Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key


Play button


Play button




Click to flip

929 Cards in this Set

  • Front
  • Back
When should you suspect Guillan Bgarre?
ascending paralysis after a viral illness
what is a diagnostic test for Guillan barre?
increased protein in CSF
what is the Rx for Guillan Barre?
plasmapharesis, IVIg
What is a classic sign of Impaired leukocyte adhesion?
delayed seperation of the umbilical cord.
normal lymphocytes, gamma globulin. Peridontal infections
what organism is likely in an opsonization defect?
S. pneumo
What organism attacks in someone with complement deficiency?
what is the diagnositic test for defective intracellular killing?
what drugs treat influenza A?
oseltamivir, zanamivir (neuroaminidase inhibitor)
Rimantidine, amantidine
What is a common sign of Midpelvis contraction?
prominent ischial spines. Prevent expansion of the cervix
what eye tumor is seen in NF type I
optic glioma
what eye tumor is seen in tuberous sclerosis?
Retinal hamartoma
what ophthalmologic sign is seen in optic neuritis?
What is Hehect's syndrome?
recurrent oral ulcer's, genital ulcers, erythema nodosum, + pathurgy
- seen in turkish, asian, middle eastern
what is seen on EKG in a ventricular aneurysm?
ST elevation
what does a double apical beat signify?
ventricular aneurysm
How soon after an MI would one have Dressler's?
2-10 wks
what can pseudotumor lead to?
Define HTN retinopathy:
Grade I
I- AV nicking
II- Copper wiring
III- sliver wiring, hemorrhage
IV- papilledema
what does dark field microscopy test for?
syphilis (blood tests take a bit)
What does frei test test for?
what does wright stain test for?
granuloma inguinale
What does Tzanch test test for?
what happens to sleep when you age?
wake up more, shortened cycle
what can be used for continued CSF drainage (> 4 days)?
spinal drainage, acetazolamide to decrease ICP
when is craniotomy considered for CSF rhinorrhea?
What are the findings on a stress test that indicates need for angiography?
faliure to increase BP, cannot complete stage 1 with bruce criteria, ST changes
at what gestational age can transiet htn be considered?
20 wks. b4 20 it's chronic htn or mole
when is a gunshot considered to have the abdomen involved?
below the 4th intercostal (nipple line). Ex lap needed.
When do u hospitalize a bulemic?
metabolic abnlties, medically unstable, suicide risk, failed outpt therapy
What is deQuervians tendonits?
What muscles does it effect
what diagnostic PEX maneuver?
What's the Rx?
tendonitis seen post partum. Affects flexor pollicus longus, extensor pollicis brevis
Rx is roids
What is Dubin-Johnson?
what triggers it?
what labs?
chronic hyperbili- triggered by OCPS, Pregs, illness
conjugated bili, black liver.
what is rotor syndrome?
hyperbili due to defect of hepatic storage.
Unconjugated, conjugated hyperbili
what is Crigler-Najar?
hyper bili that can cause severe neuro damage and death. Unconjugated hyperbili
Rx is phototherapy, plasma pharesis?
What are the systemic findings of rheumatic fever?
Erythema marginatum
Subcutaneous nodules
Will diuretic abuse give you high or low Cl in urine?
What is the blood test of choice for screening for addison's?
cosyntropin stim test
What is Job syndrome?
recurrent bacterial infections, high IgE, skin infections
What is wiskott aldrich syndrome?
eczema, TTP, pyogenic infections
High IgA, IgE, low IgM
what is the pathomnemonic finding in chornoic eosinophilic pneumonia?
CXR w peripheral infiltrates, no pulm edema
When is bronchoalveolar lavage useful?
What is the most common cause of endocarditis?
How is CO2 interbeted in an ABG?
if high, it means a resp acidosis, or compensation for a met alk.
How is bicarb interpreted in an ABG?
if high,-> met alk, or compensation.
What are the common causes of resp acid?
COPD, Asthma, Benzos, barbs, alcohol (resp depressants), chest wall problems, sleep apnea (if you can't blow off CO2 you get acidotic)
what are the common causes of met acid?
ethanol, ketoacidosis, uremia, lactic acid, methanol, aspirin, diarrhea, carbonic anhydrase inhibitors
what are teh common causes of resp alk?
anxiety, aspirin, salicylate
what is the common metabolic disturbance w/ aspirin?
met acid
resp alk

look for tinnitus, hypoglycemia, vomiting
what are the common causes of met alk?
Vomiting, diuretics, volume contraction, antacid abuse, hyperaldo
what is the treatment for salicylate OD?
bicarb to speed up excretion
what happens to pH to peeps with chronic lung issues?
sleep apnea, chronic lung diseasess cause a baseline alkalosis. (normal compensatory met alk for resp acid is no longer compensitory but a primary issue)
Should you give bicarb to peeps with acidosis?
never, first fluids
What is the deal with a sleepy asthmatic and a normal blood gas?
could mean crashing. pH is normally high in asthma because they are eliminated CO2. If pt is not breathing aappropirately, CO2 will rise and pH will accumulate. If acidotic, they need intubation.
What are teh signs and symps of hyponatremia?
lethargy, mental status changes, anorexia, seizures, cramps, coma
What are teh hypovolemic causes of hyponatremia?
dehydration, diuretics, addisons, hypoaldo
what are the euvolemic causes of hyponatremia?
SIADH, phychogenic polydipsia, oxytocin use
what are teh hypervolemic causes of hyponatremia?
heart failure, nephrotic syndrome, cirrhosis, toxemia, renal failure
How do we treat hyponatremia?
hypovolemic = NS.
euvolemic, hypervolemic = fluid restriction. (may use diuretic for hypervolemia
What med is used for SIADH if water restriction fails?
demeclocycline (induces nephrogenic DI)
what is the consequence of too quick a correction of hyponatremia?
central pontine mylinolysis.
When is hypertonic saline used?
only for seizures, and even then, only briefly
what can cause false hyponatremia?
what is the cause of hyponatremisa in post op pts
narcotics (SIADH)
extra IV fluids.
(adrenal insufficiency)
what is a classic cause of hyponatremia in a preggers?
what are teh signs and symps of hypernatremia?
menstal status changes, hyperreflexia, seizure, coma
what are teh causes of hypernatremia?
dehydration, DI, diuretics, diarrhea, renal disease iatrogenic. sickle cell is rare. hypokalemia, hypercalcemia
how is hypernatremia treated?
usuall NS if dehydrated.
no D5W.
what are the signs of hypokalemia?
muscle weakness (can lead to paralysis, vent failure, ileus, hypotension)
what are the ekg findings of hypokalemia?
loss of T wave, T-wave-flattening, U waves, premature ventricular and atrial complexes. Vtach, atrial tachy
what is the effect of pH on K?
pH can cause cellular shift
alk-> hypo
acid-> hyper

