Pattern Recognition

Front 1

2yo M with recurrent infections and eczema. Workup reveals thrombocytopenia.

Back 1

Wiscott Aldrich. X-linked.

Front 2

70yo white M with easy bruising, visual disturbance, and elevated IgM

Back 2

Waldenstrom's macroglobulinemia

Front 3

12yo M with bleeding, elevated PTT, and reduced quantitative factor VIII level. Platelets do no aggregate with ristocetin test.

Back 3

von Willebrand's disease

Front 4

23yo HIV positive F recently started SMX-TMP with rash, confusion, fever, anemia, thrombocytopenia, tachycardia.

Back 4

TTP

Front 5

6yo F with itching, joint pain, skin rash who received penicillin six days previously for strep infection.

Back 5

Serum sickness (Type III hypersens.)

Front 6

62yo Jewish M with pruritus, melena, epistaxis, and history of DVTs.

Back 6

Polycythemia vera (itching, epistaxis) Treat with phlebotomy, hydroxyurea for myelosuppression, aspirin for DVT prophy. Risk = develop CML, AML, myelofibrosis.

Front 7

12yo M with bony-hard swelling above knee.

Back 7

Osteosarcoma

Front 8

53yo M with painless lumps in neck, fever, weight loss.

Back 8

Non-Hodgkin's lymphoma

Front 9

54yo M with fatigue, splenomegaly, anemia, and 'dry tap' on bone marrow biopsy

Back 9

Myelofibrosis with myeloid dysplasia

Front 10

64yo black M with bone pain, fatigue, and recurrent URIs

Back 10

Multiple myeloma

Front 11

24yo M with painless lump in neck and CXR with hilar masses.

Back 11

Hodgkin's.

Front 12

8yo M with palpable rash, hematuria, and joint pain. CBC reveals normal platelet count.

Back 12

Henoch-Schonlein Purpura. Small vessel vasculits. IgA deposits. Hemmorhagic urticaria with fever, arthralgias, GI and renal involvement. Associated with URIs.

Front 13

21yo F with sudden onset bruisability, edema, and rash following diarrheal illness. Low platelet count.

Back 13

HUS

Front 14

61yo M with mycobacterium avium infection, splenomegaly, and leukocytes with cytoplasmic projections seen on CBC.

Back 14

Hairy cell leukemia (B cell)

Front 15

45yo M with fever, rash, diarrhea, and jaundice. Elevated IgE level and history of leukemia.

Back 15

Graft-versus-host

Front 16

45yo M with frank rigors 1hr following blood transfusion.

Back 16

Febrile nonhemolytic transfusion rxn

Front 17

25yo F with continued bleeding following delivery.

Back 17

DIC

Front 18

55yo M with no complaints, found on physical exam to have splenomegaly and leukocytosis.

Back 18

CML

Front 19

65yo M with lymphadenopathy, hepatosplenomegaly, and leukocytosis with smudge cells.

Back 19

CLL

Front 20

66yo M with CLL has urine that gets darker during the day.

Back 20

autoimmune hemolytic anemia

Front 21

18yo M with pallor, petechiae, and recurrent URIs

Back 21

aplastic anemia

Front 22

25yo F with recent infection, gingival hyperplasia, and leukocytosis with bone marrow expansion.

Back 22

AML

Front 23

43yo M with epigastric pain and diarrhea refractory to medical management.

Back 23

ZE syndrome

Front 24

40yo F with intellectual impairment, jaundice, and choreiform movements.

Back 24

Wilson's

Front 25

37yo M with acute pain in anorectal area and BRBPR for 4 months.

Back 25

thrombosed ext. hemorrhoid

Front 26

45yo F with pruritus, fatigue, and jaundice.

Back 26

PBC

Front 27

33yo M with four months epigastric pain radiating to back relieved by eating and leaning forward.

Back 27

posterior duodenal ulcer

Front 28

36yo F with difficulty swallowing and craving for ice. Physical exam reveals angular stomatitis and glossitis.

Back 28

Plummer-Vinson syndrome.

Front 29

24yo F with crampy abdominal pain and dark spots on lips.

Back 29

Peutz-Jehghers. Multiple polyposis of small intestine, pigmented melanin macules on oral mucosa. Associated with gynecological cancers, but actually a low to moderate colon CA risk.

Front 30

51yo M with 4 months pruritus, jaundice, and abdominal pain. Recent 15 pound wt loss.

Back 30

pancreatic CA (CEA, CA19-9)

Front 31

65yo M with abdominal pain, nausea, vomiting, and diarrhea. Has been suffering abd. Pain 30 min after eating.

Back 31

ischemic bowel

Front 32

50yo M with EtOH cirrhosis develops oliguria and abdominal distenstion.

Back 32

hepatorenal

Front 33

65yo M alcoholic with RUQ pain, jaundice, anorexia, and distention worsening over two months.

Back 33

hepatocellular carcinoma

Front 34

40yo M with increased pigmentation. PE reveals cardiomegaly. UA reveals glycosuria.

Back 34

hemochromatosis (cirrhosis, bronze diabetes, heart failure)

Front 35

24yo F found on dental checkup to have supernumerary teeth. Has father with history of colon polyps and

Back 35

Gardener's syndrome.

Front 36

44yo M with hematemesis and melena. Has had recurrent painless hematemesis for several years.

Back 36

gastric leiomyoma (#1 benign tumor of stomach)

Front 37

83yo M with epigastric pain, anorexia, and frequent vomiting. Guaic positive stools. Palpable mass over L shoulder.

Back 37

gastric CA (atrophic gastritis, pernicious anemia, ulcers, type A blood = risk; Krukenberg tumor = retro peritoneal spread to ovaries.

Front 38

68yo F smoker with dysphagia.

Back 38

esophageal CA (squamous > adeno in distal third)

Front 39

54yo F with colicky LLQ pain and bloody stools that have returned intermittently over several months.

Back 39

diverticulitis

Front 40

45yo M with recurrent epigastric pain that radiates to back and foul-smelling stools.

Back 40

chronic pancreatitis (alcoholism, cystic fibrosis)

Front 41

25yo F with diarrhea, foul smelling stools, pruritus, dry skin, and bruising.

Back 41

celiac disease (anti-gliadin Ab, nutrient malabsorption)

Front 42

67yo F with several months fatigue, weight loss, intermittent diarrhea with palpable RLQ mass.

Back 42

cecal CA (anemia and + guaic test + virchow's node)

Front 43

52yo M with diarrhea and facial flush.

Back 43

carcinoid = primary GI tumors arise from neuroendocrine cells "Kulchitsky cells" and secrete 5-HT, histamine, gastrin, and prostaglandins. Malignant or benign.

Front 44

45yo M with AIDS now with painful swallowing.

Back 44

candida esophagitis (candida, rx with oral fluconazole)

Front 45

34yo M with mediepigastric pain, periumbilical/flank bruising, and hypotension.

Back 45

acute pancreatitis (Cullen's / Grey Turner's sign, assoc. with gallstones and alcohol)

Front 46

33yo F with substernal pain and difficulty swallowing. Sometimes regurgitates food.

Back 46

achalasia (loss of ganglion cells in Auerbach's plexus). Esophageal CA risk. Can arise from Chagas disease (also with cardiomyopathy).

Front 47

50yo F with cold nodule in the neck. Normal TSH, T3 and T4.

Back 47

thyroid CA (risk = ionizing rad - papillary CA c best prognosis, also follicular, mixed, and medullary assoc c MENIIa and IIb) psammoma bodies on FNA.

Front 48

30yo F with weight loss, 2yrs amenorrhea following delivery of healthy baby.

Back 48

Sheehan's (postpartum pituitary infarction) decreased levels of all trophic hormones, can occur in males and nonpregnant females following trauma, SS anemia, DIC, and stroke)

Front 49

33yo F with menstrual irregularity and milky nipple discharge.

Back 49

prolactinoma (most common pituitary adenoma; GnRH suppressed by excessive prolactin, reduces LH and estradiol. In males = HA, impotence, visual disturbance.

Front 50

56yo F with flank pain, confusion, constipation, thirst and polyuria.

Back 50

hyperparathyroidism (symptoms of hypercalcemia, bank keratopathy, cystic bone lesions = osteitis fibrosa cystica, adenoma = 1 gland, hyperplasia = 4 gland, renal stones, elevated serum Ca and AP with lowPO4.

Front 51

42yo F with hypertension, weakness, and decreased urinary volume.

Back 51

Conn's (hypokalemia, hypernatremia, hypertension, increased urinary aldosterone, low plasma renin). Usually adrenal cortex adenoma, sometimes adrenal cortical hyperplasia.

Front 52

53yo F with fatigue, insomnia, depresison. Thinning of skin, hirsutism, vaginal atrophy.

Back 52

menopause (hot flashes, vaginal atrophy, osteoporosis). Post-menopausal bleeding gets biopsy to r/o endometrial cancer.

Front 53

48yo F with weakness, lethargy, cold intolerance.

Back 53

hypothyroidism (weight gain, constipation, coarsening of facial features, hair loss, hoarseness, depression, loss of outer third of eyebrows, delayed recovery phase of achilles. Most common = Hashimoto's

Front 54

46yo M with impotence, fatigue and decreased peripheral vision. Is also hypotensive.

Back 54

hypopituitarism: Low FSH, LH, TSH, ACTH. Most common cause adenoma compressing anterior pituitary.

Front 55

29yo F with seizure. Has history of thyroid surgery two years ago.

Back 55

hypoparathyroidism (circumoral and foot numbness, fasciculations, chvostek's sign, trousseau's sign, brittle nails, low serum calcium, elevated PO4, low Mg, low PTH. Most commonly d/t thyroidectomy, symptoms d/t hypocalcemia.

Front 56

24yo F with weight loss despite good appetite, anxiety, menstrual irregularity, and tremors.

Back 56

hyperthyroidism = diarrhea, heat intolerance, palpitations, tremors, increased T4, decr. TSH. Hot nodule with decreased uptake in surrounding tissue and other lobe d/t atrophy of remainder of gland. Rx with propranolol, PTU, methimazole.

Front 57

45yo F with anterior neck fatigue, history of RA, and cold intolerance.

Back 57

Hashimoto's (anti-thyroglobulin and antimicrosomal Abs, often assoc with other autoimmune dx including SLE, pernicious anemia, Sjogren's, hepatitis, HLA-DR5/3. May see thyrotoxicosis early during disease course.

Front 58

55yo M with obesity, thirst, and excessive appetite.

Back 58

DM2. Can develop nonketotic hyperosmoler coma but not DKA.

Front 59

44yo F with irritability, easy bruising, weight gain, and glucosuria.

Back 59

Cushing's (truncal obesity, moon facies, buffalo hump, hirsutism. Elevated plasma cortisol with high ACTH, hypokalemia, leukopenia, osteoporosis, adrenocortical hyperplasia and pituitary adenoma.

Front 60

60yo M with rash composed of red plaques with scaling and nodules. Has not responded to steroid rx.

Back 60

Mycosis fungoides. Malignant cutaneous helper T-cell lymphoma; disseminated disease with exfoliative dermatitis and lymphadenopathy = Sezary syndrome. "Red man's disease". CBC shows lymphocytosis.

Front 61

68yo outdoor construction worker, raised bleeding lesion over upper lip.

Back 61

basal cell carcinoma. Most common skin cancer. Light-skinned people. Sun-exposed areas, slow growing, metastatic disease rare. Increased incidence in xeroderma pigmentosum.

Front 62

60yo farmer with skin lesions on forehead, upper lip, dorsum of hands. Scaly rough plaques.

Back 62

actinic keratosis. Most common precancerous dermatosis --> squamous cell CA. Signs that preceed malignancy include elevation, ulceration, inflammation, and enlargement >1 cm.

Front 63

35yo M with cramping in calves with walking, smokes 3 ppd. PE reveals pallor and cyanosis of distal extremities.

Back 63

thromboangiitis obliterans = occluded small and medium arteries, no atherosclerosis, inflammation of all layers of arterial wall. Smoking cessation critical. Amputation may become necessary of fingers/toes.

Front 64

79yo F with unilateral HA, jaw pain, visual disturbance in ipsilateral eye.

Back 64

temporal arteritis. Most common vasculitis in US. Often coexists with polymyalgia rheumatica. Ophthalmic artery occlusion --> blindness. Biopsy positive 60%, so treat on clinical picture with steroids before biopsy.

Front 65

50yo M with palpitations and CP. Has had multiple sexual partners. Has diastolic murmur.

Back 65

Syphilitic aortitis. Signs include collapsing pulse, wide pulse pressure, LVH with strain, mid-diastolic murmur at apex = Austin-Flint, VDRL / FTA-ABS positive. "Tree bark" calcification of arch and ascending aorta on CXR, tertiary stage syphillis.

Front 66

30yo F with HTN and elevated plasma renin.

Back 66

Renovascular hypertension. "String-of-pearls" pattern seen on renal angio. +/- renal artery bruit. Mostly fibromuscular dysplasia (young female), atherosclerosis (older male), <5% of all HTN. Rx with ACE-I but contraindicated in bilateral RAS.

Front 67

34yo F in 27th week of pregnancy with dyspnea and orthopnea. History of recurrent strep pharyngitis as child.

