Pdci Shelf

Front 1

Sx: Chest pain, shortness of breath, maliase, HA, fever, dry cough, abdominal pain, nausea, pleural effusions
CXR: Widened mediastinum
Leads to sepsis, shock, respiratory failure
Pt: Farmers, tannery workers, wool workers, veterniarians, bioterrorism

Back 1

Inhalation Anthrax

Front 2

Mucopurulent sputum
Chest pain
Hemoptysis

Back 2

Pneumonic Plague

Front 3

Gram (-) coccobacillus
Causes pneumonia accompanied by bilateral hilar adenopathy

Back 3

Tularemia

Front 4

Generalized mucous membrane hemorrhage
Evidence of pulmonary, renal, neurologic, and hematopoietic dysfunction

Back 4

Hemorrhagic Fever

Front 5

Rodent-borne RNA virus
More common in SW US
Present shocklike state with thrombocytopenia and leukocytosis

Back 5

Hantavirus

Front 6

Sx: Fever, regional adenopathy, painless ulcer covered by black eschar & surrounded with extensive non-pitting edema

Back 6

Cutaneous Anthrax

Front 7

Pale, anesthetic, erythematous macular or nodular skin lesions

Back 7

Leprosy

Front 8

Acute infection in children and young adults
Transmitted by cats through scratch or bite
Develop a papule or ulcer at site of inoculation & weeks later develop fever, malaise, HA, & regional lymphadenopathy

Back 8

Cat-scratch disease

Front 9

Generalized macular or papular-vesicular-pustular eruptions
Greatest concentration of rash being on face & the distal extremities, esp the palsm

Back 9

Smallpox

Front 10

gestational diabetes complications

Back 10

increased risk of maternal/fetal demise, increased risk of fetal abnormalities, macrosomia (large baby), hypoglycemia, polychtemia, hypocalcemia, hyperbilirubinemai)

Mothers also increase their risk for development of type 2 in 5 -15 yrs.

Hint 10

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Front 11

Present with dysphagia, dysphonia, visual distubrances, diplopia, ptosis, fixed, dilated pupils
Usually found in canned, smoked, or vacuum-packed foods

Back 11

Botulism

Front 12

Noninflammatory diarrhea
Friend rice consumption

Back 12

Bacillus cereus

Front 13

Gram (+) organisms, may branch out into bacillary forms
Infection typically follows trauma, such as dentral extraction

Back 13

Actinomyces

Front 14

Intracellular pathogen with predilection for causing illness in immunocompromised pts, including the elderly
Transmission is food-borne
Implicated Foods: coleslaw, soft cheese, pasteurized milk, undercooked hotdogs, deli meats
Typically present with bacteremia and CNS infection

Back 14

Listeria

Front 15

Body's requirement for calories and protein is not met by the diet
Characterized by wasting, loss of lean body mass, and loss of subcutaneous fat stores

Back 15

Protein-Energy Malnutrtion (PEM) or Marasmus

Front 16

Severe deficiency of protein
Characterized by edema, skin changes, change in hair pigmentation, & hypoalbuminemia

Back 16

Kwashiorkor

Front 17

Present with Psoriasiform rash, eczematous scaling, hypogeusia

Back 17

Zinc Deficiency

Front 18

Present with scrotal dermatosis, photophobia, conjunctival inflammation, glossitis, angular stomatitis, tongue atrophy

Back 18

Riboflavin Deficiency

Front 19

Arm spans greater than their height & above average crown-to-hell height
Hyperextensible joints
Arachnodactyly (long, spiderlike, slender fingers)
Positive Steinberg sign (when fingers are clenched over the thumb & thumb protrudes beyond ulnar margin of hand)
High-arched palate, kyphoscoliosis, sublaxation of lens
Murmur of mitral valve prolapse
Complications: Aortic regurgitation & dissection of aorta

Back 19

Marfan Syndrome

Front 20

X-linked Disorder
Present with self-mutilation, choreoathetosis, spasticity, gout, mentral retardation

Back 20

Lesch-Nyhan syndrome

Front 21

45, X
Gonadal dysgenesis
Primary ammenorrhea, short stature, webbed neck with low posterior hairline
Multiple congenital abormalities

Back 21

Turner Syndrome

Front 22

Hyperelasticity of the skin
"Rubber man" syndrome
Hypermobile joints

Back 22

Ehlers-Danlos syndrome

Front 23

AD
Webbed neck, short stature, congenital heart disease
Normal karyotypes & normal gonads

Back 23

Noonan Syndrome

Front 24

Night blindness, keratomalacia, scaling of skin, increased intracranial pressure, depressed immunity

Back 24

Vitamin A defiency

Front 25

Hx of previous bowel resection
Present with Megaloblastic anemia, altered cerebral function, neuropsychiatric changes, difficulty with balance (posterior columns)
Loss of vibration and position sense

Back 25

Vitamin B12 defiency
(since the vit B12-intrinsic factor complex is absorbed in ileum)

Front 26

Osteomalacia and Rickets result from

Back 26

Vitamin D deficiency

Front 27

Rare, pt may present with neuropathy, ophthalmoplegia, & ataxia
Hemolysis may occur in infants

