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367 Cards in this Set

  • Front
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Erythrocyte protoporphyrin dosage

Which clinical situation?
In children with high lead levels, EP becomes elevated because lead interferes with the creation of red blood cells. Screening by measuring this chemical in the blood [erythrocyte protoporphyrin (EP)] is done every time your child has a lead level drawn.
Most common cause of mid systolic click
Floppy mitral valve
Auer Rods
Pathognomonic of AML
How to differentiate between AML and leukemoid reaction
ALP is always elevated in leukemoid reaction.
Surgical indications for herniated disc
Unresponsive to treatment after 3 months
Progressive neurological deficit
Cauda equina
Presentation and characteristics of IgA deficiency
Selective IgA deficiency is a relatively common condition in which patients are unable to synthesize IgA.

Most patients with IgA deficiency are asymptomatic. The condition becomes clinically significant when blood transfusion is required, since they may develop anaphylaxis when exposed to blood products containing IgA.
Dyspnea in patient taking Bleomycin, what to suspect?
Pulmonary Fibrosis
Indication for excisionnal biopsy of a pigmented lesion
Excisionnal biopsy should be carried out in any case of pigmented skin lesion that shows one or more of the following features :
- asymmetric or fuzzy border
- irregular or variegated color
- diameter greater than 0.6 cm
ABCDE mnemonic for melanoma
Diameter > 0.6 cm
Presentation and characteristics of IgA deficiency
Selective IgA deficiency is a relatively common condition in which patients are unable to synthesize IgA.

Most patients with IgA deficiency are asymptomatic. The condition becomes clinically significant when blood transfusion is required, since they may develop anaphylaxis when exposed to blood products containing IgA.
Dyspnea in patient taking Bleomycin, what to suspect?
Pulmonary Fibrosis
Indication for excisionnal biopsy of a pigmented lesion
Excisionnal biopsy should be carried out in any case of pigmented skin lesion that shows one or more of the following features :
- asymmetric or fuzzy border
- irregular or variegated color
- diameter greater than 0.6 cm
ABCDE mnemonic for melanoma
Diameter > 0.6 cm
Thrombotic Thrombocytopenic Purpura Pentad
1- Thrombocytopenia : bruising + bleeding
2- Microangiopathic hemolytic anemia
3- Neurologic symptoms
4- Kidney failure
5- Fever
Blood marker for hepatocellular carcinoma
AFP (alpha feto protein)
Most common sites for hypertensive hemorrhage
The caudate and the putamen are most common sites (70%).
These can lead to dangerous elevations of intracranial pressure.
Parkinsonian symptoms that do not respond to medical therapy, which disease should be suspected?
Progressive supranuclear palsy
Progressive supranuclear Palsy
PSP is a degenerative disorder that predominantly affects the midbrain and basal ganglia. The clinical hallmarks are symmetric Parkinsonism with vertical gaze limitation and axial rigidity.

These patients tend to have falls as their earliest symptoms. There is an associated mild-to-moderate dementia that usually involves frontal lobe functions more than hippocampal/memory systems.
Carcinoid Syndrome
The classic triad of this disorder is :
1- Flushing
2- Watery diarrhea
3- Valvular heart disease

The first test for screening carcinoid syndrome is the determination of 5-HIAA in a 24 hr urine sample.

Carcinoid syndrome is aslo associated with hypotension, bronchospasm, telangiectasia and abdominal cramps due to the release of serotonin and vasoactive peptides.

Symptomatic treatment of carcinoid syndrome consists of giving Octreotide.
Serum marker for melanoma
AFP marker
Testicular and ovarian cancer with a yolk sac component.
Ovarian tumours
LCA marker
Marker for lymphoid neoplasms
Wernicke-Korsakoff syndrome
Wernicke's encephalopathy
1. Ataxia
2. Confusion ... coma...
3. Ophthalmologic manifestations
- nystagmus
- ophtalmoplegia
- anisocoria

Korsakoff's psychosis
1. Antegrade / retrograde amnesia
2. Hallucinations
3. Confabulation
Screening for diabetic nephropathy
24 hour urine collection

Microalbuminuria is the earliest expression of diabetic nephropathy
Tumour lysis syndrome complication prevention
Allopurinol and intensive hydration

TLS results from the acute lysis of lymphoma cells and the acute renal failure from the precipitation of uric acid and hypoxanthine in the renal collecting tubules.

Patients should receive allopurinol, a xanthine oxidase inhibitor that reduces the synthetis of uric acid, and should be aggressively hydrated prior to the initiation of chemotherapy to reduce the incidence of TLS.
Graft versus host disease prevention in bone marrow transplant recipients
The incidence of graft versus host disease can be reduced by removal of T cells from the donor marrow by using monoclonal antibodies, rosetting techniques, or mechanical separation.
Idiopathic Thrombocytopenic Purpura
ITP is most common in adults (women > men) aged 20-40 years.

Bleeding, epistaxis, oral bleeding or menorrhagia can occur and isolated thrombocytopenia (< 10 000) is characteristic.

10% of patients will have coexisting autoimmune hemolytic anemia.

The first line therapy is prednisone if the patient is not actively bleeding.
Orphan Annie Eyes
Papillary structures within follicles that have epithelial cells with nuclei with cleared centres indicate the presence of papillary carcinoma of the thyroid.

Of all the thyroid cancers, 60% to 70% are papillary carcinomas. The condition is more frequent in younger patients but tends to be more aggressive in the elderly.

There is usually a single dominant nodule that is "cold" on thyroid scan.

Among the different thyroid cancers, papillary carcinoma tends to be the one with the best prognosis overall, and smaller lesions can be treated with thyroid lobectomy alone.
Histologic types of esophageal cancer
Cancers involving the upper third of the esophagus are usually squamous cell in origin. Lower oesophageal cancers may be either squamous cell carcinoma or adenocarcinoma (usually arising from Barrett Esophagus)

Predisposing factors for squamous cell carcinoma of the esophagus include:
- alcohol use
- tobacco use
- esophageal scarring
- sclerotherapy
- chronic achalasia
Ductal carcinoma of the pancreas imaging
Ductal carcinoma of the pancreas is often devastating because, in roughly 90% of cases , it presents late in the clinical course when it is no longer resectable.

CT-Scan is the most effective method of diagnosing and staging the disease.
Amaurosis fugax
A senstation of curtain passing across the visual field can be characteristic of either amaurosis fugax or retinal detachment. If the phenomenon is transient , amaurosis fugax is more likely than retinal detachment.

Fleeting blindness is characteristically caused by retinal emboli from ipsilateral carotid disease. The visual loss is described as a curtain passing vertically across the visual field, with complete monocular visual loss lasting a few minutes

Amaurosis fugax may be due to cholesterol plaque release and is a precursor of retinal artery occlusion.
Wich serologic marker excludes discoid lupus from the diagnosis?
Medullary thyroid carcinoma
Medullary thyroid carcinoma
Drugs that can cause neutropenia
Chemoterapeutic agents
Complicated parapneumonic effusion
Organisms in the fluid
Leukocyte in the fluid > 50 000
Low pH

Such collections tend to loculate and form adhesions if not immediately drained with a chest tube.
Treatment for lyme disease
Contraindications to use of anticholinergics
Narrow angle glaucoma
Severe constipation
Prostatic hyperplasia or symptoms of urinary retention
Causes of hepatocellular carcinoma
Analgesic nephropathy
Analgesic nephropathy affects patients who consume significant amounts of aspirin, NSAIDs, phenacetin or acetaminophen for at least 3 years.