Back 67

Mitral stenosis. Opening snap and mid-diastolic murmur at apex. +/- LVH and a-fib.

Front 68

37yo M with fatigue and dyspnea with exertion. Pansystolic murmur at the apex with radiation to the axilla.

Back 68

Mitral insufficiency. Common causes: mitral valve prolapase, ischemic papillary muscle, endocarditis, rheumatic. S3 may be present.

Front 69

42yo M with CP, headache and confusion. Has history of HTN.

Back 69

malignant HTN. Severe diastolic hypertension, papilledema, hematuria, proteinuria, small scarred kidneys. Rx with sodium nitroprusside or IV beta-blockers to prevent end-organ damage due.

Front 70

21yo M with DOE and an episode of syncope while playing tennis.

Back 70

HCM. Signs = S4, SEM incr by valsalva, decr by squatting. EKG shows LVH. Echo: asymmetrical septal hypertrophy, ant. motion of mitral valve. Rx with beta-blockers, avoid sports, amiodarone may prevent fatal arrythymia, surgical myomectomy.

Front 71

29yo F recently delivered baby, now with dyspnea and pedal edema.

Back 71

dilated cardiomyopathy. Systolic dysfunction, decr ejection fraction Peripartum period (3 mo.), alcoholism, hypothyroidism, Freidreich's ataxia, previous myocarditis coxsackie B, adriamycin, tricyclic antidepressants, lithium, cyclophosphamide.

Front 72

60yo M with COPD with severe dyspnea at rest, bulging neck veins, and peripheral edema.

Back 72

cor pulmonale. Right heart failure d/t pulmonary cause, usually COPD. Other causes include pulmonary fibrosis, pneumoconioses, recurrent PE, PPHTN, obesity with sleep apnea, kyposcoliosis.

Front 73

24yo M with angina, DOE, occasional fainting, and systolic ejection murmur to right of sternum.

Back 73

aortic stenosis. Crescendo-decrescendo SEM, paradoxical splitting. Causes include congenital bicuspid valve, degenerative calcification, rheumatic.

Front 74

31yo M with ankylosing spondylitis develops severe SOB.

Back 74

aortic insufficiency. Signs include bounding pulse, wide pulse pressure, diastolic decrescendo murmur at left sternal border. Causes include rheumatic, ankylosing spondylitis, marfan's, reiter's, tertiary syphillis.

Front 75

35yo M with nonproductive cough and chest pain worse with inspiration, relieved by sitting up.

Back 75

pericarditis. +/- friction rub, incr JVP (c inspir = Kussmaul's sx), elevated ESR, CPK-MB nl, diffuse ST elev., pericardial effusion. Coxsackie A/B, TB, staph/strep, amebiasis, actinomycoses, CRF, SLE, scleroderma, RA, CA, MI, trauma.

Front 76

25yo F with myalgias and low-grade fevers starting one week after a dental extraction.

Back 76

subacute bact. endocarditis. Ass. c rheumatic dx, mvp, etc. AB prophy prevents. Janeway = periph hemmorhage, Osler's = painful, Splinter hem. = subungal linear, Roth's spots = oval retinal. Strep viridans = most common subacute.

Front 77

25yo M with SOB and ankle edema following severe URI.

Back 77

viral myocarditis. Cocksackie B > Borrelia burdorferi (Lyme), trypanosome cruzi (Chagas), hypersensitivity rxn in SLE or drug rxn, radiation, sarcoidosis. Echo: dilatation c low EF. ASO titers not elevated. ESR elevated.

Front 78

35yo M develops pruritus and blistering rash over shins following camping trip.

Back 78

Contact dermatitis = type IV hypersensitivity rxn. Papulovesicular rash c oozing and crusting. Rx c topical and systemic corticosteroids. Also occurs with various irritants, diaper rash.

Front 79

5yo M with yellow crusty lesions behind the ear and around the mouth.

Back 79

impetigo. "honey-colored" lesions. Group A strep. Rx with cephalosporin, pcn, or erythromycin. ASO titer negative. Highly communicable. Staph. aureus superinfection may cause bullous impetigo. Group B strep impetigo in newborns.

Front 80

30yo homosexual M with skin eruption on upper limbs, trunk, anogenital areas.

Back 80

molluscum contagiousum. Poxvirus. Opportunistic AIDS infection. Painless, pearly-white, dome-shaped, waxy, umbilicated nodules, 2-5mm, palms and soles not affected.

Front 81

16yo M with headache, fever, and rash on the palms and soles. Recent camping in North Carolina. UA demonstrates proteinuria and hematuria.

Back 81

RMSF. Rash periph. to central, palms/soles, petechial, thrombocytopenia, + Hess' test = Rumpel-Leede phenomena, + Proteus OX19 / OX2 Weil-Felix rxn. Rickettsia rickettsii. Rx tetracycline. Dermacentor wood tick. East coast of US.

Front 82

24yo F with extensive denuding of skin and recent skin infection.

Back 82

Scalded skin syndrome. Vesicle fluid is sterile. S. aureus on blood culture. Rx IV methicillin or oxacillin. Phage group 2 staph exotoxin.

Front 83

30yo M with bilateral circular red eruption in the groin.

Back 83

tinea corporis = ringworm. Circular papulosquamous eruption. Hyphae on KOH skin scrapings. Rx clotrimazole, miconazole, ketoconazole cream. Also systemic griseofulvin, keto/itraconazole prn. Tinea capitis = children.

Front 84

28yo M treated for UTI develops raised, red, pruritic rash over trunk and limbs.

Back 84

urticaria. wheal and flare rxn, "hives". Rx: stop causative agent, H1/2 blockers, calamine lotion, corticosteroids.

Front 85

11yo M with jaundice, dark urine, and recent shellfish ingestion.

Back 85

Hep A. Hyperbilirubinemia, ALT>AST, +/- AP, incr PT, incr. urine urobilinogen and bili, + IgM Ab to HepA. No infectivity in 3wks. Fecal/oral, bad water. Not chronic. HAV = naked, ssRNA, picorna. Prevent with killed vaccine and immune globulins.

Front 86

25yo M with jaundice following needle stick two months ago.

Back 86

HBV. Hyperbili, ALT>AST, +/- AP, HBsAg +, IgM anti-HBc + (window period). Liver biopsy = Councilman bodies. 5% progress to chronic c risk cirrhosis and HCC. Long incubation = 3 months. Enveloped DNA hepadna. HBsAg = chronicity.

Front 87

30yo M intermittent jaundice for two years following a motorcycle accident.

Back 87

HCV. Percutaneous transmission = 90% of cases. >50% progress to chronic, leading to cirrhosis in 20%. PCR test.

Front 88

50yo alcoholic with fever, abdominal pain, and progressive distention of abdomen.

Back 88

SBP. Ascites fluid leukocyte count >500/cc; PMNs >250 = diagnostic, low protein and glucose, ascites culture may be negative. Rx empirically, then organism-specific if possible. E. coli = most common.

Front 89

56yo M with diarrhea for 2 months, arthritis, and weight loss.

Back 89

Whipple's disease. Increased fecal fat. Macrocytic, hypochromic anemia. Small bowel biopsy c PAS + macrophages. Gram + actinomycete bacilli in macs. Rx with bactrim or ceftriaxone for 1 year. Tropheryma whippellii. Vitamin malabsorption.

Front 90

19yo F with recurrent episodes of periorbital swelling and dyspnea lasting up to 24hrs.

Back 90

C1 esterase inhibitor deficiency. Autosomal dominant. Decreased C4= best screening test. Decreased C1 inhibitor (confirmatory test). Decr. C2, but normalC3, normal IgE. Also called hereditary angioedema.

Front 91

3yo M with albinism and recurrent infections with recurrent staph and strep infections.

Back 91

Chediak-Higashi. Also nystagmus, photophobia. Decreased neutrophil count. Normal platelet count. Large cytoplasmic granules (Giant Lysosomes) in WBCs. Autosomal recessive, defect in microtubule polymerization in leukocytes. Defective chemotaxis.

Front 92

2yo M with recurrent fungal and staph furunculosis and neutrophilic leukocytosis.

Back 92

Chronic granulomatous disease. X-linked disorder of neutrophils, deficient NADPH oxidase . Normal chemotaxis, degranulation, and phagocytosis. Deficient killing d/t myeloperoxidase system. Recurrent staph infections. Rx SMP-TMP prophy.

Front 93

25yo F with recurrent sinusitis, multiple allergies, watery diarrhea, and hypopigmented skin lesions.

Back 93

IgA deficiency. No blood or plasma transfusions! #1 congenital immunodeficiency. Diarrhea usually G. lamblia, sinopulmonary infection with S. pneumo, H. flu, or S. aureus. Assoc with allergies/autoimmune dx. May be d/t isotype switching defect.

Front 94

7 month M recurrent URIs, skin infections, and asymetric arthritis of the kness. No tonsillar tissue on exam.

Back 94

X-linked hypogammaglobulinemia. Selective B-cell defect. Recurrent bacterial infections. a.k.a. Bruton's disease. Tyrosine kinase receptor defect, impaired maturation of antibodies. Labs = panhypoglobulinemia: very low IgG; IgA and IgM not detectable.

Front 95

15yo M with thick yellow discharge that prevents eye-opening in the morning.

Back 95

Conjunctivitis. Rx topical AB drops. Usually viral = adenovirus. Self-limiting. Secondary staph/strep may result.

Front 96

8yo F with rash, diffuse joint pain, fever, and sore throat two weeks ago.

Back 96

Acute rheumatic fever. Erythema marginatum = blanching ring-shaped over trunk and extremities. Elevated ASO titer, incr ESR, incr C-reactive protein. Blood culture negative. Endo/myo/pericarditis. Rx aspirin/corticosteroids, pcn/erythromycin.

Front 97

35yo F with pain in upper teeth and face, nasal congestion and discharge.

Back 97

sinusitis. boggy nasal mucosa. Common pathogens = S. pneumo, other streptococci, H. flu, Moraxella. Rx amoxicillin or TMP-SMX, decongestants.

Front 98

48yo missionary returns from West Africa with lethargy, nuchal rigidity, HA, drowsiness.

Back 98

African trypanosomiasis. Tsetse fly. Painless lymphadenopathy in posterior neck & supraclavicular = Winterbottom's sign. Does not respond to antibiotic rx. Chancre with induration at bite site. AKA African sleeping sickness. Rx suramin / pentamidine.

Front 99

45yo M Peace Corps in Mexico with spiking fever, RUQ pain, and bloody diarrhea with mucus. Tender hepatomegaly on exam.

Back 99

Amebic liver disease. Entamoeba histolytica. Cavitating liver lesion with chocolate-colored pus that is sterile, ameba obtained from periphery of lesion. Rx includes metronidazole and abscess drainage.

Front 100

30yo sheep farmer with dyspnea, nonproductive cough, and black skin lesions.

Back 100

Anthrax. CXR c mediastinal widening = hemorrhagic mediastinits. Vesicular papules covered by "black eschar". Bacillus anthracis. Rx IV penicillin G. Isolation precautions. Cell-free anthrax vaccine for high risk groups.

Front 101

38yo M on chemotherapy with pleuritic chest pain, fever, and productive cough.

Back 101

Aspergillosis. Multiple nodular infiltrates. Branched hyphae c silver stain, vascular invasion --> thrombi. Rx Amphotericin B c flucytosine. Lobectomy for fungus ball. Invasive dx: AIDS, neutropenia, chronic granulomatous dx, steroid rx, transplant pts.

Front 102

25yo M c sudden onset double vision, dry mouth, weakness, dysarthria, and dysphagia. Ate some home-canned peaches the night before.

Back 102

Botulism. Flaccid paralysis. Rx antitoxin, resp. support. Botox cleaves synaptic docking/fusion machinery. Disease d/t ingestion of toxin produced by C. botulinum. Often seen in infants after honey.

Front 103

28yo M with hip pain, undulating fever for two months, and pain in testicle. Drinks unpasteurized milk.

Back 103

Brucellosis. Blood culture demonstrates B. abortus, transmitted from milk or direct contact with animal tissues. Rx combination of doxycycline/SMX-TMP plus rifampin/streptomycin.

Front 104

49yo obese, diabetic F with pruritus underneath her breasts.

Back 104

candidiasis. Denuded, beefy red areas with whitish curd-like material. Budding cells with short hyphae on KOH prep. Rx clotrimazole, keep area dry.

Front 105

24yo F with fever and swelling over eye after trip to Brazil.

Back 105

Chagas dx. Eye swollen shut = Romana's sign. Encapsulated, nodular area at bite site = Chagoma. Ipsilateral retroauricular & cervical nodes. Trypanosoma cruzi, reduviid bug injects feces. Complications = dilated cardiomyopathy, megaesophagus/colon.

Front 106

30yo M with profuse watery diarrhea, vomiting, and abdominal pain following trip to India.

Back 106

Cholera. Vibrio cholerae. Severe dehydration, rice-water stools gram - rods c darting motility, O1 antigen, decreased serum chloride with increased serum sodium. Heat-labile exotoxin, stimulates Gs via ADP ribosylation incr cAMP --> secretory diarrhea.

Front 107

19yo Arizona migrant worker with cough, pleuritic CP, fever and tender nodules over the both shins.