Back 27

Vitamin E deficiency

Front 28

Prolonged clotting times result from what deficiency

Back 28

Vitamin K

Front 29

Used to quantify consciousness and assess cerebral cortex and brainstem function by assessing the pts verbal response, motor response, and eye opening response to stimuli

Back 29

Glasgow Coma Scale (GCS)

Front 30

Characterized by vasodilation resulting in warm, flushed pt with normal or elevated cardiac output
Fever, agitation, or confusion is often present

Back 30

Early Phase of Septic Shock

Front 31

Pt is obtunded with decreased cardiac output and hypotension that is not reversible by fluid replacement

Back 31

Late Phase of Septic Shock

Front 32

Signs of pulmonary vascular congestion (jugular venous distention, S3 gallop, bilateral lung crackles)
Increased PCWP
Decreased cardiac output

Back 32

Cardiogenic Shock

Front 33

Follows a spinal cord injury
Present with warm skin, bradycardia, neurologic deficits

Back 33

Neurogenic Shock

Front 34

Characterized by volume depletion (tachycardia, hypotension, cool, clammy skin, poor capillary refill)

Back 34

Hypovolemic Shock

Front 35

An increase in systolic blood pressure that coincides with inspiration rather than expiration
-Occurs when a stiff ventricle is unable to fill adequately, as w/ Hypertrophic Obstructive Cardiomyopathy

Back 35

Reverse Pulsus Paradoxus
(Normally, inspiration causes a dec in intrathoracic P & inc venous return to RV w/ dec in venous return to LV --> due to pooling of blood in pulm bed & leftward shift of sputum into the LV)

Front 36

Smaller left ventricular end-diastolic volume that results in a lower stroke volume and a lower systolic BP, w/ a severe drop (>20mmHg)
-May be seen in tamponade, constrictive pericarditis, lung disease, pulmonary embolism, shock, RV infarction, RV failure

Back 36

Pulsus paradoxus

Front 37

Occurs in pts w/ CF b/c pancreatic enzymes are not available to cleave the R-protein & assist in vitamin B12 absotpion
Increased foul-smelling bowel movements
Cachectic
Prolonged prothrombin time (PT)

Back 37

Malabsorption

Front 38

Performed with a caliper that measures that thickness of the skin & fat at the middle of the nondominant arm over the triceps muscle
-Represents the amount of calories stored as subcutaneous fat
>95th percentile implies obesity

Back 38

Triceps Skinfold Measurement (TSF)

Front 39

What type of diet do pts who are post-transplant require and why

Back 39

Increased high-protein and high-calorie diets (regardless of TSF or BMI) to replete stores and assist with wound healing during the catabolic state following surgery

Front 40

Pts taking this drug are susceptible to hyperkalemia, hypertriglyceridemia, & hypercholesterolemia

Back 40

Cyclosporine
-Dietary intake of potassium, saturated fats, and cholesterol should be limited

Front 41

What are the stages of high blood pressure

Back 41

Based on the average of 2 or more readings
Normal: <130/<85
High Normal: 130-139/85-89
Stage 1: 140-159/90-99
Stage 2: 160-179/100-109
Stage 3: 180-209/110-119
Stage 4: >210/>120

Front 42

Most common benign neoplasms of the breast
Well demarcated, rubbery, mobile, & nontender

Back 42

Fibroadenomas

Front 43

Most common cause of breast lumps
Tend to occur in association w/ other cysts
Round, mobile, soft with a cystic consistency
Tender premenstrually, become smaller immediately after menses, & regress w/ menopause

Back 43

Benign Cysts

Front 44

Mass in breast that is localized, tender, swollen, erythematous and flucant

Back 44

Breast Abscesses

Front 45

Breast mases that are painless, irregular in contour & shape, hard, nonmobile, not well demarcated

Back 45

Malignant Breast Lesions

Front 46

Appropriate method for feeding in a pt with poor appetite or anorexia, inability to ingest food due to dysphagia or injury to head & neck, gastroparesis, & maldigestion

Back 46

Enteral Tube Feeding

Front 47

Appropriate method for feeding reserved for pts who require short-term perenteral nutrition, not hypermetabolic or fluid restricted
-Must have suitable peripheral venous acces

Back 47

Peripheral Parenteral Nutrition (PPN)

Front 48

Appropriate method for feeding in a pt with poor peripheral veous access or in those who require long term nutrition (> 7 days)

Back 48

Central Total Parenteral Nutrition (TPN)

Front 49

What nerve mediates taste (salty and sweet) on the anterior 2/3 of the tongue

Back 49

Facial nerve (CN VII)

Front 50

What nerve mediates taste (bitter and sour) on the posterior 1/3 of the tongue

Back 50

Glossopharyngeal nerve (CN IX)

Front 51

Pt presents with edema, proteinuria, hypoalbuminemia, hyperlipidemia

Back 51

Nephrotic syndrome (may be secondary to HIV disease)

