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610 Cards in this Set

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Cardinal Symptoms of Cardiovascular Disease
•Chest pain or discomfort
•Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, wheezing
•Palpitations, dizziness, syncope
•Cough, hemoptysis
•Fatigue, weakness
•Pain in extremities with exertion (claudication)
Components for differential diagnosis of palpitations
•Atrial or ventricular extrasystoles (extra beats)
•Ventricular or supraventricular tachyarrhythmias
•Anatomic abnormalities such as mitral valve prolapse
NYHA Class I
No limitation of physical activity; no symptoms with ordinary exertion
NYHA Class II
Slight limitation of physical activity; ordinary activity causes symptoms
NYHA Class III
Marked limitation of physical activity; less than ordinary activity causes symptoms; ASYMPTOMATIC at rest
NYHA Class IV
Inability to carry out any physical activity without discomfort; SYMPTOMATIC at rest
Acyanotic congential heart disease with a Left-to-Right shunt
•Atrial Septal defect
•Ventricular septal defect
•Patent ductus arteriosus
Acyanotic congenital heart disease without a shunt
•valvular defects (can be valvular, subvalvular, or supravalvular)
•Coarctation (narrowing) of the aorta
Cyanotic congential heart disease
•Causes decreased pulmonary blood flow
•Tetrology of Fallot
Coarctation of the aorta
•Fibrotic narrowing of the aortic lumen
•Produces obstruction to LV outflow → LV hypertrophy develops to maintain SV in the face of increased afterload
Most common extracardiac abnormality with coarctation of aorta
aneurysm of Circle of Willis
Pulmonic Valve Stenosis results in:
Results in RV hypertrophy
Physical exam findings in pulmonic valve stenosis
•Physical Exam may reflect right ventricular lift, normal S1, opening click, systolic murmur best heard at left upper sternal border
Most common cyanotic congenital heart lesion in adults
Tetrology of Fallot
Components of Tetrology of Fallot
Pulmonic valve stenosis which causes right ventricular outflow obstruction
Ventricular septal defect (VSD) – allowing blood to pass between left and right ventricles; right to left shunt results from right ventricular hypertrophy
Overriding aorta across the VSD -- this aorta is between the left and right ventricles, directly over the VSD; As a result, oxygen poor blood from the right ventricle can flow directly into the aorta instead of into the pulmonary artery to the lungs
Right ventricular hypertrophy -- the right ventricle thickens because the heart has to pump harder than it should to move blood through the narrowed pulmonary valve
Atrial Septal Defect
Hole or defect in the atrial septum
Symptoms usually secondary to RV dysfunction (fatigue, dyspnea)
Ventricular septal defect
•Oxygenated blood from LV is shunted through the VSD into the RV
•If defect is large, RV dilates and pulmonary blood flow increases; if uncorrected, pulmonary vascular obstruction could ensue, causing right-to-left shunting and cyanosis (Eisenmenger’s complex)
Patent Ductus Arteriosus
This opening allows blood to flow directly from the aorta into the pulmonary artery, which can put a strain on the heart and increase the blood pressure in the lung arteries
•Physical exam reflects loud, continuous machinery-like murmur in left infraclavicular region
Most reliable enzymes reflecting heart damage
•Troponin I and T
Cardiac Enzymes
Creatine Kinase (MB)
Troponin I and T
Myoglobin
Lactic Dehydrogenase
Onset, Peak, Return to normal of Creatine Kinase (MB)
Onset: 6-12h
Peak: 24h
Normal: 3-4days
Onset, Peak, Return to normal of Troponin I and T
Onset: 1-3h
Peak: 24h
Normal: 14-15days
Onset, Peak, Return to normal of Myoglobin
Onset: 2h
Peak: 6-8h
Normal: 20-36h
Onset, Peak, Return to normal of Lactic Dehydrogenase
Onset: 24h
Peak: 3days
Normal: 8-9days
Echocardiogram
•Noninvasive technique to determine heart size, position, chambers, and velocity of blood flow
Indications for Echocardiogram
suspected valve, chamber disturbances, evaluation of pericardial effusion
Indications for cardiac MRI
examine size and thickness of heart chambers, determine extent of damage caused by MI or progressive heart disease
Contraindications for cardiac MRI
implanted metal devices pacemaker
pregnancy
Gold Standard for NONINVASIVE cardiac assessment
Echocardiogram
Indications for Cardiac catheterization
suspected myocardial ischemia and/or valvular abnormalities
Conditions associated w/ Mitral Valve Prolapse
o Marfan Syndrome
o Ehlers-Danlos Syndrome – Types I, II, and IV collagen disorders
o Rheumatic endocarditis
o Acquired collagen-vascular disorders
physiolgic consequences of Mitral Regurgitation
•Places volume overload on LV; LV responds with hypertrophy and dilation to increase SV; eventually LV dysfunction develops if volume overload is uncorrected
Symptoms of Mitral Regurgitation
o Dyspnea
o Orthopnea
o PND
Physiologic consequences of Mitral Stenosis
• Obstruction to LV inflow increases LA pressure and limits cardiac output; mitral valve obstruction increases the pressure work of RV, which is also adversely affected by the pulmonary hypertension that develops
Common cause of mitral stenosis
rheumatic fever
Physiologic consequences of Aortic Stenosis
• Pressure overload on the LV with compensation by LV hypertrophy; as disease advances, reduced coronary flow causes angina; hypertrophy and afterload excess lead to systolic and diastolic LV dysfunction
Physical exam findings in Aortic Regurgitation
o Quinke’s pulse = visible pulse in nail beds
o Corrigan’s pulse = bounding pulse
o Musset’s sign = head nodding with each heartbeat
o Hill’s sign = extremely elevated BP in lower extremities
o Austin Flint Murmur = diastolic “blowing” murmur
Quinke’s pulse
visible pulse in nail beds
Corrigan’s pulse
bounding pulse
Musset’s sign
head nodding with each heartbeat
Hill’s sign
extremely elevated BP in lower extremities
Austin Flint Murmur
diastolic “blowing” murmur
Physical exam findings in Pulmonic Valve Stenosis
o Palpable lift due to RVH
o Loud, harsh systolic murmur
o Murmur increases with inspiration
What are the three acyanotic congential heart diseases?
Atrial Septal Defect
Ventricular Septal Defect
Patent Ductus Arteriosus
What is the most serious complication of statin drugs?
Rhabdomyolysis
Action of Statins
o Inhibit synthesis of cholesterol by cells
o Lower LDL cholesterol
o Promotes LDL clearance
What are the 9 valvular diseases?
MVP
aortic stenosis
mitral valve stensosis
Mitral regurg
aortic regurg
tricuspid stenosis
pulmonary stenosis
What are the three signs and symptoms associated with Printz metals angina
Elevated ST,
Symptoms in the morning, Female less than 50
What are the three main coronary arterties assoc. with MI?
LAD, RCA, and circumflex
According to ATPIII (2002) a high risk pt. is what and what is your LDL goal?
2 or more risk factors and diabetes, CAD, peripheral disease
LDL goal is under 70
What are 4 EKG findings assoc. with MI?
Elevated ST
peaked T wave
Q wave development
then t wave inversion.
Hallmarks of acute bacterial endocarditis?
osler’s nodules
janeway lesions
roth spots on eyes
What are 7 lifestyle risk factors in hyperlipidemia?
Smoking , diet, sedentary lifestyle, alcohol, elevated Trig., low HDL, metabolic syndrome, HTN (130/85), waist circumference (35 for female, 40 for male), high blood sugar (over 110)
First line therapy for MI?
MONA= morphine, oxygen, nitroglycerine, aspirin
List Duke’s criteria for positive bacterial endocarditis.
2 majors
1 major and 3 minors
5 minors
Describe Duke's Major and Minor criteria for positive bacterial endocarditis
Major: 2 positive blood cultures and evidence of vegetation on prosthetic valve
Minor: predisposing condition, fever, immunologic signs (Osler's nodes, Roth spots, Janeway lesions), positive echo not meeting major criteria
What are 7 of the secondary causes of HTN?
Pheochromocytoma, kidney dz, diabetic nephropathy, thyroid dz (myxedema), drug reaction, stress, oral contraceptives.
What are three uncontrollable risk factors for ischemic heart disease?
Age, gender, family history
What are the 12 initial labs you are going to order to evaluate HTN?
TG’s, LDL, HDL (lipid panel), kidney function, liver function, thyroid test, echo, chest xray, UA, glucose, electrolytes, CBC
Whats the drug of choice for acute anginal attack?
Sublingual nitroglycerin
What antihypertensive medication would you avoid in a pt. with past history of asthma?
Beta-blockers
According to JNC 7 what are the four bp classifications and what are the systolic and diastolic readings for each?
Optimal (<120/80)
Pre HTN (120-139/80-89)
Stage I (140-159/ 90-99) Stage II (>160/100)
What are the 9 risk factors for thrombis or embolis?
Birth control, sedentary, blunt trauma, Afib, previous DVT or PE, post op lower extremity sx, hyercoaguable state, obesity
What are the 8 most common causes of acute pericarditis?