Back 107

Coccidioidomycosis. Erythematous skin rash, erythema nodosum, positive skin test with coccidioidin, dimorhphic fungi, eosinophilia, caseating granulomas. Rx amphotericin B. Endemic in southwestern US. Inhalation of spores.

Front 108

30yo M with AIDS presents with profuse, nonbloody diarrhea.

Back 108

Cryptosporidium parvum. Dehydration. Acid-fast stain --> oocyts in fresh stool. Rx is supportive only. Self-limiting in immunocompetent pts.

Front 109

13yo F s/p BMT on immunosuppresion now with fever, dyspnea, dry cough.

Back 109

CMV pneumonitis. Insterstitial pneumonitis, intranuclear inclusions with surrounding halo (owl's eye). Rx ganciclovi ). #1 pneumonia and death in BMT patients. Common in AIDS. Enveloped dsDNA herpesvirus.

Front 110

5yo M with fever, cervical lymphadenopathy, and grey membrane on tonsils.

Back 110

Diptheria. Cornybacterium diphtheriae growth on Loffler's blood agar. Heat-labile exotoxin --> myocarditis and neuritis (blocks EF-2 via ADP ribosylation --> decr ribosomal fnctn & protein synth. Rx: PCN or erythromycin, antitoxin.

Front 111

56yo veterinarian with sudden high fever, jaundice, and RUQ pain.

Back 111

Echinococcosis. Hepatomegaly, + immunoblot test : echinococcal antigens, large septated liver cysts. +/- lungs/kidneys/bone/brain. Scoleces c inner germinal & outer laminated layer, fibrotic rxn. Rx: surgical cyst removal, albendazole.

Front 112

36yo woman with AIDS and pneumonia develops spiking fever, chills, and delirium.

Back 112

Endotoxic shock/gram neg. sepsis. E. coli on urine & blood culture. CXR with fluffy infiltrates (ARDS). Sequelae: ATN, DIC, multiorgan failure. Rx: fluid, IV ABs, manage ARDS c O2 and PEEP. Usually d/t gram negative endotoxins &gram positive exotoxins.

Front 113

28yo Guatamalan refugee with severe headache, fever, and rash on trunk and extremities; palms and soles spared. Spent time in refugee camp.

Back 113

Epidemic typhus. Rickettsia prowazekii. Cerebral edema/myocarditis/pneumonia, peripheral spreading rash. + Weil-Felix rxn. Path: Zencker's degeneration of striated musc. Rx: tetracycline, chloramphenicol. Intracellular. Lice vector. war/famine/crowding.

Front 114

21 yo F with low-grade fever, pain and swelling over left knee, and dysuria.

Back 114

gonnococcal arthritis. Intracellular diplococci bean-shaped. Migratory polyarthralgias. Incr WBCs c urethral smear & synovial fluid. Rx: IV ceftriaxone. Rapidly destroys cartilage. Associated with skin rash over affected joint, complement deficiencies.

Front 115

19yo M with burning urination and greenish-yellow purulent discharge.

Back 115

gonorrhea. Intracellular gram negative diplococci, confirmed c Thayer-Martin medium culture. Rx: Ceftriaxone + doxycycline/erythromycin for Chlamydia coverage. Gonorrhea can involve throat, anus, rectum, epididymis, cervix, fallopian, prostate, joints.

Front 116

25yo M with painful skin rash in the perianal area.

Back 116

Herpes simplex 2. Vesicular in clusters with clear fluid over erythematous base. Giant cells on Pap-stained scraping. Rx: acyclovir. dsDNA virus. Transmitted to fetus through birth canal.

Front 117

27yo F with two months fever, mouth ulcers, fatigue, and weight loss. Started new job on farm in Ohio.

Back 117

histoplasmosis. Histoplasma capsulatum.Rx: itraconazole or amphotericin B. Intracellular budding fungus in reticuloendothelial cells. Hilar adenopathy. Associated with bird or bat feces. Transmitted by inhalation of mold spores.

Front 118

37yo M black male from the Caribbean with swollen glands in armpits and groin, feeling of heavyness in abdomen.

Back 118

Human T-cell leukemia virus type 1 (HTLV-1). Lymphadenopathy & splenomegaly. Skin biopsy --> leukemic CD4+. Type C is assoc. c adult T-cell leukemia/lymphoma --> high incidence blacks in Carribean/SE US, Subsaharan Africa/Japan.

Front 119

20yo M with sore throat, lymphadenopathy, and malaise.

Back 119

IM (EBV). Lymphocytosis c atypical lymphs. Incr ALT/AST/bili. Positive heterophil Ab test (Monospot / Paul-Bunnell test). IgM antibodies to viral capsid = monospot positive.

Front 120

40yo M smoker with high fever, nonproductive cough, pleuritic CP, and coworkers with similar symptoms.

Back 120

Legionella pneumonia. Gram stain shows no organisms. Direct immunofluorescence confirms indirect fluorescent antibody titer. CXR: ill-defined nodules. Rx: erythromycin. Outbreaks d/t drinking water, humidifiers.

Front 121

30yo Pakistani immigrant with history of red papule on arm following insect bite; now with chronic fever, skin darkening, and massive splenomegaly.

Back 121

Leishmaniasis / "kala azar". Leshmania donovani zoonosis. Transmitted by Phlebotomussandfly. Labs = anemia, leukopenia, thrombocytopenia. Amastigotesin buffy layer. Rx: pentavalent antimony = Na stibogluconate; amph. B, or pentamidine.

Front 122

26yo M from India with hypopigmented anesthetic skin patch on face and swelling in elbow in area of ulner nerve.

Back 122

Leprosy: Mycobacterium leprae. Acid-fast bacillus. Thermolabile, divides slowly --> long course. Tuberculoid = skin with limited nerve /involvement (ulner/peroneal). Lepromatous = diffuse skin involvement/eyes/nerves/disfigurement (leonine facies).

Front 123

12yo M with fatigue, joint pain, and rash.

Back 123

Lyme. Borrelia burgdorferii, spirochete. IgM ELISA, confirm c WB. Rx: doxy or amox. 3 stages; 1= erythema chronicum migrans + constitutional si/sx. 2= cardiac & neuro. 3= persistent migratory arthritis/synovitis/acrodermatitis chronicum atrophicans.

Front 124

25yo with tender masses and painful groin ulcers after unprotected sex.

Back 124

Lymphogranuloma venerum. Inguinal adenitis, buboes. + complement fixation and IF tests. Ulcerated nodule --> secondary = inguinal bubo (enlarged node +/- fistula/balanitis/phimosis/rectal involvement. Rx: doxycycline. An STD d/t C. trachomatis (L1/2/3).

Front 125

30yo missionary with high fever, chills, and severe HA after returning from Africa 1 wk ago.

Back 125

Malaria. peripheral smear = plasmodia in erythrocytes. Rx: chloroquine, quinine for cerebral malaria, tetracycline for resistant areas. Anophelesmosquito. Plasmodium falciparum may be lethal --> cerebral malaria.

Front 126

12yo F with fever, severe HA, and stiff neck who fainted at school.

Back 126

Meningococcemia. +/- petechial rash. Kernig's / Brudzinski's. CSF = incr prot, low gluc. Hypoglycemia, hypo-Na, hyper-K = Waterhouse-Friedrichsen's = adrenal necrosis --> death. Rx: steroids, IV fluid, DA, PCN-G. Prophylactic rifampin for contacts.

Front 127

24yo F in hospital for DKA develops periorbital swelling and purulent postnasal discharge that fails to respond to ABs. PE reveals black ulceration of nasal mucosa.

Back 127

Mucormycosis. Irregular nonseptate hyphae branching at wide angles. Mucor and Rhizopus molds. Conjunctival swelling = chemosis, black ulceration of nasal mucosa, CNIII palsy, necrotic destruction. !Suspect if AB-resistant sinusitis in DM/lymph/leukemia!

Front 128

20yo M college student with productive cough, malaise, and fever. Cough started out nonproductive.

Back 128

Mycoplasma pneumonia. CBC: normal leukocyte count. Elevated cold agglutinin titer >1:128. CXR: patchy infiltrates appear worse than clinical picture. Rx: erythromycin. #1 atypical pneumonia. Rapid spread in close quarters.

Front 129

45yo M undergoing chemotherapy for Hodgkin's now with SOB/cyanosis; has had greenish sputum for 3 months.

Back 129

Nocardiosis. Gram + filamentous, partially acid-fast bacteria. Nocardia asteroides. Chronic infection: DM/leukemia/lymphoma/IC'd pts. Usually lungs, +/- brain/SC tissue. Rx: SMX-TMP 6mo.

Front 130

56yo F with visual acuity change, generalized itching after showering, and recent travel to tropics.

Back 130

River blindness. Hypopigmentation, nodules, keratitis, chorioretinal lesions.Diethylcarbamazapine --> pruritus, rash, fever, conjuctivitis = Massotti reaction. Rx: ivermectin. Blackfly --> Onchocerca volvulus. Larvae in SC tx and lymphatics.

Front 131

28yo diabetic with immobility of knee, swelling, tenderness, and elevated ESR.

Back 131

Osteomyelitis. Periosteal thickening. New bone = involucrum traps necrotic bone = sequestrum. Rx IV ABs, surg. #1 =Staph > strep > enterobacteria. SC = E. coli > Salmonella. DM/puncture = Pseudomonas. IC'd = Sporothrix.Human bite = anaerobes.

Front 132

18 month F with irritability and ear discharge. Recurrent URIs.

Back 132

Otitis media. E. coli,staph, Klebsiella (neonates); S. pneumo, H. flu, Morexella, group A strep (kids). Rx amoxicillin-clavulanate. Complications = ingrowth of epithelium of middle ear = cholesteatoma. Hearing loss, mastoiditis, CNS abscess.

Front 133

25yo M bitten by a cat with shiny, edematous tender hand draining purulent fluid.

Back 133

Pasturella multicoda. Gram neg rod with bipolar staining. Catalase and oxidase positive. Rx: Incision and drainage + amoxicillin/clavulanate, tetracycline, or penicillin. Can progress to osteomyelitis.

Front 134

14yo M bitten by younger sister with shiny, edematous, tender hand draining fluid.

Back 134

Eikenella corrodens. Rx: PCN + I&D.

Front 135

44yo archaeologist returns from dig site in Arizona with high fever, severe myalgia, and painful inguinal swelling.

Back 135

Plague. Yersinia pestis. Enlarged inguinal nodes = buboes. No genital lesions. Gram negative bacilli c safety pin appearance in aspirates from buboes. Rx: streptomycin / tetracycline. Rodents and fleas in Southwestern US. Death rapid if untreated.

Front 136

11yo M with blood-tinged, mucoid sputum and pleuritic chest pain.

Back 136

Pneumococcal pneumonia. Incr fremitus & dullness over afffected lobe. Gram positive diplococci in sputum, alpha-hemolytic colonies. CXR = homogenous opacification of affected lobe +/- pleural effusion. Rx: IV PCN. #1 community acquired pneumonia.

Front 137

32yo HIV + M with progressive dyspnea over 3 wks.

Back 137

PCP. dry cough, fatigue, hypoxemia out of proportion to clinical findings. Rx: SMX-TMP. Interstitial pneumonia in IC'd pts. Bactrim prophylaxis for HIV pts if CD4 <200. Labs: serum LDH elevated.

Front 138

14yo M Russian immigrant with weight loss, fever, night sweats and bloody sputum.

Back 138

TB. Primary = lower lobes / subpleural. Secondary = cavity lesions in upper lobes. Rx: RIPE therapy = rifampin, isoniazid, pyrazinamide, ethambucil.

Front 139

28yo M with numbness of R arm following bat bite. Refuses to drink water.

Back 139

Rabies. Hydrophobia, neuropathy. Long incubation period 3-8wks, prevent occurrence with vaccine. Negri bodies = cytoplasmic inclusions in Ammon's horn. Positive rabies antigen on corneal scraping.

Front 140

27yo Peace Corps volunteer in Africa with fever, sweats, abdominal pain. Had an itchy rash after swimming several weeks ago.

Back 140

Schistosomiasis. CBC: eosinophilia. Rx: praziquantel. Snail-infested ponds/lakes. Hepatosplenomegaly d/t portal hypertension d/t granulomas = periportal fibrosis.

Front 141

36yo M executive with sudden nausea, vomiting, and diarrhea with blood and mucus after business trip to South America.

Back 141

Shigellosis. + fecal leukocytes. Shigella on stool culture. Not motile. Outbreaks c overcrowding, fecal-oral. Can be complicated by Reiter's syndrome = arthritis, conjunctivitis, urethritis (HLA-B27 individuals). Rx: ampicillin or SMX-TMP.

Front 142

37yo with ulcerated nodule on hand after trauma while doing yardwork.

Back 142

Sporotrichosis. Sporothrix schenckii. Nonpainful, soft, ulcerated nodule at inoculation site = sporotrichotic chancre. Rx: itraconazole. (Sporothrix is a dimorphic fungus = cigar shaped budding cells). May cause bone/joint infection.

Front 143

9yo M with odynophagia and erythematous tonsils with white exudate.

Back 143

Strep pharyngitis. Rx: oral penicillin V. Streptococcus pyogenes. Complications include glomerulonephritis and rheumatic fever.