Front 52

Response to a variety of clinical situations characterized by 2 or more of the following:
(1) temp >100.5 F or <97 F
(2) HR > 90/min
(3) RR > 20/min
(4) PaCO2 < 32 mmHg
(5) WBC > 12,000 or < 4,000 or >10% immature (band forms)

Back 52

Systemic Inflammatory Response Syndrome (SIRS)
--> Sepsis

Front 53

Sepsis associated w/ organ dysfunction, hypoperfusion, or hypotension (i.e. lactic acidosis, oliguria, altered mental status)

Back 53

Severe Sepsis

Front 54

Sepsis-induced hypotension despite adequate fluid resuscitation

Back 54

Septic Shock

Front 55

Systolic BP of < 90 mmHg or a reduction of > 40 mmHg from baseline in absence of other causes to explain the hypotension

Back 55

Sepsis-induced hypotension

Front 56

Present of organ dysfunction in an acutely ill pt such that homeostasis can't be maintained w/o innervention

Back 56

Multiple Organ Dysfunction Syndrome (MODS)

Front 57

Trosier's node

Back 57

palpable supraclavicular node on left side, may represent intraabdominal or intrapelvic malignancies

Front 58

Virchow's node

Back 58

Large, left supraclavicular node representing metastasis from gastric carcinoma

Front 59

Present with pinpoint pupils, hypothermia, bradycardia, hypotension, & shallow breathing
Dx and Tx?

Back 59

Dx: Opiate Overdose
Tx: immediate reversal of the opiates w/ naloxone

Front 60

Pts experience yawning, diaphoresis, rhinorrhea, restlessness, anxiety, muscular twitching, vomiting, diarrhea, hypertension, tachycardia, & tachypnea during withdrawal from?

Back 60

Opiates

Front 61

Ingestion that results in blindness
Dx & Tx

Back 61

Dx: Methanol
Tx: Ethanol (prevent formic acid formation)

Front 62

Ingestion leads to seizures and comas
Oxalate crystals in urine, & deposition may result in renal failure
Dx & Tx?

Back 62

Dx: Ethylene glycol
Tx: Ethanol (prevent formic acid formation)

Front 63

Pt develops a cherry red appeanance, HA, dizziness, confusion, visual field defects, blindness, nausea, abdominal pain, syncope, chest pain, heart arrhythmias, seizures, coma
Pulse oximetry may reveal a falsely elevated saturation

Back 63

Carbon monoxide Poisoning
-CO binds preferentially to Hb & dec O2 release to tissues
Confirm Dx by determining the actual carboxyHb fraction in an arterial blood gas

Front 64

Poisoning that results in acrodynia (pink disease due to flushing & desquamation), & neurological, gastrointestinal, & renal problems

Back 64

Mercury (found in thermometes, dental amalgams, batteries)

Front 65

Occurs several minutes after introduction of a specific antigen
Present with pruritus, urticaria, angioedema, abdominal pain, nausea, vomiting, respiratory distress & shock
Dx & Tx

Back 65

Dx: Anaphylaxis
Tx: immediate Tx w/ Epinephrine (for alpha & beta adrenergic effects --> vasoconstriction), Antihistamines, B-agonists inhaled Tx for bronchospasm, O2, steroids, vascular & ventilatory support

Front 66

Occurs at the mucosal surfaces of the upper respiratory tract
Characterized by nonpitting edema of the subcutaneous tissues
Risk of feath due to airway obstruction from laryngeal edema
May appear w/ or w/o urticaria

Back 66

Angioedema

Front 67

Reccurent episodes of facial swelling w/o urticaria w/ FHx
Dx and Deficiency

Back 67

Dx: Hereditary Angioedema (AD)
Deficiency of C1 inhibitor

Front 68

Reccurent episodes of facial swelling w/o urticaria w/o FHx, & associated lymphoproliferative disorders

Back 68

Dx: Acquired Deficiency of C1 inhibitor

Front 69

Due to deposition of drug-antibody complexes causing compliment activation & subsequent urticaria, arthralgias, lymphadenopathy, glomerulonephritis, & cerebritis

Back 69

Serum Sickness (most cases due to penicillin)

Front 70

Occurs in pts w/ spina bifid or congenital urologic defects who have undergone repetitive surgeries
Other groups at risk include employess at rubber manufactures & health care workers

Back 70

Dx: Latex Anaphylaxis
Confirmation: Skin prick testing for IgE to latex or radioallergosorbent test (RAST)

Front 71

Enzyme deficient in 50% of Chinese & Japanese, develop facial flushing & erythema after ingestion of alcohol

Back 71

Aldehyde dehydrogenase (ALDH)
-results in accumulation of acetaldehyde after ingestion of alcohol

Front 72

Best Screening tool for alcohol dependence

Back 72

CAGE Questionaire, "yes" to more than one 1 answer, alcoholism is like
(1) Cut down
(2) Annoyed by criticisms
(3) Guilty
(4) Eye opener

Front 73

Used to screen for Domestic violence

Back 73

SAFE Questionnaire
S = Do you feel Safe or Stessed in a relationship
A = Have you ever been Abused or Afraid in a relationship
F = Are your Friends and Family aware of your relationship problem
E = Do you have an Emergency plan if needed