Chronic tubulointerstitial nephritis : progressive polyuria because of inability of the renal tubules to concentrate urine, hyperkalemia, presence of radiologic signs of papillary necrosis, concomitant microhematuria and proteinuria.
Crystals in gout and pseudogout
- rhomboidal negatively birefringent crystals
- monosodium urate

- rhomboidal positively birefringent crystals
- calcium pyrophosphate
Preferred imaging techniques to quickly diagnose aortic dissection
TEE if available
CXR if not available (will show mediastinal widening)
Initial manifestation of gonococcal arthritis
Acute onset tenosynovitis
Management of solitary pulmonary nodule radiographically detected
60% of solitary pulmonary nodules are benign, and granulomas represent the most common benign lesion.

There is no infallible clinical or radiological set of criteria that can discriminate between benign and malignant lesions.

Factors favoring a benign lesion include :
- young age (< 40)
- small size (< 2 cm)
- smooth margins of the lesion
- absence of symptoms
- slow growth on successive films

Generally, calcifications are not a malignang malformation and presence of "popcorn-like" calcifications definitely favors hamartoma.
A hamartoma is a malformative lesion resulting from random admixture of tissues normally present in the lung, including cartilage, bronchial mucosa and smooth muscle. It is usually discovered incidentally.
Hepatitis B and hives
Up to 25 % of acute hepatitis B infections present with urticaria
Causes of wide split S2
Pulmonic stenosis
Pulmonary embolus
Ectopic or pacemaker beats originating in the left ventricle
Management of asymptomatic hyperparathyroidism
In most cases, hyperparathyroidism is asymptomatic, manifesting only with hypercalcemia incidentally in the course of routine laboratory investigations conducted for other reasons.
The most common cause is parathyroid adenoma.

If is the only clinical sign, without associated complications such as renal stones, bone disease or cataracts, abundant fluid intake is the only measure recommended to prevent formation of calcium stones in the urinary system.
False cause of depressed pancreatic enzymes level
Type I and V hyperlipoproteinemia

They are a cause of acute pancreatitis. Look for other typical signs of acute pancreatitis.
- neutrophilic leukocytosis
- hyperglycemia
- hypocalcemia
- elevated CRP
- "sentinel loop"
- Typical CT-Scan
Colloid use
Burns rehydration
HIV and persistent diarrhea

Which microorganisms should be suspected

These organisms should be though for by examination of fresh stool sample for parasites.
Recurrent UTIs and kidney stones
Urease-producing organisms create a high urinary pH, contributing to the development of struvite kidney stones.

Acetohydroxamic acid is an effective urease inhibitor.


Less commonly : Pseudomonas and Providencia
Churg-Strauss Vs Goodpasture syndrome
Goodpasture syndrome
- autoantibodies against a domain of type IV collagen in the basement membranes of both glomerular and alveolar capillaries
- Linear deposition of IgG and complement

Churg-Strauss syndrome
- blood and tissue eosinophilia
- circulating ANCA (p-ANCA)
Most common cause of status epilepticus
Drug non compliance

2 types of status epilepticus
- convulsive
- non convulsive

Other causes :
- alcohol withdrawal
- head trauma
- hypoxia
- intracranial infection
- cranial tumour

Infection is the most common cause in childhood.
Causes of focal segmental glomerulonephritis

Heroin abuse
Morbid obesity
Indications for cryoprecipitate use
Hemophilia A
von Willebrand disease
Most common primary cardiac tumour
Atrial myxoma

It affects women more than men and grows in the left atrium in 80% of cases. It may present with a systemic illness mimicking infective endocarditis, give rise to systemic embolism or present with signs and symptoms of mitral valve obstruction.

The change of murmur when the patient changes position is suggestive of an atrial myxoma.
Relapsing polychondritis
An autoimmune condition that occurs as an isolated process or together with other autoimmune disease, including rheumatoid arthritis, systemic vasculitis and SLE.

Presentations can include bilateral swelling of the external ears, nasal involvement, arthralgias to symmetric arthritis (with a predilection for the costochondral joints), and involvement of the larynx, trachea and bronchi.
Treatment of TCA intoxication
Maintain an alkalemic state
- Hyperventilation
- IV bicarbonates
ECG sign of TCA intoxication
Prolonged QT + widening QRS
Proper position for insertion of thoracocentesis needle? (pleural effusion)
5th intercostal space
Posteriorly - Between the tip of the scapula and the mid axillary line
Superior edge of 7th rib (in order to avoid the neurovascular bundle which runs along the inferior edge of the rib)

Make sure that the effusion is free flowing by ordering a lateral decubitus CXR
Presentation of CLL
Usually asymptomatic.
Increased lymphocytosis on routine bloodwork.
Accumulation of lymphocytes in bone marrow.

In the first stage, no treatment is necessary.

It usually follows an indolent course and aggressive chemotherapy seems to have little impact on survival.

When CLL advances, Chlorambucil is the standard treatment.
- progressive fatigue and organomegaly (stage II)
- severe anemia (stage III)
- thrombocytopenia (stage IV)
HLA phenotypes of type I diabetes
DR3 and DR4
Hepatic enzymes in alcoholic hepatitis
AST : ALT > 2
Infectious causes associated with membranous glomerulonephropathy
Nephrotic syndrome with p-ANCA positive
Churg Strauss syndrome
Wegener's Granulomatosis
Microscopic polyangitis

All these conditions are associated with sites of involvement other than the kidneys.
Glomerulonephritis with elevated IgA?
Berger Disease (a.k.a IgA nephropathy)

Glomerulonephritis with recurrent hematuria and/or proteinuria + upper respiratory flu-like syndrome or interstitial infection.
Glomerulonephritis and elevated C3 nephritic factor?
Type II membranoproliferative glomerulonpehritis
Glomerulonephritis and AIDS?
Focal segmental glomerulosclerosis
Glomerulopathy and positive ANA
Renal cell carcinoma triad
Flank pain
Abdominal mass
Type of hyperbilirubinemia in Dubin-Johnson Syndrome?
Genetic causes of indirect hyperbilirubinemia?
Criggler Najjar
Familial hypercholesterolemia
Dominant autosomal disorder that affects the LDL receptor. It increases the risk of CAD (3x hetero 6x homo)
Apolipoprotein E deficiency/mutation
It causes hyperlipoproteinemia type I and IV.

It is characterized by recurrent pancreatitis and hyepatosplenomegaly.
Causes of hypophosphatemia
Aluminum hydroxyde long term use
Theophylline intoxication
Chronic diuretic administration
Utility od carbohydrate deficient transferrin
The serum level of this marker can be used in the follow up of patients with heavy drinking who are enrolled in specialized programs for treatment of alcoholism.
Meniere disease
Generalized dilation of the membranous labyrinth of the inner ear.