Infection (viral, TB, bacteria, fungal)
autoimmune
drug reaction
trauma
post MI
uremia
Which AV block is a gradual progression of the PR with at least one non conducted P wave?
Mobitz Type I (Weinkebach’s)
Describe the electrical conduction of the heart?
SA node, propogates to the atrium, AV node, Bundle of his, left and right bundle branches, perkinje fibers
What is the most common cause of acute bacterial endocarditis?
Staph. Aureus
What are the four systems to evaluate for end organ damage for HTN?
Kidneys (kidney failure, proteniur, hematuria)
Heart (cardiomegaly (LVH), ischemia, EKG changes)
Brain (stroke, hemorrhage, encephalopathy)
Eyes (copper wire, hemorrhages)
Drug of choice for HTN pt. with diabetes?
ACE Inhibitor
What is the intrinsic rate for SA node, atrial tissue, bundle of His and ventricles?
SA is 60 or greater,
atrial is 60 or greater
AV node is 50-60,
Bundle of His is 30-40 Ventricles are less than 30
Correlate the electrical components of the heart with the EKG
P wave is atrial depol.
QRS is ventricle depol.
T is ventricle repol.
PR interval is conduction through AV node
What is the classic EKG finding in most anginas?
ST depression (Printzmetals is the only one with elevation)
What are the 10 factors associated with the worst prognosis of HTN?
Obesity, hyperlipidema, end organ damage, smoking, diastolic blood pressure that is over 115, diabetes, African American, young, male, excess of alcohol intake
What is the most common cause of subacute bacterial endocarditis?
Strep. Viridans
What are the 5 general treatments for CHF?
Diuretics, Beta blockers, ACE-I, intrinsic agents, Vasodilators
What are the 3 types of cardiomyopathies and what is the most common?
Dilated, restrictive, obstructed hypertrophic and non obstructed hypertrophic. Most common is dilated.
Which arrythmia is classic for a saw tooth pattern?
Atrial Flutter
Describe four of the signs & symptoms of Raynaud’s?
Vasoconstriction in the hands, aggrevated by cold and stress, gangrene, tingling, white red and blue changes, clubbing of fingers, 2nd-4th decade, females greater than men, worse with smoking and beta
blockers
What is the tx. of choice for cardiac tamponade?
Pericardiocentesis
What are the best post MI management options?
Beta blockers, CCB, ACE I, identify the risk factors and control the risk factors, and anti platlet agents (aspirin)
What’s the primary organism in acute rheumatic fever?
Beta hemolytic Strep
In order to diagnosis PE what is the most noninvasive test?
Doppler Echo
Which AV block has every other P wave non conducted?
Mobitz Type II (2nd degree AV block)
What's Virchow’s triad?
Trauma to vessel, blood stasis and hypercoaguable state
Which AV block has every P wave conducted?
1st degree AV block
AV block where no P waves conducted and requires a pacer?
3rd degree
What antihypertensive med do u avoid in a pt. with hx. Of gout?
Thiazide diuretics
On Phys.Exam how would you differentiate ASD,VSD and PDA?
ASD is wide fixed
VSD is holosystolic left sternal murmur
PDA is loud continuous machinery murmur on left upper back
Gold standard for Pulmonary Embolism
Pulmonary Angiography
Gold standard for DVT?
venogram
Criteria of Metabolic Syndrome
Any 3 of:
Waist Circumf. (Men > 40in. Women >35 inches)
Triglycerides >/= 150
HDL (Men <40, Women <50)
BP >/= 130/85
Fasting glucose >/= 110
ATP III classification of triglycerides
Normal <150
Borderline High 150-199
High 200-499
Very High >/= 500
Pericarditis: physical findings
• Pericardial friction rub
– Scratchy, like creaking leather
– Best heard while patient sitting up, leaning forward, & in full expiration
Use of Jones Criteria
Diagnosis of Acute Rheumatic fever; Need 2 major or 1 major and 2 minor for diagnosis
Major and minor Jones Criteria for Acute Rheumatic Fever
Major criteria:
Carditis
Erythema marginatum and subcutaneous nodules Sygenham’s chorea
Polyarthritis
Minor:
Fever, polyarthralgias, reversible prolongation of the PR interval, rapid ESR rate, positive throat culture or rising streptococcal antibody titers
most common pathologic condition associated with aortic aneurysm
atherosclerosis
Cardiac causes of A. Fib
Sick Sinus syndrome
HTN
Valvular dz
Ischemic dz
Non-cardiac causes of A. Fib
Thyroid dz
Alcohol
COPD
3 problems caused by A. Fib
Thromboembolic events (clots and stroke)
Loss of atrial – ventricular synchrony (atrial kick)
Rapid Irregular Ventricular Rate
Mechanism of Atrial Flutter
A single reentrant wave of activity circles in the right atrium at ~ 300bpm
the AV node filters the atrial activity resulting in 2:1 or even 3:1 or 4:1 conduction
Most common arrhythmia in ASD pts
A. fib
2nd degree, Mobitz Type 2 AV block
At least one non-conducted P wave
No prior PR prolongation preceding block
3rd degree AV block
No conducted P waves
More P waves than QRS’s
Permanent pacemaker required if chronic
Etiology of Cardiac Tamponade
MEDICAL EMERGENCY!!compression of heart due to accumulation of fluid in pericardial sac which may lead to hemodynamic compromise
Signs & symptoms of Acute Cardiac Tamponade
Tachycardia
JVD
Distant heart sounds-also present in subacute
Pulsus paradoxus=Fall in systolic BP by >10mmHg with inspiration
Treatment for Cardiac Tamponade
pericardiocentesis
Physical exam findings of Dilated Cardiomyopathy
Enlargement of all cardiac chambers; hypocontractile heart
S3 gallop
Mitral regurgitation may be present due to LV dilation
2 common causes of dilated cardiomyopathy
Alcoholism
Peri-partum
Physical exam findings of Hypertrophic Cardiomyopathy
S4 gallop
Heart murmur:
Systolic
Increases with valsalva, standing, post-PVC
Decreases with squatting, beta-blockers
May be confused with aortic stenosis
General Principles of CHF Treatment
1. Diuretics
2. ACEI/ARB
3. B-Blockers
4. Spironolactone
5. Vasodilators
6. Inotropic agents
What drug improves survival rates for pt's post-MI?
Beta-Blockers
Most important test in diagnosing pericardial effusion
Echocardiogram
Treatment of pericardial effusion
percardiocentesis
Etiology of pericardial effusion
any cause of pericarditis can lead to pericardial effusion (abnormal amt. of fluid in pericardial space)
Describe Osler's nodes and Janeway lesions; What disease are they present in?
Osler's nodes = small tender nodules on the finger and toes
Janeway Lesions = small hemorrhages on the palms and soles
Seen in Bacterial endocarditis (acute and subacute)
Gold standard for diagnosing myocarditis
Biopsy of myocardium
Pt. complains of pain, erythema, swelling, swelling is inferior & Medial to the right lower lid, and sup. Lat. to the nose, what is the most likely diagnosis?
Dacryocystitis
What are the diseases that cause cotton wool spots?
Trauma, HIV, Diabetes, HTN
What are the four hallmarks for acute glaucoma?
Pain, steamy cornea, fixed dialated pupil, red eye
Lifeguard who does not wear sunscreen, has a yellow wedge shape growth on the lateral aspect of his eye, affects his cornea, but not the vision?
Pterygium
What are the six causes of vitreous hemorrhage?
Trauma, diabetes, HTN, detached retina, CRVO, bleeding disorders
A pt. presents with c/o red eyes, purulent discharge for three days, preauricular lymph nodes enlarged, what is diagnosis?
Bacterial Conjunctivitis
Open angle glaucoma is usually asymptomatic what is the primary signs you are looking for on physical exam?
Cup:disc ratio
What are the three most common organisms assoc. with bacterial conjunctivitis?
Staph Aureus, Strep. Pneumo, H. Flu
Acid burns to the eye have a better outcome than alkaline burns, what sign is a poor prognosis of an acid burn?
Blanching of vessels (white); the redder, the better
What are the 9 causes of red eye?
Conjuctivitis, corneal disease second. to trauma, allergic conjunctivitis, episcleritis, subconjuctivial hemorrhage, scleritis, dry eyes, ant. uveitis, acute glaucoma and blepharitis
Pt. presents with severe photophobia, pain and decreased vision in right eye, right pupil is injected and cells in ant. chamber on slit lamp exam what is the diagnosis?
Anterior uveitis
describe the pathway of the aqueous humor?
produced in ciliary body, travels to posterior chamber, thru pupil to anterior chamber thru trabecular meshwork to Canal of Schlemm
Which photoreceptor are responsible for differentiating colors?
Cones
Pt. complains of bloody appearance in sclera only after giving birth to baby two days ago?
Subconjuctival hemorrahage (anything that causes increased pressure)
What is the most common ocular complication of systemic steroids?
Posterior Subcapsular cataract
What is the systemic dz associated w/ dry eyes?
Sjogren’s syndrome
What is one of the major complications assoc. w/ hyphema?
