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343 Cards in this Set
- Front
- Back
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acute adrenal insufficiency
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acute onset of N/V, abd pain, hypoglycemia, hypotension
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when will patients have howell jolly bodies
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no spleen or nonfunctioning (ie sickle cell)
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who have heinz bodies?
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G6PD def and thalassemia--> can also have bite cells
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causes of diarrhea in HIV pt
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nonopportunistisc(salmonella, campylobacter, entamoeba, chlamydia, shigella, giardia) opportunistic (CMV, cryptosporidium, isopsora belli, blastocystis, MAC, HSV, adenovirus, HIV), noninfectious (kaposi sarcoma, lymphoma of GI tract)
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which cause flask shaped colonic ulcers?
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E. histolytica, bloody diarrhea, trophozoites on stool exam
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what genetic d/o causes defective intracellular killing
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chronic granulomatous disease, X linked recessive defect in NADPH oxidase
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genetic cause of decreased circulating lymphocytes?
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SCID (adenosine deaminase defect), HIV
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impaired chemotaxis
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leukocyte adhesion defect, defect in integrin beta2
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cushings
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severe fatigue, muscle weakness, HTN, high sugars, irritability, anxiety, depression, sexual dysfunction, hypokalemic alkalosis, adrenal CORTICAL hyperplasia
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uremic coagulopathy
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ecchymosis and epistaxis, platelet vessel wall and platelet platelet interaction, guanidinosuccinic acid toxin, increased BT, tx: DDAVP, cryoprep and conjugated estrogens
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RA
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symmetric polyarthritis, anticyclic citrullinated peptide, juxta articular osteoporosis and narrowing of joint spaces, PIP and MCP most affected, TX: methotrexate, hydroxychloroquine, sulfasalzine, leflunomide, etanercept, infliximab, azathioprine
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what affects HDL
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alcohol, exercise and estrogens increase, smoking, androgens, progesterone and hypertg DECREASE HDL
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what do geriatric pts need MORE of?
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sodium, B12, vit D, Ca, Folate, nonheme iron
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vit A def
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night blindness, scaly rash, xerophthalmia (dry eyes), bitots spots, increased infections
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vit A tox
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pseudotumor cerebri,bone thickening, teratogenic
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vit E def
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anemia, peripheral neuropathy, ataxia
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B2 def (riboflavin)
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cheilosis, angular stomatitis, dermatitis
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B6 (pyridoxine) def
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peripheral neuropathy, cheilosis, stomatitis, convulsions in infants, microcytic anemia, seborrheic dermatitis
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B6 (pyridozine) excess
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peripheral neuropathy
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selenium def
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cardiomyopathy and muscle pain
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selenium excess
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loss of hair and nails
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chromium def
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impaired glucose tolerance
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def in alcoholics?
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folate, thiamine, phosphorus, magnesium
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constrictive pericarditis
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caused by surgery, radiation, viral. increased JVP, hepatomegaly, ascites, edema b/c of decreased diastolic filling and impaired CO
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tx of symptomatic hyperca
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bisphosphonates and loop diuretics
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tx of cholecystitis due to pigmented stones (spherocytosis)
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folate and splenectomy
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gaucher's disease
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anemia, thrombocytopenia, hepatosplenomegaly, cortical bone pain, eccentric nucleoli PAS positive staining
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hepatic encephalopathy
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accum of ammonia, false NT, increased sensitivity of CNS to GABA(inhib), zinc def
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precipitates hepatic encephalopathy
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high protein diet, alkalosis, diuretics, excessive GI bleeding, narcotics, hyponotics, sedatives, meds with ammonium or amino compounds, high volume paracentesis, hepatic or systemic infection, portocaval shunts
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paroxysmal nocturnal hemoglobinuria
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GP1 is abnl, helps inhibit destruction of RBCs, intravascular hemolytic anemia with elevated bili and LDH, hepatic vein thrombosis
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serum ascites albumin gradient
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diff of 1.1 or greater= transudative= portal HTN - ascites from increased hydrostatic presure within the liver's capillary beds
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mobitz 1
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digitalis tox, increased vagal tone, inferior wall MI, dropped QRS after increasing pr
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whipples disease
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weight loss, diarrhea, abd pain, distension, flatulence, steatorrhea, migratory polyarthropathy, chronic cough, myocardial or valvular involvement--> CHF or regurg, pigmetnation, lymphadenopathy, PAS in lamina propram joint pain, vision abnl tx: TMP SMX or ceftriaxone
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erythema induratum
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nodualr eruption in pts with TB, crops of small tender, erythematous nodules involving the shins and calves
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tx of ascites
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sodium and water restriction --> spironolactone --> loop--> paracentesis (as long as okay renal function)
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celiacs have malabsorption of..