Associated with attacks of vertigo, tinnitus and initially fluctuating and later progressive hearing loss.
Vestibular neuronitis
Presents initially with a persistent severe episode of vertigo that eventually fades to a paroxysmal form, which completely disappears within a year or two.
Herpez Zoster Oticus
Hearing loss, Vertigo

sometimes facial nerve paralysis
Best initial treatment of hypertrophic cardiomyopathy
Beta-Blockers or CCB

Outflow obstruction in hypertrophic cardiomyopathy causes impaired diastolic filling .
Most common cause of asymptomatic hypercalcemia
Primary Hyperparathyroidism
Three most common causes of steatosis
Diabetes Mellitus
Two most common causes of ketoacidosis
Radial nerve palsy
a.k.a Saturday night palsy


Triceps, Brachioradialis, Wrists and finger & thumb extensors

Clinical features include
- wrist drop
- inability to extend elbow & fingers

Most common causes :
- saturday night palsy (alcoholism)
- crutches
Axillary nerve

Deltoid + teres minor

Clinical features :
- weakness in shoulder abduction
Median nerve palsy

Abductor pollicis brevis, forearm, pronator, finger & thumb flexors

Carpal tunnel syndrome

Paresthesia in the ventral 2 1/2 fingers
PBC antibodies
Is PBC intrahepatic or extrahepatic or both?
PSC : intrahepatic, extrahepatic or both?
Takayasu Arteritis
a.k.a. Pulseless disease

Inflammatory arteritis that affects the main branches originating from the aortic arch, causing sings and symptoms of ischemia to the brain and upper extremities.

Young women are mostly affected.
Churg strauss syndrome
Small vessel vasculitis that affects :
- lungs
- kidneys
- skin

Usually associated with eosinophilia and p-ANCA
Giant cell arteritis
Most commonly affects the brances of the external carotid artery, especially the temporal artery.
Henoch Schonlein Purpura
Most commonly affects :
- skin
- GI tract (abdominal pain + bleeding)
- joins (arthritis)
- glomerulonephritis

Usually associated with auto-immune complexes containing IgA
Kawasaki syndrome
Usually seen in children.

Fever for 5 days associated with 4 of the following changes
- Bilateral non suppurative conjunctivitis
- One of more changes of the mucous membranes of the upper respiratory tract, including pharyngeal injection, dry fissured lips, injected lips, and "strawberry" tongue
- One or more changes of the extremities, including peripheral erythema, peripheral edema, periungual desquamation, and generalized desquamation
- Polymorphous rash, primarily truncal
- Cervical lymphadenopathy >1.5 cm in diameter

†A diagnosis of Kawasaki disease can be made if fever and only 3 changes are present in conjunction with coronary artery disease documented by two-dimensional echocardiography or coronary angiography.
nummular eczema
Coin shaped lesions covered by uniform scaly crust
+/- itching

no central clearing
seborrheic dermatitis
Scaly, oily, dandruff-like rash in the scalp and eyebrows of infants (cradle cap).

Up to 50% of AIDS patients develop seborrheic dermatitis in unusual locations. Other patients predisposed to this condition are the elderly and Parkinsonnians.
Allergic contact dermatitis
Mediated by type IV hypersensitivity reaction to a variety of allergens.
Tinea corporis
Tinea corporis is due to dermatophytes, fungal organisms that colonize the most superficial layers of the epidermis.

the most characteristic appearance of skin lesions associated with tinea corporis is a ring-like pattern.

KOH treated skin scrapings examined under a microscope allow identification of spores or hyphae.
Dialysis indications
Refractory hyperkalemia
Refractory acidosis
Refractory fluid overload
Uremic complications
- pericarditis
- peripheral neuropathy
- encephalopathy
Tricyclic intoxication
Toxic effects atribuable to anticholinergic activity and "quinidine" like action

Mild overdose is principally associated with anticholinergic effects such as mydriasus, tachycardia, impaired sweating with flushed skin, dry mouth, constipation and muscle twitching.

More severe intoxication leads to cardiac arrhythmias, namely ventricular tachyarrhythmias and bradycardia.

Prolongation of the QRS complex (>0.1 sec) is typical and constitutes a more sensitive indicator of toxicity than serum drug levels.

Seizures, coma and hypotension are the most severe manifestations.

Gastric lavage in the first hour following ingestion, supportive care, anticonvulsants and appropriate antiarrhythmic drugs (sodium bicarbonate bolus, lidocaine and phenytoin) are the recommended treatments.
Paget disease
Idiopathic bone disease characterized by localized areas of hyperactive bone (osteoclasts and ostebolasts).

It causes typical radiologic signs.

It can also cause peripheral nerve entrapment (including hearing loss) or bone fractures.

It can also cause bitemporal enlargement.

It is usually accompanied with elevated of alcaline phosphatase and others are normal. + increased urinary excretion of pyridinoline links.

Drug therapy (biphosphonates / calcitonine) can help.
Cystic Schistosomiasis
It manifests with recurrent hematuria and predispose to squamous cell carcinoma of the bladder

Search for ova in the urine is the fundamental diagnostic test.
Live attenuated vaccines
Oral polio vaccine
Yellow fever
Presentation of fat emboli
Fat emboli occur after the introduction of neutral fat into the venous circulation, occuring most commonly after bone trauma or fracture.

After a latent period of 12-36 hours, during which the patient is asymptomatic, cardiopulmonary and neurologic deterioration occurs. Dyspnea, tachypnea and tachycardia occur with radiographic findings of diffuse bilateral infiltrates, consistent with ARDS.

Treatment is supportive. Mortality is high.
CREST antibodies
Scleroderma antibodies
Scl-70 a.k.a. tropoiosomerase
Menetrier disease
Uncommon gastric disorder characterized by markedly thickened gastric folds.

The disorder is idiopathic and it causes reduced acid secretion (hypochlorydria) and a protein losing enteropathy with weight loss and edema secondary to hypoalbuminemia.

Medical treatments are typically ineffective, and some patients require partial or complete gastric resection to control severe hypoalbuminemia.
Markers for CRC
Most common site for hypertensive hematomas?
Most common skin cancer
Basal cell carcinoma

Squamous cell carcinoma is the 2nd most common (usually occurs on the lower lips)
Cold agglutinins causes
- Mycoplasma Pneumonia

- Lymphoma

Idiopathic (auto-immune anemia)
Most common causes of intracerebral masses in AIDS patients

They both show as ring enhancing lesions on imaging.

Toxoplasmosis usually responds to therapy, so when the latter fails, primary brain lymphoma should be suspected.
Multiple Myeloma primary features
Elevated serum proteins
Normocytic anemia
CRF + Bence Jones
Susceptibility to infections
Side effects of amiodarone
Thyroid disorders
Pulmonary fibrosis
Torsades de pointes
Skin discolouration
Oligoclonal bands in CSF
Multiple sclerosis
Scabies diagnosis
The most effective way to confirm a diagnosis of scabies is to place a drop of mineral oil on a suspected area then unroof the burrow hole with a curette ring and obtain scrapings that are examined under microscope.

The ares of the body most frequently affected include the axillary and genital regions, waistline and finger webs.