Secondary glaucoma
What is the primary dz assoc. w/ Argyll Robertson pupil?
Tertiary syphilis
Drusen’s are assoc. with what disease?
AMD (age related macular degeneration)
What are the 7 causes of double vision?
Head injuries, cataracts, strabismus, lesions that affect CN 2, 4 and 6, amblyopia, misalignment of the eyes, masses or tumors
Define hyperopia and kind of lens do you use to correct it?
Far-sighted, use convex (plus)
What is the medical term for wall eyes?
Exotropia
What is the normal range for IOP?
13 +/- 3 mmHg
AMD (age related macular degeneration) is the leading cause of permanent blindness in the elderly what are two of the five risk factors assoc. with AMD?
Age over 50, smoking, female gender, family hx
What disease is the “cherry red spots” associated with?
Central retinal artery occlusion (CRAO)
Pt complains of nonpainful nodule on upper eyelid for 6 weeks?
Chalazion
What organism is most commonly assoc. hordeolum?
Staph. Aureus
What is the triad of Horner’s syndrome?
Myosis, ptosis, and ipsilateral anhydrosis
what is the cause of Horner's syndrome
Tumor in apex of lung compressing sympathetic chain
What are the eleven ocular conditions that are a result of blunt trauma?
Retinal detachement, hyphema, and vitreous hemorrahage, acute angle glaucoma, blow out fracture, subconjuctivial hemorrhage, diplopia, ruptured globe, blurred vision, lens dislocation and eye muscle swelling (myoedema)
What is the medical term for cross eyes?
Esotropia
Glaucoma is the leading cause of irreversible blindness in the world, what are the 4 risk factors?
Family history, age, elevated IOP, race
Which cranial nerve or nerves is responsible for ptosis?
CN III-Oculomotor
What are the 7 systemic dz’s assoc. w/ optic neuritis?
Multiple Sclerosis, Lyme Dz, Syphilis, Sarcoidosis, Wegner’s Granulomatous, SLE, Vit B12 Def
A lesion in the optic chiasm results in which visual field defect?
bilat temporal vision loss
Which CN is responsible for pupil reaction?
CN III- Oculomotor
A disease that gives you Beriberi is caused by a def. in what?
Vit. B1- thiamine
What are the 4 main signs and symptoms of a detached retina?
Flashing lights, curtain over vision, floaters, decrease in visual fields
Which CN is responsible for lid lag (closing of the upper eye lid)?
CN VII- Facial
Common child hood disease is varicella zoster, name the 5 ocular complications?
Conjunctivitis, swollen lids, vesicular lesions, uveitis, optic neuritis
What are the 7 conditions that predispose a pt. to corneal infection?
Corneal abrasion, contact lens wearer (no.1), trauma, structural eyelid abnormality, exotropia, esotropia, dry eyes, chronic epithelial disease, topical medication toxicity, immunosupression
Pt. presents with c/o painful red nodule on right upper lid for three days, no change of vision, what is most likely diagnosis?
Hordeolum
What are three of five symptoms for keratoconjuctivitis sicca?
Irritation, redness, dryness (this is dry, scratchy eyes)
What are the 3 CN responsible for eye movements?
CN III, IV, VI
What are the 2 most common organisms found in orbital cellulitis?
Step. Pneumonia, H. Flu
What are the 8 causes of papillodema?
HTN, cerebral tumor, abscesses, subdural hematoma, AV malformation, meningitis, encephalitis, subarachnoid hemorrhage
A pt. presents with red eyes, watery discharge for 2 days, no allergy symptoms, what is the most likely diagnosis?
Viral conjunctivitis
Which pathogen is a zanck smear used to detect?
Herpes
What is the most worrisome side effect of isotreniton (accutane)?
Birth defects- also want to test liver and lipids
Name the two pathogenic types of contact derm
Irritant and allergic (irritant will be more localized to where the thing touched the person)
Molluscum contagiosum- is it a wart?
No- it is a viral infection caused by the pox virus
Which bacteria is the most common cause of skin infection?
Staph. Aureus
Which skin lesion is associated with a pos. dimple sign?
Dermatofibroma
What is the most common cause of acute urticaria?
Allergic reaction
Hanson’s disease is also known as?
Leprosy
What disease process is characterized by skin that is smooth, ivory colored and tight along the fingers with violaceous streaks?
Scleroderma
What drug is usually associated with erythema nodosum?
Birth control pills- most commonly seen in young women- it is tiny red nodules on the tibia
What is the most common pustular skin eruption?
Acne vulgaris
Name a medical condition that is associated with really bad seb. Derm.?
HIV, Parkinson’s disease
Name the disease associated with the term spaghetti and meatballs
Tinea (any type) and it represents the budding hyphae
What is the name of the skin condition that will fluoresce coral red under the lamp?
Erythrasma
MOHS surgery is used to treat what?
Basal Cell Carcinoma
What is the proper medical term for a skin tag?
Acrochordon
What is the pathological condition of pulling all your hair out?
Trichlilomania
What is the rash of lyme disease called?
Erythema migrans
Name the disease characterized by superficial, stuck on honey colored crust?
Impetigo
What is alopecia totalis?
Loss of hair over the entire body
In dealing with topical steroids, category 1 is in low potency or super potency?
Super Potency
What is the most common cause of green nails?
Pseudomonas infection
What is the official dermatological terminology for slapped cheeks disease?
Fifth’s disease, erythema infectiosum, parvovirus (B19)
Which virus causes purpura of the hands and feet in children?
Parvovirus B19
In little kids, blisters on palm and soles of feet and sometimes in mouth (hand, foot and mouth disease) is caused by what virus?
Coxsackie virus
Broken shafts of hair are pathopneumonic for what condition?
Tinea capitis
What class of drugs is the most common cause of anaphylaxis?
Penicillins
Which class of drugs commonly causes angioedema?
ACE-I
What compound causes the most cases of contact derm?
Nickel
In atopic derm. which comes first, the rash or the itch?
The itch (it’s called the itch that rashes)
What derm. condition has either the Kevner’s phenomenon or the Auspitz’s sign?
Psoriasis- Auspitz’s is when you scrape it and underneath they have little tiny specks of bleeding. Kevner’s phenomenon is the predilection to lichenification
What is the diagnostic test of choice for a pt. presenting with a suspected syphilis chancre on his penis?
Dark field microscopy- look for spirochetes under the microscope
This lesion is flat, circumscribed skin discoloration that lacks elevation or depression?
Macule
In what stage of syphilis do you see neurologic symptoms?
Tertiary
Treatment for leprosy (Hansen’s Disease)?
Rifampin, Dapsone
What is the vector for leichmeniasis?
Sand fly
Give three cutaneous side effects from topical steroids?
Atrophy of skin, hypopigmentation, striae, increased incidence of infection
What are the 4 charc. Noted on a Tympanic Membrane exam?
Pearly grey tympanic membrane, landmarks (cone of light, malleus, umbo), intact Pars flaccida and Pars Tensa, make sure the tympanic membrane is mobile
What are the 12 systems you examine in a head and neck exam?
ears, nose, throat, thyroid, lymph nodes, sinuses, oral pharynx, nasal pharynx, larynx, face, neck scalp, skin, and neuro
Whats the frequency of the tuning fork you use for weber and renee?
512 mHz
Name 5 drugs that leads to ototoxic hearing loss?
Salicylates, asa, loop diuretics, erythromycin
What is bell’s palsy?
Idiopathic, unilateral facial droop. It’s sudden onset, usually after viral syndrome
What is the most common cause of conductive hearing loss in adults?
Cerumun impaction
Five indications of bilateral PE tubes?
Chronic OM lasting over 3 months, hearing loss over 30 decibles, 3 infections in 6 months, poor response to antibiotics, complications
5 complications to untreated OM?
sensiorneural Hearing loss, mastoidis, parotitis, labrynthitis, tympanic perforation, cholesteoma, meningitis, brain abcess
5 symptoms for cholesteoma?
Progressive conductive hearing loss, crusting form tympanic perforation, TM perforation, chronic ear infections
What are the 9 major causes of sensiorneural hearing loss?
Presbycupia, hereditary, occ. Noise exposure, oto toxicity of drugs, immune related, idiopathic, Menieres, infections
What is otomycosis and how is it treated
Fungal infection of the ears and treat with antifungals (topical)
What are the 5 ENT differential diagnosis for dizziness?
Meiniere’s, aucostic neroma, viral labryntthisi, benign parxosysml postional vertigo, migraines
What are the three most common causes of traumatic tympanic perforation?
Trauma (head slap), foreign body, gun fire
What is dix hall- pike maneuver used for?
This is testing for benign paroxysmal positional vertigo
What is the most common site for ant. Epistaxis and what is the most common cause?
Kesselbachs and trauma (digital)
What are salute signs and allergic shiners and first step for TX
Allergic Rhinitis and removing allergic agent (environment)
Why are younger children predisposed to Otitis Media
Their Eustachian tube is more horizontal and adult becomes wider and more angled.
What three organisms are most common cause of OM?