can give bicarb for very hyprK pts.
what is the interaction between dig and serum K?
dig pts are very sensitive to K.
how do you replace K?
slowly correct.
oral preferred.
IV if deranged, not greater than 20 per hr.
when hypokalemia persists, what do you do?
check mg
if mg is low, K can't go back
what are teh signs and symps of hyperK?
weakness and paralysis may occur, but cardiac is best studied. watch for PEA
what are the EKG effects seen in hyperK?
tall, peaked T waves, widened ARS, prolnged PR, loss of p waves. Sine wave EKG.
asystole and vfib.
what are the causes of hyperK?
renal failure
tissue destruction
adrenal insufficiency
what is to be suspected in a nl pt with hyperK?
hemolyzed sample
What is the first step when hyperK comes back from a lab?
When is advanced therapy needed?
decreased intake of K
sodium polystyrene resin (K binder)
>6.5 or cardiac tox IV therapy is needed
CaGluc, bicarb, glucose and insulin
beta2 agonists
if renal failure, dialysis
what are teh signs and symps of hypoCa?
Chvostek's (cheek tap)
Trousseau's- bp cuff-> spasms
what lab is the first thing that you check with low Ca?
check albumin. 1:.8
What causes hypocal?
renal failure (vit D)
Vit D deficiency
pseudohypoparathyroid (short fingers, short stature, mental retard, nl levels of parathyroid
acute pancreatitis
what is the relationship between low Ca and low Mg?
must correct hypoMg to fix hypoCa
how does pH affect Ca?
alk-> hypoCa (shifts Ca intracellularly)
hyperventilation, anxiety
what is the relationship between Ca and Phos?
usually go in opposite directions.
what are teh signs and symps of hyperCa?
bones, stones, grones, psychiatric overtones
bones- osteoporosis
stones- kidney
groans- ab pain, anorexia, constipation, ileus, N/V
psych- depression, psychosis, etc.
what EKG change is seen in hyperCa?
shortened QT
what causes hyperCa?
hyperpara, malignancy
Vit A or D intox
famililial (low u
what is seen on urine for familial hypocaliuric hypercalcemia?
low urinary ca
Why is asymptomatic hyperCa treated?
prolonged hyperCa will cause nephrocalcinosis and renal failure.
how is hyperCa treated?
IV fluids
oral phos
when is hypoMg seen?
Mg wasted by kidneys
what are teh signs and symps of hypoMg?
when is hyperMg seen?
iatrogenic in preggers
renal failure
can cause decreased deep tendons, then hypotension and resp failure
how do you treat hypermg
ABCs. Fluids, furosemide
when do you see hypoP?
uncontrolled diabetes (ketoacidosis) and alcoholics
symps- neuromuscular (encephalopathy, weakness)
WBC, platelet dysfunction
why can't you give glucose before thiamine in an alcoholic?
you can cause wernicke's
what is wernicke's?
acute encephalopathy characterized by ophthalmoplegia, nystagmus, ataxia, and confusion. Can be fatal, reversible
what is korsakoff?
psychosis with anterograde amnesia, confabulation.
irreversible, 2/2 to damage to mamillary bodies and thalamic nuclei. Both are from no thiamine
can alcohol w/drawal kill?
needs treatment on inpt basis
how do you Rx alcohol w/drawal?
what is acute alc w/drawal?
tremors, sweating, hyperreflexia, seizures 12-48hrs
what is alcoholic hallucinosis?
24-72 hrs
auditory and visual hallucinations and illusions w/o autonomic signs
what is delirium tremens?
2-7 days
hallucinations, illusions, confusion, poor sleep, autonomic lability
what are the physical stigmata of liver disease?
abdominal wall varices
esophageal varices
testicular atrophy
palmar erythema
spider angiomas
prolonged PTT
what diseases and conditioni may be caused by chronic alcohol?
peripheral neuropathy
dilated cardiomyopathy
fatty change
cerebellar degeneration.
what is the classic AST and ALT in alcohol?
AST:ALT is 2:1
what is the best treatment for alcoholism?
what are the effects of alcohol in pregs?
mental retardation, microcephaly, microphthalmia, short palpebral fissures, midfacial hypoplasia, cardiac defects. No alcohol is good alcohol in pregs
what kind of pneumonia is seen in alcoholics?
anaerobes, e.coli, strep, staph. Klebsiella if currant jelly sputum or mucoid capsules
what are the electrolyte abnlties in alcoholism?
low mg, K, Na, elevated uric acid
decreased folate, thiamine
how are varices treated?
IV fluids, blood
sclerotherapy of the veins.
mortality is high. Rebleeding is common.
TIPS shunt is better than open surgical portacaval shunt.
splenorenal is also teh most physiologic.
what are the common causes of acute sinusitis?
s. pneumo
h. flu
what is the Rx for BV in pregs?
clinda or metro cream
what is the Rx for pancreatic abscess?
antibiotics and drainage
ST changes in II, III, AVF, what type of MI, what artery?
inferior wall, RCA esp if w/ brady
what is the parkland formula?
4ml x kg x %
1/2 in first 8hrs
what is the most common cause of back pain in 3rd trimester?
what are the complications of a horseshoe kidney?
UPG obstructions, renal stones, chronic UTI, vesicoureteric reflux
what gives dullness to percussion and increased breath sounds?
what gives dullness to percussion and decreased breath sounds?
what gives hyperresonance and decreased sounds?
emphysema, penumothorax
are premis given vaccine's by chrono or gestational?
chrono, hep b > 2kgs
what causes bloody diarrhea w/ normal stool in HIV?
CMV- CD<50; owl's eyes
Rx is gancyclovere
what type of ulcers does entamaeba give you?
what drugs cause hearing loss?
furosemide, aminoglycocides, vanc, quinine, chloriquine
what labs in PKU?
increased phenlalanine >20
urinary phenylacetic acid
nl tyrosine
what are the characteristics of a PKU kid?
blond, blue eyes, fair skin
musty, mouse odor urine
mental retard, seizure, psychotic
what is bullous pemphigoid?
tense blisters in flexural areas, elderly w/ uticaria
IgG, C3 at dermal-epidermal junctions
- BP 230, 180
what is pemphigus vulgaris
IgG intercellularly in pidermus flacid bullae
what is cicatrical pemphigoid?
linear IgG deposits, mucosal blistering
what is herpes gestationis
C3 @ BM zone, 2nd trimester pregs
what is infradermal edema w/ leukocyte infiltrate a sign of?
how do you treat diabetic gastroparesis?
1. improve glucose control
2. small, frequent meals
3. metoclopramide, domperidone
4. bethachol
5. erythro: promotes emptying
6. lisapride
what lab in CML?
leukocyte alk phos is elevated
What is seen in AML?
aauer rods
what is seen in Poly vera?
decreased urine Epo
what is the test for c. diff?
cytotoxin stool assay
what is the first line in hyperCa
fluids, then furosemide
what is the cause of kidney failure in hodgkins?
minimal change
what is the cause of kidney failure in carcinomas?
how do you diagnose ZE?
gastrin serum
secretin if gastrin not indicative
mycoplasma causes what skin manifestation?
erythema multiforme
what panic disorder drug can cause seizures with w/drawal?
alprazolam- short acting benzo
what is the Rx for enterobius vermicularis?
how do you diagnose?
scotch tape test
what psych disorder in kids is expressionlessness in social situations?
selective mutism
what arrythmia can quinidine cause?
what is the Rx for epidural hematoma?
waht inhalation injureis occur in burn pts?
upper airway obstruction 2/2 to edema
reactive bronchospasm from aerosolized irritants
small airway occlusion 2/2 edema, sloughing
microatelectasis- loss of surfactant
when can you not use sux?
or injuries that can lead to hyperK (crush, burn)
guillan barre, tumor lysis syndrome
what can you use instead of sux in hyperK pts?
vecuronium, rocuronium
what is the mech of mitral regurg in HOCM?
systolic ant. motion of mitral leaflet
What organism causes eroding abscesses on the oral cavity, lungs, gi tract?
actinomyces israelli.
what is the microscopic finding with actinomyces?
yellow (sulfur) granules; Rx PCN
what is the radiologic finding on chronic pyelo?
blunting of calyces, focal parenchymal scarring
What are the physical exam findings in NEC?
abd distension, gas restriction
who will get NEC and when?
2 wks
what is marjolin's ulcer?
squamous cell- occurs in non-healing wounds
what diagnoses a luteal phase defect?
endometrial biopsy
what vitamin deficiency does INH cause?
what causes B12 deficiency?
pernicious anemia
veg diet for years
what causes a butterfly w/ central necrosis on head CT?
glioblastoma multiforme - high grade astro
what is lymphangioleiomyomatosis?
cystic disorder in ladies
cough, dyspnea, hemoptysis, pneumothorax, 50% goto pneumothorax
what part of the brain is affected by huntingtons?
caudate nucleus
what elements would steer you away from MI?
<40, unless mad risks.
no risk factors
reproducible by pain, not sharp or well locallized. not related to foods
what findings on EKG make you worry about MI?
flipped or flattened Ts, ST elevation, q waves (II, III, AVF for inferior)
what is the Rx for MI?
early thrombo lysis; coronary angiography with PTCA or bipass if thrombolysis is contraindicated
2. EKG monitoring. Lidocaine or amiodorone if warranted (not prophylactic)
3. o2, sat>90%
4. morphine
5. nitrus
6. beta blocker (not w/ heart failure)
8 ACE, statin
what drug in acute MI can relieve pulm edema?
when do you give heparin in an MI?
unstable angina. Thrombus, severe CHF on Echo
what clues suggest gERD?
foods, smoking, caffeine, lying down. Relieved by antacids. H. Pylori
what clues suggest chest wall?
localized, reprducible
what suggests esophageal problems?
negative MI, no risk factures. Abnl barium swallow, esophageal manometry.
what is the Rx for achalasia?
pneumatic dilation or botulism toxin
what is the Rx for nutcracker esophagus and espophageal spasm?
Ca Channel blocker.
what are clues for pericarditis?
recent URI, EKG with diffuse ST segment elevation
elevated ESR
low grade fever
pain relieved by sitting forward
what chest pain clues suggest PNA?
pleuritis, cough, fever, sputum
what suggests aortic dissection?
ripping pain to the back
blunt chest trauma
how is prinzmetal's treated?
ca blocker
responds to nitrus
what is virchow's triad?
endothelial damage, venous stasis, hypercoagulable
when do you think of DVT?
inherited condistions
what should be considered with repeated episodes of superficial thrombophelbitis?
malignancy, trousseau's, migratory thrombo is classic for pancreatic cancer
what is the Rx for superficial thrombo?
NSAIDS, warm compresses
Give the cause of PE with each:
when would one see hemoptysis with PE?
lung infarct
when does HITT usually happen?
3-7 days post
how do you reverse aspirin bleeding?
Hemophelia A causes what lab test to be different?
prolonged PTT, low levels of 8, nl PT, bleeding time
how does vWF change labs?
bleedign time and PTT prolonged, nl 8 and 9; nl PT
how does DIC change labs?
prolongs PT, PTT, bleeding time; d-dimer
postpartum, infection, malignancy
schistocytes, fragmented cells
what vitamin deficiency can prolonged antibiotic use cause?
vit K
Left sided vs. right sided CHF
Left- orthopnea, paroxysmal nocturnal dyspnea; pulm congestion, kerly Bs, pulm vasc congestion and edema; bilateral pulm effuctions
Right: peripheral edema, JVD, hepatomegaly, ascites, underlying lung disease
what can precipitate CHF?
noncompliance, MI, HTN, arrhythmias, infections, fever, pe, anemia, thyrotoxicosis, adn myocarditis
what is cor pulmonale?
right ventricular enlargement, hypertrophy, and failure 2/2 lung disease. COPD, PE
how do you Rx cor pulmonale?
ca channel blockers
What causes restrictive cardiomyopathy?
amyloidosis, sarcoid, hemochromatosis, myocardial fibroelastosis.
abnl biopsy
what is constrictive pericarditis
pericardial knock, calcification of pericardicum. nl vetricular biopsy
what physical exam signs are seen in constrictive pericarditis and restrictive cardiomyopathy?
S4, Right sided heart failure
what is the Rx for HOCM?
b-blockers, verapamil for more filling time.
no competative sports
NO dig, diurectics, or vasodilators
what is the method for Rx of afib?
rate control with b-blocker, ca blocker, or dig
- acude, caardiovert w amiodarone, procainamide, or DC cardioversion
- chronic, anticoagulate, then cardiovert: if it fails, leave pt on dig, and warfarin
how do you treat aflutter
rate control- carotid massage, b-blocker, ca blocker, other
what is the Rx for WPW?
procainamide or quinidine; no dig, verapamil
what is used for Vtach?
amiodarone, lidocaine
what is used for vfib?
what is used for sinus brady?
atropine if symptomatic
what is used for sinus tacy?
beta blocker or ca blocker
what is the presentation of WPW?
child becomes dizzy or dyspneic, passes out after playing. Recovers and has no symps. Delta wave
What is PDA associated with?
congenital rubella, high altitudes
open with E1,
close with indomethacin or surgery
what is the most common congenital heart defect?
seen in fetal alcohol, TORCH, downs
when does ASD cause a problem?
fixed splid S2, palpitations.
what is the most common cyanotic congenital heart defect?
what is the tetralogy?
Pulm stenosis
overriding aorta
"tet spells" after squatting
where is the highest o2 concentration in fetal circulation?
umbilical vein
Lowest umbilical arteries.
what is the change in infant circ when intrauterine to extrauterine life?
inflated lungs, decreased pulm vasc resistnace, increases blood flow to pulm arteries. Clamping of cord increases left sided heart pressures, foramen ovale closes. o2 cuts off prosta production and ductus closes
what part of the brain is affected in wilson's?
what are teh typical TFTs in pregs?
elevated t4, nl TSH; increased thyroid binding (stimmed by BHcg and increased egen to bind to)
what the are the fundoscopic signs of DM retinopathy?
background or simple microaneurysms, hemorrhages, exudates, edema
- preproliferative- cotton wool spots
- proliferative- new vessels
what is characteristic macular degeneration?
distorted vision, central scotoma
what radiographic sign is seen in coarctation?
rib notching
what is the treatment for acute vasoocclusive crisis in sickle cell?
exchange transfusion
what is sclerosing pannicullitis?
tender lesion over medial malleolus with venostasis
what is erysipelas?
cheak cellulitis
what is LAP a marker for?
leukemoid reaction
what is haptoglobin?
binds hemoglobin; decreases in RBC destruction
what is the Rx for PCP?
TMP, conditional roids
roids if PaO2 < 70 or A-a>35
what is a frequent cause of osteo with prosthetic devices?
with sickle cell?
with UTI?
s. epidermis
what is the hallmark of bernard soulier?
giant platelets, no receptor for vWF so no function with ristocetin
what is glanzman's
nl platelet cound, but platelets don't aggregate with ADP
what are the keys to lewy body disease diagnosis?
parkinsons, hallucinations
what bug causes pneumonia, abdominal pain?
also with headache, hyponatremia
what can a buccal smear diagnosie?
what is significant about Mammary enlargement and vaginal discharge in a newborn?
not much, they are transient
what is significant about recurrent chelazion
squamous cell carcinoma
what is the best Rx for prostate bone mets after orchiectomy?
when should external cephalic version be performed?
after 37wks
how do you calculate confidence interval?
mean +- SD/sqrtN
what are teh common causes of contact dermatitis?
poison ivy, oak, sumac, gino
Nickle, formaldehyde, fragrances, polish, chemicals
what is the Rx for contact dermatitis?
topical antihistamines, steroids
what is the murmur of HOCM?
harsh, diamond shaped systolic murmur, increases with valsalva
what renal failure is induced by NSAIDS?
tuberointerstitial nephritis, papillary necrosis
what is seen on U/A in tuberointersticial nephritis?
WBC casts, sterile pyuria
hat are teh characteristics of nephritic syndrome?
hematuria, RBC casts, edema, HTN, proteinuria
what are the hallmarks of silicosis?
glassmaker, pottery
small nodules in upper lung
when would one suspect berrylliosis?
high tech jobs- aerospace, electronics
what is alveolar proteinosis
build up of protein in alveolar space
CXR w bilateral alveolar infiltrates
impaired clearance
PFTs restrictive
Biopsy w PAS confirms Dx
when do you supect hormone insues in 1ry amennorhea?
>16 w 2ry sex; >14 w/o out
the workup is FSH if increased it's peripheral so karyotype
if decreased it's central so GnRH stim.
when do we screen for cholesterol?
every 5 yrs at 20, sooner for obese or fhx
what are some signs of hypercholesterolemia?
xanthelasma, tenson xanhomas, corneal arcus in younger pts, milky serum.
what is the current management of chol?
total <200
TG < 150
LDL < 160 for no rsks (meds for >190
<100 for greated tahn 2 CHD risks (meds for >130)
<100 for CAD or equivalent (meds for >100)
<70 for very high risk (meds for >100)
what are CHD risk factors?
low HDL
what are weak risk factors?
obesit, type a, stress and physical inactivity
hyper TG
how is LDL calculated?
LDL=total - HDL - tg/5
what is th etreatment for hyperchol?
statins (liver, muscle damage)
niacin (raises HDL)
bile acid-binding resins
What changes HDL
increased by moderate alc, exercise, egens
lowered by smoking, androgens, progesterone, hyperTG
Where does Wilm's tumor originate
when do you suspect wilm's tumor?
flank mass
palpable kidneys
when do you suspect neuroblastoma?
flank mass
non-palp kidneys
what are the signs of membranous GN?
thickened BM, supepithelial spikes
what are the signs and symps of freidrich's ataxia
unstable gain, difficulty speaking, falling
- concentri HCM, DM, Scoliosis, hammer toes
what is affected in freidrich's ataxia?
spinocerebellar tracts, post columns, pyramidal tracts
What is bruton's agammaglobulinemia?
decresed Igs, few B cells. Affected 6-9 months old
what is common variable immunodeficiency?
decreased Igs, nl B cells
15-35 y/o
what is the common presentation for DiGeorge?
hypoCa sezures
esophageal atresia, CHD, anomalies of great vessels, hypoplasia, low-set notched ears
what is myotonic muscular deficiency?
- AD inheritance
- all muscle types involved.
- thenar, hypothenar wasting
- temporal wasting, ant. compartment of lwoer legs,
DM, teste atrophy, frontal baldness, hypothyroid
How does aspirin cause met acidosis?
uncouples ox phos
hyperpyrexia inhibs carb and lipid metabolism
how do you manage hepatic encephalopathy?
deal with the precipitating factor- hypovol, GI bleed, hypoK, met alk, hypoxia, setative, hypoglycemia, infection
- decrease blood NH3 with lactulose
- ornithine -asp or NaBenzoate if lactulose doesn't work
what is the Rx for ankylosing spondylitis?
what si the empiric Rx for infected diabetic ulcer?
cefotetan, amp/sulf, clinda/fluorquinolone
vit c causes what kidney issue?
oxalate stones
what valve issue can displace the R main stem bronchus?
MS (enlarged atria)
what is afib in pregs significant for?
what is the liver histology of alpha1antitrypsin?
PAS uptake, diastase resistant
what pulm issue is seen in alpha1antitripsin?
what is the most commmon organism in joint infection?
s. aureus
e. coli
Pseudomonas in drug users
why colonoscopy in colon ischemia?
differectiate between ischemia and c. diff also to see if ischemia is transmural. If transmural-> OR
how do you treat superficial thrombophlebitis?
NSAIDS, warm compress
what is intrahepatic cholestasis in pregs?
2nd, 3rd trimester
genetic (seen in hisp. (bolivia))
intense pruritis
increased bile acids
how do you treate intrahepatic cholestasis in pregs?
ursodeoxycholic acid
what is the fatty liver of pregs?
prolonged PT, increased LFTs
microvesicular fatty deposition, no inflamm
how do you suppress Lactation?
tight bra, ice packs.
egen and testosterone also used in combo. NO bromocriptine
what is fetal hydantoin syndrom?
epileptic mom with anticonvulsants
- microcephaly, hypoplasia of distal phalynx, fings, toes
nail hypoplasia, low nasal bridge, irsuitism, cleft palate, rib anomalies
what are the signs of congenital syphilis?
hydrops, anemia, thrombocytopenia, leukopenia, pneumonitis, hepatitis, osteochondritis
Late- fever osteitis, osteochondritis, HSM, lymphadenopathy
what is teh presentation of fetal alcohol?
IUGR, microcephaly, MR, renal, card defects, midfacial hypoplasia, micrognathia, flattened philthrm, short fissure, short vermillion border
what happens to cocaine babies?
ICH, NEC, cardiac GU
what is waterhous-frederichson syndrome?
acute adrenal insufficiency from DIC bleeding into adrenals (what kills in meningitis)
when should one suspect tricuspid atresia?
left axis deviation
hypoplastic RV, VST, TGA
what are teh EKG findings of tetrology?
right atrium dilation, RVH
what are the CXR and EKG findings of truncus?
increased vasc markings, r aortic arch, biventricular hypertorphy
what should you look for after Myasthenia diagnosis?
what is erlichiosis?
tick bite
g neg bacteria
fever malaise, myalgias, headache, N/V; no rash, decreased WBC, decreased platelets, increased LFTs
what is the treatment for erlichiosis, RMSF, lyme disease?
what is the treatment for RSMV in pregs?
what is zenkner's diverticulum?
herniation of the cricopharyngeal muscles
neck bulge that increases in size with drinking liquids
Rx is excision, myotomy
what causes malbasorption in ZE?
pancreatic enzyme inactivation
what does anchovy paste signify?
amebic abscess
in liver caused by e. histolytica
a sign is recent imigration.
Rx is metronidazole
what differentiates 1ry vs. secondary hyperPTH
if from renal, it will be low Ca stimming increased PTH
what are common causes of thyrotoxicosis with decreased radioiodine uptake?
subacute, painless thyroiditis
subacute granulomatous thyroiditis
iodine induced thyroid toxicosis
levosynthroid OD
struma ovarrii
what Na disorder can NSAIDs cause?
when are bite cells and heinz bodies seen?
- x-linked
what are heinz bodies?
update of crystal violet staining
what triggers G6PD dysfuntion?
drugs- sulfa, choriquine, infections, fava beans
what gene is involved in osteogenesis imprefecta?
type I collagen
(blue sclera, deaf, short, scoliosis)
what gene is involved in marfan's?
fibrillin I
what is the hallmark of PCP toxicity?
vertical nystagmus, confusion, ataxia, decreased sensation, hallucination
how do you diagnose a stress fracture
CT, bone scane
how do you manage non-bleeding varices?
if they bleed-> banding or sclerotherapy
if that doesn't work, then TIPS
what are hallenhorst bodies?
cholesterol particles
what tumor is associated with Red Cell Dysplasia?
what is the labs for 2ry amennorhea?
pregs, TSH, PRL
then estrogen then FSH
what is recommended for threated ab?
bed rest, no sex
what congenital defect causes incrased K, decreased Na?
21 deficiency
increased 17, decreased gluc and mineral
11 deficiency has less gluco, less mineralo or both?
increased mineral
when a baby is cyanotic when feeding but not when crying, what do you suspect?
choanal atresia
what is the hallmarg of laryngomalacia?
insp stridor that increases w exertion
in 1st 2wks
if acute pyelo does not resolve, what is needed?
US to look for abscess or stone
what is seen on blood smear in sideroblastic anemia?
dimorphic RBC population
what is seen on bone marrow biopsy in sideroblastic anemia?
ringed sideroblasts
what causes sideroblastic anemia?
decreased b6
what cancer is caused by cyclophosphamide?
bladder cancer from increased acrolein
to prevent, mad fluids and frequent urination
what are the indications for aortic valve replacement?
symptomatic AS
AS and other procedure
asymp w poor lVF, LVH, valve < .6cm2
what is vitiligo associated with?
pernicious anemia
type I diabetes
antibodies to melanin, parietal cells, thyouid
what is a macule?
flat spot less than 1cm
what is a patch?
large macule
what is a papule
solid, elevated lesion < 1cm
what is a plaque
large papule
what is a nodule?
palpable, solid lesion, no flat top
what isa vesicle
elevated, circumscribed lesion < 5mm with clear fluid
what is a bulla?
large vesicle
what is a wheal?
itchy edematous area
what conditions cause itching?
obstructive biliary disease
polycythemia vera (after shower or bath)
dermatitis, lichen planus
what is atopic dermatitis?
chronic allergic condition that begins in the first year of life with red, itchy, weeping skin on head, upper extremities, diaper
can lead to bacterial infection.
Rx is no dry soap and antihistamines
what is seborreic dermatitis?
cradle cap and dandruff
scaling skin on the scalp and eyelids
treat with selenium, corticosteroids, ketoconazole
tinea corporis
red ring-shaped lesions with raised borders, clear centrally when they expand
tinea pedis
macerated scaling web spasociated with thickened disorted toe nailse associated with thickened disorted toe nails
tinea unguium
thickened distored nails
tinea capitus
scaly patches of hair loss, boggy granuloma of scalp kerion
if florescen under wood's lamp, microsporum is the cause
what is tinea cruris
jock itch
what are the organisms that cause fungal infections?
trichophyton speieas
how do you diagnose fungal infection?
koh prep to visualize the fungus
how to treat candidiasis?
nystatin, or miconazole, clotrimazole
what is the classic definition of scabies?
tunnels into skin, leaves visible burrows on the skin, finger web spaces and flexor surface of the wrists
how do you treat scabies
Dx by scraping mite out of a burrow and viewing it under a microscope.
Treat scabies with permethrin cream
No lindane
how do you treat tinea versicolor
torso of young adults
areas fail to tan
KOH prep
sulfide shampoo or topical imidazoles
what causes lice?
pediculosis pediculus capitis
phthirus pubis for crabs
permethrin cream
how do you treat warts?
salicylic acid, liquid nitrogen, curettage
what is molluscum?
skin colored, smooth, waxy papules, central depression
inclusion bodies
freeze and curettage
what bacteria is involved in acne?
propionibacterium acnes
blocks pilosebaceou glands
what are the Rx for acne?
benzoyl peroxide
topical clinda