Front 144

38yo diplomat in Nigeria with diarrhea, fever, dry cough, and dyspnea. Frequently walks barefoot through his neighborhood.

Back 144

Strongyloidiasis. Eosinophilia with motile rhabditiform larvae. Rx: thiabendazole or ivermectin. Results from poor hygeine in tropics. CXR: bilateral transient migratory infiltrates.

Front 145

54yo F with spiking fever, loss of appetite, and RUQ pain who underwent emergency cholecystectomy 10d ago.

Back 145

Subdiaphragmatic abscess. Rx: percutaneous drainage. Findings include pain on percussion, left-shift, fluid collection below diaphragm. Occurs typically >1wk after abdominal surgery.

Front 146

18yo M with painless ulcer on penis.

Back 146

Syphillis. Dark-field exam of exudate = treponemes. VDRL and FTA-ABS positive. Rx: Benzathine PCN IM, 2.4U single dose. STD d/t Treponema pallidum.

Front 147

23yo F with nonpruritic skin rash, hair loss, and copper-colored maculopapular rash on palms and soles.

Back 147

Secondary syphilis = generalized tender lymphadenopathy, rash on palms/soles, coalescent papules/plaques in groin = condyloma lata, hair loss = alopecia. Rx: IV benzathine PCN.

Front 148

12yo M with dysphagia. Stepped on a nail about a week ago.

Back 148

Tetanus. Clostridium tetani. Trismus = jaw m rigid, Risus sardonicus = facial m spasm; dysphagia, neck rigidity, painful facial spasms, opisthotonos. Rx: debride wound, tetanus immune globulin IM or intrathecally, diazepam; tetanus toxoid; IV PCN.

Front 149

40yo HIV + M with severe HA. Has 2 cats at home.

Back 149

Toxoplasmosis. Toxoplasma gondii. Host = cats. Rx: pyrimethamine or sulfadiazine. PE reveals generalized lymphadenopathy, papilledema. CT/MRI-head reveals mass lesions with ring or nodular enhancement. Compl include seizure, brain abscess.

Front 150

50yo M with generalized myalgia and low-grade fever. Had severe abdominal pain and diarrhea several weeks ago after eating at a pigroast.

Back 150

Trichinosis. Labs: elevated CPK, LDH, and AST. Normal ESR. Eosinophilia. Raw/undercooked pork. Trichinella spiralis. Affects facial, neck, lower back, and diaphragm. Biopsy of SCM reveals organism.

Front 151

20yo M with ulcer on wrist, lymphadenopthy in ispilateral axilla with suppuration. Recently trapped and disposed of rabbit on his property.

Back 151

Tularemia. Francisella tularensis. Rabbits, squirrels, rodents, ticks. E levated ESR. Lymph nodes with suppuration + necrosis. Direct fluorescentantibody staining. May be tonsillar, oculoglandular, pneumonitic, typhoidal. Rx: streptomycin + tetracycline.

Front 152

27yo M with increasing fever, constipation, and faint erythematous macules over the trunk. Visited Southeast Asia three weeks ago.

Back 152

Typhoid fever. Salmonella typhi. Rx: ciprofloxacin. Infection of Peyer's patches c subsequent mucosal necrosis. Fever c stepladder pattern. Macules = "Rose spots" Infection from contaminated food or water. Typhoid vaccine available.

Front 153

5yo M with pruritic rash on scalp, face and trunk.

Back 153

Varicella zoster. Lesions appear in crops q3-5d. Macules, papules, vesicles, pustules, and scabs all present at same time. Leukopenia. Tzank smear = inclusion bodies (Lipschutz bodies) + MNG cells. DNA herpesvirus.

Front 154

45yo HIV+ M with painful, burning skin rash on left side of chest.

Back 154

Zoster (shingles). Vesicular rash on erythematous base. Dermatomal distribution. Exquisitely tender. Acantholytic cells on Tzanck smear from base of vesicles. Cowdry A = intranuclear eosinophilic inclusions surrounded by clear halo. Rx: acyclovir.

Front 155

24yo South American male develops high fever. He develops yellow eyes, and coffee-ground emesis four days later.

Back 155

Yellow fever. Flavivirus transmitted by Aedes mosquito. Affects liver and kidneys: liver midzonal lobular necrosis, severe renal tubular damage. Rx: symptomatic only. Preventable by vaccine. 5-10% mortality, most cases mild.

Front 156

50yo M with sudden fever, chills, neck stiffness.

Back 156

Bacterial meningitis. S. pneumoniae = most common adult. Photophobia, obtundation. Tap = high pressure, cloudy, high protein, very low glucose, high cells mostly WBCs.

Front 157

33yo HIV+ M with persistent HA.

Back 157

Cryptococcal meningitis. Encapsulated spherical fungi on India ink prep. CT/MRI-brain multiple ring-enhancing lesions. Rx: amphotericin B + 5-flucytosine. Acquired from pigeon droppings, usually seenin IC'd pts.

Front 158

30yo HIV+ M with rapidly progressive visual loss.

Back 158

CMV retinitis. Cotton-wool exudates, necrotizing retinitis, perivascular hemorrhages. Rx: ganciclovir; foscarnet. Occurs in 20% of AIDS pts. Blindness in HIV = toxoplasmosis, PML, and CMV.

Front 159

45yo hog farmer with visual loss, severe HA, and projectile vomiting.

Back 159

Neurocysticercosis. Taenia solium. Papilledema, free-floating cysts in vitreous body of right eye. Ingestion of ova is fecal-oral. CT/MRI-brain: intracranial cysts or calcifications. Eosinophilia.

Front 160

54yo man with ataxia, MS changes, deformed ankles, and shooting pain in extremities.

Back 160

Tertiary syphillis. Gummas = subcutaneous nodules. Dorsal column --> reduced position/vibration sense. Charcot's neuropathic arthropathy. Broad-based gait. Romberg's sign. Light reflex lost with retained accomadation = Argyll Robertson. "Tree-bark" aorta.

Front 161

25yo F with dysuria, frequency, and hematuria after her honeymoon.

Back 161

Acute cystitis. E. coli > Proteus, Klebsiella, Staph. saprophyticus, and Enterococcus. Hemorrhagic cystitis may also result from adenovirusinfection.

Front 162

28yo F in 27th week of pregnancy with R flank pain, fever, and dysuria.

Back 162

Acute pyelonephritis. UA: proteinuria, WBC casts, >100,000 cfu E. coli. Rx by sensitivity, ampicillin empirically. E. coli, Klebsiella, Proteus, and Enterobacter.

Front 163

19yo M with painful urination and yellow-green urethral discharge. No bacteria seen on Gram stain.

Back 163

Nongonnococcal urethritis. Rx: doxycycline. Most common = C. trachomatis, also Ureaplasma urealyticum. Frequentl coinfection c gonnococcal urethritis. Direct immunofluorescence using monoclonal Ab to Chlamydia. No growth on culture.

Front 164

15yo M with painful bilateral parotid swelling and left-sided scrotal pain.

Back 164

Orchitis. Mumps, E.coli, enterobacteria, chlamydia, gonnorhea, mycobacterium tuberculosis. May cause sterility if bilateral. Rx: scrotal support, ice packs, steroids. CBC: lymphocytosis, hyperamylasemia.

Front 165

25yo F with burning on urination.

Back 165

UTI. E. coli, staph saprophyticus = #1 and 2 causes. Others include proteus, klebsiella, enterobacter, serratia, psuedomonas, enterococcus, chlamydia, neisseria. Risk = females, sex, pregnancy, obstruction, bladder dysfunction, reflux, catheters.

Front 166

34yo M with multiple myeloma develops reticular skin infarction, necrosis, and ulceration.

Back 166

Cryoglobulinaemia. Associated with paraproteinemias, RA, SLE, mononucleosis, lymphoma, PBC, and HCV. Small vessel vasculitis that may involve kidneys = renal failure. Rx: plasmapheresis.

Front 167

54yo F with RA develops Bence Jones proteinuria.

Back 167

Monoclonal gammopathy of uncertain significance (MGUS). Monoclonal paraprotein without B-cell tumor. Assoc c hepatitis, leptospirosis, autoimmune dx. Follow closely 10-20% develop myeloma. Rx: None necessary. Close f/u.

Front 168

78yo M with fever, anemia, fatigue, petechiae and recent lacunar stroke.

Back 168

Waldenstrom's macroglobulinemia. Old men 2:1. Normochromic normocytic anemia. Rouleaux RBCs. ESR elevated. Serum M protein, cryoglobulin, and cold-reacting Abs. Hyperviscosity --> stroke, MI, Raynaud's, pyoderma gangrenosum.

Front 169

55yo M with anemia, leukopenia, thrombocytopenia and bone pain.

Back 169

Multiple myeloma. Infections (70%), renal failure (50%), bone pain (100% with progression), bleeding (10%). Very high ESR, rouleaux RBCs. Diagnosis = 2 of following: Bence Jones, bone marrow plasma cells, punched-out bone lesions.

Front 170

19yo M with recurrent DVTs for one year.

Back 170

Antithrombin III deficiency. Diagnosis = antithrombin level. Rx: coumadin. AT-III activity enhanced by binding heparin (don't use heparin to treat AT-III deficiency). Inherited disorder, screen family. Onset in late teens typical.

Front 171

24yo M with recurrent DVTs. Family history of DVTs affecting mother and sister.

Back 171

Factor V Leiden. #1 thrombophilia. 20-40% of pts c DVTs esp. young ages. Auto dom: homoz's with 80x risk, hetero 7x risk. Incr risk in pregnancy & contraceptive use. Mutation eliminates protein C cut site. Rx: coumadin for homos, prophy for hetero's.

Front 172

23yo M bitten by snake now with purpuric skin lesions.

Back 172

DIC. Causes include meningococcal, snakebite, staph septicemia, obstetric, malignancy (bronchus, pancreas, ovary, prostate, leukemias), shock, massive transfusion, vasculitis (HUS/TTP), bypass, cavernous hemangiomas.

Front 173

16yo M with massive hematomas and no history of trauma.

Back 173

Differential includes: Christmas dx, von Willebrand's, hemophilia, or uncontrolled anticoagulation.

Front 174

15yo M with acute hot, red, swollen knee and easy bruising.

Back 174

Hemophilia. Prolonged aPTT, normal PT. Rx: factor VIII replacement. X-linked recessive.

Front 175

13yo M with recurrent bleeding episodes and normal factor VIII levels and activity assay.

Back 175

Christmas disease. Factor IX deficiency. Complications of both include: chronic degenerative joint dx, compression neuropathy, renal pelvic / ureteral obstruction, intestinal obstruction.

Front 176

53yo homeless man with bleeding gums, purpura, and perifollicular bleeding.

Back 176

Scurvy = vitamin C deficiency.

Front 177

6yo F with generalized skin rash following mild URI. Rash became purpuric after one day.

Back 177

HSP. Drugs, food, insect bites, infections. Purpura +/- glomerulonephritis. Immune complex deposition. Children > adults. Glomerulonephritis in 33%.

Front 178

14yo with recurrent epistaxis and multiple small red lesions on lips, mouth, tongue. Mother and uncle have similar condition.

Back 178

Hereditary hemorrhagic telangiectasias = Osler-Weber-Rendu. Autosomal dominant. Mucosal bleeding. Association with pulmonary AV fistula.

Front 179

9yo F with recurrent URIs, diarrhea, and failure to thrive.`

Back 179

CF. High Cl sweat test.CXR: brochiectasis. Pseudomonasand staph infections of the lung. Mucous plugging, small bowel obstruction = meconium ileus. Rx: pulmozyme (DNAse breaks up airway). Azithromycin. Inhaled tobramycin (Tobi). Male sterility.

Front 180

23yo M with chronic productive cough and wife with difficulty becoming pregnant. Apical impulse not present on L side.

Back 180

Kartagener's syndrome. Sperm immotility, bronchiectasis. Dynein defect leads to immotile cilia. Autosomal recessive. Dextrocardia.

Front 181

23yo M goes to family doctor for evaluation of sterility. Found to have height greater than arm span, crown-pubis length greater than pubis-floor.

Back 181

Klinefelter's. 47XXY. Male hypogonadism. High incidence of breast CA, COPD, DM, mild mental retardation. PE: small testes, gynecomastia, "eunuchoid" body proportions. Increased gonadotropin with reduced testosterone.

Front 182

26yo M with flat nose, and single palmar crease. Had silver spots on iris at birth.

Back 182

Down's. Epicanthal folds, Brushfield spots, Simian crease. Double bubble on KUB: dilated stomach proximal duodenum d/t duodenal atresia. Hypoplastic phalanges in 5th digits (acromicria). Usually nondisjunction; Robertsonian translocation or mosaicism.

Front 183

7yo boy with diminished visual acuity and long arms, legs, and fingers.

Back 183

Marfan's syndrome. Arm span > height, arachnodactyly, ectopia lentis, severe myopia, high-arched palate, flat feet = pes planus, aortic insufficiency, pectus excavatum. Rx: beta-blockers, endocarditis prophy. Auto-dom. fibrillin = elastin scaffold.

Front 184

17yo F with amenorrhea, lack of breast development, and harsh systolic murmur.