Strep Pneumo, H. flu, Moraxella Catarrhalis
Whats the first line of treatment for AOM
Amoxicillin or Augmentin
What is the Meinere’s triad?
Vertigo, tinnitus, progressive permanent hearing loss
What is the treatment for motion sickness
Scopolamine patch
What are three oral cancers of the oropharynx
Squamous cell carcinoma, leukoplakia, erythroplakia
What are the nine common causes of salivary gland enlargement?
Silothiasis, paromyxovirus (mumps), morten’s duct stones, tumors, TB, lead toxicity, alcoholism
What is Sampter’s triad?
Aspirin allergy, rhinitis (polyposis), asthma. Also watch these people for urticaria
What is thrush? Whats the most common cause in children? And how is it diagnosed?
It’s a yeast infection (oral candidiasis) and usually caused in children from overuse of antibiotics and diagnosed b/c you can scrape off with tongue depressor and do KOH stain
Whats the most common sinusitis and whats the three most common bacterial causes and whats the drug of choice?
Maxillary sinus. Strep. Pneumo, H. flu, Moraxella Catarrhalis, drug of choice is Augmentin or Amoxicillin
Pt. presents with trismus, uvular deviation, dysphonia, hot potato voice, drooling and fever, what is diagnosis?
peritonsillar abcess
tx is I&D
What are the 10 most common causes of hoarseness?
Laryngyl cancer, tonsillitis, vocal fold mucocele, nodule, polyp, cyst, hypothyroidism, sinusitis with Post nasal drip, GERD, recent intubation
What are the 6 signs and symptoms of Croup and whats the most common cause?
Barking cough, inspiratory stridor, fever, steeple sign, n/v, child b/w 3-6 yo, occurs in fall and winter Most common cause is parainfluenza.
S&S of epiglottis?
Drooling, tripod, appears ill. Most common organism is H. influenza. This is a medical emergency. Have to keep quiet
Which type of leukemia is identified by a smudge cell?
CLL
Which leukemia has the philidelphia chromosome?
CML
Which of the leukemias has the best cure rate?
ALL
What is the life span of the RBC in a patient with sickle cell?
14 days
What is the definitive test to diagnose sickle cell?
Hemoglobin electrophoresis
In the diagnosis of multiple myeloma what is the definitive abnormal protein that defines MM?
Bence Jones proteins in urine
What is the most common presenting symptom in patients with MM?
Bone pain
Name a drug that has received FDA approval to reduce breast cancer risks that are at increased risk for breast cancer?
Tamoxifen
What is the most common malignancy of the oral pharynx?
Squamous Cell Carcinoma
How is cervical cancer diagnosed?
Tissue biopsy
Women w/ Sickle cell anemia who use Oral contraceptives are at higher risk for?
thromboembolism and MI
What cell is pathopneumonic for hodkin’s disease?
Reed Sternberg cell ("eye" cell)
In what bone is osteosarcoma most commonly found in?
Femur
lay term for nephroblastoma?
Kidney tumor (Wilm’s tumor)
What is the single best test to discriminate b/w iron def. anemia and anemia of chronic disease?
Ferritin
What does the MCV have to be to be a megaloblastic anemia?
Greater than 100
What are seven cancer screening tests as the pop. ages for people that are at average risk
Colonoscopy, pap smear, mammogram, PSA, DRE, fecal occult blood test and a clinical breast exam
What is the most common presentation for esophageal cancer?
Dysphagia
What is the primary treatment for tumors of the colon and rectum?
Excision
3 pop. susceptible to Iron def. anemia
Women of child bearing age, toddlers, adolescent females (also vegetarians)
Clinical signs of Iron def. anemia:
Pica (eating clay,paper,coal), glottitis, angular chelitis (corner of mouth irritation), kolionychia(spoon shaped nails), pallor, fatigue, decrease exercise tolerability
Side Effects of oral iron supplement
Consitipation, abdo. Pain, diarrhea
Megaloblastic anemia is def. of what? Found in whom?
B12 and Folate: Found in alcoholics and pernicious anemia
What is Schilling test used to diagnose?
Pernicious Anemia
What is G6PD deficiency?
genetic disorder common in African Americans
Medications like antimalarial drugs (primaquine) and sulfonamides will cause hemolysis (jaundice, pallor, back pain, and dark urine); G6PD is an enzyme for red cell integrity; deficiency results in acute hemolytic anemia with hemoglobinuria
Patient with sickle cell will have what type of anemia symptoms?
Mild until crisis
What is polycythemia?
Increase in cells, increase in hematocrit and platlets
What is Wilson’s disease
Copper accumulation in tissues
Patient pop. suspect for Hodgkin’s disease:
bimodal: 15-40 and greater than 55
Area of oral cavity most associated with malignancy
Lips
Most common causes of esophageal cancer
smoking and alcohol
Most common virus implicated in aplastic crisis of sickle cell anemia?
Parvovirus (B19- fifth’s disease)
Treatment for sickle cell crisis
oxygen, hydration and pain control
Most common cause of sudden death in MI
V.Fib
photoreceptor most sensitive to light
Rods
Area of eye with highest concentration of cones
macula
What is myopia and what kind of lens corrects it?
Near sighted; Minus lens (concave lens)
Eye condition containing drusens
AMD (Age related macular degeneration)
S&S of AMD
Loss of central vision
Assoc. w/ aging
leading cause of blindness in patients >65 y/o
AMD
Differentiate between "wet" and "dry" drusen
Wet = white and exudative
Dry = yellow and non-exudative
Crucial test for wet drusens in AMD
Fluorescein Angiography
What is amblyopia?
Lazy Eye
Differentiate between anterior and posterior uveitis
Anterior= Inflammation of the iris and ciliary body
Posterior= inflammation of the choroid
2 diseases assoc. w/ anterior uveitis
Herpes Zoster and Sarcoidosis
Most common cause of anterior uveitis
Trauma
Used to measure gas diffusion in lungs
Carbon Monoxide (CO)
Total lung capacity
Vol. in lungs at end of maximum inspiration (IRV + TV + ERV + RV)
Tidal Volume
Air inspired or expired during normal respiration
Inspiratory Reserve Volume
Add'l air that can be inhaled after tidal breath in
Functional Residual Capacity
Amount of air left in lung at end of normal breathing exhalation (ERV + RV)
Vital Capacity
Amount of air that can be forced out after maximum inspiration (IRV + TV + ERV)
Residual Volume
Amount of air left in lung after maximum exhalation
Inspiratory capacity
volume that can be inhaled after a tidal breath out (TV + IRV)
Expiratory Reserve Volume
Amount of additional air that can be breathed out after normal expiration
Oxygen is transported in the blood by
Either dissoved in plasma or bound to hemoglobin
Oxygen content in the blood depends on:
Arterial PO2 and hemoglobin level
Tissue oxygen delivery depends on:
Oxygen content in the arterial blood and cardiac output
CO2 is carried in blood as:
HCO3- or CO2 dissolved in plasma
True or False: Disorders that affect the airway reduce the diffusing capacity of Oxygen
False; only disorders that affect the lung tissue (parenchyma) will reduce the oxygen diffusion capacity
What are the normal values for arterial blood gases - pH, PaO2, PaCO2, HCO3
pH 7.35-7.45
PaO2 >80 mmHg
PaCO2 35-45 mmHg
HCO3 24-28 mEq/L
Describe the relationship between pH and PaCO2
They are INVERSELY related; when PaCO2 increases, then pH decreases (acidic)
Describe the relationship between pH and HCO3-
They are DIRECTLY related; when HCO3- increases, then pH increases (Basic)
Describe the level of pH, CO2, and HCO3- in Respiratory Acidosis
pH is decreased
CO2 is increased
HCO3- is increased
Describe the level of pH, CO2, and HCO3- in Respiratory Alkalosis
pH is increased
CO2 is decreased
HCO3- is decreased
Describe the level of pH, CO2, and HCO3- in Metabolic Acidosis
pH is decreased
CO2 is decreased
HCO3- is decreased
Describe the level of pH, CO2, and HCO3- in Metabolic Alkalosis
pH is increased
CO2 is increased
HCO3- is increased
Condition that is assoc. with an elevated anion gap
Metabolic acidosis (anion gap >12; normal is 10-12 mEq/L)
How do you calculate anion gap
Na - (Cl + HCO3)
MUDPIES
pneumonic for causes of anion gap indicating metabolic acidosis:
Methanol
Uremia (renal failure)
Diabetic Ketoacidosis
Paraldehyde
Infarction (MI) or Isoniazid (TB tx)
Ethylene glycol
Salicylate
Valuable tool in characterizing diseases of the chest wall, pleura, hilum, and mediastinum
Computed tomography (CT)
Use for bronchoscopy
visualization of airways - foreign body
mucous plug visualization
Use of Thoracocentesis
Used to remove air or fluid from pleural space
Frequently used in pleural effusion
Name 3 categories of info given by Pulmonary function tests
Lung volumes
Flow rates
diffusing capacity
What is FEV1/FVC and what does it indicate?
