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130 Cards in this Set
- Front
- Back
Actinic (solar) keratosis
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Precursor to squamous cell carcinoma
Actually only 1/1000 progress to SqCC. Actinic keratosis is easier felt than seen - rough, like sandpaper. Treat topically - 5-fluorouracil will initially give it a beefy red color |
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Acute gastric ulcer associated with CNS injury
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Cushing's ulcer
Inc. intracranial pressure stimulates vagal gastric acid secretion. Cushing's triad: Inc. ICP Inc. HR Dec. respiration |
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Acute gastric ulcer associated with severe burns
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Curling's ulcer
Greatly reduced plasma volume causes sloughing of gastric mucosa Think: "curling iron" to remember "burn" |
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Alternating areas of transmural inflammation and normal colon
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Skip lesions
Seen in Crohn's disease One of the major differences between Crohn's and ulcerative colitis Can be seen on radiograph |
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Aneurysm, dissecting
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Usu due to hypertension
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Aortic aneurysm, abdominal and descending aorta
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Usu due to atherosclerosis
Most common area for atherosclerosis is abdominal aorta |
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Aortic aneurysm, ascending
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Tertiary syphilis
Marfan's syndrome Possibly from hypertension With tertiary syphilis: aortic regurgitation or stenosis, tree-barking of aorta, "prostate's pupil," tabes dorsalis |
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Atrophy of the mammillary bodies
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Wernicke's encephalopathy
(thiamine deficiency causing ataxia, ophthalmoplegia, and confusion) Seen most often in chronic alcoholics Other B1 deficiency diseases: Wet beriberi (cardiac manifestations); Dry beriberi (neurological manifestations) |
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Autosplenectomy (fibrosis and shrinkage)
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Most commonly from sickle cell anemia (HbS)
Malformed RBCs cause autoinfarction in spleen -> sclerosed, shrunken tissue In asplenia, beware encapsulated organisms: S. pneumoniae, Klebsiella, H. influenzae, N. meningiditis, Salmonella, Strep B |
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Bacteria associated with stomach cancer
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H. pylori
Pretty much anytime they ask about bacterial pathology in the stomach, think H. pylori. |
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Bacterial meningitis in adults & elderly
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S. pneumoniae considered #1 cause
#2 - Neisseria meningitidis |
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Bacterial meningitis in kids & newborns
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Newborns - Group B strep or E. coli
Kids - S. pneumoniae or N. meningitidis |
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Benign melanocytic nevus
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Spitz nevus
Most common in first two decades of life |
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Bleeding disorder with GpIb deficiency
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Bernard-Soulier disease
Defect in platelet adhesion to vWF (von Willebrand's factor) Causes inc. bleeding time, but not inc. PT or PTT |
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Brain tumor (adults)
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Most common: metastases
Then: Glioblastoma multiforme (or astrocytomas) Then: meningioma Then: schwannoma Mnemonic: MGM Studios |
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Brain tumor (kids)
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>70% are infratentorial: astrocytoma > medulloblastoma > ependymoma
Supratentorial: most often craniopharyngioma (origin in Rathke's pouch, like adenohypophysis) |
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Breast cancer
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Most common: infiltrating ductal carcinoma
Same as invasive ductal carcinoma Approx. 1 in 8 American women will develop breast cancer |
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Breast mass
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Most likely: Fibrocystic change
Second: Carcinoma (in postmenopausal women) |
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Breast tumor (benign)
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Usu fibroadenoma
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Primary cardiac tumor (kids)
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Rhabdomyoma
May be assoc w/tubular sclerosis (in which case, may also have ash leaf spots & seizures) |
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Cardiac manifestation of lupus
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Libman-Sacks endocarditis
Nonbacterial, affects mitral valve |
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Cardiac tumor (adults)
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#1 - Metastasis
#2 - Primary myxoma (4x as ofen in left atrium than right) "Ball and valve" action -> syncope |
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Cerebellar tonsillar herniation
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Chiari malformation
May be asymptomatic OR - may present with progressive hydrocephalus or syringomyelia |
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Chronic arrhythmia
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Atrial fibrillation most common
Assoc w/high risk of emboli (Stasis of blood inc. risk. Must treat with warfarin before attempting to correct arrhythmia) |
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Chronic atrophic gastritis (autoimmune)