Pruritus tends to be particularly intense at night.
Aortic dissection risk factors
Marfan syndrome
Treatment of hypertensive emergency

Treatment of hypertensive urgency
Hypertensive emergency :
1- Nitroprusside
2- BB (if Myocardial ischemia) or nitro IV
3- Diuretic (if CHF)

Hypertensive urgency :
1- Clonidine or CCB

1- Hydralasine
Hepatic adenoma usual presentation
Hepatic adenomas are infrequent benign tumours. They are often silent and occur most frequently with OCP and anabolic steroids.

when symptomatic, its most common clinical presentation is rupture into the peritoneal cavity with consequent hemoperitoneum and shock.
Wegener granulomatosis sites
Paranasal sinuses
Upper respiratory tract
Skin (subcutaneous nodules and purple papules)

Behcet disease features
Oral ulcers
Genital ulcers
Ocular disease (relapsing iridoclytis that causes pain and photophobia)
skin lesiosns (papules, pustules, vesicles or folliculitis)
mild arthritis of large joints

Other features may include CNS involvement and migratory thrombophlebitis
PRICE mnemonic for sprains
P : protect
R : rest
I : ice
C : compression
E : elevate
Mixed connective tissue disease antibodies
Libman Saks endocarditis
aseptic vegetations on valves associated with SLE.
No bacterial endocarditis.
Epidural bleed
Epidural bleed is usually due to rupture of middle meningeal artery.

The initial concussion leads to a brief loss of consciousness, which is followed by a lucid interval lasting several hours. As the epidural hematoma progressively enlarges and pushes the underlying brain, the patient becomes comatose again and may display signs of uncal herniation. The herniating uncus pushes on the third cranial nerve, producing ipsilateral fixed pupillary dilatation. Papilledema is usually a late sign and indicates cerebral edema.
Nystagmus in BPPV
Geotropic rotatory nystagmus
Common ototoxic drugs
Swimmer's ear
Otitis externa
Territory supplied by the right coronary artery
Inferior and posterior segments

Territory supplied by the circumflex artery
Anterolateral regions

V5-V6 and I-aVL
Territory supplied by the LAD artery
Anteroseptal and ateropical regions

Territory supplied by the LAD
Territories of LAD and circumflex

V1-V6 and I-aVL
Territory supplied by the posterior descending artery
Posterior aspect of the heart

Tall R waves in V1-V2
Bleeding after antibiotic course and parenteral nutrition
Consider vitamin K deficiency among other causes
Polymyositis presentation
Proximal muscle weakness and pain.

Elevated CK
Inclusion Body myositis
Distal muscle weakness

Rimmed vacuoles on pathology
Mimics polymyositis on muscle but with skin involvement.

30% of cases are associated with underlying malignancy.
Hypocalcemina post-op of parathyroidectomy
Caused by atrophy of the other parathyroid glands

Treat transient hypocalcemia with IV calcium gluconate followed by oral calcium and vitamin D administration.
Cardiomyopathy caused by chronic alcoholism
Dilated cardiomyopathy
Treatment of adrenal crisis
IV hydrocortisone (100-300 mg)
Giant platelets
Consider essential thrombocytopenia

also : platelet aggregates and megakaryocytes fragments
Use of oral neomycin
Aminoglycoside (poorly absorbed)

Adjunct to lactulose therapy in hepatic encephalopahty cases in order to reduce the bacteria load in the intestine.
Hemolytic anemia which may be triggered by :
- fava beans
- sulfonamides
- salicilates
G6PD deficience

X linked recessive.
ACTH suppression test
Dexamethasone can inhibit ACTh secretion by the pituitary. In its simplest form, 1 mg oral dose is given at night; the following morning, a single plasma cortisol is taken, which in normal individuals will suppress to less than 5 mg/dl. Most patients with non pituitary Cushing syndrome will not have a suppression of cortisol in this setting.

A more elaborate form of the test can be given. Low dose dexamethasone can be given for 2 days (0.5 mg Q6H) which will inhibit ACTH secretion in normal subjects, but not in patients with an ACTH secreting pituitary tumour. These patients can however, be suppressed with the higher dose given on the last 2 days of the test, unlike patients with either ACTH secretion by other tumours (such as scc) or primary adrenal disease producing the cortisol.
Pulmonary radiotherapy :
Fibrosis Vs. Pneumonitis
Acute radiation pneumonitis develops 2-3 months after exposure and manifests with insidious onset of shortness of breath and chest pain (sharp demarcation of pulmonary infiltrate on CXR corresponds to the treated area).

Pulmonary radiation fibrosis is a delayed complication of radiation injury and manifests 6-12 months following radiation exposure.
Three most common causes of atrial fibirillation
Myocardial ischemia
Mitral valve disease
Sporotrichosis, which occupation is linked to it?
Gardners or forest workers.

It is a saprophytic mold present on rose bushes, barberry bushes and other mulches and is typically introduced at a site of minor trauma.

Helpful diagnostic clues are absence of systemic symptoms, subcutaneous nodules (adenopathies) in chains.

Tx = itraconazole PO
Rate of chronicity of HCV infection
Rate of chronicity of HBV infection
5% to 10%
Does basal cell carcinoma have metastatic potential?

Basal cell carcinomas are the most frequent skin malignancies. They develop on sun exposed areas, often in fair skinned individuals, grow slowly for years, and finally develop a central ulceration.
Abdominal pain that is relieved when the patients lies quietly?
Consider peritonitis
Mutation associated with osteogenesis imperfecta?
Collage type I mutation

Fetal type : in utero fractures and deformities
Adult type : extreme bone brittleness and frequent fractures and is also associated with characteristic constellation of signs including : bluish sclerae, bluish misshapen teeth and conductive hearing loss.

Positive family history
Marfan syndrome
Marfan syndrome is characterized by long limbs and fingers (arachnodactyly), ectopia lentis (dislocation of the lens), and proximal aortic dilatation resulting in aortic insufficiency, mitral valve prolapse and laxity of joints.

Patients with marfan syndrome are usually very tall : most of the height is due to the lower extremities. Pectus excavatum and pectus carinatum (pigeon breast) and protuberant forehead are frequent associated skeletal anomalies.

A mutation of the fibrillin gene is the underlying molecular defect.

Cardiovascular complications, particularly aortic dissection, represent the most common cause of death in marfan patients.
Virtually all patients with ARDS have reduced lung compliance.

ARDS begins with compromise of capillary integrity, which causes extravasation of fluid, fibrin and protein into the alveoli. Thus, the lungs become wet and stiff, causing reduced lung compliance.

It is characterized by severe hypoxia caused by extreme V/Q imbalance and shunting of blood in the fluid filled areas of the lung.

Clinical features include progressive tachypnea. Specific physical features are usually absent, except for bilateral diffuse rales.

ARDS can be initiated by many different events and conditions, including shock, aspiration of fluid, DIC, sepsis trauma, blood transfusion, pancreatitis, smoke inhalation and heroin overdose.

The ultimate goal of treatment is to provide adequate tissue perfusion and oxygenation while addressing the precipitating event.
Initial treatment of polymyositis
Daily corticosteroids until the level of CPK normalizes in 3 months.
Brown pigement stones
infected bile
black pigment stones
chronic hemolysis
Test for carcinoid syndrome
5-HIAA urinary test

(serotonin metabolite)
Absolute contraindication for spinal tap?
Increased intracranial pressure
Pneumovax (polysaccharide) indications
> 65 years olds
> 2 years olds with chronic disease or immunosuppression
Prevmar (conjugate) indications
< 23 months old
< age of 5 with chronic disease or immunosuppression
Meningococcal C conjugate vaccine indications
Complement, factor D or properdin deficieny
12 months old (Quebec)
Pneumonia treatment

Urea > 7
Respiratory rate > 30
Blood pressure <90/60

0-1 : outpatient
2 : hospitalize
3-5 : ICU
Argyll Robertson Pupils
Pupils that accomodate to close objects but do no react to light.