The ratio of forced expiratory volume in 1 second and forced vital capacity;
Indicates OBSTRUCTION to airflow
What happens to FEV1, FEV1/FVC, and RV in obstructive dz's such as COPD or Asthma
FEV1 decreases
FEV1/FVC decreases
RV increases (due to increased lung volume)
Flow rate decreases
What happens to FEV1/FVC and TLC in restrictive dz's such as Cystic fibrosis
FEV1/FVC remains normal
TLC decreases
Diffusion capacity decreases
Clinical features of pulmonary effusion
dyspnea
pleuritic chest pain
dullness to percussion
decreased tactile fremitus
decreased breath sounds
pleural friction rub
Clinical features of pneumothorax
acute onset of chest pain
dyspnea
decreased breath sounds over affected area
Hyperresonant to percussion
Physiolgic conditions that cause Metabolic Acidosis
This is assoc. w/ an accumulation of acids and/or a loss of a buffer
Diarrhea—loss of bicarbonate
• Renal failure—inadequate formation and reabsorption of bicarbonate and the inability to excrete acids
• Accumulation of organic acids
• Certain drugs—salicylates, methanol
Physiolgic conditions that cause Metabolic Alkalosis
This is associated with an accumulation of bicarbonate and/or a decrease in acid
• Vomiting—loss of stomach acid
• Nasogastric suctioning—again, loss of stomach acid
• Loss of potassium
• Exogenous alkali—use of NaCO3 (baking soda), antacids
• Drugs—diuretics, corticosteroids
Acute bronchitis is usually caused by
Virus (95% of the time)
S&S of acute bronchitis
Productive Cough (worse lying down & at night)
• Malaise
• Variable crackle, rhonchi & wheezing up to 6 weeks
• Fever absent or mild
• Fever may be prominent with H. flu
Describe sputum production in acute bronchitis
Initially, dry & nonproductive, small amount sputum
After a few hrs or days, sputum more abundant & mucoid
Most common type of lung cancer
adenocarcinoma
Most aggressive and easily metastasizing lung cancer
small cell (oat cell) carcinoma
Describe exudative pleural effusion
occurs when LOCAL factors change the formation and absorption of pleural fluid
Examples: TB, hemorrhage, malignant neoplasm
Describe transudative pleural effusion
occurs when SYSTEMIC factors change formation & absorptio of pleural fluid
Examples: CHF, Cirrhosis, nephrotic syndrome
clinical sign of tension pneumothorax
Trachea deviated to unaffected side due to positive pressure from pneumothorax
Hyaline Membrane Disease
Disease of infants that do not have enough surfactant;
also called respiratory distress syndrome
Tumor that causes Horner's syndrome
Pancoast Tumor (apical lung tumor)
What causes Mesothelioma
Asbestosis exposure
What is Hamartoma
Benign mass in lung composed of normal tissue
What is characterized by "popcorn calcification" in the lung on CXR
Hamartoma
Empyema
pus in the pleural space
What is a chronic multisystem dz where abnormal collections of inflamm. cells (granulomas) form in many organs of the body?
Sarcoidosis
Hampton's Hump and Westermark's Sign on CXR are hallmarks for what condition
Pulmonary Embolism
What is a laboratory test used to detect DVT/PE
d-dimer
Hallmark of Sarcoidosis
Lofgrens Syndrome (Erythema Nodosum on lower extremities and Bilateral hilar adenopathy)
Noncaseating epitheloid granulomas
Polyarthritis
Nodular opacities and eggshell calcifications of hilar lymph nodes on CXR is indicative of?
Silicosis
Lung condition caused by exposure to silica thru mining, stone cutting, and sand blasting that is rapidly fatal?
Silicosis
S&S of Foreign body aspiration
wheezing
non-productive cough
decreased breath sounds
stridor
dyspnea
cyanosis
Hereditary dz that causes certain glands to produce abnormal secretions resulting in tissue and organ damage
Cystic Fibrosis
GI problems in Cystic Fibrosis
Pancreatic insufficiency
Protein & Fat malabsorption
Frequent bulky, foul-smelling stools
Vit. E & K deficiency
Diagnostic test for CF
Sweat Test to analyze Na & Cl levels
Most common cause of Pulmonary HTN
Left Heart Failure
Controller of choice for asthma
Inhaled corticosteroid
Hallmarks of COPD
EXPIRATORY FLOW LIMITATION
• Compromises ability of pt to expel air
• Hyperinflation and air trapping occurs
• Rib cage reconfigures over time
• Ventilatory muscles adapt temporarily
Tx's of COPD based on stages of FEV1
Stage I (>50%) Short acting B2 agonist PRN
• Stage II (35-49%) Add Anticholinergic
• Stage III (<35%) Add long acting B2 agonist and/or SR theophyline – consider oral glucocorticoid
Cor Pulmonale
Right ventricular hypertrophy caused by any factor that increases pulmonary artery pressure e.g. PE, COPD
2 conditions that make up COPD
Ephysema
Chronic Bronchitis
pathogen that causes Croup
Parainfluenza Virus type 1
"Hour glass" and "Steeple Sign" are indicative of?
Croup
barking, spasmodic cough followed by horseness usually seen at night accompanied by stridor, rhonchi, and wheezes
Croup
Disease with airway narrowing (which increases airway resistance), Barrel-chest,and Decrease in elastic recoil and collapse of airways during exhalation
Emphysema
"pink puffers"
Emphysema
"Blue bloaters"
Chronic Bronchitis
Infant w/ Cyanosis,Flaring nostrils, Tachypnea, Grunting sounds with breathing, Chest retractions
Hyaline Membrane Dz (Resp. Distress Syndrome)
S&S of Influenza
Sudden chills & fever, malaise & myalgias, sore throat, severe headaches, weakness, coughing
Cough producing foul-smelling sputum (feculent)
Lung abcess
Bronchiectasis
Chronic dilatation of bronchi or bronchioles as a sequel of inflammatory disease or obstruction.
hallmarks of Asthma
decrease in airway diameter
• increased airway resistance
• airway obstruction
Clinical features of asthma
Cough
• Dyspnea
• Chest tightness
• Wheezing
Common causes of fungal pneumonias
histoplasmosis, cryptococcosis, aspergillosis
Coal Miner's Lung
Pneumoconiosis/Silicosis
Pneumonia
An acute infection of lung parenchyma including alveolar spaces & interstitial tissue
Cough (sounds like a whooping sound),Sneezing, Low grade fever, Rhinorrhea, Conjunctivitis and increased lacrimation are indicative of what condition?
Whooping cough (Pertussis)
An infectious atypical pneumonia transmitted to humans by birds thru inhalation of dried excrement
Chlamydia psittaci
Most common cause of Community Acquired Pneumonia
Streptococcus Pneumoniae
3 typical organisms implicated in community acquired pneumonia
1. Streptococcus pneumoniae 40-60%
2. Haemophilus influenzae
3. Staphyloccus aureus
S&S of Comm. Acq. Pneumonia
Abrupt onset
–Fever / chills
–Cough with purulent sputum
–Pleuritic chest pain
–Tachycardia / tachypnea
Organism of ATYPICAL CAP
Mycoplasma pneumoniae
most common respiratory infection in 5 - 35 y.o., students and military
Atypical CAP (walking pneumonia)
Most common fungal infection in AIDS pts
Pneumocystis carinii pneumonia(PCP)
Most common organisms of HAP (hospital acquired pneumo)
Pseudomonas aeruginosa and Staph. Aureus
Red Currant Jelly sputum indicates what organism?
Klebsiella Pneumoniae
Severe pneumonia seen in older men from the air conditioning, in patients > 50 y/o and smokers
Legionella pneumophila
Most common cause of bronchiolitis and pneumonia among infants and children under 1 year of age
Respiratory syncytial virus (RSV)
Tx for CAP
Cephalosporins (Rocephin)
• Fluoroquinolones (Cipro)
•Macrolide/Azalides/Ketolides (Zithromax)
• Aminopenicillins (Augmentin)
• Tetracyclines (Doxycycline)
• TMP/SMX (Bactrim
Useful screening tool to R/O PE
V/Q scan (ventilation/perfusion scan)
Gold Standard for detecting Pulm. Embolism
Pulmonary angiography
Organism that causes TB
Mycobacterium tuberculosis
S&S of TB
• weight loss
• Fever
• Cough
• night sweats
• Hemoptysis
Interpretation of positive PPD test for HIV, high risk settings, no risk factors
Must be indurated to be positive
• 5 mm or greater if HIV positive or immunosuppressed
• 10 mm or greater in high risk setting
• 15 mm or greater if no known risk factors
Trench Mouth, Vincent’s angina is?
Acute Necrotizing Ulcerative Gingivitis
“Punched out” ulcerations on interdental papillae, Spontaneous bleeding,Odor, and Pain are indiciative of?
Acute Necrotizing Ulcerative Gingivitis
Most common pathogens causing acute otitis media
Strep Pneumonia
H. Influenza
Moraxella catarrhalis
S&S of Acute OM
•Otalgia
•Otorrhea
•Hearing loss
Condition that lasts up to 4 weeks with complete resolution of symptoms characterized by Facial pain/pressure, Nasal congestion/discharge and Cough
Acute Sinusitis
Allergic shiners, Allergic salute (salute sign), Allergic crease (nose), Adenoid facies, and Denie’s line are hallmarks of?