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D,K, B12, Ca, Folic acid, zinc
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tuberous sclerosis
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ash leaf hypopig, cardiac rhabomyomas, kidney angioleiomyomas, MR, seizures
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milk alkali
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hyperca, alkalosis, renal failure, low PTH
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multiple system atrophy (shy drager synd)
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parkinsonism, autonomic dysfunction, widespread neuro signs, orthostatic hypotension, impotence, incontinence, tx: intravascular volume expansion with fludrocortisone, salt supplemetation, alpha adrenergic, application of constrictive garments to lower body
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riley day synd
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ashkenazi jew, gross dysfunction of autonomic nervous system w/ severe orthostatic hypotension
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ischemic/ shock liver
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huge increase in transaminases with modest increase in bili and alk phos; day after they present with shock
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Friedreich's ataxia
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gait disturbance, pes cavus, ataxia, absent ankle jerks, frequent faills, dysarthria, concentric hypertrophic cariomyopathy, diabetes, skeletal deformities
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werdnig hoffman's (infantile spinal muscualr atrophy)
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prox and dsital hypotonia since birth, ormal social and language skills, tongue fibrillations
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S3
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LV failure, tx is diuretics
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tx of close contacts of HAV pt
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immunoglobulin
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blood diarrhea
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salmonella, shigella, Ecoli 0157H7, yersinia (pork)
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Type A chronic gastritis
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requires B12 replacement, from anti parietal cell antibodies
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which type of ulcer is most likely h pylori
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duodenal (improved with eating) also rarely malignant
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posterior ulcer vs anterior
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posterior (hemorrhage - gastroduodenal artery) anterior (perf)
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whipples triad/ insulinoma
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hypoglycemia when fasting, hypoglyemia, improvement with carbs
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glucagonoma
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refractory DM, migratory necrolytic erythema, mental status changes
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risks for primary biliary cirrhosis
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RA, sjogrens, scleroderma, F,antimitochondrial antibodies tx: ursodeoxycholic acid, colchicine or methotrexate
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bronchoalveolar adenoca of lung
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related to pul scars like fibrosis
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multiple myeloma
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plasma cells, lytic bone lesions, marrow plasmacytosis, urine and serum monoclonal proteins, back pain, renal failure, hypercalcemia, and hypervisocity syndrome
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tx of supraventricular tachy
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adenosine--> if doesnt work, CCB, BB, or cardioversion or carotid massage
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tx of Vtach
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amiodarone
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CHAD score
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CHF (1), HTN (1), age >75 (1), DM (1), prior stroke (2)-- 0 aspirin, >2 warfarin, 1 or 2 aspirin or warfarin
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myotonic muscular dystrophy
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AD, unable to release hand after handshake, all muscles are involved, nl at birth, wasting esp distal muscles of hands, posterior forearm, ant lower legs, temporal wasting, thin cheeks, V lip
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when to give noninvasive positive pressure ventilation
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resp distress pH<7.35 or PaCO2 >45 or resp rate >25, CONTRA in septic, hypotensive, dysrhythmic pts
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TTP HUS
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hemolytic anemia, thrombocytopenia, renal failure, neuro symptoms, mircoganiopathic hemolytic anemia, def or autoantibody against von willebrand factor cleaving protease (ADAMTS-13), tx plasmapheresis
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when to transfuse?
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Hb <7-8 for CAD CHF pts if Hb<10
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diabetic delayed gastric emptying
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postprandial bloating, early satiety, constipation, diarrhea, tx: improve glycemic control, small meals, dopamine antagonist (metoclopramide, domperidone) before meals, bethanechol, erythromycin (promote gastric emptying), cisapride
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lowering cutoff pt...
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increases sensitivity but decreases specificity
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fever , malaise, burning, itching in periorbital region, vesciualr rash in the distribution of the cutaneous branch of the first division of the trigem nerve, conjunctivitis and dendriform corneal ulcers characterize the eye involvement
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herpes zoster opthalmicus, tx high dose acyclovir
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herpes simplex keratitis
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pain photophobia, decreased vision, dendritic ulcers, minute clear vesicles in the corneal epithelium
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dacryocystitis
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inf of lacrimal sac, obstruction of duct, pain, swelling, tenderness, redness in tear sac area, mucous or pus can be expressed
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bacterial keratitis
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contact lens wearers, after corneal trauma, lazy corena with central ulcer and adjacent stromal abscess, hypopyon
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gallbladder ca
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W, SW indians, mexicans risks: chronic gallbladder inflammation, gallstones, porcelain gallbaldder, salmonella typhi, anatomic variations, carcinogen exposure
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adrenoleukodystrophy
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accumulation of very long chain FA within adrenal glands, leads to adrenal insuff
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temporal arteritis pts get serial CXR?
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aortic aneurysm
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indications for O2 therapy inCOPD
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PaO2 <55, SaO2 <88, hct >55, evidence of cor pulmonale
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afferent loop syndrome
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bilious vomiting relieves abd pain (after billroth)
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secretory diarrhea
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toxins, bile acids, VIPomas
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henoch schonlein purpura
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GI bleeding ,abd pain, URI, rash on legs and buttocks, swelling in hands and feet, arthritis(no actual long term damage) and/or hematuria, proteinuria, IgA mesangial deposition
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EKG making you think MI
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flipped or flat T, ST elevation, Q waves
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what is silent MI
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present with CHF, shock, confusion and delirium
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causes of dilated cardiomyopathy
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myocarditis, alcohol, doxorubicin
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tx Afib
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slow V rate (digoxin, BB, CCB), if acute (cardiovert w/ amiodaron, procainamide, DC), if chronic (anti cog then cardiovert)
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systolic dysfunction of heart
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inadequate CO for systemic remain from decreased contractility, increased preload, increased after load, HR abnl, high output
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diastolic dysfunction
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decreased compliance, decreased filling, increased diastolic pressure, decrease CO, from hypertrophy or restrictive cardiomyopathy
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acute endocarditis
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s. aureus, s. pneumo, s. pyogenes, n. gonorrhea
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subacute endocarditis
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s. viridans, enterococcus, fungi, s. epidermidis
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culture negative endocarditis
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hemophilis, actinoacilius, cardiobacterium, eikenella, kingella
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porphyria cutanea tarda
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def of uroporphyrinogen decarboxylase, painless blisters, skin frailty on dorsal hand, facial hypertrichsis, and hyper pig, triggered by ethanol, estrogens, tx phlebotomy or hydroxychloroquin or interferon alpa (if they have Hep C)
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dermatitis herpetiformis
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pruritic papules and vesicles that appear on elbows, knees, buttocks, posterior nek and scalp, celiacs
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conjugated hyperbili, what does high aminotransferases say? high alk phos?