Back 184

Turner's. Short stature, webbed neck, shield-like chest with wide-spaced nipples. High serum FSH/LH; no Barr bodies on buccal smear. Get US pelvis --> streak ovaries. Karyotype 45, XO; sometimes mosaicism --> skeletal, CV, horshoe kidney.

Front 185

5yo Asian F with sudden eye pain and loss of vision after watching a film. Reports seeing halos around lights at night.

Back 185

Acute glaucoma (angle closure). Hazy cornea, elevated intraocular pressure. Rock-hard eye. Rx: analgesics, IV acetazolamide, topical beta-blocker, steroids, pilocarpine, laser iridotomy. Precip'd by mydriatics and switch from dark to well lit areas.

Front 186

49yo M with progressive weakness, difficulty speaking, and fasciculations.

Back 186

ALS. Bilateral hand wasting, DTRs absent in upper limbs, muscle weakness, + Babinski sign (upgoing great toe) = upper motor neuron sign. Involves both upper and lower motor neurons. CSF normal. CT/MRI-brain normal.

Front 187

40yo M, now unresponsive, found in bathroom at work projectile vomiting. Said he was "seeing double".

Back 187

Cerebral aneurysm. Papilledema, CNIII palsy. Congenital Berry aneurysms associated with polycystic kidney disease, AV malformation. Cause subarachnoid hemmorhage. ACOMM > PCOMM > POST CEREBRAL.

Front 188

14yo M with short stature, history of polyuria, and peripheral vision loss.

Back 188

Craniopharyngioma. #1 supratentorial tumor in kids. Derived from Rathke's pouch remnants. Common cause of growth retardation, diabetes insipidus, bitemporal hemianopia, and headache d/t obstructive hydrocephalus. Bimodal with peak in fifth decade.

Front 189

62yo M with rapidly progressing decline in cognitive function, somnolence, and clonus on exam.

Back 189

Creutzfeld-Jakob. Subacute spongiform encephalopathy. Risk = dura mater, corneal transplants, cadaveric growth hormone, neurosurgical contamination. Lithium OD may mimic presentation.

Front 190

19yo F horseback rider was thrown off horse. Lost consciousness then recovered. Now with HA, confusion, and weakness of left side with projectile vomiting.

Back 190

Epidural hematoma. "Lucid interval" is classic. Signs = bradycardia, papilledema, mydriasis and CNIII palsy on ipsilateral,extensor plantar response and weakness on contralateral. CT --> lens-shaped, convex extra-axial fluid collection btwn dura & skull.

Front 191

19yo M with wide-based gait, clubfoot, and lateral curvature of spine.

Back 191

Friedreich's ataxia. #1 hereditary ataxia. Auto-dom, chromosome 9. Degeneration of doral root ganglia --> prorioceptive loss, areflexia, ataxia, Babinski's. Also causes visual loss, hypertrophic cardiomyopathy.

Front 192

60yo M with HA worse in morning, nausea, and vomiting for six weeks.

Back 192

Glioblastoma multiforme. CT = irregular enhancing left-sided mass with necrotic center; mass effect and surrounding edema.

Front 193

38yo M with symmetric muscle weakness started in feet, now involving legs and shoulders. Had diarrhea and fever.

Back 193

Guillain-Barre. Symmetrical proximalweakness / flaccidity. Increased CSF protein concentration without cellular increase. VDRL negative. Decreased nerve conduction velocity. Preceeded by GI/respiratory/EBV/Campylobacter/CMV +/- respiratory paralysis.

Front 194

65yo M with sudden severe HA and hemiplegia. Now incontinent.

Back 194

Hypertensive stroke.

Front 195

59yo F with retro-orbital HA and diplopia. Diagnosed with lung cancer.

Back 195

Metastatic dx. Intracranial mets from lung, breast, GI, GU, CA, and melanoma.

Front 196

25yo with weakness, droopy eyelids, double vision, and dysphonia.

Back 196

Myastenia gravis. Autoimmune c Abs to acetylcholine receptor subunits. Thymoma is present in 20% of cases.

Front 197

46yo M with HAs in the morning, seizures, and CT showing nodular calcifications in a frontal lobe mass.

Back 197

Oligodendroglioma. Usually low grade, but may be anaplastic. More sensitive to chemo than astrocytomas. Calcification in 90% of cases.

Front 198

30yo M with anesthesia and weakness in both arms, occipital HAs, and stiff gait.

Back 198

Syringomyelia. MR/CT --> cystic dilatation within central cervical cord. Hydromelia is lined by ependymal tissue, syringomyelia is not.

Front 199

18yo M with wide-based gait and headaches. Father died of renal cell carcinoma at young age.

Back 199

von Hippel-Lindau. Auto-dom, renal cell CA + renal, hepatic, pancreatic cysts + cerebellar ataxia.

Front 200

49yo alcoholic with confusion, stupor, and nystagmus following 5% dextrose infusion.

Back 200

Wernicke's encephalopathy. Due to thiamine deficiency.

Front 201

22yo F with abnormal Pap smear and no history of irregular menstrual, postcoital bleeding, or vaginal discharge.

Back 201

Cervical carcinoma in situ.

Front 202

29yo Vietnames F with nausea, vaginal bleeding, dyspnea, and hemoptysis.

Back 202

Choriocarcinoma. Can develop during normal pregnancy, s/p hydatidiform mole, or previous spontaneous abortion. Elevated hCG.

Front 203

45yo F with gross difference in size of her breasts with sensation of fullness but no pain. Exam reveals large, firm mass.

Back 203

Cystosarcoma phyllodes. Less common benign tumor of breast. Mass tends to be mobile and is well circumscribed. Path = cystic spaces on cut section, producing recesses and longitudinal openings with 'leaflike' (phyllodes) appearance.

Front 204

25yo W with amenorrhea for 6 weeks and development of pelvic pain for 1 day.

Back 204

Ectopic pregnancy. Risk factors = previous tubal surgery, tubal ligation, endometriosis, previous ectopic pregnancy, ovulation induction, pelvic inflammatory disease. Test of choice = hCG and ultrasound (can get transvaginal US if needed).

Front 205

60yo F with obesity presents with intermittent vaginal bleeding for three months. Has never had children.

Back 205

Endometrial CA. Estrogen-dependent cancer. Rx: hysterectomy, radiation. Important to include in differential of postmenopausal bleeding.

Front 206

27yo with inability to conceive, painful intercourse, and painful menses.

Back 206

Endometriosis = extrauterine endometrial tissue. Can be located in various locations with unique symptoms , most frequently bilateral ovaries = chocolate cysts.

Front 207

27yo F marathon runner with painful lump breast. Mammography reveals irregular mass with focal areas of calcification.

Back 207

Fat necrosis. Indurated lesion with retraction of overylying skin. Unilateral localized process associated with trauma, breast biopsy, and radiation. Easy to confuse with CA… pain is the key distinguishing feature.

Front 208

25yo F with right breast lump that is small, encapsulated, and freely moveable.

Back 208

Fibroadenoma. #1 benign breast tumor in young women; sometimes enlarges during pregnancy or normal menstrual cycles. Mammogram = "popcorn calcifications".

Front 209

20yo F with chronic left lower quadrant pain and left adnexal mass on exam.

Back 209

Follicular ovarian cyst. #1 cause of ovarian enlargement. Test = US to look for cyst. Rx: Follow-up ultrasound (many disappear spontaneously); laparoscopic removal if persistent.

Front 210

52yo nulliparous F with painles lump in breast. PE reveals fixed, hard, nontender mass with retraction of overlying skin and palpable ispilateral nodes.

Back 210

Infiltrating ductal CA = #1 breast cancer. Risk = family hx, estrogen "exposure", atypical hyperplasia, previous breast cancer. Fibrosis with induration = desmoplastic reaction. Rx = surgery, tamoxifen if E receptor positive.

Front 211

59yo F with pain and swelling in breast with erythematous overlying skin with peau d'orange appearance.

Back 211

Inflammatory carcinoma of breast. Highly malignant with early and widespread metastases.

Front 212

39yo F with heavy and frequent periods, occasionally painful.

Back 212

Leiomyoma. #1 tumor of uterus, most common tumor in women. Estrogen-dependent. US reveals multiple heterogenous masses, 95% intramural myometrium location, round, firm, well circumscribed.

Front 213

60yo F with foul-smelling, blood-tinged, purulent vaginal discharge. Tumor projecting from cervical os on speculum exam.

Back 213

Leiomyosarcoma. CT = large complex mass in uterus. Biopsy = spindle-shaped cells with many mitotic cells. Rx: adriamycin, progestins, combination therapy. Aggressive malignant tumor of the myometrium, can arise from leiomyoma or de novo.

Front 214

56yo F with history of breast CA with pelvic mass identified on routine physical exam.

Back 214

Ovarian carcinoma. Serous type most common, often bilateral and advanced at diagnosis. Elevated CA-125, psammoma bodies.

Front 215

68yo F with itchy, painless scaling and oozing of erythematous nipple.

Back 215

Paget's carcinoma. Characteristically a scally skin lesion of areola and nipple arising from ductal adenocarcinoma.

Front 216

35yo F with bloody nipple discharge originating from one of the duct openings.

Back 216

Papilloma of the breast. Benign proliferation of ductal epithelial tissue. #1 cause of serous / bloody nipple discharge.

Front 217

88yo M with purpura over extensor aspect of both hands. CBC reveals not abnormality.

Back 217

Senile purpura. Benign disease of elderly, characteristically extensor hand surfaces, forearms, and neck. Defect in collagen support of dermal cappillaries. No treatment available. Cosmetic consequence only.

Front 218

18yo M with small purple skin lesions following URI two weeks ago.

Back 218

ITP. Abrupt onset. Viral illnesses, drugs = thiazides, gold, carbamazepine, phenothiazines, quinine, rifampicin, valproate, sulphonamides, penicillins. Drug binds pltlt or drug binds plasma protein, forms immune complex, binds pltlt. Rx: steroids.

Front 219

Causes of purpura.

Back 219

Senile, Osler-Weber-Rendu (hereditary haemorrhagic telangiectasia), giant cavernous hemangioma (can cause DIC), Ehler's-Danlos, Marfan's, HSP, scurvy, Cushing's, steroid use, uremia, liver dx.

Front 220

64yo M with testicular swelling.

Back 220

Lymphoma of testis. #1 testicular neoplasm in elderly.

Front 221

29yo M with painless lymph node in the axilla, normochromic, normocytic anemia, and elevated ESR. Next test?

Back 221

Node biopsy. Hodgkin's --> Reed-Sternberg. Non-Hodgkins' --> spectrum small lymphocytic (low-grade) to large cell centroblastic (high grade). A2 staging; I=nodes 1 region II=2 regions, same side III=nodes both sides hemidiaphragm, IV=diffuse.

Front 222

45yo F with anemia, bone tenderness, and abdominal distension. Smear demonstrates blasts at all stages of maturation. Recent DVT.

Back 222

CML. Philadelphia chromosome 22 bcr-abl translocation 9:22 (95% of cases). Complications = hyperviscosity (rx with leukophoresis).

Front 223

60yo F with diffuse lymph node enlargement and smear with increased lymphocytes, smudge cells.

Back 223

CLL. Most common leukemia in US and Europe. Monoclonal transformation of B cells. Diagnosis = persistent lymphocytosis with increased lymphs. Warm antibody hemolytic anemia may result. No rx if asymptomatic.

Front 224

Causes of asplenia (anatomic or functional).

Back 224

SLE, sickle cell, celiac, lymphoma, post-surgical. Risk of infection with S. pneumo, H. flu, N. meningitidis, malaria.

Front 225

34yo M with facial plethora (redness), conjunctival suffusion, and splenomegaly.

Back 225

Polycythemia. True or d/t excess EPO --> polycystic kidneys, renal CA / cysts, chronic glomerulonephritis, liver disease, hepatocellular CA, overian CA, bronchial CA. Hypoxia, lung disease, congenital heart disease, smoking. Enlarged retinal vessels.

Back 226

P. vera: Hyperuricemia (rx with allopurinol), thrombotic events (less risk in secondary dx), 20% progress to myelofibrosis. Rx with phlebotomy. High incidence of HTN, itching, hepatomegaly, gout.

Front 227

Causes of warm antibody autoimmune hemolytic anemia.

Back 227

Lymphoma, leukemia (CLL), SLE, HIV. Causes spherocytes (also seen in congenital spherocytosis). Rx: prednisolone may induce remission; consider splenectomy.

Front 228

Causes of cold antibody autoimmune hemolytic anemia.

Back 228

Infectious mononucleosis, mycoplasma pneumonia, malaria, idiopathic (IgM paraprotein).

Front 229

Cigar shaped erythrocytes.

Back 229

Hereditary elliptocytosis. Usually asymptomatic.

Front 230

Spherocytes on peripheral smear.

Back 230

Perform osmotic fragility test. Spectrin defect = hereditary spherocytosis.

Front 231

2yo with frontal bossing and "hair-on-end" appearance on skull x-ray. Has painful swelling of the fingers.

Back 231

Sickle cell. Salmon-patch retinal hemmorhages. Homozygotes affected, heterozygotes asymptomatic until exposed to low O2 tension. Test with Hb electrophoresis and sickling test.

Front 232

25yo black M develops painful joints and severe stomach pain one day into ski trip in the French Alps.

Back 232

Sickle cell trait. Crisis at low O2 tensions.