Allergic Rhinitis
Ulcers located on lip and gingival mucosa with raised yellow borders with surrounding erythema
Apthous Ulcer (Canker sore)
Small, red, pink dome shaped lump with pearly borders
Basal Cell Carcinoma
Facial Drooping due to damage of facial nerve (VII)
Bell's Palsy
Ear condition that starts after latency period, Crescendo-decrescendo manner, Lasts 20-30 seconds, Nystagmus, but No hearing Loss
BPPV (benign paroxysmal positional vertigo)
Cancer Risk Factors
Tobacco
Alcohol
Sunlight Exposure
Age
Gender
Race
White plaques easily removed
Can be seen after treatment with antibiotic
Can be seen after chronic treatment with steroids
Common in pts with diabetes or HIV
Common in infants
Oral Candidiasis (thrush)
Often first sign of HIV infection
Oral candidiasis (thrush)
S&S of chronic OM
Perforation
Discharge
Mastoiditis
Hearing Loss
Unilateral facial swelling lateral to nose with redness & typical loss of the nasolabial fold
Dental abcess
Organism that causes membranous pharyngitis
Diphtheria (Corynebacterium diphtheriae)
"thumb sign" is hallmark of
Epiglottitis
Procedure to remove insect from ear
apply lidocaine before irrigation
Child presents with a purulent unilateral nasal discharge
Foreign body
Organism that causes Herpangina
Group A coxsackieviruses
Painful vesiculoulcerative mucosal lesions most commonly in infants & children on soft palate or tonsils
Herpangina
Most common neck space infection life-threatening, bilateral, cellulitis of the sublingual & submandibular spaces that usually starts in an infected lower molar and may cause airway compromise
Ludwig's Angina
History of increasing ear fullness, Roaring tinnitus followed by a sensation of blocked hearing, nausea, vomiting, and lasting more than 20 min
Meniere's dz
The eardrum becomes inflamed, and small, fluid-filled blisters (vesicles) form on its surface & caused by mycoplasma
Myringitis
Painful blisters & vesicular lesions along the vermilion border
Oral herpes simplex (HSV-1)
Any white lesion that cannot be removed by scraping the mucosal surface (unlike candidiasis)
Oral Leukoplakia (can be pre-cancerous)
Similar to leukoplakia except has a definite erythematous component and often becomes cancerous
Oral Erythroplakia
Most common pathogen of Otitis Externa
Pseudomonas Aeruginosa
Acute or chronic, aggressive, invasive, & destructive inflammatory process of the ear canal commonly caused by Pseudomonas Aeruginosa
Malignant (Necrotizing) OE
Organism that causes Mumps (parotitis)
Paramyxovirus
painful enlargement of salivary glands, most commonly the parotids, with pain on chewing or swallowing acidic liquids such as vinegar or lemon juice
Parotitis (Mumps)
Long term complication of Mumps
Sterility
Severe sore throat, Uvula deviation, and “hot-potato” voice are characteristic of?
Peritonsillar Abcess (Quinsy's Abcess)
Organisms implicated in Pharyngitis & Tonsillitis
Group A Beta Hemolytic Strep
Criteria to determine presence of Group A Beta Hemolytic Strep in Pharyngitis
1. Fever
2. Adenopathy
3. Exudate
4. No cough or rhinorrhea
associated with Varicella-zoster virus (VZV), Painful red rash with fluid filled blisters on the eardrum, external ear canal, roof of the mouth or tongue, Facial palsy on the same side as the affected ear, Difficulty closing one eye, Hearing loss, Tinnitus, Vertigo, Loss of taste are symptoms of?
Ramsey-Hunt Syndrome
an infection with group A streptococcus bacteria that can cause the scarlet-colored rash with classic red streaks that turn white when you press on them
Scarlet Fever
Most common pathogens in acute sinusitis
Streptococcus Pneumoniae
Haemophilus influenza
Moraxella Catarrhalis
Swelling in submandibular area that starts after a meal
Purulent D/C from Sialolith in salivary duct
Pain & swelling eating tart foods
Sialadenitis
This virus is assoc. w/ Oral Hairy Leukoplakia
Epstein-Barr Virus
most common malignancy of the endocrine system
Thyroid cancer
S&S of Thyroid cancer
Hoarseness
– Neck Pain
– Enlarged thyroid nodules
– Swollen lymph nodes
Neuropathic disorder of Trigeminal nerve (CN V)
characterized by Intense pain of the eyes, lips, nose, scalp, forehead and jaw
Tic Douloureux (trigeminal neuralgia)
Schwann Cell Tumor (Tumor of CN VIII)
Acoustic Neuroma
Most common type of thyroid cancer and tends to grow very slowly
papillary thyroid cancer
Blood & Thunder, tortuous veins, flame-shaped hemorrhage and cotton wool spots characterize this condition
Central Retinal Vein Occlusion
Condition involves the maxillary bone and posterior medial floor ethmoid bone, Eye appears sunken in, and best seen on Water's view x-ray
Blow Out Fracture
Snowflake” cataract is Hallmark for?
Diabetes
"box-carring" and "cherry-red spots" seen in the eyes are indicative of?
Central Retinal Artery Occlusion -- Ophthalmic Emergency!
A chronic inflammation of the meibomian gland in the eyelid
Chalazion
Abnormal development of blood vessels (telangiectasia) behind the retina, leaving cholesterol deposits and damaging the retina
Coat's Disease
Leading cause of visual loss in AIDS pts
Cytomegalovirus retinopathy
Key finding in Proliferative Diabetic Retinopathy
Neovascularization of the disc
3 findings in pre-proliferative diabetic retinopathy
Hemorrhages, hard exudates, Cotton Wool Spots
Tool used to measure intraocular pressure to detect glaucoma
tonometer
Condition characterized by painless, insidious raise in IOP, normal acuity until late stages
Open angle glaucoma
Condition with sudden rise in IOP, painful, Nausea/Vomiting, Steamy cornea, fixed, mid-dilated pupil, EMERGENCY
Closed angle glaucoma
Tx for open angle glaucoma
decrease aqueous production
Tx for closed angle glaucoma
Miotics increase trabecular meshwork outflow e.g. Pilocarpine
- A special contact lens on the topically anesthetized cornea to examine a patient with suspected glaucoma that can examine the anterior chamber angle structures
Goinoscopy
Dendritic staining pattern in the eye
Herpes Simplex Keratitis
CWS, flame shaped hemorrhages, macular edema (rare), disc edema, macular star/ring of exudates are findings in this condition
Hypertensive Retinopathy
Differentiate between Diabetic retinopathy and HTN retinopathy
HTN retinopathy is mostly a dry eye condition ( multiple CWS, rare hemorrhage, edema, and exudates) whereas diabetic retinopathy is a wet eye condition, rare CWS, extensive hemorrhages, edema, and exudates)
classic “ketchup” and “pizza” retina is found in?
AIDS pts
Infection/ inflammation of the cornea accompanied by pain, red eye
Keratitis
White reflex that is an emergency in children
and may signify retinoblastoma or cataract
Leukocoria
Most common intraocular tumor in adults and demonstrates metastasis to liver
Melanoma
finding during the swinging-flashlight test whereupon the patient's pupils appear to dilate instead of constrict when the light swings from the unaffected "good" eye to the affected "bad" eye
Marcus Gunn Pupil
This is an acute infection of the tissues immediately surrounding the eye, including the eyelids, eyebrow, and cheek and needs immediate attention to prevent blindness
Orbital Cellulitis
inflammation of the optic disc only with a
central field defect
Papillitis
disc swelling due to increased intracranial pressure where both optic discs are equally affected
Papilledema
yellow-white deposit on the conjunctiva adjacent to the limbus often due to aging
Pinguecula
Loss of accommodation reflex due to age
presbyopia
inherited disorders where individuals first experience defective dark adaptation or nyctalopia (night blindness), followed by constriction of the peripheral visual field and, eventually, loss of central vision late in the course of the disease
Retinitis Pigementosa
defined as a fleeting loss of vision caused by transient
occlusion of the retinal circulation. This symptom should prompt investigation
of the ipsilateral carotid circulation for atheroma which may be the source of the
retinal emboli.
Retinal Vascular Occlusion or
Amaurosis Fugax
Most common INTRAOCULAR malignancy in children characterized by Leukocoria (white reflex)
Retinoblastoma
Most common primary pediatric ORBITAL malignancy with very rapid onset of unilateral proptosis
Rhabdomyosarcoma
These are retinal hemorrhages with white or pale centers composed of coagulated fibrin observed in leukemia, diabetes, subacute bacterial endocarditis, pernicious anemia, ischemic events associated with elevated venous pressure and systemic vascular conditions with capillary fragility.
Roth Spots
Misalignment of eyes sometimes caused by lesion on CN III or lack of innervation to orbital muscles; also may be a sign of increased intracranial pressure
strabismus
bleeding in the vitreous cavity that may occur in response to direct trauma or those conditions
causing retinal neovascularization (diabetes, retinal vein
occlusion)
Vitreous Hemorrhage
transparent, colorless, gelatinous mass that fills the space between the lens of the eye and the retina lining the back of the eye.