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Predisposition to gastric carcinoma
Can cause pernicious anemia Attack on parietal cells -> loss of Intrinsic Factor -> inability to absorb B12 in ileum |
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Clear cell adenocarcinoma of the vagina
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DES exposure in utero
Exposure occurs in the womb when the mother takes DES. The female fetus, later in her life, develops this. |
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Congenital adrenal hyperplasia, hypotension
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21-hydroxylase deficiency
Unable to synthesize mineralocorticoids or glucocorticoids. Precursors are shunted towards androgen production. Dec. mineralocorticoids -- hypotension, hyperkalemia, salt wasting. Inc. renin activity. Dec. cortisol -- inc. ACTH (hyperpigmentation) Inc. androgens -- masculinization (of female infant) |
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Congenital cardiac anomaly
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VSD (Ventricular Septal Defect)
Of course, not the only congenital cardiac anomaly, but it is the most common. |
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Congenital conjugated hyperbilirubinemia (black liver)
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Dubin-Johnson syndrome
Inability of hepatocytes to secrete conjugated bilirubin into bile |
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Constrictive pericarditis in developing world
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Tuberculosis
1/3 of the world is infected with TB (whether active of latent) |
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Coronary artery involved in thrombosis
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LAD > RCA > LCA
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Cretinism
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Iodine deficit/hypothyroidism
Occurs early in life (begins in utero). CNS is not able to mature. Easily treated if recognized early. Also presents with macroglossia, umbilical hernia, mental retardation, and short stature. |
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Cushing's syndrome
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#1 - Corticosteroid therapy. Also know as exogenous Cushing's.
#2 - Cushing's disease: excess ACTH secretion by the pituitary Diagnosis: ACTH is not suppressed by low-dose dexamethasone, but CAN be suppressed by high doses. |
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Cyanosis (early - in neonates. Less common)
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Tetralogy of Fallot
Transposition of great vessels Truncus arteriosus In all cases, pulmonary circulation is bypassed; systemic organs cannot receive oxygenated blood |
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Cyanosis (late - in children. More common)
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VSD, ASD, PDA
Eisenmenger's Syndrome - defect begins as a L->R shunt, so blood is properly oxygenated. After years of smooth muscle hypertrophy and fibrosis, pulmonary vasculature develops hypertension. With increased pressure, the shunt becomes R->L. To compensate, kids squat to increase afterload. |
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Death in CML
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Blast crisis
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Death in SLE
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Lupus nephropathy
anti-dsDNA strongly associated with lupus-related renal disease |
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Dementia
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#1 - Alzheimer's disease
#2 - Multiple infarcts, often from carotid artery stenosis |
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Demyelinating disease in young women
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Multiple sclerosis
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DIC
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Gram-negative sepsis, obstetric complications, cancer, burn trauma
Mnemonic: STOP Making New Thrombi Sepsis Trauma OB complications Pancreatitis Malignancy Nephrotic syndrome Transfusion |
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Dietary deficit
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Most commonly iron.
HOWEVER - most common VITAMIN deficiency is folic acid |
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Diverticulum in pharynx
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Zenker's diverticulum
Diagnose with barium swallow |
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Ejection click
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Aortic or pulmonic stenosis
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Esophageal cancer
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Worldwide - squamous cell carcinoma
In US - adenocarcinoma This is due to high rates of GERD causing Barrett's esophagus, a precursor to esophageal adenocarcinoma. |
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Food poisoning (exotoxin mediated)
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S. aureus, B. cereus
Toxin is preformed in food; induces vomiting within a few hours, fairly quick recovery. |
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Glomerulonephritis (adults)
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Berger's disease (IgA nephropathy)
DO NOT confuse this with Buerger's disease - a vasculitis often seen in smokers |
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Gynecologic malignancy
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Worldwide - cervical
US - endometrial carcinoma (#4 cancer in females) After that, ovarian. |
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Heart murmur, congenital
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Mitral valve prolapse
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Helminth infection (US)
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#1 - Enterobius vermicularis
Diagnose with "Scotch tape test" #2 - Ascaris lumbricoides Treat both with a -bendazole drug |
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Heart valve in bacterial endocarditis