This is pathognomonic of tertiary syphilis.
Syphilis screening and confirmatory tests
Screening Tests : VDRL, RPR, EIA

Confirmatory tests : TPI, FTA-Abs, MHA-TP, TPPA
Treatment of syphillis
Primary, secondary or latent (<1 year) : Pen G 2.4 million U IM x 1

Tertiary or latent (> 1 year) : Benzathine Pen G 2.4 million U IM x 3 weeks

If allergic to penicillin :
doxycline or tetracycline
Classic triad of congenital toxoplasmosis
Intracranial calcifications

Maternal infection occurs via contact with the oocysts present in the feces of an infected house cat or by consuming undercooked meat of infected animals.

The most widely accepted regimen for treatment of infected neonates is pyrimethamine, sulfadiazine and leucovorin.
Fluoroquinolones side effects
GI upset
Headaches and dizziness
QT prolongation
Tendonitis and Achilles tendon rupture
Why shouldn't doxycycline be used in children < 8 years old?
Risk of tooth discolouration
Coxsackie Virus A infection
Hand-foot-and-mouth disease.

Patients typically present with a mild illness that may or may not have the presence of fever. The oropharynx is inflamed, with vesicles scattered on the tongue, buccal mucosa, posterior pharynx, gums, palate, and lips.

Hands and fingers, feet, buttocks and groin may also demonstrate maculopapular, vesicular, or pustular lesions.
Use of acyclovir in varicella infection
Oral acyclovir should be considered for immunocompetent patients (> 12 patients) who have an increased risk of severe varicella infection.

Oral acyclovir therapy in this population, beginning within 24 hours of symptom onset, has been shown to decrease the duration of lesions and fever and diminish the symptoms and duration of disease.
Tubo-ovarian abscess management
A TOA is a result of an inadequately treated PID.

Patients with TOA will often be febrile, nauseated, tachycardic, and complain of abdominal and pelvic pain.

Inpatient with IV antibiotics.
Complications of measles
Subacute sclerosing panencephalitis
Hepatic side effect of INH
Hepatotoxicity. INH usually increases liver enzyme levels = asymptomatic hepatitis.

Concomittant iv drug use and alcohol abuse can cause symptomatic hepatitis.
Management of needle stick injury from an HIV positive patient
The average risk of seroconversion following a needle stick injury is about 0.3% without prophylaxis and is reduced by 80%, when post exposure prophylaxis is administered in a timely fashion.

Recommended management of high risk exposure includes 2 anti retrovirals and a protease inhibitor.

A low risk exposure involves prophylaxis with the NRTIs alone.

HIV serology should be tested at baseline, 6 weeks, 12 weeks and 6 months following the exposure.
Toxic shock syndrome is most often caused by S. Aureus or GAS.

Factors that increase the risk of TSS include high absorbency tampons and using a single tampon for multiple days. Non menstrual causes of TSS include a variety of infections, as well as both vaginal and cesarean childbirth.

Symptoms of TSS include high fevers, headaches, GI distress, neurologic symptoms, hypotension and erythematous macular rash.

Treatment is supportive with admission to ICU + removal of foreign objects.
No antibiotics, IVIG or corticosteroids.
Rifampin side effects
Orange discolouration of urine and tears
GI upset
The disease is bacillary angiomatosis, caused by Bartonella Henselae infection.

It is caused by vascular proliferation and neutrophilic inflammatory response to the bacteria and can look similar to Kaposi's sarcoma.

Biopsy of the lesion often shows tiny clumps of bacilli on Warthin-Starry silver stain.

It can be treated with antibiotics : erythromycin or doxycycline for 2-4 months.

If osteomyelitis, splenitis or endocarditis : 6 months.
Histoplasma capsulatum
Exposure to bird and bat droppings or soil contaminated with bird or bat droppings is a well known cause of histoplasmosis.

Histoplasmosis is an indolent fungal infection and the acute lung form of the disease usually presents with chest pain, dyspnea and dry cough.

Symptoms occur within 10 days of exposure.

Treatment is usually with Ketoconazole or voriconazole.
Use of aztreonam
It can be used safely to replace penicillin and cephalosporin in patients who have anaphylaxis to these products.
Chronic granulomatous disease
This diagnosis shoudl be suspected in patients with recurrent lymphadenitis, multiple site osteomyelitis, cutaneous abscesses, a family history of recurrent infections, or unusual infections with catalase positive organisms such as S. Aureus or Aspergillus.

X linked inheritance pattern
Kawasaki disease
Vasculitis that occurs in young children.

More common in asian children.

Patients initially present with URTI symptomatology. Then, aside from fever, patients have at least 4 of the following:
- adenopathies
- rash
- strawberry tongue
- swollen hands and feet
- conjunctivitis

ECGs should be obtained to r/o MI and echocardiogram should be obtained to confirm the diagnosis.

Dilation of the coronary arteries typically appears after 10 days. High dose ASA is given to control inflammation and fever, but has no effect on aneurysm formation.

IVIG are given with ASA to reduce the risk of coronary aneurysm.
Kaposi's sarcoma
KS is a low grade vascular tumor associated with infection by HHV-8.

There are 4 types, the most common one is the one associated with AIDS.

Cutaneous involvement is common, but the disease can cause extracutaneous manifestations, including disease in the oral cavity, GI tract and the respiratory tract.

The development and progression of KS can be halted with highly active antiretroviral therapy.
Lymphogranuloma venerum
LV is caused by C. Trachomatis serotypes L1, L2 and L3.

HIV seropositivity is the strongest risk factor.

Primary infection with LV is characterized by a genital ulcer that heals within a few days. Inguinal lymphadenopathy occurs 2-6 weeks later and represents direct extension of the infection to inguinal lymph nodes.

Diagnosis is usually made through serologic testing.

Treatment is with docycycline.
S. Aureus Vs B. Cereus "source"
S. Aureus : undercooked meat, potato, eggs or dairy

B. Cereus : fried or undercooked rice

Sx : acute (< 24 hrs) vomiting, nausea and GI upset.
Which drug to give for pnemocystis jirovecii prophylaxis with Bactrim allergy
CML genetic mutation
9:22 translocation
Type of neuropathy associated with CRF
Glove and stockings
Back pain relieved by pushing cart?
Spinal stenosis pain is relieved by flexing back
Chronic cuticle infection by C. Albicans
Best treatment to reduce symptoms of PAD
Smoking cessation
Prevention of vertebral fractures
Effect of biphosphonates on fracture risk
Biphosphonates decrease fracture risk even if they don't increase bone density
Vitamin that reduces the risk of falling in the elderly
Vitamin D
What treatment reduces mortality during COPD exacerbation
What treatment reduces mortality in COPD patients