Isotretinoin is a last resort, but not for pregs.
what is rosacea
acne, but in middle age
rhinophyma 9bulbus red nose)
topical metronidazole, oral tetracycline
what is a pathologic cause of baldness?
trichotillomania- pulling out your hair
alopecia areata- antimicrosomal antibodies
what is keys to psoriasis?
caucasians, early onset
pitting nails, arthritis
what is the rx for psoriasis?
sunlight, lubricants, topical corticosteroids
what si the classic description and natural course of pityriasis rosea?
herald patch- scaly, ring-shaped patch on the trunk
followed by itch
christmas tree pattern
what are the four ps of lichen planus?
pruritic, purple, polygonal papules
wrists, lower legs
what causes photosensitivity?
what is paget's disease of the nipple?
unilateral red, oozing nipple
underlying breast cancner
invasive ductal carcinoma
what is stomatitis
inflamation of the mucous membranes of the mouth. Corners of the mouth
vitamin c
when do we worry about actinic keratoses?
nodular, warty or ulcerated
what is keratoacanthoma?
mimics squamous cell cancer
flesh colored, keratinous material
rapid onset 1-2 months
what can cause uncontrolled sweating?
pheo, mi, tb, hyperTSH
what is dermatitis herpetiformis?
celiac sprue
pruritic vesicls on elbows knees
IgA deposits
what is pemphigus vulgaris?
autoimmune disease against desmoglein III
bullae, starting in oral mucosa