Vitreous Humor
This leukemia has a variation called "Hairy Cell Leukemia"
CLL
Areas of metastasis for lung cancer?
adrenal glands and brain
Areas of metastasis for breast cancer?
bone, liver and lung
Areas of metastasis for Colon Cancer?
liver and lung
Areas of metastasis for prostate cancer
bone
Areas of metastasis for cancers of connective tissue (sarcomas), and testicular cancer
lung
Organism that causes Burkitt's Lymphoma
Epstein-Barr Virus
Organism that causes cervical cancer
Human Papilloma Virus
Condition that causes hepatocellular carcinoma
Hepatitis B and C
This virus causes Adult T-Cell Leukemia
HTLV-I (assoc. w/ ALL)
Organism that causes genital cancers
Human Papillomavirus
Dz where Auer rods are seen on blood smear
AML
In this condition, chronic renal failure causes defective platelet function and/or decreased platelets
Uremia
is a destruction of leukemic WBC’s leading to acute rises in uric acid (hyperuricemia) which may cause renal failure; is a side effect of chemotherapy
Tumor Lysis Syndrome
is a disorder caused by an inherited mutation in the beta-globins component of hemoglobin molecule
Sickle Cell Syndrome
Complications of Sickle Cell disease
Renal defects (Renal insufficiency)
Chronic skin ulcers of leg and ankle
Sepsis (most common cause of death in children)
Pneumonia
Bone infarctions
Condition where X-ray shows "punched out" bone lesions due to osteoclasts
Multiple Myeloma
Condition with proliferation of monoclonal IgM protein with symptoms of anemia, hypercalcemia, and BONE PAIN primarily in back and chest
Multiple Myeloma
Condition of over-production of RBC
Polycythemia Vera
Anemia where key clinical feature is a normocytic anemia with increased reticulocyte count
Hemolytic Anemia (Cells are being destroyed & bone marrow responds by increased production of reticulocytes)
Kayser-Fleischer rings and “sunflower” cataracts are ophthalmic findings in what condition?
Wilson's dz
"Target Cells" are seen in these 2 conditions
Sickle cell anemia and Thalassemia
Howell-Jolly Bodies
Nuclear remnants in RBC
Basophilic stippling is seen in this condition
Lead poisoning
TAILS is a pneumonic for what condition
Microcytic Anemia:
Thalassemia
Anemia of Chronic dz
Iron Deficiency
Lead poisoning
Sideroblastic Anemia
Thalassemia defects that are incompatible with life
defect in 3 of 4 alpha chains
or defect in both beta chains
Procedure to diagnose sideroblastic anemia
bone marrow biopsy
Condition caused by defect in binding of iron onto heme molecule
Sideroblastic anemia
sore tongue is indicative of this deficiency
Vitamin B12 and/or Folic acid deficiency
Conditions that lead to Macrocytic anemias
B12 and Folic acid deficiency
Hypothyroidism
Chronic liver disease
Alcoholism
Pernicious Anemia is due to:
Lack of intrinsic factor which is needed for B12 absorption; this results in B12 deficiency
Burr cells and spur cells are due to:
Decreased erythropoietin production due to renal failure
painful, red, tender nodules on lower legs
Erythema Nodosum
any eruption of the skin accompanied by inflammation, such as measles, scarlatina, or erysipelas
Exanthems
Derm. condition w/ increased serum IgE levels
Atopic Derm (Eczema)
Papule or pustule surrounded by an erythematous halo caused by shaving hairy regions such as the beard area, axillae, or legs facilitates Staph. infection
Folliculitis
Grouped vesicles on an erythematous base; Once infected it persists in sensory ganglia for life
Herpes Simplex Virus
Unilateral pain and vesicular or bullous eruption limited to dermatomes innervated by corresponding sensory ganglion
Herpes Zoster (Varicella Zoster) AKA “shingles"
chronic disease of axilla, anogenital region and scalp can be associated with severe nodulocystic acne; “bridge” scars and "double comedomes" present
Hidradenitis Suppurativa
2 Organisms that commonly cause Impetigo
Staph aureus and strep pyogenes
violaceous lesions and lymphedema of the lower extremeties often seen in immunocompromised/HIV pts
Kaposi's Sarcoma
dome-shaped nodule with a central keratotic plug mimics basal cell carcinoma; usually found on face and has rapid growth rate
Keratoacanthoma
Head lice
Pediculosis Capitis
Pubic lice
Pediculosis Pubis
Flat-topped violaceous, shiny, pruritic papules on skin with white lines (Wickhams striae) on mouth, wrists, and sun-exposed sites
Lichen Planus
Area of cutaneous thickening and hardening from continued irritation/itching; area is like an erogenous zone
Lichen Simplex Chronicus
the simplest dermatological lesion; It is flat and can only be seen and not felt
Macule
Precursors of Cutaneous Melanoma
1. Congenital nevomelanocytic nevus (giant or small)
2. Clark’s (dysplastic) melanocytic nevus
3. Lentigo maligna
tumor from the beginning is in the “vertical growth” phase
"blueberry-like” nodule
Nodular Melanoma
mask of pregnancy
Melasma
Skin colored papules, often umbilicated with central keratotic plug caused by MC virus (poxvirus); severe in HIV pts
Molluscum contagiosum
Localized cutaneous sclerosis where hair follicle and sweat duct holes disappear; considered to be localized scleroderma
Morphea
Coin shaped plaques with small grouped papules and vesicles on erythematous base
Common in lower legs of older males during winter
Nummular eczema
Infection of finger or toenail caused by fungi, yeasts and molds
Onycomycosis
Superficial solid lesions less than 1 cm in diameter
Palpable
May invade epidermis and upper dermis but not sub Q
Papule
Fungal infection of nails with pus
Paronychia
Most common photodermatosis characterized by abnormal reactions to UV radiation,
pruritus and parasthesia
Photo Light eruption
Begins w/ “herald plaque”
Lesions cleavage in “Christmas tree” pattern
Pityriasis rosea
Inflammatory reaction caused by an antigen (allergen)
Elicits type IV hypersensitivity reaction
Confined to the site of exposure to allergen
Allergic contact dermatitis
 Can be life threatening
 Starts with burning erythema that spreads in hours
 Fiery red skin
 “Lakes” filled with purulent fluid
Psoriasis Erythroderma
o Infestation by mite
o "7 year itch"
Scabies
o Yellow, greasy scaling where sebaceous glands are
o Scalp: dandruff or cradle cap in infants
o High incidence in HIV and Parkinson’s
Seborrhic Dermatitis
o Lesion has stuck on appearance, with “warty” surface
o “horn cysts”
Seborrheic keratosis
Malignant tumor of epithelial keratinocytes
Squamous cell carcinoma (SCC)
Drug induced or idiopathic skin tenderness and erythema of skin and mucosa
o Variant of erythema multiforme
o Target like lesions
Can be life threatening
Steven-Johnson syndrome
Painless Chancre indicates this disease
Primary Syphilis
GUMMA lesions indicate what disease
Tertiary Syphilis
Mutlisystem disease of connective tissue and blood vessels that mostly occurs in black females w/ symptoms of Skin lesions and Arthritis
Systemic Lupus Erythematous (SLE)
Fungal infection of scalp resulting in scarring and alopecia
Tinea capitis
Ringworm; Fungal infection of the trunk, legs and arms
Tinea corporis
Jock Itch; Fungal infection of inguinal folds
Tinea cruris
Athlete’s Foot
Tinea Pedis
Tinea ungium
Also known as Onychomycosis; Fungal infection of finger
Lesions on the palms and soles that appear 2-6 months after initial painless chancre is indicative of what disease
Secondary syphilis
"oil spot" and "pitting" on nails is indicative of?
Psoriasis Vulgaris
Systemic disease caused by Staph characterized by
o Fever
o Malaise
o N/V/D
o Red rash that looks like sunburn
Toxic Shock Syndrome
Wheals that develop upon dermographism; can be detected with "ice cube" test
Urticaria
Dew drops on a rose petal
Varicella (Chicken pox)
Common Warts
Verruca Vulgaris
diffuse, velvety thickening and hyperpigmentation of the skin, chiefly in axillae, around the neck, and other body folds
Acanthosis nigricans
o Development of chalk white macules, round, elongated with convex margins
Absence of melanocytes (hypopigmentation)
Vitiligo
Condition of the face characterized by rhinophyma, that is exacerbated by hot liquids, spicy foods, and sun exposure
Acne Rosacea
most common type of skin cancer
Basal cell carcinoma (BCC)
This malignant tumor is locally invasive, aggressive, and destructive, but there is a limited capacity to metastasize.
Basal cell carcinoma (BCC)
Ulcerated nodule or papule with rolled "pearly" border
Basal cell carcinoma (BCC)
eruption is an adverse hypersensitivity reaction to an ingested or parenterally administered drug characterized by a cutaneous eruption that mimics measles
Exanthematous Drug
Eruption
This lesion is derived from epidermis or the epithelium of the hair follicle, and is formed by cystic enclosure of epithelium within the dermis that becomes filled with keratin and lipid-rich debris.