Which bacteria can cause pulmonary abscesses
S. Pneumoniae
H. Influenzae
S. Aureus
P. Carini
Signs of morphine OD
Respiratory depression
Somnolence... coma
Cold and clammy skin
Constricted pupils
What is the risk of thrombo embolism with AF and paroxystic FA?
The risk is the same.
Treatment of restless leg syndrome
Advantage of triazolam compared to other benzodiazepines
Shortest half life
Side effects of chlorpromazine
Pseudo parkinsonism
Hypotension + HTO
Nasal congestion
Retinitis pigmentosa
Prolonged QT, Torsades
Agranulocytosis, cytopenias..
Cholestatic jaundince syndrome
Drug induced lupus
Neuroleptic malignant syndrome
Prehn's sign
Testicular pain relieved by supporting the testicles

Associated with epididymitis

Not associated with testicular torsion
Niacin effect on lipids and glucose
Increases glucose
- Triglycerides
- Ratio
- Total cholesterol
Sleep pattern change in elderly
Healthy older adults spend fewer hours in stage of deep sleep compared to younger healthy adults
Benefice of simvastatin
Simvastatin reduces the risks of sudden death, MI and stroke regardless of lipid levels.
Which oils contain the highest amount of omega 3
1. Flaxseed
2. Canola
3. Walnut
Best treatment for petit mal seizures
Ethosuximide (Zarontin)

Second line agents include valproate and lamictal
Early treatment of parkinson
Dopaminergic agents
Indications for PTH surgery
Symptomatic hypercalcemia (i.e. nephrolithiasis)
Serum calcium 1 mg/dl higher than upper limit
Age < 50
Reduced bone density
Is there cough in acute tonsillitis?
Features of polycythemia vera
Normal SaO2
Decreased EPO
Increased Hb (erythrocytes)
Sodium homeostasis in elderly?
Elderly patients have tendency towards hypernatremia because they have diminished thirst response.
Effect of amiodarone on quinidine
Amiodarone reduces the clearance of quinidine.

Higher risk of arrhythmias
EEG evidence of petit mal
Bilateral 3 Hz spike and wave activity during attacks
Bilateral 3 Hz spike and wave activity during attack.
Petit Mal
How to distinguish a pseudoseizure from a real one?
Prolactin measurement (Increases after true seizure)
Normal semen analysis
Must be obtained after 48-72 hours of abstinence
1. Volume : 2-5 cc
2. Count > 20 million/cc
3. Motility > 50% forward progression
4. Morphology > 30% normal
5. Absence of pyospermia, hyperviscosity, agglutination

NB. Does not assess sperm function
Type 4 allergic reaction
Type 4 reaction are T cell mediated. These cells, sensitized after contact with a specific antigen, are activated by reexposure to the antigen.
They damage tissue by direct toxic effects or through release of cytokines, which activate eosinophils, monocytes and macrophages.

Disorders involving type 4 reactions :
- Contact dermatitis
- Hypersensitivity pneumonitis
- Allograft rejection
- Tuberculosis
- Many drug hypersensitivity
Typical presentation of pneumonia with S. Pneumoniae?
Tachypnea + fever

Lobar consolidation infiltratre
Typical presentation of pneumonia with H. Influenzae
Mainly children

Lobar consolidation infiltrate
Typical presentation of pneumonia with M. Pneumoniae
Tachypnea + Fever +/- Erythema multiform

Fine interstitial pattern
Typical presentation of pneumonia with C. Pneumoniae
No fever + No erythema multiform

Fine interstitial pneumonia
Typical presentation of pneumonia with Influenzae A
Systemic symptoms of virus

Interstitial pneumonia
Classification of asthma
Mild intermittent
- daytime symptoms no more than 2 days per week
- nighttime symptoms no more than 2 nights per month
- FEV1 > 80%

Mild persistent asthma
- daytime symptoms more than 2 days per week but less than once a day
- nighttime symptoms more than 2 nights per month
- FEV1 > 80%

Moderate persistent asthma
- daytime symptoms daily and nighttime symptoms more than one night per week.
- FEV1 60-80%

Severe persistent asthma
- continuous daytime symptoms and frequent nighttime symptoms
- FEV1 <60%
Drugs associated with Acne
Rx causes of gynecomastia
Hormones (androgens, anabolics, estrogen)
Antibiotics (INH, Ketoconazole, metronidazole)
Anti-ulcer (cimetidine)
Characteristics of neurofibromatosis
> 6 café au lait spots
> 2 fibromas
Axillary freckling
Optic gliomas
Iris hamartomas (Lisch nodules)
Osseous lesions
Lab test affected by type A hemophilia
Activated thromboplastin time

+ Factor VIII levels
Treatment of phenylketonuria
Lifelong phenylalanine restricted diet.

Mainly due to teratogenic effect on fetus.
Transmission pattern of Duchennes
Sex linked recessive
Transmission pattern of achondroplasia
Autosomal dominant
Transmission pattern of cystic fibrosis
Autosomal recessive
Transmission pattern of hemophlias
Sex linked recessive
ITP management
Usually choose to treat because recovery takes a few months, and risk of bleeding

- IV Ig or oral prednisone
- IV anti-D (if blood group is +)
- Splenectomy only for life threatening bleeding
- Avoid ASA/NSAIDs
- No contact sports
Best position for gynaecological exam for girls < 2 years old
Knee Chest position
Antiarrhythmic to give to a patient presenting with SVT and WPW?

Do not give adenosine, BB, CCB
Antihypertensive associated with rebound hypertension on withdrawal?
Most common antibiotics associated with esophgitis
Brown Séquard Syndrome
Ipsilateral Weakness
Contralateral loss of sensation
Loss of proprioception + spastic paralysis + hyperactive deep tendon reflexes ipsilaterally
Transmission of huntington's
Autosomal dominant
Treatment of diabetic gastroparesis
Smaller more frequent meals
Improve glycemic control
Domperidone (less effective than metoclopramide)
Leading cause of morbidity and mortality within the first year following cardiac transplant?
Most important test for diagnosing hepatitis A infection
Anti Hepatitis A IgM
Possible treatments of myasthenia gravis
Anticholinesterase drugs
What imaging method should be ordered after a myasthenia gravis diagnosis?
Chest CT or MRI to r/o thymoma
What is active charcoal ineffective against?
Charged (ionized) chemicals and dissociated salts such as :
- iron
- lithium
- fluoride
- cyanide
- mineral acids
- alkalis
- inorganic compounds
Treatment of toxic iron ingestion
Gastric evacuation with ipecac or lavage
Whole bowel irrigation with polyethylene glycol
Chelation with deferoxamine
Characteristic feature of secretory diarrhea
Persistent diarrhea despite fasting
Electrolytic causes of torsades de pointes
Main organism responsible of chronic diarrhea in HIV positive patients
Significant side effect of PTU
Liver damage
Antihypertensive to give to patients with angina pectoris
Type of hypokalemia associated with hypoMg
HypoK refractory to K replacement until Mg is repleted
What can aggravate grave's ophtalmopathy?
Radioactive iodine treatment
How to differenciate papilledema from optic neuritis?
Optic neuritis is usually associated with pain on eye movement and with vision loss.
Changes associated with papilledema
Blind spot enlargement
Blurring of the disk margins
Engorgement of retinal veins
If a patient has S. Aureus GU infection, what should be done?
Look for the primary infection!
Mechanism of action of organophosphate intoxication
Cholinesterase inhibition
Iliotibial band syndrom
occurs in runners and presents with stinging pain over the lateral femoral epicondyle
Osteitis Pubis
occurs in distance runners and presents with pain in the anterior pelvic area and tenderness over the symphysis pubis
Which Rx is more effective than epinephrine for the treatment of asystole?
ddx of pulseless electrical activity?
Hyperkalemia or Hypokalemia
Tablets or toxins
Tension pneumothorax
Thrombosis (MI / PE)
How is nasopharyngeal carcinoma monitored
Measurement of EBV antibodies

This carcinoma is more frequent in the South China Sea region and there is a hereditary predisposition.