Front 74

Can occurs at altitudes greater than 9,500 ft & moutain climbers at extreme altitudes (> 18,000 ft)
Susceptible to hypoxemia & physiologic deterioration

Back 74

High Altitude Sickness

Front 75

Characterized by HA, breathlessness, nausea, vomiting, weakness, lassitude, may progress to ataxia, altered mental status, pulmonary edema, cerebral edema, coma
Fundoscopic Exam: Retinal hemorrhages & venous tortuosity
Dx & Tx

Back 75

Dx: Acute Mountain Sickness
Tx: Descent

Front 76

Core body temp < 95 F (35 C)

Back 76

Hypothermia

Front 77

Six Stages of Behavior Changes in Addicted Personalities

Back 77

Precontemplation = Denies problem, no intention of changing
Contemplation = Acknowledges problem; seriously thinks about solving it
Preparation = Committed to action, needs to plan
Action = modifies behavior & surroundings
Maintenance = at risk for relapse if not committed to dollowing through with changes
Termination = No continuing effort needed; addiction no longer a threat

Front 78

Maintain their body weight by induced vomiting or use of laxatives or diuretics
Present w/ dental enamel erosion, excessive dental caries, parotid enlargement, scars on dorsal surfaces of hands
Electrolytes may reveal abnormalities
Irregularities in menstrual cycle may be presenting sign

Back 78

Bulemia

Front 79

Present below their ideal body weight
Present with cold intolerance, emaciated appearance, hypothermia, hypotension, & bradycardia
Irregularities in menstrual cycle may be presenting sign

Back 79

Anorexia nervosa

Front 80

Causes of Unilateral Clubbing

Back 80

-Aortic Aneurysm
-Innominate artery
-Subclavian Artery
-Pancoast's tumor
-Placement of AV fistula for dialysis

Front 81

Causes of Bilateral Clubbing

Back 81

Intrathoracic:
-bronchogenic carcinoma, metastatic lung CA, Hodgkin's disease, mesothelioma, bronchiectasis, empyema, lung abscess, CF, pulmonary interstital fibrosis, pneumoconiosis
Cardiovascular:
-Congenital cyanotic heart disease, subacute bacterial endocarditis
Gastrointestinal
-Cirrhosis, Inflammatory Bowel Disease, Carcinoma of colon or esophagus

Front 82

Maneuver to confirm the loss of the subungual angle in pts w/ bilateral clubbing
-When the terminal phalanges of paired digits are juxtaposed, the diamond-shaped window normally present disappears

Back 82

Schamroth's sign

Front 83

Angle b/w the base of the nail & the surrounding skin, > 180 degrees in pts w/ clubbing

Back 83

Lovibond's angle

Front 84

Burn that involves only the epidermis

Back 84

1st degree burn

Front 85

Burn that may be superficial (papillary layer) partial thickness & deep (reticular layer) partial thickness

Back 85

2nd degree burn

Front 86

Full-thickness burns that involve the entire thickness of the skin

Back 86

3rd degree burn

Front 87

Burn that extends through the skin to the subcutaneous fat, muscle, & bone

Back 87

4th degree burns

Front 88

Can result from Chemicals, Antimalarials, Sulfonamides
Cyanosis that is unresponsive to oxygen
Pts have chocolate-colored blood, a gray appearance, & a falsely normal saturation

Back 88

Methemoglobinemia

Front 89

Dx panic disoder you need to have 4 of the 5 criteria

Back 89

PANIC
P = Palpitations
A = Abdominal pain
N = Nausea
I = Increased perspiration
C = Chest pain, Chills, or Choking

Front 90

Arbovirus
Causes malaise, lethargy, sore throat, stiff neck, n/v.
Progresses to stupor, convulsions, CN palsies, paralysis of extremities, and exaggerated DTR (signs of UMN disease)

Back 90

West Nile Virus

Front 91

Superficial freeze injury that causes no tissue loss
Pts complain of some discomfort
Involved area is pale, rewarming resolves Sx

Back 91

Frostnip

Front 92

Characterized by partial skin freezing, erythema, edema, no blisters
Desquamation several days later

Back 92

First-Degree Frostbite

Front 93

Characterized by full-thickness freezing, erythema, edema, and the presence of clear blisters
Pt complain of throbbing & numbness

Back 93

Second-Degree Frostbite

Front 94

Characterized by damage that extends into the subdermal plexis
Skin is blue or gray Hemorrhage blisters
Pts complain of burning, shooting pains, & the feeling that the involved area feels like a block of wood
Poor Px

Back 94

Third-Degree Frostbite

Front 95

Injury extends into the subcutaneous tissue, muscle, & bone
No edema
Skin is mottled and cyanotic
Eventually forms a mummified eschar

Back 95

Fourth-Degree Frostbite

Front 96

complication of neuroleptic medications (esp Haloperidol)
Present w/ hyperthermia, rigidity, catatonia, labile blood pressure, autonomic dysfunction, tachycardia, tachypnea
Usually occurs w/in 30 days of starting drug but can occur anytime during use