fishnet immunofluorescence
Rx with corticosteroids
what is erythema nodosum?
red tender nodules
with UC, sarcoid, coccidiomycosis
What type of therapy do social phobias need?
flooding, biofeedback, relaxsation, exposure desensitization
what steps must be taken in pneumomediastinum after pneumothorax?
air can enter via the hilum of the lung
what is Hanman's sign?
crunching with each heart beat, heard in pneumomediastinum
when does a pneumomediastinum need needle decompression?
CV compromise
when does pneumomediastinum need surgical decompression?
when associated with mediastinitis
what infection causes nasal septum perforation?
3ry syph
when there is a midluteal progesterone defect in pregs, what are teh signs and what is the Rx?
signs: corups luteum doesnt' cut it and decreased prolif of endometrium (confirm by biopsy)
Rx- progestin suppositories
what is the characteristic rash of rubella?
erythematous, maculopapular. Face-> trung, extremitis
Prodrome: fever, lymphad, malaise
what is the difference in prodromes between measles and rubella?
measles- cough coryza, fever, conjunctiva (koplik spots)
rubella: fever, lymphad, malaise
hwat causes croup?
racemic epi
what is the cure for hypertonic contractions?
with silent chest in ashtma, what's the next step?
what congenital disease can cause meconium ileus?
what is Todd's paralysis?
post-ictal paralysis
what is a luteoma?
benign lesion of overy in pregs
looks like tumor
suspect in multiparous AA women
what can a vericocele that does not empty indicate?
what might cause increased Hbg, thrombocytosis in a pt with unemptying vericocele?
RCC-> increased epo
what is grover's disease?
acantholytic dermatosis
brown keratotic papules over ant chest, upper back, lower rib cage.
what thyroid cancer can develope from hashimotos?
what is the role of ursodeoxycholic acid in gallstones
decreases chol content of bile
needed if pt does not want surgery
what is the Rx for toxo?
sulfadiazine, pyrimidamine
what is shydragger syndrome?
autonomic dysfunction
cerebellar probs
Rx- fludrocortisone, salt to keep volume
what is riley-day?
ashkenazi autonomic dysfunction
what is the common cause of esophagitis in AIDs?
candida-> fluconazole
if no response biopsy and look for CMV, HSV
what is the best HTN drug in osteoporosis?
what are the contraindications to triptans?
1. pregs
2. familial hemiplegic migraine
3. uncontrolled HTN
4. CAD
5. prinzmetal
5. ischemic stroke
6. basilar
what are the teratogenic effects of rads?
preg loss, growth restriction, eye malformations, CNS defects

discuss Ab if exposed to 5-50 gray
what are the major pathologies of liver disease w alcohol?
1. fatty liver
2. alc hepatitis
3. alc fibrosis/cirrhosis
what electrolyte imbalance can occur in surgery w mult transfusions?
low Ca
what are the most common casues of acute pancreatitis?
- stone, alcohol, increased TGs, recent ERCP
- Rx- IV fluids, NG tube, NPO, analgesia
If there is subcutaneous epmphysema, what must be ruled out?
what is needed to diagnose malignant HTN?
what bug makes alkaline urine?
what is concernting about lochia that may make you think of endometritis
foul smell
what drug is good for HTN and essential tremor
what is a common SE of clomiphene?
hot flashes, breast pain
what are the Sx of reyes?
vomiting, agitation, irrational behavior, lethargy, stupor
increased NH3, bili, alk phos, ptt
decreased sugar
when do you suspect pinworm in vulvovaginitis?
nightime itching
other kid infected
what is the Rx for fulminant hepatic failure?
vag bleeding with delivery then decreased pituitary is?
what are teh presenting signs of lymphocytic hypophysitis?
headache, vision changes with decreased pituitary function
what lady cancer is associated with DES?
vag adenocarcinoma
clear cell
when do we see retinal vein occlusion?
HTN, clotting disorders, DM, glaucoma
what are the sx of glaucoma?
red eye, hazy cornea, fixed pupil
what is the best anti HTN in LVH?
beta blocker
in elderly with low Fe anemia, what's first?
colonoscopy to rule out cancer
what is vasa previa?
ruptured fetal vessel.
who do you screen for dm?
obese, >45, fhx, minorities, pregs
what is the definition of dm?
>126 fasting or random >200
pregs: >200 after 2hrs, 70gm load
what is the islet cell pathology in DM 1?
what is the islet cell path of DM 2?
amyloid deposits
what are the sugar goals in DM?
post parandial < 200
fasting <130
what is the role of c-peptide in pt w hypoglycemia?
c-peptide means insulinoma
no c-peptide means abuse
what are the signs of DKA?
kussmal breathing, dehydration, hyperglycemia, acidosis, increased ketones
what is the Rx for DKA?
IV fluids
electrolyte replacement (K, Phos)
what are teh common causes of DKA?
no insulin
what is nonketotic hyperglycemic hyperosmolar state?
type II w/o adequeate Rx.
hyperglycemia, increased serum osms, no ketones, or acidosis

Rx- hydration, lots of it.
insulin is also required
what are teh classic symps of DM?
polydip, polyuria, candida
what is a kimmelstiel-wilson nodule?
golmerular change in dm.
what is the Rx for diabetic gastroparesis?
what is the rx for diabetic retinopahty?
panretinal laser photocoagulation.
what is the somogyi effect?
body's reaction to hypoglycemia
Too much NPH at dinner will cause low sugars at 3am.
this caues stress hormones-> high glucose at 7am
if this is the case then decrease nighttime insulin

the dawn phenomenon is what happs with GH release in the am
how do you manage a diabetic who's NPO?
1/3rd the insuilin. Gcose is monitored closely by the anesthesia.
what happens with B-blockers in diabetics?
b-blockers mask the classic symps of hypoglycemia.
if there is a previous MI, use it, but otherwise, think a little omre
what is the most common cause of LMN facial nerve paralysis?
bell's palsy. sudden, unilateral onset, usually after a URI. Possibly latent herpes. hyperacusis. Everything is loud cause of the stapedius muscle.
sever cases, pts unable to close the affected eye. Must use drops. valacyclovir may help
what is ramsay hunt syndrome?
herpes infection, causes facial nerve paralysis.
vesicles on the pinna, inside the ear, encephalitis, meningitis may be present
what are some causes of faical nerve paralysis?
middle ear or mastoid infection
temporal bone fracture
what are the common causes of hearing loss?
prolonged exposure to loud noise
labyrinthitis- viral
what is the usual cause of sudden deafness
viral from mumps, measles, flu, chickenpox, adnovirus.
what is the ost common cause of acquired hearing loss in kids?
what are the common causes of vertigo
8th nerve damage
how is a deviated nasal septum treated in pts with recurrent sinusitis?
surgical correction
how do you treat viral rhinitis?
rhinovirus, influ, paraflu, coxsacki, adeno, RSV, etc. Treat symps
what is the cause of bacterial rhinitis?
group A strep, pneumococci, staphylococci.
what causes nosebleeds?
trauma (nose-picking)
tumor - angiofibroma adolescent boys
what are the characteristics of a thyroglossal duct cysts?
midline, elevate with tongue protrusion
what is a bracnchial cleft cysts?
lateral, infected
what is a cystic hygroma
benign tumor aka lymphangioma. Turners; needs surgical rsection
what causes cervical lymphadenitis
strep pharyngitis, ebv, cat scratch fever
what do you think with neck mass in adult?
1ry tumor
mets (Scc)
what is the work-up for neck cancer?
biopsy of nasopharynx, palatine tonsils and base of the tongue, laryngoscopy, bronchoscopy, esophagoscopy
what causes swimmer's ear?
pseudomonas. pain with manipulation.
Rx- neomycin, polymyxin B
what are the complications of otitis media?
TM perf
cranial nerve palsies
cerebral abscess, dural sinus thrombosis, chronic otitis media.
what si teh problem with recurrent otitis?
can cause hearing loss, then speech problems
what causes infectious myringitis?
otoscopy reveals vesicles on the TM.
s. pneumo
what are teh common bacterial causes of sinusitis?
s. pneumo, h. flu
tenderness over sinuses, purulent discharge, headache
CT to diagnose
what age are teh frontal sinuses well developed?
what is otosclerosis?
otic bones become fixed together and impede hearing.
Rx with hearing aid
what is the most common cause of conductive hearing loss?
what is the most common cause of sensorineural hearing loss?
what causes parotid gland swelling?
neoplasm (pleomorphic adenoma, Sjogren's)
what is a complication of nasal fracture?
nasal hematoma-> septal necrosis
what is the weber test used for?
conduction between two ears.
if conductive hearing loss, good on affected ear
if sensorineural, good on unaffected ear.
what is the rinne test?
air conduction to bone conduction. should be able to hear once removed from mastoid.
if conductive loss, cannot hear when in the air.
if sensorineural, both should be deminished.
what are the three cuases of burns?
thermal, chemical, electrical
remove clothes,

low threathold for intubation
100% o2
what are the important sequelae of electrical burns?
muscle necrosis, myoglobinuria, acidosis, renal failure. arrhythmia
how are chemical burns managed?
copious irrigation
alkali burns are worse
what can burned skin develop?
infection, S. aureus, pseudomonas.
topical prophylaxis.
tetanus booster
what is hypothermia?
<95 degrees
MS changes
conscious = slow rewarming
unconsious, gastric, bladder lavage with warm water, warm IV fluids