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If rheumatic fever - mitral
2nd - aortic If IV drug abuse - tricuspid |
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Hematoma - epidural
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Rupture of middle meningeal artery
Biconvex shape on imaging; risk of uncal herniation Usu from trauma to the head. Unconsciousness -> lucid period -> confusion/delirium from increasing intracranial pressure |
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Hematoma - subdural
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Rupture of bridging veins
Crescent shaped on imaging Usu from trauma - deceleration injury, mild injury in elderly (due to slight atrophy of cerebral & vascular tissues) Slow bleed - symptoms may not present for a few days |
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Hemochromatosis
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Multiple blood transfusions - seen in pts with sickle cell anemia or thalassemia
Hereditary HFE mutation Excess Fe deposits in tissues. Can result in CHF, "bronze diabetes," or inc. HCC risk Triad: cirrhosis + diabetes mellitus + skin pigmentation |
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Hepatocellular carcinoma
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Cirrhotic liver
Often associated with HBV/HCV |
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Hereditary bleeding disorder
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#1 - von Willebrand's disease (autosomal)
#2 - hemophilia A - deficiency of factor VIII (X-linked) |
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Hereditary harmless jaundice
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Gilbert's syndrome - benign congenital unconjugated hyperbilirubinemia
From dec. amt UDP-glucuronyl transferase or dec. bilirubin uptake by hepatocyte Usu diagnosed incidentally, only presents in times of stress or illness |
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HLA-B27
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"PAIR" - Seronegative Spondyloarthropaties
Psoriasis (doesn't always cause arthritic Sx) Anklosing spondylitis IBD (Crohn's dz, ulcerative colitis) Reiter's syndrome (can't see/pee/climb a tree |
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HLA-DR3 or HLA-DR4
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Diabetes mellitus type I
Rheumatoid arthritis SLE |
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Holosystolic murmur
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VSD
Tricuspid regurgitation Mitral regurgitation These are heard throughout ventricular contraction. Aortic or pulmonary stenosis will only be heard during the second portion of systole (There is no turbulent blood flow during ISOVOLUMETRIC contraction) |
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Hypercoagulability, endothelial damage, blood stasis
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Virchow's triad
(results in venous thrombosis) |
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Secondary hypertension
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Usu renal disease - renal artery stenosis, chronic renal failure, etc.
If female with new onset, investigate OCP use |
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Hypoparathyroidism
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Thyroidectomy - parathyroids are accidentally damaged or removed
Will show signs of hypoCa (tetany) |
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Hypopituitarism
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Pituitary adenoma (usu benign)
Most common pituitary adenoma - prolactinoma |
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Infection secondary to blood transfusion
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HCV
Although - other sources claim CMV. I can't make promises on this one. |
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Kidney stones
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#1 - Calcium. Will be radiopaque.
#2 - Struvite (NH4 + Mg + PO4). Also radiopaque. Formed by urease-positive bugs - Proteus, Staph, etc. #3 - Uric acid. Radiolucent (if imaged with dye, they look like empty spots). From hyperuricemia, leukemia treatment (tumor lysis syndrome), Leisch-Nyhan, inc. cellular breakdown |
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Late cyanotic shunt
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Eisenmenger's syndrome - from an initial L->R shunt (ASD, VSD, PDA)
Shunt is present at birth, but is L to R and largely asymptomatic. Over time, pulmonary HTN inc. R pressure, and shunt reverses (R to L). To continue perfusing tissues, RBC production increases (polycythemia). Child squats - inc. mean arterial pressure -> inc. afterload -> inc. L heart pressure. |
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Liver disease
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Usu alcoholic cirrhosis
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Lysosomal storage disease
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Gaucher's disease
Histologic hallmark: "crinkled tissue paper" cytoplasm. First Aid p 111 |
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Male cancer
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Greatest incidence - prostatic carcinoma
Greatest fatality - lung. (Prostate is #2) |
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Malignancy assoc w/noninfectious fever
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Hodgkin's lymphoma
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Malignant skin tumor
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Basal cell carcinoma
(Malignant, but rarely metastasizes) |
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Mental retardation
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#1 - Fetal Alcohol Syndrome
#2 - Down Syndrome (Trisomy 21) #3 - Fragile X Syndrome |
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Metastases to bone
(mnemonic) |
P.T. Barnum Loves Kids
Prostate Thyroid, Testes Breast Lung Kidneys Breast & Lung metastasize just about everywhere. Most other bone mets are GU-related. |
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Metastases to brain
(mnemonic) |
Lots of Bad Stuff Kills Glia