Back 96

Neuroleptic malignant syndrome

Front 97

Present with choreathetoid movements of the face and mouth (lipsmaking)
Common complication of neuroleptics

Back 97

Tardive dyskinesia

Front 98

Present with torticollic, rigidity of back muscles, carpopedial spasm, blepharospasm, chorea
Complication of neuroleptics
Tx: Sx usually resolve w/ anticholingerics

Back 98

Dystonic Reaction

Front 99

Hypersensitive Rxn that causes urticaria & anaphylaxis
-Seen with Penicillin, Insulin, Sulfonamides, Morphine, & constrast Media

Back 99

Type I

Front 100

Hypersensitive Rxn due to transfusions (ABO mismatch) or use of medications (quinidine, heparin, phenacetin, sulfonamides)
Typically cause hemolysis, thrombocytopenia & nephritis

Back 100

Type II

Front 101

Hypersensitive Rxn seen with penicillin, propylthiouracil, hydralazine, procainamine
-Cause serum sickness

Back 101

Type III

Front 102

Hypersensitive Rxn seen with tetracyclines, nitrofurantoin, neomycin, parabens, and sulfonamides
-Cause contact dermatitis, pulmonary fibrosis, photosensitivity, toxic epidermal necrolysis

Back 102

Type IV

Front 103

Subcutaneous blood over the mastoid due to a Fx of the petrous bone

Back 103

Battle Sign

Front 104

Subcutaneous blood around the eyes due to Fx through the cranial fossa

Back 104

Raccoon Eyes

Front 105

Pts w/ basilar skull Fx may present with

Back 105

Battle sign & Raccoon Eyes

Front 106

Fx's associated with CSF otorrhea & CSF rhinorrhea

Back 106

Fx's throughout the cranial fossa

Front 107

Pt typically present after a lucid period
Arterial hemorrhages from tears of the middle meningeal artery from temporal bone Fx
Death occurs if bleeding is not controlled

Back 107

Epidural Hematoma

convEx on CT scan (Epidural = EE)

Front 108

Venous hemorrhages
Pt present w/ HA, confusion, hemiparesis
Appear as concave hyperdensity on CT

Back 108

Subdural Hematomas

Front 109

Temporary impairment of cerebral function w/o structural cerebral damage
Pt complain of personality changes, dizziness, HA

Back 109

Concussion

Front 110

Bruising of the brain tisse
-at the site of impact
-at the opposite site of impact

Back 110

Contusion
-Coup
-Contracoup

Front 111

Causes compression of CN III & results in a blown pupil (dilated and nonreactive)

Back 111

Uncal Herniation

Front 112

Results in compression of pons and medulla
Pt present with severe HTN, dizziness, ataxia, drowsiness, weakness, spasticity
If left untreated, coma and death

Back 112

Tonsillar Herniation

Front 113

Bitter almond breath odor

Back 113

Cyanide Poisoning
(venous O2 saturation may be elevated b/c tissues fail to take up arterial O2)

Front 114

Fruity breath odor

Back 114

Diabetic ketoacidosis

Front 115

Respiration which is deep (increase in tidal volume) as well as rapid

Back 115

Kussmaul breath

Deep Respiration (Hyperpnea)

Front 116

Garlic breath odor

Back 116

Arsenic ingestion and Parathion Poisoning

Front 117

Rotten Egg breath odor

Back 117

Hydrogen sulfide mercaptans poisoning

Front 118

Odor of camphor

Back 118

Ingestion of napthalene (mothballs)

Front 119

Pts are arousable for short periods of time to visual, verbal, or painful stimuli
Often moan or have slow motor movements to stimuli

Back 119

Stuporous pts

Front 120

Pts are confused & hallucinate
They are anxious and demonstrate motor & sensory excitement

Back 120

Delirious pts

Front 121

Pts are drowsy and fall asleep easily, but once aroused, respond appropriately

Back 121

Lethargic pts

Front 122

Pts have poor memory and decreased attention spane & respond inappropriately to questions

Back 122

Confused Pts

Front 123

Pts are neither aware or awake

Back 123

Comatose pts

Front 124

Pts extend to painful stimuli

Back 124

DecErebrate (Extend EE) pts

Front 125

Pts flex to painful stimuli

Back 125

Decorticate pts

Front 126

AD polyposis
Characterized by small multiple macules (lentigines) on the lips & oral membranes
Abdominal Sx due to multiple benign hamartomatous polyps in small & large bowel & in stomach

Back 126

Peutz-Jeghers Syndrome (PJS)

Front 127

Lighter lesions due to increased epidermal pigment in the distribution of sun exposed areas

Back 127

Freckles (ephelides)

Front 128

AD
Characterized by facial cysts and adenomatous polyps in small & llarge intestines

Back 128

Gardner Syndrome

Front 129

Painful vesicles which are grouped and confluent

Back 129

Herpes Simplex Virus

Front 130

Highly contagious systemic infection
Characterized by Ulcerative oral lesions and a vesicular exanthem on the distal extremities
Caused by Coxsackievirus A16

Back 130

Hand-Foot-and-mouth Disease

Front 131

Target lesions that are burning and pruritic
They are generalized and often involve the oral mucosa
Etiologies: Drugs (i.e. Phenytoin, Sulfonamides, Barbiturates, Allopurinol), HSV
Positve Nikolsky sign

Back 131

Erythema Multiforme

Front 132

Finger pressure in the vicinity of a lesion leads to sheetlike removal of the epidermis
What is this called?