Monitor EKG
what is teh classic EKG finding in hypothermia?
J wave, small posititve deflection following QRS
what is the difference between frost nip and frost bite?
nip is painful
frostbite is numb
warm the areas with water. Not dry heat
what is hyperthermia?
>104, caused by meds, infection and heat stroke
cool with wet blankets, ice, cold water
diazepam for convulsions
CV collapse
what is malignant hyperthermia?
general anesthesia; succs or halothate
treat with dantrolene
what is neuroleptic malignant syndrome
antipsychotic causes hyperthermia
CPK, MS changes
IV fluids
how are pts treated after near drowning?
intubate if unconsious, monitor ABGs
fresh water worse becasue of potential for hypervolemia, elyte disturbances, hemolysis
Wegener's, what is the cause, the findings, the tip offs?
kidney lung disease. Peeps may have recurrent sinusitis.
c-ANCA seen
CXR may show nodular cavities
what is seen in good pastures?
hwo is bladder rupture classified?
1. contusion
2. extrapertoneal rupture (more common than intraperitoneal, lateral border or base)
3. intraperitoneal rupture (full bladder)
with abdominal trauma when do u peritoneal lavage, when ex lap?
ex lap if obvous peritoneal irritation.
otherwise lavage
when do you supect aorta rupture in MVC?
sternum fracture, first rip or scapula
what is the Rx for turets?
pimozide, haloperidol
what does and elevated DHEA point towards?
what is the steps in managing pyloric stenosis?
correct elytes, then surgery
what can a new onset RBBB be indicative in a pt with SOB?
what congenital malforamtion is seen with lithium use?
what is the tirad of congenital rubella?
deaf, cataract, pda
what congential heart defect is seen in DM moms?
Gastroschisis membrane or no?
what is the management for gastroschisis and omphalocele?
wrap, decompress, abtics and fluids
then surgery
omphalo may require multiple steps
omphalo also has other abnlties
what is the best Rx for General anxiety disorder?
what is a common SE of mono?
hemolytic anemia
What non GI findings are seen in whipple disease?
hyperpigmentation, heart murmur, arthralgia, cough
what is turcot's syndrome?
brain tumor with familial polyposis
what is gorduer's syndrome?
Autosomal dominant disease
polyps with extraintestinal lesions.
What do you look for in elderly with hyper TSH?
toxic nodule
thyroid adenoma (lump that is "hot")
subacute thyroiditis
struma ovarii
why is free t4 better than total?
measures active form
pregs, egen, ocps, increase TBG
nephrotic, cirrhosis, coricosteroid decrease TBG
what is euthyroid sick syndrome?
any pt with any illness may have temporary derangements in thyroid.
what are the symptoms of cushings?
weight gain, changes in appearance, easy bruising, acne, hirsutism, emotional labillity, depression, psychosis, weakness
buffalo hump, hirsutism, weakness, purplish striae
what causes ectopic ACTH?
small cell lung cancer
adrenal adenomas, carcinomas (kids)
what is the test for cushings?
24 hr cortisol in urine
then dexamehtasone suppresion
ACTH (if increased MR brain, if decreased stomach)
what are the signs and symps of hypoadrenal?
anorexia, weight loss, weakness, apathy
hypotension, hyperK, hypoNa
hyperpigmentation, N/V, diarrhea, ab pain, mild fever, hypoglycemia, eosinophilia
what is the mos common typoe of hypoadrenal?
2/2 steroids
ACTH high, cortisol low
prophylactic steroids needed
wha are the other common causes of hypoadrenalism
hypothyroid, pernicious anemia, vitiligo, dm, hypopara
who is hypoadrenal diagnosed?
ACTH stim test
what causes virilization in kids?
90% are do to 21-hydroxylase
what cancer is causesd by obesity?
what is precocious puberty?
before 8 in female
before 9 in male
pseudo precocious is 2ry sex develop cause of androgen or estrogen (no pituitary)
how can physical exam differentiate true precocious from pseudoprecocious?
teste or ovarian enlargement
what labs in precocious?
GnRH stim test
MRI of brain should be done
what causes pseudo precocious puberty?
hormones, adrenal tumors, CAH, McCune Albright in females (cafe-au-lait, ovarian cysts, polyostotic firous dysplasia of bone)
how is precocious puberty treated?
long acting GnRH to suppress the pituitary
What are teh signs of primary hyperaldo?
conn's syndrome
weakness, edema
htn, hypoK, hyperNa, edema
low renin, high aldo
CT to find, surgery
what are 2ry causes of hyperaldo?
low kidney perfusion
k is normal or high.
what is the clinical discription of a pheo
wild swings in bp, tachy, postural hypotension, headaches,sweating, dizziness. impending doom
metanephrines, homovanillic acid, vanillylmandelic acid
what causes central DI?
lack of ADH production
trauma, neoplasm, sarcoid
what causes nephrogenic DI?
lithium, methoxyflurane, demeclocycline
what diagnostic test can reveal DI
give ADH
what is the rx for nephrogenic DI?
what causes SIADH?
narcotics, preggers, chlropropramide, antiepileptics
how do you treat SIADH?
restric water
no hypertonic saline unless seizure
emeclocycline can be used. it induces nephrogenic DI.
what should people with GERD avoid?
coffee, alcohol, tobacco, spicy and fatty foods, chocolate
what are the sequelae of GERD?
eophagitis, esophageal stricture, esophageal ulcer, hemorrhage, barrett's metaplasia, esophageal adenocarcinoma
what is the difference between hiatal and paraesophageal hernia?
paraesophageal, GE junction is below diaphragm, but stomach herniates. may strangulate the stomach
how does PUD present?
intermittent epigastric pain, relieved by antacids or milk.
epigastric tenderness
what are the differences between gastric and duodenal ulcers?
duodenal- high acid, h. pylori, forites, pain gets better then worse 3 hrs later
gastric- low acid, nsaids, fifties, no pain relief with food
what is the most feared complication of PUD?
peritoneal signs, free air
abitcs and laparotomy iwth repair.
what is triple therapy?
amox, metronidazole, bismuth
what are teh complications of billroth surgery??
dumping syndromome (weakness, dizziness, sweating, N/V after eating
afferent loop syndrome (bilious vomiting after meal)
bacterial overgroath
what surgical treatement is available for ulcer?
antrectomy, vagotomy.
what is achlorhydria?
absence of HCl secreation, pernicious anemia
what are the differences between upper and lower GI bleed?
upper- proximal to ligament of treitz; cuased by gastritis, ulcers, varices, eophagitis; stool is tarry, black; NGT is + for blood