Epidermal Cysts
Button-like dermal nodule usually occuring on extremities and has "dimple" sign
Dermatofibroma
Dermal condtion characterized by "spaghetti and meatballs" on KOH prep
Tinea Versicolor
Blue/green fluorescence of scales under Wood's Lamp
Tinea Versicolor (Pityriasis versicolor)
Iris or target lesions are typical on the dorsa of hands, palms, and soles; forearms; feet; face; elbows and knees
Erythema Multiforme
potential precursor of superficial spreading melanoma and also a marker of persons at risk for developing primary malignant melanoma of the skin
Clark’s (dysplastic) melanocytic nevus
Tapioca-like vesicles on fingers, palms, and soles
Dyshidrotic Eczematous Dermatitis
Papulopustules, comedomes, or nodulocystic lesions on the face that can lead to pitted or hypertrophic scars
Acne Vulgaris
Positive Nikolsky sign (blister formation from slight pressure) is seen in these 2 conditions
Erythema Multiforme Major (Severe form)
Pemphigus Vulgaris
Destructive ulcers of the genital region that have beefy-red granulated tissue base with sharply defined edges; late sequela is SCC of genital skin
Donovanosis
Congenital gray-blue macular lesion of lumbosacral area that disappears in early childhood
Mongolian Spot
Single or multiple benign subcutaneous tumors composed of fat cells that are movable against overlying skin
Lipoma
This dermal tumor is in the "vertical growth" phase from the beginning
Nodular Melanoma
excessive hair growth in androgen dependent hair patterns; women w/ excessive facial hair
Hirsutism
hickey
Annular Erythematus Erogeniosum
ANA test is used to diagnose this condition
Systemic Lupus Erythematosus
Sexually transmitted painful ulcer at inoculation site caused by Hemophilus Ducreyi
Chancroid
This condition develops from precancerous lesions often found on the lips and other sun-exposed sites and has great capacity to metastasize
Squamous Cell Carcinoma
These lesions show initial radial growth followed by vertical growth and can become cancerous
Melanoma
Condition where loss of scalp hair is in an "M" shaped recession
Androgenetic Alopecia
Describe phases of hair growth: telogen, anagen, catagen
Telogen = resting phase
Anagen = active growth
Catagen = transition phase
Hair loss caused by crash dieting, giving birth, or cessation of oral contraceptives; pt will bring in "bags of shed hair"
Telogen Effluvium
Cafe au lait spots are indicative of what condition?
Neurofibromatosis
This condition causes fine, downy hair to cover the body and is usually a harbinger of malignancy
Hypertrichosis
Disease w/ factor VIII deficiency and how it affects PT and PTT
Hemophilia A
PT is normal
PTT is prolonged (reflecting that Factor VIII is in the intrinsic pathway)
Disease w/ factor IX deficiency and how it affects PT and PTT
Hemophilia B
PT is normal
PTT is prolonged ((reflecting that Factor IX is in the intrinsic pathway)
Deficiency in this vitamin causes decreased production of factors II, VII, IX, X in the liver
Vitamin K
assesses integrity of extrinsic coagulation pathway (extrinsic requires Factor VII and X)
Prothrombin time (PT)
PT is prolonged (increased) if there are deficiencies of clotting factors in extrinsic pathway and the common pathway
this test assesses integrity of intrinsic coagulation pathway (intrinsic pathway requires Factors VIII, IX, X)
Partial Thromboplastin Time (PTT)
This factor is required for adhesion of platelets to injured endothelium (formation of platelet plug)
VonWillebrand Factor
A condition characterized by massive, uncontrolled intravascular coagulation eventually leading to depletion of blood clotting components; usually due to massive trauma or sepsis
Disseminated Intravascular Coagulation (DIC)
Christmas Dz
Hemophilia B
Primary Hemostasis
Inability to form a platelet plug due to platelet defects or decreased number of platelets
Secondary Hemostasis
Inability to form an adequate fibrin clot due to decrease or absence of plasma coagulation factors
An autoimmune dz where body produces antibodies against own platelets; condition is improved w/ splenectomy
Idiopathic Thrombocytopenia Purpura
Zoster Sine Zoster
Nerve involvement that occurs without cutaneous involvement
melanoma can be recognized by these 3 physical characteristics
color, contour, and size of the lesion
4 predisposing risk factors for Melanoma
1. Presence of precursor lesions (Clark’s dysplastic melanocytic nevus, congenital melanocytic nevus)
2. Family history of melanoma in parents, children, or siblings
3. Light skin color with inability to tan with ease (skin phototypes I and II)
4. Excessive sun exposure, especially during preadolescence
pigmented lesions of the skin usually present at birth, may be any size from very small to very large and are benign neoplasms but may be precursors of malignant melanoma
Congenital Nevomelanocytic Nevus
Precursor of malignancy, this is a dermal lesion with variations in hues of brown and black, appears like a “stain,” haphazard network of black on a background of brown; has irregular borders, often with a notch, “geographic” shape with inlets and peninsulas
Lentigo Maligna
an acute, chronic, or recurrent dermatosis of the fingers, palms, and soles, characterized by a sudden onset of many deep-seated pruritic, clear vesicles; later, scaling, fissures and lichenification occur
Dyshidrosis
an acute beta-hemolytic group A streptococcal infection of the skin involving the
superficial dermal lymphatics that causes marked swelling, high fevers, shaking, chills, fatigue, headaches, vomiting, and general illness within 48 hours of the initial infection
Erysipelas
Hallmarks of Asthma
decrease in airway diameter
• increased airway resistance
• airway obstruction
Definition of Chronic Bronchitis
• Chronic/recurrent cough with excess mucus production (for most days at least 3 months during 2 consecutive years) in absence of other illness
• Airway narrowing from inflammation / hyperplasia and hypertrophy of mucous glands edema which increases airway resistance
• Loss of ciliary transport
• V/Q mismatch from bronchial narrowing and mucous plugging
describe the physiology of Cystic Fibrosis
↑ Na absorption and ↓ CL secretion → thick, sticky mucus→ impaired lung defense against infection
Cystic Fibrosis pt's get chronic infections from these 2 organisms
Staph. Aureus and Pseudomonas aeruginosa
CXR findings in pt's w/ Emphysema
Hyperinflated lung field (hyperlucency)
• Bullae – local radiolucencies
• Vertically elongated lung field
• Low flattend diaghrams
• Increased retrosteral airspace
Most virulent type of Influenza
Influenza A
Describe Reye's Syndrome
acute fatty deterioration of liver, encephalopathy, hypoglycemia, lipidemia in children treated with Aspirin or Salicylates
Risk factors for Pulm. Embolism
• Immobilization
• Post-operative states
• Chronic venous insufficiency
• Use of oral contraceptives
• Obesity
• Cancer or chemotherapy
• Post-partum state
• Indwelling central venous catheter
• Deficiency of proteins of antithrombotic activity
– Antithrombin III
– Protein C
– Protein S
• Presence of Factor V Leiden
S&S of Pulm. HTN
shortness of breath
dizziness
fainting
fatigue
nonproductive cough peripheral edema
hemoptysis
"helmet" cells are seen in?
Poikilocytosis (abnormally shaped blood cells)
Acute bacterial infection causes an increase of this cell type in circulation
neutrophils
Most common Thalassemia type
Thalassemia Minor = less severe form; has 2 alpha globin and 1 beta globin
Most common presenting sign in CML
Splenomegaly
Leukemia characterized by splenomegaly, hepatomegaly, lymphadenopathy, and pancytopenia
ALL
Leukemia assoc. with HTLV-1 (human T lymphocyte virus 1)
ALL
What is the most aggressive malignant disease of humans?
AML
2 leukemia types characterized by increased blast (immature) cells
ALL and AML
Leukemia characterized by a chronic stable phase followed by "blast crisis" when disease becomes very aggressive
CML
Leukemia w/ onset at age >50
CLL
"B symptoms" carry an unfavorable prognosis in this disease
Hodgkin's Disease
Organism that causes infectious mononucleosis
Epstein-Barr virus
Virus assoc. with Hodgkin's disease
Epstein-Barr virus
2 aggressive variations of Non-Hodgkins Lymphoma
Burkitt's Lymphoma
Lymphoblastic lymphomas
What are the components of "B symptoms"?
Intermittent fever >100.5
Night sweats
Weight loss >10% of normal body weight
Describe stages of assessing Hodgkin's diseases
Stage I= involves single lymph node region
Stage II= involves 2 or more lymph node chains on same side of diaphragm (above or below)
Stage III= involves lymph node chains on both sides of diaphragm (above and below)
Stage IV= Diffuse or disseminated dz involving lung, liver, or bone marrow
What condition is characterized by "fragile blood"
Spherocytosis: RBCs lack spectrin, a cytoskeletal membrane protein, making RBC's fragile and osmotic forces cause cells to break
Priapism (persistent painful erections) is assoc. w/ crisis of what disease?
Sickle cell