Back 132

Nikolsky sign

Front 133

Chronic Bullous Autoimmune Disease usually seen in middle-aged adults
Positve Nikolsky sign

Back 133

Pemphigus vulgaris

Front 134

Round to oval maculopapular lesions 0.5 to 1.0 cm in diameters
Eruptions typically involve the palms and soles

Back 134

Primary Syphilus

Front 135

Lesions that flat & soft with predilection for mouth, perineum, & perianal areas
-called condylomata lata

Back 135

Secondary Syphilus

Front 136

Characterized by pruritic wheals typically lasting several hours

Back 136

Urticaria

Front 137

After infestation by the mite Sarcoptes scabiei
Spread by skin-to-skin contact
Pts complain of intense pruritus
Areas of excoriated papules in interdigital area

Back 137

Scabies

Front 138

Large, erythematous, serpiginous tracks
Commonly from Ancylostoma brasiliense due to the dog & cat hookwork

Back 138

Cutaneous Larva Migrans

Front 139

Characterized by tiny papules, vesicles, urticarial wheals
Associated with gluten-sensitive enteropathy

Back 139

Dermatitis herpetiformis

Front 140

Infectious skin disease due to either Staphylococcus aureus or Streptococcus pyogenes
Typically seen on the face and characterized by discrete vesicles that rupture to form a yellowish crust

Back 140

Impetigo

Front 141

Macular lesion with a distinct red border w/ central clearing
Early pathognomonic eruption of Lyme disease, a spirochetal infection transmitted to humans by the bite of an infected Ixodid deer tick
Rash typically occurs 1 to 2 weeks after the bite

Back 141

Erythema Migrans

Front 142

Maculopapular rash that begins peripherally and often involves the palms and soles
Transmitted by dog or wood ticks

Back 142

Rocky Mountain Spotted Fever (R. rickettsii)

Front 143

Toxin-mediated multisystem infection
Rash is typically generalized & macular & involves the mucous membranes
Desquamation of palms and soles and subsequent multisystem failure
Risk Factors: Surgical wounds, nasal packs, burns, skin ulcers, postpartum infections, eye injuries, vaginal tampons

Back 143

Toxic Shock Syndrome (TSS)
caused by Staphylococcus aureus

Front 144

Acute infection of the dermal & subcutaneous infections
Characterized by erythema, warmth, & tenderness of the skin at the site of entry of bacteria

Back 144

Cellulitis

Front 145

Begins as a painful induration of the underlying soft tissues with rapid development of an eschar & necrotic mass

Back 145

Necrotizing Fasciitis

Front 146

Seen in children & due to an exotoxin-produing strain of group A Streptococcus
Characteristic confluent erythema which begins centrally, spreads to the extremities, and then desquamates

Back 146

Scarlet Fever

Front 147

Mucocutaneous, primarily drug-induced eruption
Characterized by generalized erythema & exfoliation that may lead to multsystem failure
Implicated Drugs: Sulfa derivatives, Allopurinol, Hydrantoins (begins 1-3 weeks after drug exposure)

Back 147

Toxic Epidermal Necrolysis (TEN)

more severe varient of Stevens-Johnson syndrome (SJS)

Front 148

Characterized with patchy hair loss on the back of the scalp, well-demarcated areas of erythema & scaling
Hairs that are still present in this area are extremely short & broken in appearance
-usually seen in school-aged children & transmitted from person to person

Back 148

Tinea capitis, due to either Trichophyton tonsurans or Microsporum canis

Front 149

Hereditary disorder characterized by scaling patches & plaques appearing in specific areas of the body, such as the scalp, elbows, lumbosacral region & knees
Lesions are salmon pink w/ silver-colored scale that on removal produces blood (Auspitz sign)

Back 149

Psoriasis

Front 150

Salmon pink pink lesions with silver-colored scale that on removal produces blood
What sign is this

Back 150

Auspitz sign

Front 151

With trauma, the lesion jumps to a new location, it is also elicited in pts w/ psoriasis

Back 151

Koebner Phenomenom

Front 152

Common chronic dermatosis occuring in areas with active sebaceous glands (face, scalp, and body folds)
Seen in infancy or people over the age of 20
Eczematous plaques that are yellowish red and often greasy w/ a sticky crust

Back 152

Seborrheic Dermatitis

Front 153

Progressive hereditary bitemporal, frontal, or vertex blading that may begin any time after puberty

Back 153

Androgenic hair loss

Front 154

Deep infectious collection og interconnecting abscesses (furuncles) arising from several hair follicles