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hepatocellular if ast, alt high; intra or extra hepatic if alk phos high (next step u/s)
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parkinsons
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alpha synuclein, substaintia nigra, rest tremor, rigidity, bradykinesia, starts as asymmetric resting tremor, basal ganglia
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gram + diplococci, cocci in clusters, rods
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s. pneumo; staph, listeria/ bacillus
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gram- cocci, rods
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neisseria,;;; pseudomonas, haemophilus, klebsiella, legionella
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legionella pneumonia
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GI symptoms, hypoNa, LFTs mildly elevated, diag with urinaryantigen or cx, tx quinolone or macrolide
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CLL
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smudge cells
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CML
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left shift, basophilia, marked splenomegaly
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rhizopus
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DM, low grade fever, bloody nasal d/x, nasal congestion, involvement of eyes withchemosis, proptosis, diplopia, nerotic turbinates, can lead to blindness, cavernous sinus thrombosis, coma
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what reading is htn emergency?
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>200/120
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tx of progressive renal failure, encephalopathy, papilledema
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malignant htn tx = reduce diastolic to 100 IV nitro, labetalol, nicardipine, fenoldopam, --> use oral BB and ace to reduce mean diastolic pressure to 100-105 over 2hrs. diuretics to reduce pul edema
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polyarteritis nodosa
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hep B,C, HTN, hematuria, anemia, neuropathy, weight loss, joint pain, palpable purport or ulcer on skin, p ANCA,
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biopsy of takayasu
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plasma cells and lymphocytes in media and adventitia, giant cells, vascular fibrosis
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churg strauss
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asthmatic, fatigue, malaise, mononeuropathy, rash,
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mixed cryoglobulinemia
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palpable purpura, proteinuria, hematuria, also arthralgias, HSM, hypocomplementemia, assoc with HCV
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what type of glomerulonephritis do patients with hodgkins get?
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minimal change most likely, but also focal glomerulosclerosis
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which type of glomerulonephritis is assoc with ca of lung, stomach, breast, colon
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membranous nephropathy
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reiters
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urethritis, conjunctivitis, mucocutanous lesions and arthritits, after dysenteric infection or STI
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uveitis, inflammatory arthritis, negative RF
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RA, pauciarticular variant
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what is kleptomania assoc with?
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bulimia
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preseptal vs orbital cellulitis?
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pain with eye movement, proptosis, decreased visual acuity orbital cellulitis, sinisitus
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cavernous sinus thrombosis
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periorbital edema, exophthalmos, chemosis, papilledema, dilated tortuous retinal veins, b/l
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progressive multifocal leukoencephalopathy
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HIV pt, from JC virus, hemiparesis, disturbances in speech, vision, gait, multiple demyelinating non enhancing lesions with no mass effect
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lights criteria
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pleural fluid protein/ serum >.5, pleural fluid LDH/serum >.6, pleural LDH >2/3 of upper limite of normal for serum LDH---- exudate
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complicated vs uncomplicated pleural effusion
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complicated has positive gram stain, positive cx, glucose <60---> requires chest tube and abx
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episcleritis
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inf of episcleral tissue between conjunctiva and sclera, acute onset mild to mod discomfort, photophobia, watery d/c, diffuse or localized bulbar conjunctival injection
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aspirin sensitvity syndrome
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aspirin ingestion, persistent nasal blockage, brnchoconstriction, pseudo allergic reaction- prostaglandin/ leukotriene misbalance, Tx: leukotriene receptor antagonists
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ALL
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blasts with PAS positive, condensed nuclear chromatin, small nucleoli, scant granular cytoplasm, TdT positive (pre B pre T), 2-10yo
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bartters synd
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hypok, met alk, normal BP, elevated urine chloride concentration, polydipsia, polyuria, growth abdl, defective sodium reabs
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lichen planus
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pruritic, violaceous, flat topped papules with fine white streaks on the surface (wick ham's striae)
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injection drug abuser--> tricuspid endocarditis… lung exam?
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S. aureus--> vegetataions --> nodular infiltrates with cavitation
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keratoacanthoma
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low grade malignancy, solitary firm, round, skin colored or reddish plague, develops into nodule with central keratin plug
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papulopustular then verrucous lesions that are crusted heaped up and warty with violaceous hue
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blast skin lesion
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increasing pH does what to ionized Ca?