(This is in order of occurence!) #1 - Lung #2 - Breast #3 - Skin (melanoma) #4 - Kidney (RCC) #5 - GI tumors |
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Metastases to liver
(mnemonic) |
Cancer Sometimes Penetrates Benign Liver
Colon Stomach (gastric) Pancreatic Breast Lung Breast & Lung metastasize just about everywhere. The rest are mostly areas that could easily spread through the portal vein. |
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Mitral valve stenosis
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Rheumatic heart disease
(More in older population) |
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Mixed (UMN & LMN) motor neuron disease
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ALS
Damages anterior horns (LMN) & lateral corticospinal tracts (UMN) |
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Myocarditis
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Coxsackie B
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Neoplasm in kids
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#1 - ALL
#2 - Cerebellar astrocytoma Histo: perivascular pseudo-rosettes |
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Nephrotic syndrome (adults)
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MGN - Membranous glomerulonephritis
"Spike & dome" appearance on EM SubEPIthelial deposits Capillary & GBM thickening Granular on IF |
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Nephrotic syndrome (kids)
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MCD - Minimal Change Disease
assoc w/infections & vaccinations Appear normal on LM; podocyte foot process effacement/fusion on EM Albumin lost in urine, but not Igs Tx with corticosteroids |
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Nosocomial pneumonia (4)
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Klebsiella
E. coli Pseudomonas aeruginosa S. aureus |
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Obstruction of male urinary tract
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BPH - Benign Prostatic Hyperplasia
(NOT HYPERTROPHY) Tx: alpha1-antagonists relax smooth muscle. Immediate symptomatic relief. Finasteride blocks 5alpha-reductase, dec. DHT. Slower fx. |
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Opening snap (OS)
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Mitral stenosis
Diastolic murmur beginning after OS (not heard during isovolumetric relaxation) OS due to tensing of chordae tendineae. The thicker & more fibrotic they are, the earlier the OS occurs - so the time between the A2 sound and the OS can indicate the severity of the stenosis. (Shorter time = more severe) |
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Opportunistic infection in AIDS
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Pneumonia - Pneumocystis jiroveci
Tx:prophylactic TMP-SMX (or dapsone) when CD4 < 200 Meningitis - Cryptococcus Can start fluconazole at CD4 < 50 Diarrhea - Cryptosporidium. MAC becomes common when CD4 < 100 (Prophylaxis with azithromycin) Skin disorder - Kaposi's sarcoma (HHV-8) |
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Osteomyelitis
In sickle cell patient? In IV drug user? |
S. aureus
In SCA - Salmonella In IVDU - Pseudomonas, S. aureus |
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Ovarian metastasis from gastric carcinoma or breast cancer
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Krukenberg tumor - cells secrete mucus, have "signet ring" form (mucus pushes nuclear material to one side)
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Ovarian tumor (benign)
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Serous cystadenoma
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Ovarian tumor (malignant)
Bonus point: Tumor marker |
Serous cystadenocarcinoma
Show psamomma bodies! Tumor marker - CA-125 (for all ovarian cancers) |
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Pancreatitis (acute)
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Gallstones, alcohol (most prevalent two causes)
Mnemonic: GET SMASHED Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, HyperCa, HyperTGs, ERCP, Drugs |
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Pancreatitis (chronic)
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Adults - alcohol
Kids - cystic fibrosis |
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Patient groups most likely to have ALL/CLL/AML/CML
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ALL - child
CLL & AML - adult > 60 CML - adult 35-50 **ON STEP 1 - most scenarios will feature the classic case. These age groups are VERY important! |
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Pelvic inflammatory disease
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N. gonorrhoeae
Also most common cause of monoarticular purulent arthritis in a young sexually active adult Chlamydia |
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Philadelphia chromosome
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t(9;22) - forms bcr-abl
95% - assoc w/CML possible association w/ AML or ALL |
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Pituitary tumor
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#1 - prolactinoma
Amenorrhea, bitemporal hemianopsia, gynecomastia (men) #2 - Somatotropic "acidophilic" adenoma |
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Primary amenorrhea
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Turner syndrome (XO)
Appearance - short stature, broad chest, webbed neck Streak ovaries Lymphedema Congenital coarctation of the aorta (adult type) Most common cause of secondary amenorrhea - pregnancy |
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Primary bone tumor (adults)
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Multiple myeloma
Tumor of plasma cells - monoclonal antibody spike |
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Primary hyperaldosteronism
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Adenoma of adrenal cortex
Inc. aldosterone & inc. cortisol --> Cushing's Syndrome |
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Primary hyperparathyroidism
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#1 - Adenomas
#2 - Hyperplasia #3 - Carcinoma (PTH-related peptide in paraneoplastic effect) |
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Primary liver cancer