Back 154

Carbuncle

Front 155

Slowly evolving, painful cellulitis due to gram (+) organism Erysipelothrix rhusiopathiea
Seen in ppl employed as handlers of fish, poultry, or dead meant

Back 155

Erysipeloid

Front 156

Cellulitis due to group A Beta-hemolytic streptococci

Back 156

Erysipelas

Front 157

Impetigo that extends into the dermis

Back 157

Ecthyma

Front 158

Large, well-demarcated macules affecting the intertriginous areas of the body, esp the groin
Lesions are brownish red & are due to Corynebacterium minutissimim, a gram (+) rod that is part of normal skin flora
Seen in pts w/ diabetes

Back 158

Erythrasma

Front 159

Chronic pruritis dermatitis composed of plaques of papules and vesicles
Lesions are coin-shaped and often occur on the lower extremities of older men in the winter months when dryness of skin is common
Often asso w/ a Hx of atopy

Back 159

Nummular eczema

Front 160

Due to an allergen causing a type IV cell-mediated delayed hypersensitivity rxn
May also be nonallergen such as a chemical irritant

Back 160

Contact Dermatitis
-if due to poison ivy it is usually pruritic, localized to one region, and often linear

Front 161

Childhood disease due to parvovirus 19
Characterized by edematous, erythematous plaques on the cheeks

Back 161

Erythema infectiosum or Fifth Disease ("slapped cheek" disease)

Front 162

AD, pruritic inflammation with predilection for the neck, face, flexor areas, feet, wrists, and hands
Usually person Hx of Asthma, allergic rhinitis, or hay fever

Back 162

Atopic dermatitis or Eczema

Front 163

Viral infection characterized by Conjunctivitis, Coryza, and Cough
Confluent erythematous maculopapular rash that spreads centrifugally

Back 163

Rubella (measles)

Front 164

Bright red spots with blue-white specks in the center
Appear on buccal mucosa opposite the premolar teeth

Back 164

Koplik spots
-pathognomonic for rubeola

Front 165

Lesions with a central keratotic plug that gives them the appearance of being dimpled (umbilication)
Resolve spontaneously
-Self-limited viral infection due to a pox virus
-Seen in children, sexually active adults, & HIV pts

Back 165

Molluscum contagiosum

Front 166

Warts that are firm, hyperkeratotic, round papules 1 to 10 mm in diameter
No umbilication, predilection for sites of trauma including hands, fingers, & knees
-due to HPV

Back 166

Verrucae vulgaris (common warts)

Front 167

skin-colored, isolated dome-shaped nodule ith central hyperkeratotic core usually found on the face

Back 167

Keratoacanthoma

Front 168

Painful group of vesivles on the volar finger
-due to HSV

Back 168

Herpetic whitlow

Front 169

Bright red or purple nodules or plaques that develop at birth and spontaneously disappear by the firth year

Back 169

Capillary Hemangiomas

Front 170

Occurs gradually w/ formation of intense bullae on the dorsae of the hands, feet, and nose and hypertrichosis
Elicit an orange-red fluorescene in the urine w/ a Wood's lamp
A disease of adults found equally in males & females
Often hereditary, but many induced by drugs (estrogens [OC], Chloroquine, alcohol), chemicals, & illnesses (Hep C)

Back 170

Porphyria cutanea tarda (PCT)

Front 171

Serious autoimmune bullous disorder of the skin & mucous membranes
-May be fatal w/o treatment

Back 171

Pemphigus

Front 172

Chronic bullous autoimmune disorder seen mostly in pts older than 60
Mucous membrane involvement

Back 172

Pemphigoid

Front 173

Asymptomatic dermatosis characterized by scaling macules w/ sharply marginated borders distributed throughout the trunk
Green fluorescence w/ Wood's lamp

Back 173

Tinea versicolor or Pityriasis versicolor (PV)

Front 174

A neoplastic disease of helper T cells that first manifests in the skin but eventually spreads to the lymph nodes and internal organs
Characterized by erythroderma (a generalized erythema, scaling, and thickening of skin) and leukocytosis
Abnormal circulating T cells (Sezary type) are seen on buffy coat
Scaly plaques disappear w/ sun exposure, mimicking psoriasis

Back 174

Mycosis fungoides, also called Cutaneous T cell lymphoma, Sezary syndrome

Front 175

Inflammatory dermatosis w/ unknown etiology that involves skin and mucosa

Back 175

Lichen planus

Front 176

Chacteristic course begins w/ single bright red herald or primary patch on trunk, followed 1-2 weeks later by similar nonprurtoc (may be itchy) plaques distributed in a christmas tree pattern
-self-limited & resolves w/in 6 weeks
-seen in pts under 40 yo, more common in spring & fall months

Back 176

Pityriasis rosea

Front 177

Benign epithelial tuomr seen in pts over 30 yo
Typically appears as brown plaques, papules, or nodules with a stuck-on appearance and has a predilection for the face, trunk, & upper extremities

Back 177

Seborrheic keratosis

Front 178

Multisystem vascular neoplasms
Predominantly arises in the legs
Papules & nodules are usually violaceous
Seen in elderly males of Eastern European heritage (Mediterranean or Ashkenazi Jewish) or Immunocompromised (transplante, chemo, HIV)