lower- distal to ligament of treitz; caused by vascular ectasia, diverticulosis, colon cancer, colitis, IBD, hemmorhoids; BRBPR, NGT neg for blood
how do you treat GI bleed?
IV fluids and blood products
NG tube- test aspirate for blood
endoscopy first
what radiologic imaging studies can be done to localize a gi bleed?
radionuclide scans for slow or intermittent bleeds
angiography can detect more rapid bleeds; embolization of bleeding vessels can be done during the procedure
surgery is reserved for severe or resistant bleeds, involves resection of the affected bowel
what causes diverticulosis?
low fiber, high-fat diet
what is the bad consequences of diverticulitis?
abscess, fistula formation, sepsis, large bowel obstruction
how do you dx diverticulitis?
thickened walls of sigmoid, infammation of adjacent fat
what is the Rx for diverticulitis?
floroquinolone and metronidazole
bowel rest
what are the categorization of diarrhea?
altered intestinal transit
what is osmotic diarrhea?
nonabsorbable solutes that stay in the bowel: lactose or other sugar intolerance
what causes secretory diarrhea?
cholera, ecoli
VIPoma (pancreatic islet cell tumor
bile acids
what causes malabsorbative diarrhea?
celiac sprue
post gastro
what is hemolytic uremic syndrome?
thrombocytopenia, hemolytic anemia, ARF
what are the extraintestinal manifestations of IBD?
uveitis, arthritis, anklylosing spondylitis, erythema nodosum, primary sclerosing cholangitis, failure to thrive, toxic megacolon, anemia of chronic disease, and fever.
how is inflammatory bowel disease treated?
5-asa, w or w/o sulfa
roids and azathiprine
I talk to god is an example of what?
what is magical thinking?
supernatural forces
what is the DSM IV for panic disorder?
3 attacks a wk, no stimulus, abrupt onset
what is the first step in diaphragmatic hernia?
OG tube to suction
when is paracentesis necessary?
ascites with resp distress
How does valsalva change murmurs?
increases in HOCM (smaller space causes increased volume)
decreases in AS (less flow = decreased volume)
when is DM screening mandatory in pregs?
24-28 wks
what is beckwith-wiederman syndrome?
macroglossia, macrosomia, omphaloceol
gene causes 2 11p genes
increased risk for wilms
what is WAGR syndrome?
Wilms, Aniridia, GU anomaly, Retardation
what is denys-Drash syndrome?
wilms, pseudohemphrodite, renal failure 2/2 mesangial sclerosis
what is the most frequent cause of cellulitis?
group A strep
s. pyogenes
What is the test for a TIA in the young?
what are teh causes of false elevated AFP?
fetal demise, multiple gestation, inaccurate age (most common)
What is a more common deficiency in alcoholism folate or b12?
what must be ruled out first between head injury and neck injury?
what is the typical skin lesion of Reiter's?
keratoderma Blennohagicum - clear vesicles on macules, papules
Cicinate balantis Shallow ulcers of penis
When is Koilonychia seen?
Fe deficiency anemia
what is given in HITT for anticoag?
lepirudin argatroban
what is the Rx for scoliosis?
<20 degrees you watch
>30 degrees or change of 5 degrees get a brace
>40 degrees needs surgery
what is the Rx for severe decreased Na?
3% saline and furosemide
what heart med can cause hypothyroid?
what are teh side effects of hydralazine?
SLE tachy, increased Na
What are teh SEs of verapamil
constipation, dizzy, flush
what is the major SE to HCTZ?
increased glucose, LDL, TGs
decreased Na, K
increased Ca
what is a nl AFI?
What are the signs of GVHD?
rash on palms, soles, face
diarrhea with blood
increased LFTs
caused by T cells
What are the Rx for nephrogenic DI?
NSAIDs, HCTZ, amiloride for Li induced
what is the gene involved in hemochromatosis?
chromosome 6
what is central cord syndrome?
burning pain, paralysis in upper extremities
what causes a decrease in Ca and P?
decreased Vit D, malabsorption
what are the G+ rods?
listeria, bacillus
what are teh G- rods
pseudomonas, haemophilus, klebsiella, legionella
what are teh G- cocci?
what are basal epithelial cells in vaginal discharge a symbol of?
atrophy of the vagina
what is the presentation of granulum inguinale?
inguinal lymphadenopthy, painless ulcers, + Giemsa stain
what congential error can cause stroke?
homocysteinuria-> cystathione, Marfan's
high dose Vit B6
What are the 3, 7 am glucose in dawn phenomenon?
what are teh 3,7 am glucose in poor insulin doses?
nl, high
what is the Rx for an open Fx?
stabalization, and delayed closure
what needs to be done in psych pt with one broken bone?
look for other broken bones, due to altered pain sensation
how is preeclampsia managed at first?
bedreast, decreased Na diet, Roids
what is lacid acidosis-steatosis syndrome?
with AIDS drugs (NRTIs) zidovudine from inhibition of mitochondrial DNA synthesis cause liver failure
what is the Rx for choriooamionitis?
what does jaundice after day 5 of life suggest?
when is breast milk jaundice seen?
>1 wk
what is painless hematuria significant for in an AA male?
sickle cell
what rash is seen in dermatomyositis?
dirty red rash
what is anti-RNP significant for?
what is gottron's sign?
non-scaly violaceous erythematous skin over knuckles seen in dermatomyositis
What does Nocardia look like by microscope?
crooked, branching, beaded, G+, partially acid-fast filaments
What is the best Rx for heat stroke?
evaporation coolign
what is buerger's disease?
occlusive disease, migratory thrombophlebitis, raynauds
what is a common cause of osteo in puncture wounds
how does one correct homocysteine issues?
b6, b12, folate
what is a good test for lactose intolerance?
H+ breath test
positive clinitst for reducing substances
increased osmotic gap
acidic stool
where is a symptomatic carcinoid seen?
small intestine, others are in appendix, but not symptomatic
what are the common SEs to ERCP?
pancreatitis, perforation, sepsis, peritnitis, hemorrhage
what is a specific test for acromegaly?
glucose GH test, nl patients will have decreased GH
what is the method of screenign for cadiac contusion?
what antimicrobial causes ARF?
what antibodies seen in sprue
anti-endomysial, abs
what are anti-mitochondrial abs associated with?
what is the Rx for syphylis with PCN allergy?
tetracycline, azithro
what level of TGs is a risk for pancreatitis?
what is the cause of syncope with prolonged QRS,PR?
what is the radiographic appeearance of osteosarcoma?
sunburst, codman's triangle; may need amputation
what are teh findings fo ewing sarcoma?
onion skinning; diaphysis
what is the xray of giant cell tumors?
soap bubble
when are psammoma bodies seen?
papillary thyroid Ca
what is a common cause of mucopurulent discharge from teh os?
what is RTA 4?
increased K, met acid, caused by aldosterone deficiency or insensitivity from diabetic nephropathy
what is the relationship between OCPs and Lupus?
it aggrivates
what is the cause of polyuria, polydipsia in phenothiazine use?
dry mouth causes psychogenic polydipsia
what cancer secretes pthrp
squamous cell
what is the Rx for prenatal itamin overdose?
what are teh signs of strangulation in SBO?
tenderness, guarding, no bowel sounds, SIRS, met acid
What are teh SIRS criteria?
T>38 or <36, HR > 90, RR > 20, WBC >12, <4, or > 10% bands
What is aspirin sensitivity syndrome?
persistant nasal blockage, bronchoconstriction; pseudo-allergic
Rx- leukotriene inhibitors
what is done in the initial eval of bibromyalgia?
what vitamin deficiency occurs in carcinoid?
what are teh SEs of amiodarone?
pulm fibrosis, hypothyroid, hpatotox, corneal deposits, skin turns bluish gray
what is the Rx for cholangitis?
broad spectrum abtics (piperacillin with tazobactam
cholecystectomy if common duct stones, biliary stenosis if malignent.
what is the Rx for diverticulitis?
avoid eating
broad spectrum antibiotics
NG tube
sigmoid colon resection if refractory
what drug is good for pain control in pancreatitis?
meperidine over morphine
what is the hx of perfed ulcer?
no AA abuse or gallstones
free air, can cause an increased amylase, OR
what are teh signs of LBO?
gradually increasing ab pain, abdominal distention, cramping, feculant vomiting (late)
what are the causes of LBO?
old causes are diverticulitis, colon cancer and volvulus
in kids, hirshsprungs
how do you treat LBO?
withhold food, NG
sigmoid volvulus should be decompressed with an endoscope
what are teh 3 groin hernias?
indirect: most common, inner and outer inguinal rings. lateral
direct: from weakness in abdominal muscles (right down the middle, medial to the vessels)
Femoral: more in women, throught hte fem ring onto the ant thigh.; most susceptible to incarceration.
what is an incarcerated hernia and a stragulated hernia?
incarcerated: trapped, swollen, edematous. needs prompt surgery
strangled: necrosis, death
what is the hep b window
both hbsag and hbsab are neg. if hbsab appears = immune if not, chronic
what should be given to peeps exposed to hep b?
IgG even if vaccinated
what are teh drug induced hepatitis?
HMG coa
carbon tetrachlroide
idiopathic autoimmune hepatitis
anti smooth muscle, ANA
Rx is steroids
what are the ususal causes of chronic liver disease?
alc, hepatitis, metabolic disease
what si wilson's?
excessive copper, ceruloplasmin is low or absent
CNS mannifestations- copper in basal ganglia
kayser-fleischer rings
what is alpha antitrypsin
young adult with cirhosis, emphysema without risk factors
what is the coagulopathy in liver failure?
prolonged PTT
vit k doesn't help
what is sbp?
paracentesis with wbc, gram stain, culture and sensitivity
e.coli, s. pneumo can cause
3rd generation cephalo
what are the signs and symps of biliary tract obstruction?
elevated alk phos
elevated conjugated bilirubin. conjugated bilirubin is more than unconjugated
clay stools
dark urine whcih is strongly positive for conjugated bili.
what are teh types of biliary tract obstruction
bilde duct obstruction, cholestasis, cholangitis, primary biliary cirrhosis, primary sclerosing cholangitis
what ar eth etwo major causes of bile duct obstruction?
gallstone (fat, female, forty, fertile)
- US
Cancer- (courvoisier's sign- palpable gallbladder)
what are the common causes of cholestasis?
meds- OCPs, phenothiazines, androgens
what clues suggest 1ry biliary cirrhosis?
middle aged women with no risk factors for liver or biliary disease. marked pruritis, jaundice, +anti-mitochondral antibodies.
Rx- cholestyramine
needs liver transplant
what ar teht eclassic symptoms of esophageal disease?
dysphagia, odynophagia
what is achalasia?
hypertensive LES and loss of peristalsis. it is usuallly idiopathic but may be 2/2 chagas. bird-beak narrowing. Rx is Ca channel blockers, pneumatic dilation, botulism toxin injection. lastly surgery.
what are teh signs of esophageal spasm?
nutcracker esophagus, irregular forceful and painful contractions
what clues sugggest scleroderma?
aperistalsis from fibrosis, atrophy of smooth muscle
LES is incompetent, and peeps have heartburn. +ANA, mask like facies. CREST
calcinosis, Raynauds, Esophagus, sclerodactyly, telangiectasias
what causes acute pancreatitis?
alcohol, gallstones
what is grey turner's sign?
blue-black flanks
what is cullen's sign?
blue-black umbilicus
how do you treat chronic pancreatitis?
abstinence, oral pancreatic enzyme replacement, fat soluble vitamins
what si mallory-weiss vs. boorhave?
mallory weiss is superficial, boorhave need imediate surgery
what is the rule about bowel contrast when GI perf is suspected?
barium is preferred, no barium toxic with perf, can cause peritonitis
what are teh signs of intestial atresia?
double bubble, downs, bilious vomiting
what are the signs of TE fistula?
resp compromise with feedings, asp pneumonia inability to pass NG tube
what is henoch schonlein purpura?
vasculitis, GI bleeds, ab pain
URI, rash on lower extremitis, buttocks
swelling in hands and feet, arthritis, hematuria and proteinuria
what is the most common cause of dirreha in children?
what is the first step in neonatal jaundice?
direct vs. indirect.
look for poor feeding, seizuer, flaccidity, opisthotonos, and apnea
what is pahtologic jaundice?
any jaundice at birth is pathologic
breast milk: bili of 10-20 at 2 wks
Metabolic disorders: Crigler-Najjar can cuse it. Roto and dubin johnson disease cause conjugated
biliary atresia: full term infants with clay or gray colored stools and high levels of conjugated bilirubin
Meds: no sulfa drugs
what are teh causes of peritonitis that do not require laparotomy?
pancreatitis, diverticulitis, spontaneous bacterial peritonitis
what is seen in URQ pain?
gallbladder, liver abscess
what is seen with ULQ pain?
what is seen with LRQ apin?
appendix, PID, ectopic
what is seen with LLQ pain
sigmoid colon, PID
what is seen in epigastric pain?
peptic ulcer, pancreas
what are the six fs of cholecystitis?
fat forty, femal flatulent, febrile
what are the common causes of post-op fever?
five ws- water, wind, walk, wound, weird drugs
water- UTI
wind- atelectasis
walk- DVT
wound- infection
weird drug
spikes that don't respond to abtics, think abscess
what is the most common cause of fever in teh first 24 hrs after sugery?
atlectasis- prevent and treat with early ambulation, chest physiotherapy, IS, proper pain control.
Too much pain, or too many narctoics increase the risk of atelectasis
what is fascial dehiscence?
fascial dehiscence occurs when the surgical wound opens spontaneously. look for leakage of serosanguinous film after coughing, straining. surgical reclosure of the wound and treatment of infection are required
what are teh abcdes of trauma?
airwa, breathing, circulation, disability, and exposrue.
what is the difference between airway and breathing in trauma protocol.
airway- provision, protection, and maintenance of adquate airway at all times. if pt can answer questions, airway is fine; oropharyngeal in uncomplicated cases, oxygen. intubate if blocked, cricothyroidotomy
what is circulation, disability and exposure?
circ- hypovolemia, give IVF, blood products
disability- GCS,
exposure- look at everything,
what imaging films are routinely ordered?
c-spine, chest, pelvic films
what is the best choice for head trauma?
non-contrast CT
how do you manage pts with blunt abd trauma?
if the patient is a wake, stable, and exam is benign- observe
if sunstable, go to lap
inwebtween-> CT with oral and IV contrast
how is penetrating abdominal trauma managed?
gunchot-> laparotomy
knife-> lap if unstable, CT if stable
how does tamponade present?
penetrating trauma to the L chest. hpotension from cardiac filling, distended neck veins, muffled heart sounds. normal breath sounds. Pericardiocentesis if unstable.
how is hemothorax treated?
decreased breath sounds, dull note on percusion, collapsed neck veins, tachycardia
chest tube and blood products.
CT afterwartds. Treat supportively