Symptoms develop late including unilateral bloody nasal discharge, obstruction and numbness.

Treatment with RoRx, CoRx and rarely Chx.
Most common symptoms of nicotine withdrawal?
Impaired concentration
Disturbed sleep
Intense longing for a cigarette
Increased appetite which leads to weight gain
Treatment of AMS
Treat very symptomatic patients
with acetazolamide or dexamethasone. Plus, recommend good hydration.

Acetazolamide can be given prophylactically to patients who had AMS in the past.
Solar eclipse retinopathy
Diagnosis of HIT
50% reduction in platelets 5-15 days after initiation of heparin therapy

Tests :
- Carbon 14 serotonin release assay
- ELISA for HIT-Ig
- Flow cytometry
Treatment of HIT
Stop Heparin and LMWH
Stop Warfarin (thrombotic effect)
Substitute with Heparin alternatives (Fondaparinux, Hirudin, Argatroban, Danaparoid)
Drugs that reduce both reload and afterload
First line vasopressors
Second line vasopressors
First line
- Norepinephrine
- Dopamine

Second line
- Epinephrine
- Vasopressin
- Phenylephrine
Side effects of niacin
HIgh blood sugar levels
Causes of hypoxemia with Normal A-a gradient
Elevated altitude
Causes of UPPER interstitial lung disease
F Farmer's lung
A Ankylosing Spondilitis
S Sarcoidoisis
S Silicosis
T Tuberculosis
E Eosinophilic Granuloma
N Neurofibromatosis
Causes of LOWER interstitial lung disease
B Bronchiolitis Obliterans with organizing pneumonia
A Asbestosis
D Drugs (Nitrofurantoin, INH, Amiodarone, Hydralazine, Chemo)

R Rheumatoid Arthritis
A Aspiration
S Scleroderma
H Hamman Rich Syndrome (acute interstitial lung disease)
Extrapulmonary manifestations of sarcoidoisis
Cardiac : arrhythmias and sudden death
Ophtalmic : anterior uveitis
Peripheral lymphadenopathy
Skin : skin papules, erythema nodosum, lupus pernio
Acute sarcoid syndromes

Lofgren Syndrome
Erythema nodosum
Bilateral hilar lymphadenopathy
Parotid Enlargement
Anterior Uveitis
Facial nerve palsy
Hypersensitivity pneumonitis causes
Farmer's lung
- Thermophilic Actinomycetes

Bird Breeder's lung
- Chlamydia Psitacci

Humidifier Lung
- Aureabasidium pullulans

Sauna Taker's Lung
- Aureabasidium spp
Rx that increase survival in pulmonary hypertension patients
Is smoking a risk factor for bronchogenic adenocarcinoma?
Centrally located bronchogenic cancers?
SCLS (oat cell)
SCC (squamous)
Peripherally located bronchogenic cancers?
Large cell (anaplastic)
Pulmonary cancer risk factors
Asbestos + Smoking (80-90x)
Passive smoking
Nickel, Chromium, Arsenic
Genetic damage
Parenchymal scarring
Air pollution
Mecahnism of action of warfarin
Inhibitor of epoxide reductase, thus depleting vitamin K stores
Management of nurse with accidental exposure to HBV needlestick if she received her 3 vaccines?
1. Test for HBsAg Antibodies
2. If > 10, reassure
3. If < 10, HBV Ig should be administered immediately as well as HBV vaccine booster

If the patient never received her vaccines, she should get HBV Ig and receive HBV vaccination series (3 doses).
Most common nutritional deficiency in Canada?
Management of nurse with accidental exposure to HBV needlestick if she received her 3 vaccines?
1. Test for HBsAg Antibodies
2. If > 10, reassure
3. If < 10, HBV Ig should be administered immediately as well as HBV vaccine booster

If the patient never received her vaccines, she should get HBV Ig and receive HBV vaccination series (3 doses).
Most common nutritional deficiency in Canada?
Cryptosporidiosis investigation?
Acid fast stain of the stool
West nile virus transmission and presentation
Mosquito Bites

Neuro Symptoms (encephalitis...)
Parkinson Disease Risk Factors
Exposure to pesticides
Head injury
Male gender
Positive family history
Rural living
Non motor and non drug related symptoms of Parkinson's
Loss of smell
Orthostatic hypotension
Shortness of breath
Sleep disturbances
Post MI pericarditis Vs. Dressler syndrome
Dressler syndrome occurs 8-10 weeks post MI, while post MI pericarditis occurs 7-10 days after (propagation of inflammation).
DDX of pulsus paradoxus
Cardiac Tamponnade
Constrictive Pericarditis
Severe obstructive pulmonary disease
Tension Pneumothorax
Cardiogenic shock
Pulmonary embolus
Jugular venous pressure differences between constrictive pericarditis and cardiac tamponnade
Tamponnade : no y descent
Constrictive pericarditis : prominent y descent (Friedrich's sign)
AAA screening guidelines
Men over 60 with one relative known to have AAA

Men 60-75 who have ever smoked should receive one time U>S screening
Characteristics of hairy cell leukemia
Rare malignancy of B lymphocytes

Male > Female
Prognosis > 10 years

Universal monocytopenia (predisposition to mycobacterial infections)
No adenopathies

Infiltration of spleen with lymphocytes with hair cell projections.
Why does warfarin have an initial procoagulant effect?
Warfarin inhibits the synthesis of vitamin K by inhibition of the vitamin k epoxide reductase.

The following factors are thus reduced : 2,7,9,10, C &S.

Given that the half life of proteins C and S are short, and the half life of the other factors are longer; the initial "deficiency" in proteins C and S causes a hyper coagulable state.
Treatment of Hodgkin's Lymphoma?
Stage I-II : Chemotherapy followed by local RoRx

Stage III-IV : Chemotherapy with RoRx for bulky disease.

Relapse : high dose chemotherapy + bone marrow transplant.
Complications of treatment of Hodgkin's lymphoma?
Cardiac : post RoRx or adriamycin toxicity
Pulmonary : post RoRx fibrosis/pneumonitis or Bleomycin fibrosis
Secondary malignancy in irradiated field
- 2% risk MDS, AML (within 8 years)
- solid tumours of lung, breast (>10 years after treatment)
- non Hodgkin's lymphoma

Hypothyroidism : post RoRx
Good prognostic factors of ALL?
WBC < 30
T-cell phenotype
Absence of Ph chromosome
Early attainment of complete remission
Can be warfarin be used in cases of HIT?
Diagnosis of HIT?
50% reduction of platelets 4-15 days after heparin initiation
What is post transplant lymphoproliferative disease?
Method of prevention?
Any patient who is chronically immunosuppressed is at risk for development of a PTLPD.

Heart 4% risk
Kidney 1% risk

PTLDs usually occur at extra nodal locations.