Front 233

Drug induced aplastic anemia.

Back 233

Chloramphenicol, chlorpropamide, chlorpromazine, carbimazole, carbamazepine, gold salts, methotrexate, phenytoin.

Front 234

Most common cause of iron deficiency anemia worldwide.

Back 234

Hookworm.

Front 235

58yo F with recurrent episodes of thrombophlebitis in the legs and arms.

Back 235

Pancreatic CA. Thrombophlebitis may preceed diagnosis by many months.

Front 236

64yo peanut farmer with jaundice, weight loss, and right upper quadrant pain.

Back 236

Hepatocellular CA. Test for alpha-fetoprotein. Ultrasound / CT to evaluate.

Front 237

Causes of cirrhosis.

Back 237

Glycogen storage, Fanconi's, alpha-1-antitrypsin (neonatal hepatitis with cirrhosis in childhood), cardiac cirrhosis (late complication of R heart failure), methotrexate, hereditary hemorrhagic telangiectasias, ulcerative colitis and Crohn's.

Front 238

17yo M with tremor, athetoid movements, and elevated LFTs.

Back 238

Wilson's disease. Low ceruloplasmin. Kayer-Fleischer ring in cornea. Rx: penicillammine chelation therapy.

Front 239

55yo F with pruritus and jaundice that progressed over 3 years.

Back 239

Primary biliary cirrhosis. Anti-mitochondrial Abs. Assoc. c Sjogren's, Raynaud's, thyroid dx, Addison's, RA, fibrosing alveolitis, dermatomyositis, scleroderma. Women 9:1, age 40-60. ERCP reveals normal intra/extrahepatic bile ducts. Gallstones common.

Front 240

31yo M with jaundice, pruritus, and RUQ pain. Markedly elevated AP with slight elevation in AST and ALT.

Back 240

Primary sclerosing cholangitis. ERCP shows patchy dilatation and stricturing of biliary tree. High risk of ulcerative colitis. Progresses to hepatic cirrhosis. Risk = ascending cholangitis. HLA B8, DR2, DR3.

Front 241

30yo F with hypothyroidism and rheumatoid arthritis develops jaundice.

Back 241

Autoimmune hepatitis. Type I = history or family history of autoimmune disease. Type 2 = anti-liver and kidney microsomal autoantibodies, occurs in younger children. Type 3/4 = soluble liver antigen, type 4 ill-defined similar clinical as type 1.

Front 242

31yo F with morbilliform rash and jaundice. Recently seen by a neurolgist for epilepsy.

Back 242

Drug-induced hepatitis. Phenytoin (anti-epilepsy).

Front 243

25yo with eosinophilia, chronic cough, and distal small bowel obstruction.

Back 243

Ascaris lumbricoides. Larvae migrate to lung, small bowel obstruction are complications.

Front 244

29yo HIV + F with eosinophilia, liver, heart, and renal failure.

Back 244

Strongyloidiasis. Can result in systemic invasion in IC'd pts.

Front 245

23yo M former aid worker in Guatemala has resolving bloody diarrhea nd develops stricturing and mucosal damage to colon.

Back 245

Entamoeba histolytica. Don’t confuse with inflammatory bowel disease.

Front 246

Diarrhea: viral

Back 246

Rotavirus, Norwalk, Adenovirus.

Front 247

Diarrhea: bacterial toxin

Back 247

E. coli (enterotoxigenic), Vibrio cholerae, Staph aureus, Clostridium perfringens, Clostridium difficile, Clostridium botulinum, Bacillus cereus.

Front 248

Diarrhea: bacterial invasive

Back 248

E. coli (enteroinvasive), Shigella, Salmonella, Yersinia enterocolitica, Vibrio parahemolyticus, Campylobacter jejuni.

Front 249

Diarrhea: parasites

Back 249

Giardia lamblia, Cryptosporidium parvum, Entamoeba histolytica.

Front 250

Diarrhea: drugs

Back 250

laxatives, antacids with magnesium

Front 251

Diarrhea: food toxins

Back 251

puffer-fish, ciguatoxin, scombroid

Front 252

Diarrhea: chronic GI disorders

Back 252

Ischemic colitis, malabsorption, irritable bowel, inflammatory bowel disease

Front 253

Diarrhea: secretory

Back 253

Vibrio cholera, campylobacter, E. coli, Salmonella.

Front 254

Diarrhea with systemic illness

Back 254

Salmonella typi (enteric fever with diarrhea as late symptom)

Front 255

64yo with CAD deficiency develops diarrhea, vomiting, and vague abdominal pain that rapidly progresses to hematochezia and severe abdominal pain.

Back 255

Acute mesenteric ischemia.

Front 256

48yo M with recurrent abdominal pain after eating. Also has hypercholesterolemia.

Back 256

Chronic mesenteric ischemia (intestinal angina).

Front 257

53yo M with abdominal pain and diarrhea with blood. Plain abdominal film reveals "thumbprinting" pattern in the descending colon and narrowing of the colonic lumen.

Back 257

Colonic ischemia. More common than mesenteric ischemia, typically affects splenic flexure and other watershed areas.

Front 258

55yo F previously treated for carcinoma of cervix, now with nausea, vomiting, and rectal bleeding.

Back 258

Radiation colitis. Intestinal ischemia may develop due to endarteritis obliterans. Sometimes pseudo-obstruction. Barium study = thickening of mucosal folds, narrowing of lumen. Symptoms due to rapid transit time and malabsorption.

Front 259

38yo F with celiac disease with chronic diarrhea and weight loss. Has been strictly adhering to gluten-free diet.

Back 259

Intestinal lymphoma. Increased risk in celiac disease.

Front 260

19yo F with diarrhea and bullous skin eruption.

Back 260

Dermatitis herpetiformis. Gluten senstive enteropathy (celiac disease) + bullous skin eruption. Both may respond to gluten-free diet.

Front 261

8yo M with chronic diarrhea, steatorrhea, abdominal distention, and failure to thrive.

Back 261

Celiac disease (Gluten-sensitive enteropathy). Adult presentation more vague with megaloblastic anemia, diarrhea, vague abdominal symptoms. Abs include endomysial, gliadin, and reticulin. IgA endomysial Ab with high sensitivity and specificity.

Front 262

Diagnosis of celiac disease?

Back 262

Biopsy! Flattening of vili. Definative diagnosis requires trial of gluten-free diet.

Front 263

Causes of malabsorption.

Back 263

Stomach: post-gastrectomy dumping, ZE, pernicious anemia. Hepatic/biliary: bil. obstr. / cholestasis. Pancreas: CF, pancreatitis, CA. Sm. bowel: celiac, crohn's, removal of sm. bowel, fistulae/blind loops, infection, radiation, lymphoma, drugs, whipple's.

Front 264

Approach to malabsorption?

Back 264

1. confirm impaired absorption (fecal fat, Schilling test) 2. Identify specific deficiencies (CBC, Fe, iron, folate, B12, PT/PTT, vit D 3. establish cause.

Front 265

34yo M with severe recurrent peptic ulcer, diarrhea, and weight loss.

Back 265

Zollinger-Ellison. Gastrin producing tumor associated with MENI (usually pancreatic). Diagnosis = high gastrin level and high basal secretion of acid.

Front 266

Upper GI bleeding?

Back 266

GUMBLEEDING = Gastritis, Ulcer, Mallory-Weiss, B, L, Esophagitis, Esophageal varices, angioDysplasia, Infection, N, GERD.

Front 267

Common causes of lower GI bleeding?

Back 267

hemorrhoids, anal fissure, inflammatory bowel, diverticulitis, carcinoma, intussusception.

Front 268

Test for bacterial overgrowth?

Back 268

glycochocolate breath test, based on deconjugation of radiolabeled bile acid and exhalation of labeled CO2.

Front 269

GI utility of US and CT?

Back 269

Liver, pancreas, and biliary tract.

Front 270

GI utility of plain film?

Back 270

Demonstrate dilatation (toxic megacolon), obstruction.

Front 271

GI utility of angiography?

Back 271

GI bleeding of obscure cause or suspected mesenteric ischemia.

Front 272

Unusual causes of lower GI bleeding?

Back 272

AV fistulae, hereditary-hemorrhagic-telangiectasias (Osler-Weber-Rendu), angiodysplasia, vasculitis, amyloidosis. Meckel's, blood disorders (hemophilia, thrombocytopenia), rupture of AAA into bowel.

Front 273

Common causes of upper GI bleeding?

Back 273

Duodenal ulcer > stomach erosions / gastritis > GERD > gastric ulcer > Mallory-Weiss > duodenal erosions > esophageal/gastric varices > stomach CA

Front 274

Causes of sore tongue?

Back 274

Systemic: folate/B12/Fe deficiency, collagen-vascular dx, diabetes. Local: smoking, fractured tooth/dentures/crowns, candidiasis, dry mouth.

Front 275

Teeth and gums

Back 275

Blue line at tooth/gum margin = lead; gingivae swollen and purplish = scurvy; hyperplastic gingivitis = phenytoin, cyclosporin, and calcium antagonists; yellow staining = tetracycline.

Front 276

Apthous ulcers?

Back 276

poor dental hygeine, gluten enteropathy, inflammatory bowel dx, Behcet's.

Front 277

Enlarged tongue?

Back 277

Acromegaly, myxoedema, amyloidosis, motor neuron disease.

Front 278

71yo M smoker with progressive dysphagia.

Back 278

Esophageal CA

Front 279

25yo M with progressive dysphagia and no past medical history.

Back 279

Esophageal ring. Occur at or near GE junction. Cause unknown.

Front 280

31yo M with HIV and odynophagia.

Back 280

Esophagitis due to candidia, herpes, or CMV.

Front 281

H. pylori infection.

Back 281

Association with duodenal ulcer (100%) > gastric (80%) > duodenitis/gastritis. Increased risk of gastric cancer and MALT lymphoma. Test: serology or urease breath test.

Front 282

Gastritis causes?

Back 282

Infectious = rotavirus, norwalk, E. coli, H. pylori. Drug/chemicals = aspirin and other NSAIDs, alcohol. Asymptomatic chronic = elderly persons often with H. pylori. Atrophic = autoimmune (positive parietal cell Abs) with pernicious anemia.

Front 283

38yo F presents with melena and epigastric pain. Barium study revealed rugal hypertrophy.

Back 283

Menetrier's disease (giant hypertrophic gastritis). Assoc. with protein-losing enteropathy.

Front 284

GI disease with finger clubbing?

Back 284

malabsorption, small intestinal disease, and cirrhosis.

Front 285

Hormone:

Back 285

Stimulation test and markers:

Front 286

ACTH and GH

Back 286

Insulin hypoglycemia test: GH, cortisol, blood glucose

Front 287

ACTH and GH

Back 287

Glucacon: GH, blood glucose

Front 288

TSH

Back 288

Thyrotropin releasing hormone: TSH, T3, T4, prolactin, GH

Front 289

LH, FSH

Back 289

Gonadotropin releasing hormone: FSH, LH, spermatogenesis, ovulation

Front 290

GH

Back 290

GHRH: GH

Front 291

ACTH

Back 291

CRH: ACTH, cortisol

Front 292

ADH

Back 292

Fluid deprivation:

Front 293

11yo M with with color blindness, midline facial deformity, and anosmia.

Back 293

Isolated gonadotropin deficiency = Kallman's syndrome. Prepubertal onset, hypogonadal hypogonadism.

Front 294

28yo F with resolving meningitis develops polyuria.

Back 294

Central diabetes insipidus. Most frequently associated with craniopharyngioma. Rarely with anterior pituitary disease. Test = water deprivation and measure urine osmolality.

Front 295

43yo M with thick skin, broad nose, and prominent supraorbital and nuchal ridges.

Back 295

Acromegaly. Uncommon. May occur in MEN1. Large spade-like hands. Enlargement of the tongue. Hoarse voice. Cardiomegaly, heart failure, and malignancy causes death. Tufting of terminal phalanges on x-ray.

Front 296

Elevation of prolactin level due to physiolgic cause?

Back 296

Sleep, stress, nipple stimulation, coitus, pregnancy, suckling.

Front 297

Most common cause of Cushing's syndrome?

Back 297

ACTH overproduction by pituitary 60% > ectopic ACTH (15%) > adrenal adenoma (15%) > adrenal carcinoma (10%). Cushing's disease usually pituitary microadenoma (90%) more frequently in women.

Front 298

48yo F with develops increasing pigmentation following bilateral adrenalectomy for Cushing's disease.

Back 298

Nelson's syndrome. May follow adrenalectomy if ACTH production continues in excess.

Front 299

Diagnosis of Cushing's syndrome.

Back 299

Low dose 48hr dex suppression. Screening with overnight dex suppresion test or 24hr urinary free cortisol. If plasma ACTH is undetectable, usually adrenal tumor. Pituitary-dependent disease suppresses, whereas adrenal tumors and ectopic ACTH does not.

Front 300

Ectopic ACTH tumors?

Back 300

Bronchial carcinoma, carcinoid.

Front 301

29yo F with SLE and history of DVTs develops increased skin pigmentation and profound hypekalemia.

Back 301

Primary adrenal insufficiency. Antiphospholipid syndrome can destroy adrenal glands.