if bleeding does not stop-> thoracotomy
how do you treat flail chest?
associated with pulmonary contusion, may make respiration inadequate
if not doing well, intubate and give PPV
what is teh most common cause of immediate death after an automobile accident?
aortic rupture- widened mediastinum
What are signs of splenic rubture
hypo tension, tachycardia, shock Kehr's sign
what are the three zones of the neck?
I- base of neck from 2cm above the clavicles ot the clavicles
II- midcervical region
III- top of the neck mandible to base of skill
I and III-> angiogram
what do you do if a tooth is knocked out?
put it back, stabalize.
what are the feautres of downs?
at birth: hypotonia, palmar crease
VSD, leukemia
duodnal atresia
what is edwards?
18, mental retard, small size, small head with hypoplastic mandible and low-set ears
index finger overlapps the 3rd, 4th fingers
what is patau's?
mental retard, apnea, deafness, holoprosencephaly, myelomeningocele, CV abnlties, rocker-bottom feet
what is turners?
neck lymphedema, short stature, webed neck, wide nipps
coarc, horse shoe, cystic hygroma
what is the buccal smear in turners?
barr bodies diagnsoes
what is cri-du-chat syndrome?
deletion of chrom 5
severe mental retard
what are teh findings in glactosemia?
congenital cataracts, neonatal sepsis,
vomit after breast feeding
no galactose
what are the clinical findings in tuberous sclerosis?
AD- hypopigmented skin macules, seizures, mental retard, hamartomas in CNS, rhabdomyomas, renal tumors
what is lesch-nyhan?
deficiency of hypoxanthine-guanine phosphoribosyltransferase-> hyperuricemia
mental retard, selfmulitaltion
what do elderly pts need more of in their diet?
Na, b12, D, folate, iron
what is presbyopia, presbyacusis?
presbyopia- hardening of hte lens that decreases accommodation
presbyacusis- cannot discriminate between sounds
what changes in male sex function in aging?
increased refractory period
increased time to achieve erection
delayed ejaculation
what are the normal changes in women and sex with age?
decreased lube
dypareneunia- atrophy of lit, labia, vag
delayed orgasm
what are the changes in sleep in elderly?
less sleep, sleep less deeply, wake up more often and earlier
less stage 3 and 4 REM
what is pseudodemntia?
depresion in the elderly
what aer eth common dementias?
alzheimers (gradually progressive, neurofibrillary tnagnlees)
multi-infarct- stepwise, risks of sroke
what is the most common cause of preventable infirtiliy?
what is PID?
ascending infection from endometritis, fallps, ovaries, parametrial tissues, peritoneial
- ab pain, adnexal tenderness, cervical motion tenderness
- eleveated ESR, CRp, leukocytosis, fever, or purulent cervical discharge
how is PID treated?
cefoxitin, doxy; clinda and gent for inpatient
what is endometriosis?
dysmenorrhea, dyparenuria, dyschezia or perimenstrual spotting.
how do you diagnose endometritis?
1st line: OCPs
2nd line: danazol, GnRH
candida infection in the vag?
cottgae, cheeze, pseudohyphae on KOH, dM, antibiotics or pregs
topical or oral antifungal
stage 2 sypillis?
condyloma lata, maculopapular rash, serology
when do you see the strawberry cervix?
dysuria, +culture, antibodies
doxy or azithro
what is the treatment for chlamydia in pregs?
what is the treatment for adenomyosis?
boggy uterus on exam, D&C
hysterectomy, gnrh agonists
when is dysfunctional uterine bleeding physiologic?
when not associated with tumor, inflammation, or pregs.
associated with anovulatory cycles. age is important. PCOS,
when is d and c done in women over 35?
endometiral cancer first
Hb, Hct
what else may causae DUB?
infections, endocrin coags, egen neoplasm.
if no underlying path-> Rx is nsaids, or OCPS
OCPs for menorrhagia
Nsaids for dymennorhea
progesterone for severe bleeding
what is teh ratio of LH to FSH in PCOS?
2:1 or greater
how is PCOS treated?
OCPs, progesterone
clomiphene for ovulation
increased risk in endometrial cancer
what is normal semen eval?
>1ml, >20mil/ml, >50% of sperm have initial forward motility
>60% have normal morphology
what is the next step after semen eval for infertility?
ovulation; bbt, lluteal pahse progesterone, endometrial biopsy
what test is used to examine fallps and uterus?
what test is teh last resort in work-up for infertility?
laparoscopy, LOA
what meds can be used to restore female fertility?
clomiphene for ovulation (needs normal egen)
if hypoegen, hMG is sued (combo of FSH and LH)
what are common causes of 2ry amenorrhea?
PCOS, anorexia
endocrine- headaches, galactorrhea, visual field defects
previous chemo
what are the steps of eval of 2ry amenorrhea, if no obvious sign?
give progesterone- eval for bleeding. if bleeding, good egen, if not, no egen
then check LH

what if no egen?- FSH level, karyotype abnlties,
when can 1ry amenorrhea be diagnosed?
no menstration by 16, if no 2/2 sex by 14 or w/in 2 years of 2/2 sex
what is the most likely cause of 1ry amenorrhea?
congenital- pheno normal, normal breast, no axillary- andro insensitivity. _look for uterus
if there is a uterus- look for pituitary issue
what is teh FSH in menopause?
what is teh improtant questiosn in nipple discharge?
OCPs, hormone therapies, antipsychotic meds, hypothyroid
color of discharge
unilateral vs. bilateral
what is fibrocystic breast disease?
bilateral, multiple cystic lesions, tender to teh touch, espeical premenstrually. Most common of all disease. No work-up if <35 y/o
if >35 aspirate cyst, if bloody or rapid accumulation biopsy.
OCPs, progesterone, danazol may relieve symps
what is fibroadenoma of the breast?
painless, discrete, sharply circumscribed, unilateral, rubbery, mobile mass. Most common benign tumor fo the breast.
observe for a couple cycles.
pregs and ocps may stim groth. menopause causes regression

if >35 and has any risk factors, or not clinically benign, biopsy
Phylloides tumors may masqureatde as fibroadenoma

excision is curative, but not required
breast mastitis, abscess?
normally postpartum
lactating wome. Cracked or fissured nipple.
Rx is analgesics, continue breast feeding to prevent blockage.
cephalexin or dicloxacillin given for more than mild symps.

if fluxuant mass, or no response to abtics- abscess, must be drained
what is fat necrosis fo the breast
recent trauma-> mass.
breast cancer and Step 2?
if not classic, no obvious trauma, or bilateral masses, biopsy, baseline mammography
what is a cystocele?
bladder bulges into upper ant vag.
urinary urgency, frequency, incontinence
what is a rectocele?
rectum bulges into lower posterior vag wall- difficulty defecating
what is a enterocele?
bowel bulge in upper posterior vag
what is a urethrocele?
urethra bulges into lower ant vag wall.- urinary urgency, frequency, incontinence
what is the Rx for cystocele, rectocele, enterocele, urethrocele?
pelvic relaxation with pevlic strengthening excersises and or a pessary. surgery for refractory/ severe cases
from best to least was is the best form of birth control?
sterilization, implantable hormone pellets, injectable hormone, birth control
what are the risks of IUDs?
PID- actinomyces
what is adrenogenital syndrome?
CAH, 21-hydroxylase- low Na, hyperK, hypotension, elevated 17-hyrdoxy
what is indicated by a "bunch of grapes" protruding form the pediatric vag?
sarcoma botryoides- malignant tumor of embryonal rhabdomyosarcoma
what is precocious puberty?
girls < 8, boys less than 9.
hormone secreting tumor, or cns disorder should be ruled out.
if idiopathic, treat with GnRH analog
what is the cause of vaginitis in prepubescent girls?
foreign body, sex abuse, candida.
candida may indicate DM
what are the risks and benefits of HRT after menopause?
risks: endometiral cancer, DVT, breast cancer, gallbladder disease

benefits: dcerasd osto, CHD, less symptoms
what are teh SEs of egen therapy?
endometrial bleeding, breast tenderness, nausea, bloating, headaches
what are the contraindications to egen therapy?
unexplained vag bleeding
liver disease
Hx of throbophlebitis, or embolism
endometrial or breast cancer
what are teh minor contraindicatiosn to egen therapy?
uteriine leiomyomas
familial hyperlipidemia
gallbladder disease
what test is needed before started egen therapy?
endometrial biopsy, US, or D and C
what are the absolute contraindications to OCPs?
smoking after 35
breast feeding
active liver disease
uncontrolled htn
prolonged immobilization of extremity
hx of thromboembolism or thrombophlebitis
Hx of stroke, sickle cell, egen dependent neoplasm, liver adenoma, cholestatic jaundice of pregs
what is teh relationship betwee OCPs and HTN
can cuse 2/2 htn
what are teh risks of ocps and sugrery
thromboembolism, stopped 1moth b4, 1 month after
waht are teh SEs of OCPs?
glucose intelerance, depression, edema, wight gain, cholelithiasis, benign liver adenomas, melasma; reduces effects of
rifampin and antiepileptics
OCPs and breast, cervical cancer
breast is increased in long term users, cervical neoplasia may be increased.
whaat is the relationship between OCPs and ovarian, endometiral cancer?
reduce ovarian by 50%, reduce incidence of endometrial cancer
what are pigment gallstoens a sign of?
hemolytic anemia
what meds can cause anemia?
methydopa, PCN, sulfa-> RBC antibodies-> hemolysis
chloroquine, sulfa-> G6PD
phenytoin-> megaloblastic through interference w/ folate
Chloramphenicol, cancner, zidovudine-> aplastic anemia
What do the following indicate?
basophicli stippling
Heinz bodies
Bit cells
Howell-Jolly bodies
Teardrop RBCs
Helmet cells
acanthocytes and spur cells
target cells
echinocytes, acanthocytes
iron inclusions in RBCs of bone marrow
basophilic stippling: lead
Heinz bodies: G6PD
Bite celss: G6pd, hemolytic anemias
howell-Jolly: asplenia
teardrop: myelofibrosis
helmets: hemolysis
Acanthocytes and spur cells: abetalipoproteinemia
Echinocytes, acanthocytes: uremia
Polychromasia; reticulocytosis
Rouleaux: MM
Fe inclusions: sideroblastic
what causes microcytic anemia with elevated retic?
thalassemia, hemoglobinopathy
what causes microcytic anemia with low retic?
lead poisoning
anemia of chronic disease
iron deficiency
what causes normocytic anemia with elevated retic?
acute blood loss
what causes normocytic anemia with low retic?
anemia of hronic disease
aplastic anemia/meds
renal failure
what causes macrocytic anemia?
what clues point to hemolysis?
elevated LDH
elevated bili
low or absent haptoglobin
urobilinogen, bili and hemoglobin in urine
pigmented gallstones (or at young age)
what is the most common anemia?
fe defficiency
>40-> rule out colon cancer
increased requirement in kids, pregs, breast-feeding
what is plummer-vision syndrome?
esophageal web-> dysphagia, fe deficiency, glossitis
what are teh neurolgic deficiencies seen in b12 deficiency?
loss of sensation and position, paresthesias, ataxia, spasticity, hyperreflexia, + babinski, dementia
Dx is linched by a low serum b12. Schilling for the etiology
what is seen on peripheral smears of thalassemia pts?
target cells, nucleated RBCs, diffuse basophilia, skull radiograph with crew-cut apperance.
extramedullary hematopeoisis.
when do pts become symptomatic in alpha thal?
alpha: symptomatic at birth or ftal hydrops
beta: symptomatic at 6 months
what are teh clinical manifestaions of sickle cell?
aplastic crises- parvo
bone pain- infarcts - (classic is of femoral head)
dactylitis- hand-foot syndrome
renal papillary necrosis
splenic sequestration
autosplenectomy- increased infections with encapsulated bugs- pneumoccocus, haemophilus, neisseria
acute chest
pigment cholelithiasis
how do you manage sickle cell?
prophy penicillin til 10y/o
vaccination against pneumonia, h. flu
folate supplementation
early Rx of infections, proper hydration.
how do you treat a pain crisis?
o2, iv fluids, analgesics
what are causes of autoimmune hemolytic anemia?
sle, procainamide, hydralazine, isoniazid
drugs- methydopa, PCNs, cephalos, sulfa, quinidine
leukemia, lymphoma
infection- mycoplasmosis, EBV< syphilis
what is coombs + for?
autoimmune anmeias; spherocytes,
what are the signs of lead poisoning?
hypochromic, microcytic anemia
vomiting, ataxia, colicky abdominal pain, irritability, encephalopahty, cerebral edema, seizures
basophilic stippling, elevated erythrocyte protoporphyrin or pb level.
what is screening for Pb poisoning?
6 mo, 1 and 2 ears in kids with risks- pica, old buildling, or family who work at lead smeliting, or battery recycling plant
how is pb poisoning treated?
chelation: succimer in kids
dimercaprol in adults
in severe: dimercaprol and EDTA
how is sideroblastic anemia seen on step 2?
microcytic, hypochromic with increased Fe. may be a sign of myelodysplasia.
can give pyridoxine for it.
anemia of chronic disease?
low iron and low TIBC, increased ferritin
what is myelophthisic anemia?
anemia 2/2 to space occupying lesion in bone marrow. and myelodysplaisa or myelfibrosis. on smear look for anisocytosis, poikilocytosis, and nucleated RBCs, giant or bizarre-looking platelets, teardrop shaped RBCs.
BM may have a dry tap.
how do you recognize G6PD?
x-linked recessive, males
blacks and mediterraneans. look for sudden hemolysis or anemia with fava beans.
heinz bodies, bite cells
Dx with RBC enzyme assay
what signs and symps do you look for blood transfusion reaction?
febrile- chills, vever, headache, back pain from antibodies to WBCs
hemolytic reaction- anxiety or discomfort, dyspnea, chest pain, shock, jaundice form antibodies to RBCs
allergic reaction- urticaria, edema, dizziness, dyspnea, wheezing, ananphylaxisq
what are tehe common causes of DIC?
pregs, obstetrics, malignancy, sepsis, trauma