They may respond to reduction of immunosuppression, but since the organs are necessary, RoRx can also be used.

EBV is thought to contribute to this disease. The use of Acyclovir during Tx contributes to eradicating the virus and the resolution of malignancy caused by it.
Sézary syndrome
Mucosis Fungoides
Presence of atypical T lymphocytes in the blood
Leonine Facies?
Think of Mycocis Fungoides
Stages of Seminoma cancer
Stage I : testes
Stage II : retroperitoneal involvement
Stage III : supradiaphragmatic nodal involvement
Treatment of seminomas
Stage I : Surgery
Stage II : Surgery + radiation
Stage III : Surgery + radiation

Relapse : chemotherapy
Fungal infections after bone marrow transplant
These usually occur after the first 7 days of transplant. These infections can even occur after resolution of neutropenia at day 45.

CMV pneumonia
Parasitic infection
HHV-6 infection of skin

Bacterial infection 1-4 weeks post

Nocardia 30-90 days post

HSV reactivation 2 weeks post
Stages of Mycosis Fungoides
Stage 1 : patches (Nitrogen mustard)
Stage 2 : plaques (Nitrogen mustard)
Stage 3 : Sézary (RoRx)
Lung cancer associated with gynecomastia?
Large Cell Cancer
Associations of lung adenocarcinoma?
Hypertrophic pulmonary osteoarthropathy
Nonbacterial Verruous endocarditis
Association of lung squamous cell cancer?
hypercalcemia by PTHrP
Common variable immunodeficiency?
Syndrome characterized by hypogammaglobulinemia in combination with phenotypically normal B lymphocytes.

The disease presents suddenly in the third or fourth decade after recurrent infections and lack of response to vaccines.

These patients are at increased risk of lung disease, autoimmune phenomenon and chronic diarrhea.
What should intussusception in adults raise the suspicion of?
Burkitt's lymphoma.

This disease is more common in people living in africa where the rate of EBV is higher and is associated with the lymphoma.

It is highly associated with 8:14 translocation.

High grade lymphoma responsive to chemotherapy.
Primary agents of osteomyleitis in sickle cell anemia patients?
Salmonella paratyphi
S. Aureus
Diseases associated with ALL
Down Syndrome
Fanconi's anemia
Ataxia telangiectasia
What is POEMS?
a constellation of symptoms associated with osteosclerotic multiple myeloma.

Multiple Myeloma
Skin changes
Long term treatment of sickle cell anemia
Treatment of acute promyelocytic leukaemia?
Oral tretinoin if 15L17 translocation present

Reduces the risk of DIC
Treatment of wilm's tumour
Surgery + chemotherapy

Painless mass that does not cross the midline.
+/- hyperntension / microscopic hematuria
Common complaints in Walndestrom's gammaglobulinemia
Vision changes
Raynaud Phenomenon
Positive myeloperoxidase test significance?
Li-Fraumeni Syndrome
Mutation in one copy of the p53 gene.

Predisposes patients to sarcomas, CNS tunours and carcinomas
Triggers for TTP and its pentad
HIV infection
Autoimmune disease

1. fever
2. Microangiopatic hemolytic anemia
3. Renal failure
4. Neurological symptoms
5. Thrombotic purpura
Wilson's disease features?
Basal ganglia
Hemolytic anemia
Cirrhosis - Portal Hypertension
Renal Failure - Fanconi syndrome
Hemoyltic anemia
Kayser-Fleishcer rings
Wilson's disease investigation
Gold : Liver Bx

Low serum ceruloplasmin
High urinary copper
Rule of thirds in carcinoids
1/3 metastasize
1/3 accompanied by second malignancy
1/3 present with multiple carcinoid tumours
Plummer vinson syndrome
Ferriprive anemia
Upper esophageal webs
Henoch Schnolein Tetrad
Purpuric rash
Abdominal pain
Glomerular renal involvement

Association with numerous GI complications, most classically intussusception, pancreatitis and cholecystitis.
Meconium Ileus
Pathognomonic of Cystic Fibrosis
Herniation of abdominal viscera through the abdominal wall into the base of the umbilical cord covered by amniotic membrane and peritoneum but no skin.
Types of E. coli
Bethanecol cystometry test
Bethanecol is a parasympathetic

If detrusor does not contract = detrusor damage

if spasticity = UMN lesion
Neurofibromatosis II
Acoustic Neuromas
Multiple intracranial meningiomas

Chromosome 22
Tuberous Sclerosis
Shagreen spots (leathery cutaneous thickening of the skin
Facial hamartomas
Mental retardation
Von Hippel Lindau Syndrome
Renal cell cancer
Headache that gets better with vomitting and gets worse in the morning?
Head tumour
Conduction Aphasia
Problems with repeating and naming.

Preserved fluency and comprehension

Lesion : arcuate fasciculus
Broca's aphasia
Problems with fluency
Preserved comprehension

Naming and repetition are impaired

Lesion : frontal lobe
Wernicke's aphasia
Problems with comprehension
Preserved fluency

Naming and repetition are impaired

Lesion : temporal lobe
MCA stroke
Aphasia (dominant hemisphere)
Contralateral hemiparesis
Gaze preference
Homonymous hemianopsia
ACA stroke
Leg paresis
Personality changes
Cognitive changes
Foot drop
Basilar Stroke
Cranial nerve paralysis
Visual symptoms
PCA stroke
Homonymous Hemianopsia
Memory deficits
Cluster headache
- Prevention
- Abortive therapy
- Prophylactic therapy
- Avoidance of triggers (alcohol, physical activity)

- Oxygen
- Triptans

- Prednisone
- Lithium
Serious 2nd effects of Topiramate
Short term memory loss
Word finding difficulties
Renal stones
Serious 2nd effects of Carbamazépine
Induction of P450
Liver toxicity
Blood dyscrasias
Serious 2nd effects of Lamotrigine
Stevens Johnson Syndrome
Serious 2nd effects of Dilantin
Gingival hyperplasia
Possible presentation of SEVERE CO intoxication on ABG?
Metabolic acidosis caused by lactic acid production (ischemic)
Bartter Syndrome
Metabolic acidosis
Mental retardation
Thrombolytic Therapy Contra-indications
Stroke or head trauma in the past 3 months
Active Bleeding
Hemorrhagic stroke or prior hemorrhage
Previous use of thrombolytic therapy
Recent Myocardial infarct
Major surgery in the past 14 days
GI or GU bleed in the past 21 days
Seizures at onset of stroke
Brain Death Diagnosis
Core body temperature of at least 32 degrees
Absence of intoxication or poisoning
Absence of metabolic or endocrine derangements
Evidence of catastrophic cerebral event
Absence of brain stem reflexes
Fanconi Syndrome
Proximal renal tubular dysfunction type II
Glycosuria (normal glycemia)
Type I RTA
Distal tubule injury
Defect in urinary NH4 production
Acidification of urine
Hyperkalemic, Hyperchloremic metabolic acidosis
Most common type of bladder cancer
Transitional cell carcinoma
Calcium oxalate stone prevention (non pharmacologic)
Increase Calcium intake (reduces oxalate absorption)
Increase fluid intake
Limiting sodium intake
Polycystic kidney complications
Cerebral Berry aneurysms
Renal calculi
Dominant Vs Recessive PKD
Dominant = mainly adults > 30
Recessive = children