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HCC - hepatocellular carcinoma
Causes: chronic hepatitis, cirrhosis, HBV/HCV infection, hemochromatosis, alpha-1 antitrypsin deficiency Marker: alpha-fetoprotein |
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Pulmonary hypertension
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COPD
|
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Recurrent inflammation/thrombosis of small/medium vessels in extremities
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Buerger's disease
Often in young male smokers Assoc w/Raynaud's |
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Renal tumor
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RCC - renal cell carcinoma
Assoc w/von Hippel-Lindau and ADPKD (autosomal dominant polycystic kidney disease) Paraneoplastic syndrome - can secrete EPO, renin, PTH, or ACTH |
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Right heart failure due to a pulmonary cause
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Cor pulmonale
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Most common cause of right-sided heart failure
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Left-sided heart failure
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S3 (protodiastolic gallop)
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Inc. ventricular filling, assoc w/dilated ventricles. Causes:
L to R shunt (VSD, ASD, PDA) Mitral regurgitation LV failure (CHF) |
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S4 (presystolic gallop)
"atrial kick" |
Stiff or hypertrophic ventricle: Causes:
Aortic stenosis Restrictive cardiomyopathy Hypertrophic cardiomyopathy Chronic HTN Post-myocardial infarction |
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Secondary hyperparathyroidism
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Hypocalcemia of chronic kidney disease
Inability to make 1,25-OH Vitamin D --> dec. Ca absorption in the gut --> inc. PTH |
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Sexually transmitted disease
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Chlamydia
Often coinfected with gonorrhea |
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SIADH (Syndrome of Inappropriate ADH Secretion)
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Small cell carcinoma of the lung
Causes diuresis --> hypoNa Also seen with various brain pathologies |
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Site of diverticula
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Sigmoid colon
|
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Sites of atherosclerosis
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#1 - Abdominal aorta
#2 - Coronary arteries #3 - Popliteal artery #4 - Carotid arteries |
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Stomach cancer
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Adenocarcinoma
|
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Stomach ulcerations with high gastrin levels
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Zollinger-Ellison syndrome
Gastrinoma (gastrin-secreting tumor) of duodenum or pancreas |
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t(14;18)
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Follicular lymphoma
bcl-2 activation |
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t(8;14)
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Burkitt's lymphoma
c-myc activation |
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t(9;22)
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Philadelphia chromosome - CML
bcr-abl hybrid |
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t(11;22)
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Ewing sarcoma
(bone tumor in children) |
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Temporal arteritis
(a.k.a. Giant Cell Arteritis) |
Risk of ipsilateral blindness due to thrombosis of ophthalmic artery
Polymyalgia rheumatica Often shows inc. ESR |
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Testicular tumor
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Seminoma
(Male equivalent of the dysgerminoma) |
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Thyroid cancer
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Papillary carcinoma
Histo: Orphan Annie nuclei, psamomma bodies. |
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Tumor in women
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Leiomyoma
Estrogen dependent growth of myometrium. NOT a precursor to carcinoma |
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Tumor of infancy
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Hemangioma
Benign; usually regresses spontaneously in childhood |
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Tumor of the adrenal medulla (adults)
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Pheochromocytoma
Usually benign, but secreted catecholamines can be damaging. |
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Tumor of adrenal medulla (kids)
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Neuroblastoma
Malignant Histo: Homer-Wright rosettes |
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Type of Hodgkin's
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Nodular sclerosis (65-75%)
The only type more prevalent in women. Good prognosis (few Reed-Sternberg cells). Other forms: Mixed cellularity (25%, iffy prognosis) Lymphocytic predominance (6%, good prognosis) Lymphocytic depletion (rare, bad prognosis. In older men) |
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Type of non-Hodgkin's
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Diffuse large cell
Mostly in adults; 20% in children |
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UTI
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80% are E. coli
Staph saprophyticus (sexually active women) Proteus |
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Viral encephalitis of temporal lobe
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HSV-1
|
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Vitamin deficiency (in US)
|
Folic acid
High risk in pregnant women - needed to prevent neural tube defects, but body only stores 3-4 month supply B12 deficiency much rarer; liver contains LARGE stored |