Front 302

31yo M with fatigue, weight loss, GI disturbances, and dark spots on the inside of his cheeks.

Back 302

Addison's disease. Autoimmmune or rarely TB, granulomatous disease, metastases. Other causes of adrenal insufficiency include withdrawal of steroid therapy, Waterhouse-Friderichsen, anticoagulant therapy. Hyponatremia, hyperkalemia, vitiligo.

Front 303

Poor growth syndromes?

Back 303

Rare congenital syndromes, nutritional/emotionald deprivation, GH deficiency (fat with immature facies and genitals), hypothyroidism, Cushing's. "Fat and short" likely endocrine. Turner's 45XO, and Noonan's (45XO/XY mosaic).

Front 304

34yo F with short stature, large head, prominent forehead and disproportion of body and limbs.

Back 304

Achondroplasia. Autosomal dominant. #1 short stature with abnormal proportions.

Front 305

15yo F found on pelvic exam to have bilateral masses in the labia. LH levels is high.

Back 305

Testicular feminization syndrome. XY male with X-linked deficiency of androgen receptors.

Front 306

Newborn with ambiguous genitalia, clitoral hypertrophy, and partial fusion of labioscrotal folds.

Back 306

Congenital adrenal hyperplasia. 21-hydroxylase defiency. Excess androgenic cortisol precursors.

Front 307

18yo M with small firm testes, gynecomastia, and female distribution of body hair.

Back 307

Klinefelter's. Infertile, may be unusually tall, 47XXY.

Front 308

Common causes of amenorrhea?

Back 308

Hyperprolactinemia, weight loss, anorexia nervosa, autoimmune associated ovarian failure (Addison's or other).

Front 309

24yo obese F with menstrual irregularity, hirsutism, and acne.

Back 309

Polycystic ovarian syndrome. Stein-Leventhal syndrome = obesity, amenorrhea, and hirsutism. DM2 develops in 40% by age 40. Labs = incr LH, +/- incr T, normal FSH, prolactin and TSH. Pelvic

Front 310

61yo M with new onset atrial fibrillation, heart failure, and 20lb weight loss over 12 months.

Back 310

"Masked" hyperthyroidism. Commonly due to toxic multinodular goiter. Lacks typical Grave's features.

Front 311

44yo F with diffuse goiter, pretibial myxoedema, and tachycardia.

Back 311

Grave's. IgG antibodies against TSH receptor = thyroid stimulating Abs (TSAb). Exopthalmos, lid lag, periorbital puffiness, increased lacrimation, conjunctival edema, ophthalmoplegia, loss of visual acuity.

Front 312

53yo F with hyperlipidemia, puffy face, and coarse hair, and hair loss.

Back 312

Hypothyroidism: Spontaneous atrophic, postsurgical, radioactive I, Hashimoto's (thyroid peroxidase and thyroglobulin Abs in 90%). Dry skin, coarse hair, facial edema, effusion, ascites, cardiac dilatation. Assoc c pernicious anemia and carpal tunnel.

Front 313

Most common goitrous hypothyroidism?

Back 313

Hashimoto's. Women >> Men. Older women > younger.

Front 314

58yo F from central Africa with large goiter.

Back 314

Endemic goiter. Can be euthyroid. Due to iodine deficiency.

Front 315

73yo F with hypothermia and altered mental status and history of hypothyroidism.

Back 315

Myxedema coma. marked by hypothermia, cardiac failure, altered MS, convulsion. Mortality 50%.

Front 316

46yo M with painful itchy ear following family vacation to lake. Experiences pain when tragus is pressed during exam.

Back 316

Otitis externa. Symptoms inlcude pain, pruritus, hearing loss, and fullness. Tragus = semicircular cartilage in front of ear canal. Staph and pseudomonas.

Front 317

51yo diabetic M with painful itchy ear. Physical exam reveals inflammation and swelling of the pinna.

Back 317

Cellulitis. Differentiate from otitis externa.

Front 318

47yo HIV positive M with "boring" ear pain and long-standing ear infection that has not responded well to treatment.

Back 318

Necrotizing external otitis. Occurs in ICd pts. Refer to otolaryngology.

Front 319

28yo F with diffusely swollen and tender pinna.

Back 319

Perichondirits. IV antibiotics, serious condition.

Front 320

31yo M with circumscribed swellings in the external canal with tenderness on exam.

Back 320

Furunculosis. Rx with topical ABs.

Front 321

82yo M with pruritus of the external canal. Whitish exudate with black spots on exam.

Back 321

External mycotica (otomycosis). Aspergillus niger causes black spots over white.

Front 322

44yo construction worker with dizziness, tinitus, and conductive hearing loss in the right ear.

Back 322

Cerumen impaction.

Front 323

Complications of sinusitis?

Back 323

Osteomyelitis, periorbital infections (pain with eye motion, ptosis, proptosis), cavernous sinus thrombophlebitis (CN III, IV, VI palsies), brain abscess, meningitis.

Front 324

Persistent sinusitis?

Back 324

Consider Wegener's granulomatosis, cystic fibrosis, Kartagener's, and TMJ syndrome. Need CT scan to rule out obstruction.

Front 325

25yo F develops high fever, myalgias, rhinorrhea, and sore throat.

Back 325

Common cold, due to: influenza virus, rhinovirus, coronavirus, adenovirus, parainfluenza. Rule out bacterial sinusitis, pharyngitis, and allergic rhinitis (history of itchy eyes, nose, and throat).

Front 326

25yo F develops high fever, myalgias, and palpable tender neck nodes.

Back 326

Bacterial pharyngitis. No cough or rhinorrhea. Tonsillar exudate may be present. Viral pharyngitis much more common (90%). Group A strep >> other strep, mycoplasma, chlamydia, and neisseria gonorrhea. Diptheria with grey-white pseudomembrane.

Front 327

25yo F with itchy eyes, nose, and throat. Pale edematous nasal mucosa.

Back 327

Allergic rhinitis. Seasonal or allergic pattern. Tearing. Mucosa is not erythematous.

Front 328

25yo F with purulent nasal discharge, tender face, and toothache.

Back 328

Bacterial sinusitis. Treat with amoxicillin.

Front 329

Findings suggestive of Group A strep pharyngitis.

Back 329

Recent exposure, history of infection in past yr, absence of cough, hoarseness, or rhinorrhea, temp > 101, tonsillar exudate, anterior cervical lymphadenopathy.

Front 330

Causes of secondary hypertension (5% of all HTN, primary/essential HTN 95%)

Back 330

Aortic coarctation, intrinsic renal dx, renal artery stenosis (young = fibromuscular, old = athero), primary hyperaldosteronism (suspect if hypokalemic and not on diuretic), Cushing's, Pheo,

Front 331

1 anatomic, two renal, three adrenal, and four CENTs cause HTN.

Back 331

CENTs = hyperCalcemia, Ethanol or Estrogen (oral contraceptives) most common causes, Neurologic disease = increased ICP, Thyrotoxicosis.

Front 332

21yo F develops dramatic increase in creatinine after starting ACE inhibitor therapy for hypertension.

Back 332

Consider renal artery stenosis!

Front 333

31yo M with mental status changes and blood pressure of 225/124

Back 333

Hypertensive emergency. Hypertensive urgency = systolic BP > 220. Hypertensive emergency = Urgency + End-organ damage: encephalopathy (ms changes), intracranial hemorrhage, aortic dissection, MI, unstable angina, hypertensive nephropathy.

Front 334

HTN treatment: uncomplicated, DM1, CHF systolic, CHF diastolic, isolated systolic HTN, CAD or MI, BPH, pregnancy.

Back 334

beta blocker or diuretic; ACE or diuretic; beta blocker, diuretic, or CCB; diuretic; beta blocker; prazosin; methyyldopa.

Front 335

18yo M with painful swollen knee and ipsilateral leg lower leg edema.

Back 335

Ruptured popliteal cyst.

Front 336

54yo F with inguinal lymphadenopathy, pelvic symptoms, weight loss and bilateral lower extremity edema. Dry and scaly skin on feet.

Back 336

Lymphedema.

Front 337

43yo F with painless edema worse at the end of the day. Varicose veins present. Improves with elevation.

Back 337

Chronic venous insufficiency.

Front 338

54yo F with painful thighs and bilateral lower extremity edema following knee replacement surgery.

Back 338

Bilateral DVTs.

Front 339

45yo F with tachycardia, bilateral lower extremity edema, and tremor.

Back 339

Pretibial myxedema (Grave's disease)

Front 340

12yo M with leg length discrepancy since childhood and ipsilateral lower extremity edema.

Back 340

Congenital venous malformation.

Front 341

24yo F with SLE presents with bilateral lower extremity edema.

Back 341

Nephrotic syndrome.

Front 342

28yo M with taut, shiny skin and extreme sensitivity to touch of right leg. Edema in the right leg on exam.

Back 342

Reflex sympathetic dystrophy.

Front 343

43yo M with lots of tatoos develops peripheral edema and necrotic skin lesions.

Back 343

HCV is associated with cryoglobulins and membranoproliferative glomerulonephropathy.

Front 344

45yo F with recurrent infections, nonhealing leg ulcers, history of RA, and splenomegaly on examination.

Back 344

Felty's syndrome.

Front 345

Calcinosis, Raynaud's, Esophageal dysmotility, Sclerodactyly, Telangiectasias.

Back 345

CREST

Front 346

45yo F with history of PBC with skin thickening of the fingers and difficulty swallowing.

Back 346

CREST. Associated with PBC and primary pulmonary hypertension.

Front 347

Causes of chronic cough

Back 347

Postnasal drip > GERD > asthma. Also cigarette use +/- COPD. Less common causes include bronchiectasis, CHF, ACE-I, post-pertussis cough, malignancy, chronic infection usually c systemic symptoms, and psychogenic cough.

Front 348

Headache and jaw claudication.

Back 348

Giant cell arteritis. Diagnosis with biopsy, start steroid rx immediately. Large vessel vasculitis.

Front 349

26yo Asian F with finger ischemia and arm claudication.

Back 349

Takayasu's arteritis. "Pulseless disease". Diagnosis with aortic arch angiogram.

Front 350

32yo M with skin ulceration, hematuria, abdominal pain after eating, joint pain, and right hand weakness.

Back 350

Polyarteritis nodosa (PAN). Necrotizing vasculitis of small and medium muscular arteries. 1/3 associated with HBV, also with HCV. No pulmonary findings!

Front 351

35yo M with shortness of breath, fever, maculopapular rash, palpable purpura, and cutaneous nodules. CBC reveals eosinophilia.

Back 351

Churg-Strauss. Granulomatous reaction in medium sized vessels.

Front 352

28yo M with recurrent sinusitis, hematuria, and hemoptysis. Has had recurrent fevers, weight loss and arthralgias.

Back 352

Waegener's granulomatosis. C-ANCA positive vasculitis of small arteries. Upper and lower respiratory infections.

Front 353

Drug causing palpable purpura.

Back 353

Hypersensitivity vasculitis.

Front 354

45yo M with abdominal pain, swollen joints, purpuric rash, and hematuria following URI four days ago.

Back 354

Henoch Schonlein Purpura. Definition = IgA nephropathy plus abdominal pain, join pain, and purpura.

Front 355

24yo F with history microscopic hematuria and microalbuminuria, now with gross hematuria following URI.

Back 355

IgA nephropathy

Front 356

34yo M with hemoptysis and hematuria.

Back 356

Goodpasture's syndrome. Anti-glomerular basement membrane antibody. (Anti-GBM).

Front 357

50yo M with CLL presents with blurry vision, finger ischemia, headache, and lethargy.

Back 357

Monoclonal cryoglobulinemia. Rx with plasmapheresis.

Front 358

60yo M with history of IVDA now with arthralgia, purpura, glomerulonephritis, and neuropathy.

Back 358

Mixed cryoglobulinemia. Result of immune complex deposition. Associated with HCV, lupus, and RA.

Front 359

35yo M with one year progressive dyspnea. Oxygen saturation drops with ambulation.

Back 359

Idiopathic pulmonary fibrosis or PCP pneumonia. Hallmark of interstitial lung disease.

Front 360

Dermatomyositis patients have increased risk of what?

Back 360

Malignancy: colon, lung, breast, and prostate.

Front 361

Causes of wheezing

Back 361

CARES: Cardiac asthma (CHF), Churg-Strauss, Allergic bronchopulmonary aspergillosis, Reflux esophagitis (GERD), Exposures (irritants, meds), Embolism, Sinusitis, Strongyloides.

Front 362

Causes of obstructive lung disease?

Back 362

Asthma, COPD, bronchiectasis, cystic fibrosis.

Front 363

Causes of restrictive lung disease?

Back 363

Pleural fibrosis, Interstitial (idiopathic, fungal infection: histoplasmosis, sarcoid), neuromuscular (myasthenia gravis, myopathy, Guillain-Barre), alveolar edema or inflammation, BOOP, pleural effusion, kyphoscoliosis, pregnancy, obesity.

Front 364

What causes most cases of acute bronchitis?

Back 364

Viral > atypical bacteria (Mycopl, Chlamydia, Legionella) > typical bacteria rarely (s. pneumo, h. flu, morexella) > allergic. Acute onset of cough and sputum production s hx of chronic pulm dx and no evidence of pneumonia or sinusitis. No Abs needed.

