LE hypo, just proximal to L. Subclavian
rib notching + association with turner and cerebral aneurysm later in life if not repaired |
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Porphyria
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3 types all treated w/ heme b/c can't make it:
1) Intermittant: N-V-D & abd pain on and off that mimics acute abdomen. Dx: Urine porphyrin(high D-ALA) 2) erythropoetic: painful skin & swelling at sun exposed areas Dx:serum or erythrocyte porphyrin 3) Cutanea tarda: Painful blisters at sun exposed regions Dx: All porphyrin(urine/feces/serum/erythrocyte) |
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DIC
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High D-dimer, High PT & PTT
Low fibrin and all other factors See schistocytes |
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ITP
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Thrombocytopenia after viral infection
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TTP
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Thrombocytopenia, ARF, Microangiopathic hemolytic anemia(Coombs -ve, schistocytes, helmet, high LDH), fever, neuro changes
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Evans syndrome
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TTP with Coombs +ve hemolytic anemia
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Euthyroid sick syndrome
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clinically Euthyroid but have abnormal TFT's
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Subacute thyroiditis
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Goiter that is painful post viral infection.
Tx: NSAID |
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Hashimoto
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-female w/ other AI diseases
-hypo -anti thyroid peroxidase Ab(anti-microsomal). |
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Left main coronary artery>80% stenosis
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Need CABG b/c angioplasty CI as it cuts off blood to heart when balloon filled
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IBD
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malaise, non-bloody diarrhea, abdominal cramps & low grade fever.
2 types both Dx w/ colonoscopy & biopsy: Crohn: All over(esp mouth) w/ fissure,fistula,skip lesion, well demarcated & cobblestone. -Low chance of Colon Cx -Granulomatous disease -RLQ pain from terminal illeum involvement Tx: steroids UC: Only colon & Rectum, pseudopolyps w/ high chance of colon Cx Tx: Steroids & sulfadiazine |
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Pseudomembraneous colitis
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C.dificile after antibiotics
-Green and foul smelling -Green/white patches in colon on scoping Tx: Metro/vanco |
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Mesenteric Ischemia
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Bloody diarrhea w/ abdominal pain. Can be post angioplasty.
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Hematemesis in alcoholic w/ liver disease
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Probably varice. Find w/ EGD and do banding, vasopressin & sclerotherapy. If this fails use balloon tamponade. Finally if all else fails do TIPS
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Myelofibrosis
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Marrow fibrotic so see extramedullary hematapoesis and spleen is very large w/ tear drop cells on smear.
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CLL
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High WC count and lymphadenopathy in patient 65+.
See smear cells on biopsy. |
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Leukemia age ranges
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ALL:0-15(Auer rod)
AML:15-40(Auer rod) CML:40-65(philly 9q to 22q;bcr-abl) CLL:65+(smudge) |
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Budd Chiari Syndrome
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-Someone who is hypercoagulatable who gets large clot in IVC so get ascites and LE swelling rapidly(2mo vs cirrhosis= years).
-Liver will be smooth(vs cirrhosis nodular) -Will not have JVD b/c of clot Tx: Anticoagulate Hypercoagulatable states: -Factor 5 leyden -Protein C&S def -AT3 def, -Polycthemia -Antiphospholipid Ab -SLE -Pregnant or BC |
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Necrotizing fascitis
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Get laceration then GAS infection all over and signs of septic shock. Skin will be dusky and will have loss of T.Pain and crepitus.
Tx: I&D surgery |
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Primary sclerosing cholangitis vs Primary biliary cirrhosis
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Primary sclerosing Cholangitis
-Young w/ IBD -Jaundice -Itch Get intra and extrahepatic biliary tree fibrosis seen as dilatation and strictures on ERCP. Do liver biopsy to confirm and you will see periductal fibrosis. Primary biliary cirrhosis -Female -Itch -Jaundice -Anti Mito Ab -Only affects INTRA-hepatic ducts. Tx: Cholystyramine |
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Psoriasic Arthritis
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Seen with psoriasis and is in DIP joint w/ nail piting and onchyosis
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Pseudogout
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Swollen monoarticular joint(usually knee) that will have white speckles @ articular cartilage on x-ray due to Ca pyrophosphate crystal deposition. These crystals are weakly birefringent and widen the joint space.
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VSD
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Systolic murmur at Left sternal border. If pulmonary to systemic flow ratio <1.5 leave alone and just give prophylactic Abx before procedures to prevent infective endocarditis.
If P:S ratio >1.5 then may cause pulm HTN-RVH-RH failure & shunt could reverse so surgically repair. |
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Anthrax
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Gram +ve encapsulated rod
Exposure to sheep/cattle/goats papule to vessicle to black eschar within 2 days Pen G |
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Rabies
-found in -Symptoms -treatment |
Coyote/Racoon/Skunk/bat
Hydrophobia & neurological 1)Clean wound w/ soap 2)Catch animal -wild=kill and look at brains -domestic=watch 3) Always give Ig and vaccine unless bitten by domestic animal w/ provocation. |
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Liseria
-Found in -Causes |
Unpasteurized milk,cheese,deli meats.
Miscarriage, premie labor, stillbirth |
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Diseases of Ticks
SS Tx |
RMSF(rickettsiae): East coast -headache,malaise,fever-chills
-Rash on extremities palm &soles that spreads to trunk and face Tx: doxy or chloramphenicol Lyme disease(Borrelia) -Ertythema chronicum migrans and migratory arthritis and bells palsy. Tx: Doxycycline or amoxicillin if pregnant |
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Diseases of rabbits
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Tularemia from tick on rabbit
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Diseases from birds
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Chlamydia Psittaci atypical pneumonia
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Diseases from uncooked pork
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1) Toxoplasmosis(cats too)
-Intracranial calcifications -Chorioretinitis -hydrocephaus 2) Trinchella spiralis (trichinosis) -fever -muscle pain -eosinophilia -periorbital edema 3) Cysticercosis(T.solium) -Seizure w/ ring enhancing lesion on CT |
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Diseaes from uncooked salmon
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diphylabothrium latum(B-12 def)
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Disease from canned food
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Botulism(anaerobic)
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Megaloblastic anemia
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Hypersegmented neutrophils
Folate: alcohol-phenytoin-phenobarbitol B-12(neuro): -pernicious post gastrectomy -Malabsorption post terminal illeum recetion -D.latum=uncooked salmon |
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Metatarsal stress fracture
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Seen in runner. Just gie bedrest b/c x-ray will not pick it up.
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Ischemic colitis
SS Dx Tx |
Abd pain and bloody diarrhea in 60-80 year old
Dx: Barium enema see narrow lumen from edematous mucosa and air in bowel wall. Surgical resection |
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Syndromes that are p-ANCA +ve
(Anti-myeloperoxidase Ab) |
1) churg strauss: Asthmatic w/ eosinophilia & lung granulomas that have eosinnophils
2) Polyarteritis Nodosa: Fever, abd pain, wt loss, renal dysfunction, peripheral neuropathy |