prolonged PT, PTT, and bleading timeoozing iv sites
what conditions is eosinophilia seen?
allergy, eczema, atopy
parasitic infections
blood dyscrasias- lymphoma
loffler's syndroem- pulm eos
autoimmune- lupus, RA
IgA deficiency
what conditions is basophilia associated?
allergies or neoplasm/blood dyscrasia
what are the clotting test results in vWF?
nl pt, high ptt, high bt, nl platelts, nl RBC

Autosomal dominent
what are the clotting test results in hemophilia?
nl pt, high Ptt, nl bt, nl platelt cound, nl rbc count
what are the clotting test results in DIC?
high PT, PTT, BT
low plateltes
what are the clotting test results in liver failure?
High PT, PTT
nl BT, platelets
what are the clotting test results in ITP?
nl PTT, PTT, high BT, low platelets
what are the clotting test results in TTP?
nl PT, PTT
high BT
low platelets, RBCs- hemolysis on smear
CNS symps
what are teh symps of scurvy?
splinter hemorrhages, gum petechiae, perifollicular or subperiosteal hemorrhages
myalgias, arthralgias, capillary fragility
Rx is oral vit c
how often should you scren for HTN?
every 2 years starting at 3y/o
what is the conservative management for HTN?
low salt, fat, calorie
reduce smoking, alcohol, weight loss
meds after 2 month trial of lifestyle
if stage II or comorbid conditions start meds
what is the first line for HTN
thiazide, beta-blockers, ACE inhibs, ARBs, Ca channel blockers
when are thiazides best as first drug?
Heart failure, dm, CAD, stroke, osteoporosis
who should not receive thiazides?
gout, hyponatremia, pregs
who should get beta-blockers?
stable angna, ACS, CAD, tachy, fib,
who shouldn't get beta-blockers?
asthma, copd, heart block, sick sinus
who shouldn't get ACe inhibs?
pregs, angioedea, renovascular htn
who should get Ca channels?
raynaud, atrial tachys
what is the difference between htn emergency and urgency?
emergency has symptoms angina, CP, MI, encephalopath, ARF
what causes HTN?
idopathic, essential
what are common causes of htn in young peeps?
alcohol in men
ocps or fibromuscular dysplasia in women
what are the most common causes 2/2 htn?
peho- wild swings, anxiety, diaphresiss, confusion: screen for urine catecholamines
renal artery stenosis: young pts- fibromuscular, old- atherosclerosis; bruit
PKD- flank mass, FHx, increased creatinine, BUN
cushing's- stigmata of cushings
conn's- aldosterone neoplasm
renal failure
why lower pressure?
strokes, heart disease, MI, atherosclerosis, renal failure, aortic aneurysms
what tests should be ordered in HTN?
chem 7
What causes type I hypersensitivity?
I- anaphylactic- IgE
anaphylaxis, atopy, hay fever, urticaria, allergic rhinitis, asthma. bee stings, foods, PCNs, sulfa, rubber
what are teh clinical findings of chronic type I?
allergic shiners
pale, bluish, edematous nasal turbinates
wheat meds aren't given to pts with nasal polyps?
aspirin-> severe asthma attack
what are teh sigsn and Rx for anaphylaxis?
triggers-> itching, facial swelling, difficulty breathing
secure and areway, subcutaneous epi.
what causes hereditary angioedema?
C1 esterase ingibitor.
diffuse swelling of lips, eyelids, and airway; unrealted to allergen exposure.
AD, low C4, androgens for long term treatment, increase liver production of C1 esterase
what causes type II hypersensitivity?
cytotoxic-> IgG, IgM
autoimmune hemolytic anemia
transfusion reactions
erythroblastosis fetalis
Pernicious anemia
what lab test is + with type II hypersensitivity?
what causes type III hypersensitivity?
immune complex from antigen-antibody
serum sickness
lupus, RA, polyarteritis nodosa, cryoglobulinemia glomerulonephritis
what causes type IV
cell-mediated, elayed from t lymphos
contact dermatitis
chronic rejection
how is HIV diagnosed and how long after expsure?
ELISA-> western blot
1 mnth for antibodies
what is a control test in context of PPD and HIV?
PPD for candida and mumps to see if an immune response can occur.
what are teh signs of PCP?
severe hypoxia with normla radiographs, diffuse bilateral infiltrates.
dry nonproductive cough
silver stains (wright-giemsa)
what is the most common 1ry immunodeficiency?
IgA-> recurrent respiratory gi infections
IgA levels are always low, levels of IgG are low.
(if Ig given, then anaphylaxis think IgA cause of IgA antibodies)
what is bruton's agammaglobulinemia
X-linked recessive. Low or absent Bs. lung, sinus with strep hemophilus
what is DiGeorge's?
hypoplasia of 3rd,4th pouch
thymus may be absent
what causes severe combined immunodeficiency?
adenosine deaminase deficiency: AR inheritance
b and t cell defects
what triad is the dx of wiskott-aldrich?
excema, thrombocytopenia, infections
what is chediak higashi?
giant granules in neutrophils, albinism
what is the pathophys of chronic granulomatous disease?
no burst-> staph, pseudomonas
nitroblue tetrazolium dye reaction
how often do you check a cd4 count?
6 months
when do you start antiretrovirals
when do you start PCP prophy?
what is used in sulfa alergy for PCP prophy in aids?
dapsone, penamidine
what is used for MAC prophy?
<100, azithro, clarithro, rifabutin
AIDS patients get:
annual flu?
annual PPD?
oral polio?
MMR- yes
annual flu- yes
annual ppd- yes
oral polio- no, give inactive
pneumococcal- yes
Hep- yes
what cancer in aids?
what causes chronic diarrhea only in AIDS?
cryptosporidium, isospora
what is the cause of a false positive HIV in newborns?
mom's antibodies for 6 months
what complicment defieciency of C5-9 can cause?
chronic mucocutaneous candidiasis is what?
can't fight candida.
associated with hypothyroid
what is hyper-IgE syndrome?
recurrent staph infections
high IgE
fiar skin, red hair
what is the major cause of bronchitis and how do you treat?
h flu

amox, erythro
what is the common cause of pneumonia classically?
s. peumo
what causess osteo
what causes cellulitis
strep, staph
what causes meningitis in teh neonate? child/adult?
GBS, e coli, listeria- amp, aminoglycoside, cephalo
S. pneumo, n. mening- cephalo, vanc, dxa
what bugs cause sepsis?

third gen penicillin, ceph, aminoglycoside, imipenem
what causes spetic arthritis?
gonorrhe if sexually active
what causes sendocarditis?
staph, strep
what is the drug for strep a or b
what is the drug for s pneumo?
cephalo, levoflox
enterococcus is treated with?
penicillin and aminoclycoside
what treats staph aurreus
what treats gonococcus?
ceftrixone, fluroquinolone
what treats haemophilus?
what is a plump g- rod with thick capsule?
what is a G_ with spores?
clostridium, bacillus
what bug is gram positive with sulfur granules?
what is silver staining (bug)?
what are the hallmarks of staph pneumonia?
nosocomial, cf, iv drugs, chronic granulomatous disease, empyema and lung abscesses are common with s. aureus
when do you see G- pneumonias?
pseudomonas with cf
klbsiella with skid-row- currant jelly sputum
e.coli with aspiration, neutropenia, hospital acquired.
how do you recognize mycoplasma pneumonia?
most common in adolescents and young adults
long prodrome.
CXR- pachy, diffuse bronchopneumonia- looks bad
_cold-agglutinin antibody titiers-> hemolysis, anemia
how do you recognize chlamydia pneumonia
negative cold-agglutinin
azithro or levo
what is an alternative to bactrim in HIV?
what bug when stuck with a thorn?
schenckii- K or ketoconazole
aplastic in sickle cell?
penumonia in southwest?
coccidiodes- itraconazole or fluconazole
sepsis after splenectomy?
s. pneumo, h. flu, n. meningitis
pneumonia after exposure to parrot or bird?
chlamydia psittaci
pneumonia in ohio or mississippi river valleys?
fungus ball hemoptysis after tuberculosis?
penumoia in pt with silicosis
diarrhea after hikin/drining?
stool cysts- metronidazole
prenant and cats?
b12 and ab pain
what seizures with ring enhancing lesion
taenia solium, toxo
squamous cell bladdder cancer in middle east
worm in kids
fever, muscle pain, eos, periorbital edema after raw meat?
slaughterhouse woith fever?
when is lumbar puncture contraindicated?
if acute head trauma or igns of ICH.
what is the classic description of the multiple sclerosis?
insidious onset, neurologic symps in white women, parasthesias, numbness, weakness, clumsiness, visual disturbances, gait disturbances, incontinence, urgency
what is seen on CSF in MS?
oligoclonal bands
what is the pathology in guillan barre?
demyelination, slowed nerve conduction
what causes an EMG study with no muscle activity?
intrinsic muscle disease
what causes EMG to show fascics or fibs at rest?
lower motor neuron lesion
What manifests as decreased reflexes, fascics, atrophy?
LMN disease
what causes hyperreflexia, clonus, increased muscle tone?
UMN lesion
what causes apathy, inattentin, disinhibition labile affect?
frontal lobes
what causes broca's aphasia?
dominant frontal lobe
what causes wernicke's?