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decreases, by promoting binding to albumin
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tx of tourettes
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haloperidol or pimozide (traditional antipsychotics)
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conductive hearing loss vs sensorineural hearing loss
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conductive- obstruction of external sound to ear sensorineural: inner ear, cochlea or auditory nerve
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otosclerosis
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abnl remodeling of otic capsule autoimmune process, stapes footplate fixed to oval window --> loss of piston action, tx hearing amplification or surgical stapedectomy
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etiology of hypercoag in nephrotic
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increased urinary loss of antithrombin III, altered protein C and S, increased platelet aggregation, hyperfibrinogenemia (from increased hepatic synthesis), impaired fibrinolysis
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tx of hypercalcemia from metastatic disease
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zoledronic acid (bisphosphonate) more potent than iv saline
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cirrhosis, ascites, low grade fever, abd discomfort, altered mental status, paracentesis with PMN >250 and positive ascites cx
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SBP
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when to suspect axillary nerve injury
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deltoid malfunction (inability to extend arm) or shoulder numbness following shoulder dislocation
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drug induced lupus
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antihistone antibodies- hydralazine, procainamide, isoniazid, methyldopa, quinidine, chlorpromazine
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increased risk of osteosarcoma
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pagets, p53 mut, familial retinoblastoma, radiation, bone infarct
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ones that met to bone
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renal cell, lung, lymphoma, prostate, thyroid, breast
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suppurative hidradenitis
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pilonidal disease, dissecting folliculitis of the scalp and acne conglobata
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dipyridamole tests for ischemia with...
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inducing coronary steal
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when to do valve replacement for AS?
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stable, had symptoms (angina, syncope, dyspnea), having heart surgery, LVH/ small valve size/ inapprop response to exercise
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cholangiosarcoma of liver
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IBD, liver flukes
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angiosarcoma of liver
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from exposure to vinyl chloride
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immunocompromised, upper and lower GI ulcers, bone marrow suppression, arthralgias, myalgias, multifocal diffuse patchy infiltrates on CXR
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CMV
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emphysematous cholecystitis
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risks: vascular compromise, immunosuppresion, gallstones, infection; signs: RUQ pain, N/V, fever, creptitus, curvilinear line on U/S, tx: fluids/electrolytes, CCY, abx(esp against clostrideium)
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major cause of morbidity and mortality in SAH
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vasospasm-- prevented with CCB
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S4
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stiff left ventricle, long standing HTN, LVH or restrictive cardiomyopathy
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hep C assoc with
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glomerulonephritis, B cell lymphoma,plasmacytomas,autoimmune, lichen planus, porphyria cutanea tarda, idiopathic thrombocytopenic purpura
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interstitial cystitis
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pelvic pain, urinary urgency and frequency, exacerbated by sex, bladder filling, spicy foods-- submucosal petechiae or ulcerations
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atracurium
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anesthesia, degraded in plasma, hydrolyzed by esterases
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cerebral salt wasting syndrome
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after SAH, hypoNa, increased vasopressin, increased ANP/BNP
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echinococcosis cysts and species
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alveolar- e. multilocularis; cystic- e. granulosis
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piebaldism
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lack of melanocytes, many on trunk and head, noticed at birth
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post infectious glomerulonephritis, normal complement levels
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IgA nephropathy (if low complement --> post streptococcal)
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nail puncture wound --> osteomyelitis
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pseudomonas
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normocytitic anemia, thrombocytopenia, AMS, elevated retic, indirect hyperbili, mild fever, HIV +
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TTP
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skin and primary tb
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eruptions over infected lymph nodes, scrofuloderma, facial lesions (lupus vulgaris)
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acute intermittent prophyria
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can be precipitated by primidone --> vague abd pain, neurologic, psych issues
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Dubin johnson
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jew, icterus with trigger (illness, pregnancy, oral contraceptives), increased urinary coproporphyrin I, black liver, begin
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waldenstroms
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abnl plasma ells, excess IgM, hyerviscosity, HSM, enlarged nodes, tired, bleed/ bruise, nigh sweats, headache, dizziness, visual problems, pain/numbness in extremities
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inclusion body myositis
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adult onset distal muscular weakness and atrophy, dysphagia
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overdose BB
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brady, hypotension, can lead to cardiogenic shock, bronchospasm, seizure, delirium, hypoglycemia tx: atropine +iv fluids --> glucagon
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mitral regurg after MI
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papillar muscle rupture,
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tx of uric acid stones
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increase fluid, decrease purine intake, alk urine with potassium, notice the urine with this stone is very acidic
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calcification of solitary lung nodules
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bullseye granuloma, popcorn hamatoma, calcification usually means benign
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two types of impetigo, bullous and vesicular-pustular
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staph (bullous) strep (vesicular)
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wernicke's encephalopathy
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opthaloplegia, ataxia, confusion (tx thiamine
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guillian barre
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peripheral motor nerves
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cirrhosis and hemachromatosis increase risk for which infections
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neisseria monocytogenes, yersinia, vibrio vulnificus
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which to check for re-ischemia
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CKMB
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hemophysis, throat pain, dry cough, NO fever, wheezes, clear cxr
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acute bronchitis- tx: supportive
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wegeners
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sinisitis, c ANCA, bloody/ purulent nasal d/c, oral ulcers, fever, weight loss, fatigue, nodular densities on xray
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giant cell bone tumors
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soap bubble, oval or spindle shaped intermingled with numerous multinuclear giant cells in fibrous stroma, can be locally aggressive
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dominant frontal lesion
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speech, language, calculation, motor
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parietal lobe lesion
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sensory, dom(dysphagia, dyscalculia, left/right confusion) noncom(construction apraxia, contra sensory neglect, anosognosia)
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recommendations for ca oxalate urolithiasis
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increase fluid nl or increased ca, decrease nacl, oxalate restriction, decrease dietary proteins, HCTZ
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cause of senile purpura
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perivascular connective tissue atrophy
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angioedema
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rapid noninflamm edema of face, limbs, genitalia, laryngeal, bowels (colicky abd pain), from C1 inhibitor def, dysfunction, destruction (from ACI, infection, dental procedure, trauma), also see low C4, high C2b, bradykinin
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urinary markers of bone degeneration (elevated in pagets)
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hydroxyproline, deoxypyridinoline, N telopeptide, C telopeptide
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nigrastriatal pathway
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substantia nigra to basal ganglia, coordination of movement, causes extrapyramidal SE of antipsychotics and symptoms of parkinsons
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mesolimbic pathway
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ventral tegmental to limbic, euphoria in drug use
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tuberoinfundibular pathway
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pathway that if suppressed will cause the hyperprolactin effects
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what decreases insulin secretion
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fasting, exercise
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what patients go into DKA
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noncompliant, high stress, infection, MI, high alcohol use
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hyperosmolar hyperglycemia nonketotic coma
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high glucose with profound dehydration, seizure, stroke, DM2, inf, stress
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what decreases TBG leels
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nephrotic, androgen use
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presentation of subacute thyroiditis
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enlarged thyroid, painful, symptoms of hyperthyroid, neck pain, fever, increased ESR, decreased uptake on thyroid scan
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if no menstruation with medroxyprogesteron
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LH/FSH (pitutary) problem
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what to treat ACTH excess from paraneoplastic?