Front 365

Most common immunodeficiency?

Back 365

Selective IgA deficiency. Caused by anti-IgA IgG. Recurrent sinopulmonary infections.

Front 366

Low IgA, IgG, and IgM. Normal numbers of B cells. Pts 15-30yrs old.

Back 366

Common variable immunodeficiency. Associated with autoimmune disease and lymphoid malignancies.

Front 367

Recurrent pyogenic infections of skin and lower respiratory tract. Pruritus, coarse facies, keratotic nails.

Back 367

Job's syndrome. Hyper-IgE. Autosomal recessive. Abscess, empyema, staph. aureus.

Front 368

Thrombocytopenia, eczema, and recurrent infections.

Back 368

Wiscott-Aldrich. Depressed cell-mediated immunity, high IgA.

Front 369

Low set ears, opportunistic and viral infections, severly sick after live viral vaccine, hypokalemia and hypocalcemia.

Back 369

DiGeorge syndrome. Congenital immunodeficiency with no thyroid or parathyroid. 3rd and 4th pharyngeal pouch.

Front 370

5yo M without tonsils, recurrent URIs and skin infections, and asymmetric arthritis.

Back 370

Bruton's congenital agammaglobulinemia.

Front 371

Recurrent staph and strep infections in albino child.

Back 371

Chediak-Higashi.

Front 372

34yo M with slow onset of cough and pleuritic chest pain several days following resolution of URI.

Back 372

Pneumococcal pneumonia. Usually abrupt presentation occurs insidiously following viral respiratory tract infection.

Front 373

57yo M with COPD develops pleuritic CP and worsening cough.

Back 373

H. flu pneumonia.

Front 374

88yo F develops cough, fever, and pleuritic CP.

Back 374

S. aureus pneumonia. Seen in ICd and nursing home pts.

Front 375

54yo alcoholic presents with productive cough, fever, and lobar consolidation on CXR.

Back 375

Aerobic GNR pneumonia.

Front 376

19yo F with mild pneumonia and hemolytic anemia.

Back 376

Mycoplasma. Prominent extrapulmonary symptoms including: erythema multiforme, myocarditis, erythema nodosum, bullous myringitis, neurological abnormalities.

Front 377

23yo M with mild pneumonia and hoarseness with severe pharyngitis.

Back 377

C. pneumoniae. Distinguishing feature = hoarseness with severe pharyngitis.

Front 378

Atypical pneumonias?

Back 378

Legionella, Moraxella, Chlamydia, Mycoplasma.

Front 379

Pneumonia requiring hospital admission?

Back 379

Two or more lobes, increased A-a gradient or tachypnea, mental status changes, vulnerable patient, homeless patient, very high/low white count.

Front 380

45yo M with pedal edema, nocturia, and morning headache.

Back 380

Sleep apnea. Symptoms include snoring, daytime hypersomnolence, morning headache, impotence, nocturia or enuresis, pedal edema, exercise fatigue. Exclude hypothyroidism and acromegaly.

Front 381

Abdominal Pain due to metabolic / systemic disorders: Puking My Very BAD LUNCH

Back 381

Porphyria, Mediterranean fever, Vasculitis, Black widow, Addison's / Angioedema, DKA, Lead, Uremia, Neurogenic (diabetes, syphillis, spinal nerve impingement), hyperCalcemia, Herpes zoster.

Front 382

Abdominal pain: RUQ

Back 382

liver, gallblader

Front 383

Abdominal pain: Epigastric

Back 383

stomach, pancreas, duodenum, abdominal aorta

Front 384

Abdominal pain: LUQ

Back 384

spleen

Front 385

Abdominal pain: lower quadrants

Back 385

appendix, intestine, ovary, fallopian tubes, testes, kidney, ureters

Front 386

Abdominal pain: periumbilical

Back 386

small intestine, appendix, abdominal aorta

Front 387

Abdominal pain: suprapubic

Back 387

bladder, uterus, ovaries, fallopian tubes

Front 388

Causes of secretory diarrhea that persists despite fasting?

Back 388

Thyrotoxicosis, carcinoid syndrome, colon cancer, colonic polyps, durgs.

Front 389

Drugs causing diarrhea?

Back 389

Colchicine, Mg-containing antacids, antibiotics, theophylline, lactulose, laxatives.

Front 390

Causes of osmotic diarrhea?

Back 390

Drugs, pancreatic insufficiency, celiac disease, lactose/fructose intolerance, laxatives.

Front 391

Causes of exudative diarrhea?

Back 391

(Protein, blood, mucus) Stools with leukocytes and blood. Causes include: Lymphoma, Whipple's disease, collagenous colitis, IBD, ischemic colitis.

Front 392

Intestinal motility disorders associated with?

Back 392

IBS, DM, narcotic use, systemic sclerosis, fecal impaction, surgery (post-gastrectomy dumping, post-vagotomy syndrome).

Front 393

Causes of malabsorption?

Back 393

Radiation enteritis, bacterial overgrowth, enteric fistula, ileal resection, short bowel syndrome.

Front 394

Diarrheas associated with immunodeficiency?

Back 394

Isospora belli, Microsporidia, Cryptosporidium parvum, Giardia lamblia, Strongyloides stercoralis, Entameba histolytica, Mycobacterium-avium-intracellulare complex, Clostridium difficile, CMV.

Front 395

What accounts for 50% of cases of diarrhea referred to gastroenterologists?

Back 395

Functional diarrhea. No organic cause.

Front 396

34yo M presents with low back pain worse with rest and bloody diarrhea.

Back 396

Crohn's disease.

Front 397

67yo M with CAD and familial hypercholesterolemia presents with bloody diarrhea.

Back 397

Ischemic bowel.

Front 398

31yo F with diarrhea, weight loss, and skin rash.

Back 398

Celiac disease with dermatitis herpetiformis.

Front 399

Causes of constipation?

Back 399

Neoplasia, strictures, adhesion/rectoceles, drugs (tricyclics, opiates, neuroleptics, antihistamines, CCBs, iron supplements, antacids without Mg), DM, hypothyroid, hypokalemia, hypomagnesemia, uremia, neurologic disorders, IBS, amyloid, scleroderma.

Front 400

Type 1 RTA (distal)

Back 400

H secretion. Low K. pH > 5.3. Rx: HCO2 + K. Hereditary, amphotericin, collagen vascular disease, cirrhosis, nephrocalcinosis.

Front 401

Type 2 RTA (proximal)

Back 401

Bicarb reabsorption. Low K. pH < 5.3. Rx: HCO3 + K + thiazide. Hereditary, sulfonamides, carbonic anhydrase inhibitors, Fanconi syndromes.

Front 402

Type 4 RTA (distal)

Back 402

Aldosterone defiency. High K. pH < 5.3. Rx: Fludrocortisone, K restriction, HCO3. Hyporeninemic with diabetes, HTN, or chronic interstitial nephritis; aldosterone resistance.

Front 403

Anion gap metabolic acidosis?

Back 403

MUDPILES: Methanol, Uremia, Diabetic ketoacidosis, Paraldehyde, Iron/INH, Lactic acidosis, Ethylene glycol, Salicylates.

Front 404

Hyperchloremic metabolic acidosis (no anion gap)?

Back 404

Diarrhea, RTA, spironolactone/acetazolamide, TPN

Front 405

Respiratory acidosis?

Back 405

Foreign body, pneumothorax, flail chest, hypoventilation d/t sedatives/narcs, obstructive/restrictive pulmonary disease, pleural effusion.

Front 406

Metabolic alkalosis?

Back 406

NaCl responsive = vomiting, villous adenoma, contraction alkalosis, diuretics. Rx IVF + K. Not NaCl responsive = Conn's & Cushing's, adrenal hyperplasia, licorice, Bartter's syndrome. Rx: KCl and spironolactone or acetazolimide (enhance HCO3 excretion)

Front 407

Respiratory alkalosis?

Back 407

Hyperventilation (anxiety/pain), CVA, head trauma, asthma, PE, CHF, pneumonia, pregnancy, hepatic insufficiency, ASA toxicity, thyrotoxicosis, mechanical ventilation. Rx = treat underlying cause.

Front 408

Hyponatremia?

Back 408

High osmolality = hyperglycemia or hypertonic infusion. Normal osmolality = Pseudohyponatremia, hyperlipidema, hyperproteinemia. Low osmolality = hypotonic hyponatremia.

Front 409

Hypotonic hyponatremia?

Back 409

Check FeNa: > or < 1%.

Front 410

Hypotonic hyponatremia with FeNa >1%.

Back 410

Hypervolemic = renal failure; Euvolemic = SIADH, hypothyroidism, renal failure, drugs; Hypovolemic = diuretics, RTA, adrenal insufficiency, ACE inhibitors.

Front 411

Hypotonic hyponatremia with FeNa <1%.

Back 411

Hypervolemia = nephrosis, CHF, cirrhosis; Euvolemic = polydipsia; Hypovolemic = vomiting, diarrhea, third spacing, dehydration.

Front 412

Treatment fo hypotonic hyponatremia?

Back 412

Hypervolemic = salt & water restrict; Euvolemic = salt & water restrict; Hypovolemic = normal saline.

Front 413

Hyperkalemia signs and symptoms?

Back 413

Intestinal colic, areflexia, weakness, peaked T wave, prolonged QRS and PR, low P.

Front 414

Causes of hyperkalemia?

Back 414

Cellular shifts: (tissue injury, acidosis, insulin deficiency, drugs including succinylcholine, digitalis, beta-agonists, arginine);

Back 415

Decreased excretion: renal insufficiency, drugs (spirlonolactone, triamterene, ACE-I, trimethoprim, NSAIDs), mineralocorticoid deficiency.

Back 416

Iatrogenic and spurious: hemolysis, fist clenching, leukocytosis, thrombocytosis.

Front 417

Treatment of hyperkalemia?

Back 417

C BIG K = Calcium gluconate (cardiac membrane stabilization); Bicarb, Insulin, Glucose; Kayexalate and loop diuretics (furosemide).

Front 418

Hypokalemia symptoms?

Back 418

muscle weakness, cramps, ileus, hyporeflexia, parasthesias, flaccid paralysis.

Front 419

Causes of hypokalemia?

Front 420

Linear calcification on x-ray of the knee?

Back 420

Pseudogout. Positive birefringent crystals. Associated with hemachromatosis.

Front 421

58yo F with long history of RA develops splenomegaly and leukopenia.

Back 421

Felty's syndrome.

Front 423

FEVER & RASH

Front 424

meningococcemia

Back 424

septic shock, pustules, organisms on gram stain

Front 425

gonnococcemia

Back 425

prositutes, urethritis, joint pain with effusion

Front 426

typhoid fever

Back 426

poor sanitation, prolonged fever, constipation, bradycardia, rose spots

Front 427

staph sepsis

Back 427

vesicles and bullae, IVDA

Front 428

vibrio vulnificus

Back 428

raw seafood, lesions on legs > arms, cirrhotics most susceptible

Front 429

folliculitis

Back 429

hot tubs: pseudomonas; swimmer's itch: schistosomes

Front 430

streptococcal infection

Back 430

scarlet fever: sandpaper texture of rash, cellulitis, palms peeling

Front 431

staph

Back 431

Toxic shock = palmar desquamation

Front 432

rocky mountain spotted fever

Back 432

ascending purpuritic rash on palms and soles

Front 433

HIV

Back 433

maculopapular rash, viral syndrome

Front 434

Diagnosis of amyloidosis?

Back 434

Biopsy of abdominal fat pat or rectal biopsy.

Front 435

ATPW hypocalcemia?

Back 435

Serum Ca and Mg. Serum PTH, 25 and 1,25-D, phosphate, Cl, creatinine, amylase & lipase. Obtain EKG to look for prolonged QT.

Front 436

Causes of hypocalcemia?

Back 436

HIPOCAL: Hypo-PTH, Infection, Pancreatitis, Overload (rapid IV volume expansion), Chronic renal failure, Absorption abnormality, Loop diuretics.

Front 437

Causes of hypercalcemia?

Back 437

MISHAP-F: Meds/malignancy, Intox (vit D or A) or Immobilization, Sarcoidosis, Hyper-PTH or Hyperthyroid, Addison's or milk-Alkali, Paget's or Pheochromctoma. Familial hypocalciuric hypercalcemia (benign autosomal dominant condition)

Front 438

Symptoms of hypercalcemia?

Back 438

abdominal moan, psychiatric groan, kidney stone, and urination zone.

Front 439

Most common cause of hypercalcemia?

Back 439

malignancy or hyperparathyroidism.

Front 440

Sideffect of lithium?

Back 440

Hyperparathyroidism: alters setpoint for PTH secretion.

Front 441

Thiazide diuretic sideffect?

Back 441

hypercalcemia d/t increased renal reabsorption.

Front 442

PTH-related peptide secreting tumors?

Back 442

breast, lung, renal cell

Front 443

Why does sarcoid and other granulomatous disease cause hypercalcemia?

Back 443

increased conversion of 25-hydroxyvitamin D to 1,25 in macrophages. Occurs in TB, berylliosis, and lymphoma.

Front 444

Most common hyperparathyroidism?

Back 444

Solitary adenoma > 80% of cases. Four-gland hyperplasia 10%, multiple adenomas 5%, MENI or II.