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octreotide
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17 alpha hydroxylase def
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deoxycortisone overproduction, amenorrhea, ambigulous genitalia (men), htn
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21 alpha hydroxylase def
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excess androstenedione, insuff cortisol and aldo, ambiguous genitalia (female), virilization (some), precocious puberty (men), HTN
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11 beta hydroxylase def
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excess deoxycorticosterone, deoxyortisol, androgens, insuff cortisol and aldosterone, same as 21 alpha hydroxylase def in symptoms
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tx of gastropariesis
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metoclopramide
|
|
|
diabetes with CN palsies
|
usually CN III, IV,VI, resolves in 8 wks
|
|
|
ocular toxo
|
necrosis involving inner layers of retina, white fluffy lesions around retinal edema and vitrifies, encephalitis
|
|
|
acid fast stain with oocysts in immunocompromised pt
|
most likely cryptosporidium parvum (could also be isospora belli)
|
|
|
pt with hypoK, alk, normotension
|
vomiting, diuretic abuse, bartters, gitelman
|
|
|
how to look at thyroid nodule
|
TSH --> (low radionuc scan) (high or nl u/s-->FNA)
|
|
|
ARDS
|
PCWP <18 (if >18 possibly cardiogenic pul edema)
|
|
|
viral arthritis
|
symmetric small joint arthritis, resolves within 2 m tx NSAIDs
|
|
|
hairy cell leukemia
|
B cell chronic leukemia, dry tap, tartate resistant acid phosphatase, CD11c, pancytopenia, splenomegaly tx: cladribine
|
|
|
HSV esophagitis
|
multiple small well circumscribed volcano like appearance, cells ballooning degeneration and eosinophilic intranuclear inclusion- tx acyclovir
|
|
|
CMV esophagitis
|
focal substernal burning pain with odynophagia, large shallow, superficial ulcerations, intranuclear and intracytoplasmic inclusions
|
|
|
nocardia
|
pulm, cns or cutaneous , crooked, branched beaded, gram+ partially acid fast organisms tx: TMP SMX alt is minocycline
|
|
|
tropical sprue
|
malabsorb b12, folic acid, and others, fatty diarrhea, cramps, gas, weight loss, hyperactive bowel sounds, borborygmi, diag with biopsy
|
|
|
middle cerebral artery occlusion
|
contra hemiplegia, eye deviation, hemianesthesia, hemianopsia, aphasia OR hemineglect; more upper ext
|
|
|
anterior cerebral artery occlusion
|
contra weakness, akinetic mutism, emotional disturbance, dev of eye and head to side of lesion, sphincter incontinence, more lower ext
|
|
|
diabetic, external ear pain and discharge, granulation tissue, exacerbated by chewing, radiation to TMJ
|
pseudomonas tx: ceftriaxone
|
|
|
what mimics achalasia
|
neoplasm at GE junction
|
|
|
fanconi
|
aplastic anemia, abnl thumbs, short, microcephaly, hypogonadism, hypo/hyperpigmented, cafe au lait, strabismus, low set ear,s abnl middle ear, from chromosomal breaks, affect genes responsible in DNA repair
|
|
|
d xylose absorption abnl when?
|
bacterial overgrowth and celiacs
|
|
|
new clubbing
|
malignancy
|
|
|
what does hyponatremia say about the heart failure
|
it's severe-- high renin, aldo, vasopressin and norepi if <137
|
|
|
which type of restrictive cardiomyopathy can be reversed
|
hemachromatosis, restrictive = symmetric thickening, more RHF signs
|
|
|
ichthyosis vulgaris
|
gradual progression to dry scaly skin(nl at birth),esp over extensor surfaces, lizard skin, worse in winter
|
|
|
non caseating granulomas, increased Ca, ACE, b/l mediastinal adenopathy, erythema nodosum
|
sarcoid
|
|
|
neuroleptic malignant syndrome- confusion, fever, muscle rigidity, diaphoresis, CK 50,000
|
tx: drantrolene --> bromocriptine --> amantadine
|
|
|
indications for thyroid testing
|
hyponatremia, hyperlipidemia, high serum muscle enzyme
|
|
|
isoniazid induced hepatic injury is different from other drug causes b/c?
|
usually extra hepatic hypersensitivity manifestations like rash, arthralgias, fever, leukocytosis, eosinophilia,
|
|
|
acute monocytic leukemia
|
headaches, fever, weight loss, bleeding from gums or nose, gingival hyperplasia and occasional skin lesions, positive alpha nephthyl esterase test
|
|
|
RA, enlarged kidneys, Hepatomegaly
|
possibly amyloidosis
|
|
|
how to test for disseminated histo
|
urine, serum can take 4 weeks to become positive; tx itraconazole
|
|
|
drug induced esophagitis
|
tetracyclines aspirin, NSAIDs, alendronate, potassium chloride, quinidine, iron, potassium chloride
|
|
|
HNPCC is assoc with colon and what other type of cancer?
|
endometrial
|
|
|
tx of acute COPD flare
|
bronchodilators (beta agonists) antimusc (ipratropium), abx, corticosteroids, O2
|
|
|
lead poisoning
|
neuro abnl, renal disease, anemia, constipation, diff concentrating, faitgue, myalgias, anemia, tx EDTA or succimer
|
|
|
complications of ADPKD
|
hepatic cysts, valvular disease (MV prolapse, aortic regurg), colonic diverticula, abd wall and inguinal hernia
|
|
|
hidradenitis suppurativa
|
occlusion of follicular and apocrine gland, tx abc and surg excision tx I&D, abx-- comp cavernous sinus thrombosis
|
|
|
causes of acne in adults
|
steroids androgen production /do
|
|
|
VZV can cause what in immunocompromised
|
encephalitis and retinitis
|
|
|
scabies
|
worse after bath, mite burrows, tx permethrin or ivermectin
|
|
|
assoc with erthema nodosum
|
strep, preg, unknown, drugs, behcets, ibd, tuberculosis, sarcoidosis
|
|
|
porphyria cutanea tarda
|
uroporphyrinogen decarboxylase risks: alcoholism, hep C, iron overload, estrogen use, smoking
|
|
|
excessive perspiration
|
MI, TB, infection, hyperthyroid, pheo
|
|
|
tx of polycystic kidneys
|
vasopressin receptor antagonists,amlioride,
|
|
|
risks for RCC
|
smoking, cadmium, absestos
|
|
|
pseudohyponatremia
|
hyperlipidemia, hyperglycemia, hyperproteinemia makes it appear low
|
|
|
tx of WPW a fib?
|
cardioversion or procainimide
|
|
|
tx of cocaine ischemia NOT MI
|
benzo, aspirin, nitrates
|
|
|
lacunar infarcts
|
microarthroma, lipohyalinosis risks: HTN, diabetes
|
|
|
VIPoma
|
diarrhea, abd pain, dehydration, flushing,hypoK
|
|
|
productive cough pneumo vs nonproductive
|
s. pneumo vs influenza (tx oseltamivir, zanamivir, rimantadine, amantadine)
|
|
|
emphysema vs chronic bronchitis
|
DLco is NL in chronic bronchitis
|
|
|
when to intubate
|
CO2>50 or O2<50 or pH<7.3
|
|
|
cave, birds, ohio/mississippi river valley lung nodule
|
histo
|
|
|
koilocytosis and pneumonia, HIV pt
|
CMV
|
|
|
bird dropping and pneumonia
|
chlamydia psittaci and histo
|
|
|
isolated systolic HTN
|
decreased elasticity of arterial wall--> widened pulse pressure tx: HCTZ (could also be aortic insuff)
|
|
|
hyperca due to malignancy
|
osteolytic met, secretion of PTHrP, increased 1,25 dihydroxyvitD, increased interleukin 6
|
|
|
in hyperandrogenism, excess testosterone? excess DHEAS?
|
ovarian…. adrenal
|
|
|
trachoma
|
chlamydia infection of eye, neovascularization(pannus), follicular conjunctivitis, and nasal discharge
|
|
|
glucose 6 phosphatase def
|
doll like face, thin extremities, hepatomegaly, enlarged kidneys
|
|
|
ductopenia
|
primary biliary cirrhosis, hodgkins disease, GVHD, sarcoid, CMV, HIV, med toxicity, failing liver transplantation
|
|
|
constrictive pericarditis
|
decreased CO, venous ocerload, sharp x and y descent and pericardial knock (early heart sound after S2)
|
|
|
what is post exposure prophylaxis for rabies
|
active and passive immunization
|
|
|
best means of eval acute hepatitis? chronic?
|
liver function tests and viral serology ............ liver biopsy
|
|
|
primary HIV vs mono
|
HIV also has rash and diarrhea, mono has tonsillar exudates
|
|
|
iridodonesis
|
rapid conraction and dilation of iris and results from dislocation of lens (upward in marfans, downwards in homocystinuria)
|
|
|
diastolic dysfunction
|
heart failure with preserved LV ejection fraction-- signs of CHF, LA dilation (afib)
|
|
|
causes of high output heart failure
|
anemia, hyperthryoid, beriberi, pagets, AV fistula
|
|
|
nonalcoholic fatty liver dsiease
|
from insulin resistance, increased fat accumulation in hepatocytes by increasing the rate of lipolysis and elevating the circulating insulin level, increased proinflamm cytokines, TNF alpha, can lead to cirrhosis
|
|
|
causes of sinus brady
|
physical conditioning, exaggerated vagal activity, sick sinus syndrome, hypoglycemia, meds-- tx atropine --> transcut pacing
|
|
|
meniere's disease
|
vertigo 20min-24hr, tinnitus, hearing loss, waxes and wanes, nystagmus,dizziness tx: avoid caffeine, nicotine, high salt--> meds like diuretics, antihistamines, anticholinergics (distention of endolymphatic compartment)
|
|
|
leukamoid reaction
|
high leukocyte alk phos score
|
|
|
bullous pemphigoid
|
pruritic, IgG and C3 along BM, no mucosal involvement
|
|
|
acute intermittent prophyria
|
females, episodic (usually meds) abd pain, n/v, diarrhea, sweating, agiation, anxiety, paraesthsia, confusion, NO photosensitvity
|
|
|
post CCY pain
|
CBD stone, sphincter of oddi dysfunction, functional pain
|
|
|
how to test for suspected aortic dissection
|
TEE or CT with contrast
|
|
|
different types of renal casts. broad? RBC? WBC? fatty? muddy brown?
|
CRF, glomerulonephritis, interstitial nephritis/ pyelo, nephrotic, ATN
|
|
|
bright red, firm, friable exophytic nodules in HIV pt on face
|
bartonella (bacilliary angiomatosis) tx erthyromycin
|
|
|
adrenoleukodystrophy
|
excess VLCFA, see enlarged adrenals, labs show adrenal insuff
|
|
|
cuteanous larva migrans
|
from dog/cat feces helmith, pruritic erythematous papules, serpiginous reddish brown, sandbox or beaches
|
|
|
which disturbance of Aa gradient doesn't correct with O2
|
shunting--pneumonia, pul edema, vascular shunting
|
|
|
CHF vs COPD
|
CHF (bibasilar crackles, hypoxia, hypocapnia, resp alk) COPD( diffuse crackles, hypoxia, hypercapnia, resp acidosis)
|
|
|
pernicious anemia assoc with
|
intestinal type gastric cancer and carcinoid in stomach
|
|
|
parkinsons
|
dopamine, substantia nigra, lewy body, resting tremor, shuffling gate, rigidity,
|
|
|
huntington
|
CAG, AD< chorea, dementia, seizures, caudate nucleus and putamen atrophy, tx dopa antag
|
|
|
ant vs posterior uveitis
|
ant(pain photophobia, inflam of eye and keratin deposits on cornea) posterior(mild vision abnl, inflammation, retinal lesions)
|
|
|
trichinosis
|
uncooked pork, 3 phases 1(abd pain, N/V, D) 2(larval migration hypersensitivity (splinter hemorrhages, conjunctival and retinal hemorrhages, preiorbital edema, chemosis) 3( into skeletal muscle, muslce pain, tenderness, swelling ,weakness) esoinophilia
|
|
|
ehrlichiosis
|
fever, malaise, headache, n/v, leukopenia, thrombocytopenia, hemolysis, jaundice
|
|
|
babesiosis
|
enters RBC --> hemolysis, hemolytic anemia w/ jaundice, hemoglobinuria, renal failure, death, NO RASH, from tick
|
|
|
tx of high homocysteine levels
|
pyridoxine B6
|
|
|
two types of met alk
|
chloride sensitive (urine Cl<20, volume depletion, from thiazide,s loop, loss of gastric secretions-- tx saline) chloride resistant (cl>20, and ECF expansion, from primary hyperaldo, barter, gitelman, excessive black licorice)
|
|
|
hyperthyroid htn… pathophys?
|
hyper dynamic state, increased myocardial SE calcium sep ATPase(hypothyroid uses increased SVR)
|
|
|
terminal hematuria
|
bladder or prostate
|
|
|
neurtrophilic cryptitis on bowel biopsy
|
IBD
|
|
|
stroke tx in sickle cell pt
|
exchange transfusion
|
|
|
recommendations for renal calculi pts
|
increase fluid intake and ca, decrease protein and oxalate, decrease sodium
|
|
|
appendicitis pain
|
visceral--> somatic
|
|
|
riboflavin (b2) def
|
sore throat, hyperemic and edematous oropharynx mucosa, chelitis, stomatitis, glossitis, normocytic normochromic anemia, sebhorric dermatitis, photophobia
|
|
|
interventricular wall rupture
|
new systolic murmur Left lower sternal border
|
|
|
ventricular aneurysm
|
CHF, persistant ST changes, mitral regurg
|
|
|
hyperca in metastatic solid tumors
|
cytokines
|
|
|
retropharyngeal abscess
|
muffled voice, fever, irritability, fatigue, neck stiffness
|
|
|
wilson's disease
|
basal ganglia, liver, cornea, increased LFTs, neurosymptoms
|
|
|
sehorreheic dermatitis is assoc with...
|
parkinsons and HIV
|
|
|
TTP vs ITP
|
thrombocytopenia, renal failure, anemia, neuro dysfunction, fever vs ITP (thrombocytopenia, purpura, bruising, epistaxis)
|
|
|
hypothermia
|
<95/35, risks: ETOH old; J waves, Vtach, Vfib
|
|
|
pulseless-->
|
epi-> atropine (PEA)
|
|
|
rectangular envelope shaped crystals
|
calcium oxalate (from ethylene glycol OD)
|
|
|
hexagonal crystals on U/A, positive urinary cyanide nitroprusside test
|
defective transfer of AA (increased cystine)--> cystinuria
|
|
|
primary biliary cirhosis
|
noncaseating granulomas, infiltration with eosinophils, macrophages, lymphocytes, plasma cells
|
|
|
tx of NASH
|
ursodeoxycholic acid
|
|
|
blue when feeding, pink when cry
|
choanal atresia
|
|
|
elevation of CK and myopathy, unexplained
|
hypothyroidism
|
|
|
sympathetic opthalmia
|
spared eye injury, after penetrating injury to one eye, the other eye has problem (usually ant uveitis) uncovering hidden antigen, immune mediated
|
|
|
megaloblastic anemia, increased methylmalonic acid, increased homocysteine
|
B12 def, homocysteine is increased with folate an B12 def
|
|
|
ant mediastinal mass
|
Ts: teratoma, thymoma, terrible lymphoma, thyroid neoplasm
|
|
|
analgesic nephropathy
|
papillary necrosis and tubulointerstitial nephritis(WBC casts, protein in urine)
|
|
|
common findings in anorexics
|
osteoporosis, increased cholesterol and carotene, cardiac arrhythmias (prolonged QT), euthyroid sick synd, hypothal-pit axis dysfunction, hypona
|
|
|
choledochal cyst
|
dilation of intra or extra hepatic biliary ducts, anomalous pancreaticobiliary junction, can degenerate into cholangiocarcinoma
|
|
|
acetaminophen od tx
|
get levels after 4 hrs--> charcoal--> determine if need N acetylcysteine
|
|
|
nasal obstruction, visible nasal mass, frequent nosebleeds
|
angiofibroma, benign growth
|
|
|
which stomach ca is eradicated with tx of H. pylori
|
low grade mastric MALT lymphoma
|
|
|
most common kidney stone
|
calcium oxalate
|
|
|
infection of burns
|
s. aureus and pseudomonas
|
|
|
most common thyroid nodule
|
colloid nodule
|
|
|
enthesitis
|
pain at sites where ligament attaches to bone. seen at sites of recurrent stress and HLA B27 like AS, psoriatic arthritis and reactive arthritis
|
|
|
test for adrenal insuff
|
cosyntropin test
|
|
|
nosebleeds during pregnancy
|
pyrogenic granulomas of the ant nasal septum, highly vascular
|
|
|
tx of herpes simplex keratitis
|
topical antivirals- idoxiuridine or trifluridine NO steroids
|
|
|
indications for open reduction
|
nonunion, intraarticular, blood supply compromise, multiple trauma, need for perfect realignment
|
|
|
sudden deafness
|
temporal bone fx or viral infection (returns in 2 wks)
|
|
|
infectious myringitis
|
mycoplasma, vesicles on TM, could also be from S. pneumo
|
|
|
risks for successful suicide
|
>45, depression, M, plan, prior attempts, violent behavior, drug use, recent loss, unemployment, widowed or divorced
|
|
|
longer vs shorter benzos
|
alprazolam faster, clonazepam and diazepam longer acting
|
|
|
MVP assoc with which psych d/o
|
panic d/o
|
|
|
refeeding synd
|
hypophosphatemia, CV collapse, rhabdomyolysis, confusion, seizures
|
|
|
Extrapyramidal
|
dystonia, parkinsonism, tardive dyskinesia,akathesia
|
|
|
tx of dystonia or parkinsonism
|
anti chol or antihistamines
|
|
|
tx akathesia
|
BBs
|
|
|
SE of thioridazine
|
retinal pigmentation
|
|
|
normal grief vs depression
|
not nl to have worthlessness, psychomotor retardation, suicidal ideations
|
|
|
what else can elevate amylase and lipase
|
salivary gland or bowel injury, renal failure, ruptured tubal preg
|
|
|
what increases Alk phos
|
bone, biliary, pregnancy
|
|
|
what disease inability to concentrate or dilute urine
|
sickle cell trait or diseae
|
|
|
QT when Ca is low?
|
prolonged
|
|
|
SE of thiazides
|
hyperuricemia, calcium retention, hyperglycemia, hyponatremia, hyperlipidemia, met alk hypoK
|
|
|
ambiguous genitalia and hypotension in F
|
21 hydroxylase def
|
|
|
tx of neurogenic bladder
|
cholinergics, bethanechol
|
|
|
pH of yeast infection
|
4-4.5
|
|
|
mcc nephrotic in adults
|
focal segmental
|
|
|
leukocytoclastic vasculitis
|
HSP
|
|
|
hyponatremia during meningitis
|
ADH
|
|
|
tx of h. pylori
|
PPI, clarithromycin amox (or metronidazole)
|
|
|
tx of salmonella or shigella
|
cipro/bactrim
|
|
|
how to protect stomach if taking NSAIDs
|
misoprostol, celecoxib
|
|
|
gastrectomy complications lead to def of?
|
Fe and Ca
|
|
|
volvulus
|
infant, elderly, sigmoid (sigmoidoscopy) or cecum(coffee bean- surg)
|
|
|
secretory diarrhea
|
VIPoma, gastrinoma, carcinoid, medullary thyroid ca
|
|
|
low stool pH
|
lactase insuff (6=nl)
|
|
|
t. whippelii
|
arthritis, cough, steatorrhea, fever, skin pigmentation, cardiac infx, cns, PAS+, foamy macrophages tx: bactrim or ceftriaxone
|
|
|
pulsus paradoxus
|
tamponade, tension pneumothorax, severe asthma
|