Back 178

Kapos's Sarcoma (due to HHV-8)

Front 179

Develop in the medial calf or over the malleous (both lateral & medial)
Minor trauma may precipitate formation

Back 179

Venous Ulcers

Front 180

Pt present with complaints of claudication
Arterial insufficiency may lead to atrophic skin chages (shiny & white) and loss of hair on feet & legs
Typically painful at night & improve with dependency

Back 180

Arterial Ulcers

Front 181

Early Sx may include parathesias of the leg & foot, trauma usually precedes formation
Usually on the toe, heel, or metatarsal areas
occur in diabetes

Back 181

Neuropathic ulcers

Front 182

Painful, gray-based ulcers with erythematous rims occuring in the oropharynx

Back 182

Aphthous ulcers

Front 183

Inflammation of the pilosebaceous units of the face & trunk
-occuring usually in adolescence
-manifests itself as comedones, papulopustules, or nodules and cysts

Back 183

Acne

Front 184

Chronic acneform disorder of the facial pilosebaceous untis coupled w/ increased reactivity of capillaries to heat leading to flushing and the formation of telangiectasia

Back 184

Rosacea

Front 185

Aquired hyperpigmentation that occurs in sun-exposed areas, esp the face
Common in women with brown or black skin color
-May occur in pregnancy or with oral contraceptive use

Back 185

Melasma

Front 186

Present with facial plaques that result in dispigmentation and scarring

Back 186

Discoid Lupus

Front 187

Due to histamine release and occurs in pts who receive a rapid infusion of vancomycin

Back 187

Red man (neck) syndrome

Front 188

Pulsatile arteriolar lesion that blanches with pressure and is seen in pts w/ cirrhosis (hyperestrogenism)

Back 188

Spider Angioma

Front 189

Hemorrhages < 1 mm in size

Back 189

Petechiae

Front 190

Larger hemorrhages

Back 190

Ecchymoses

Front 191

General term for a collection of red blood cell deposition in the skin and when palable represents antigen-antibody immune complex

Back 191

Purpura

Front 192

Fine, irregular line due to dilated capillary

Back 192

Telangiectasia

Front 193

White lines parallel to the lunula, separated by normal nail, that remain immobile as the nail grows (they are loctated in the nail bed, not the nail plate)
-seen in pts w/ severe hypoalbuminemia (i.e. Nephrotic syndrome)

Back 193

Muehrcke's nails

Front 194

Nail color that may be due to Wilson's disease, hemochromatosis, use of antimalarial drugs, or exposure to silver nitrate

Back 194

Blue Nails (azure half-moons)

Front 195

Times of severe stress (i.e. MI) may causes temporary growth arrest & horizontal depressures across the nail plate

Back 195

Beau's lines

Front 196

Thin & soft nail plate, seen in iron-deficiency anemia
-may be demonstrated when a drop of water on the nail does not roll off

Back 196

Koilonychia, also called spoon nails

Front 197

Nail color that occurs w/ Addison's disease, hemochromatosis, gold therapy, and arsenic intoxication

Back 197

Brown nails

Front 198

Transverse white lines distal to the cuticle seen with arsenic poisoning, chemotherapy, & Hodgkin's lymphoma, severe cardiac & renal disease

Back 198

Mees' lines

Front 199

Nail abnormality seen in pts w/ cirrhosis, non-insulin-dependent DM (type 2), chronic renal failure,or CHF whereby the proximal 4/5th of the nail is white and the distal rim is pink

Back 199

Terry's nails

Front 200

nail abnormality seen in psoriasis

Back 200

Pitting of the nails

Front 201

Brown or red streaks in the midportion of the nail
-may be seen in pts with endocarditis or trichinosis, commonly the result of trauma

Back 201

Splinter hemorrhages

Front 202

Nail color on the nail plates due to poor lymphatic circulation

Back 202

Yellow nails

Front 203

Occurs when there are white patches (subungal air bubble) b/w the nail and its bed
-may be congenital or a result of trauma

Back 203

Leukonychia

Front 204

type of nails that may be seen with hyperthyroidism, malnutrition or calcium or iron deficiency

Back 204

Brittle nails (frayed and irregular)

Front 205

Perifollicular hemorrhage and areas of ecchymosis are common, esp on the back of the lower legs, arms, and inner thighs (saddle distribution)
Loose teeth and bleeding gums are seen

Back 205

Scurvy, Vitamin C deficiency

Front 206

Causes acrodermatitis enteropathica in infancy
Characterized by the classic triad: Acral dermatitis, alopecia, and diarrhea

Back 206

Genetic Zinc Deficiency

Front 207

Seen in alcoholics
causes pellegra
Sx triad: Dementia, diarrhea, dermatitis

Back 207

Niacin deficiency

Front 208

Manifests by skin lesions, lymphadenopathy, hypercalcemia, lytic bone lesions, internal organ involvement, abnormal lymphocytes on peripheral blood smear (polylobulated lymphocytes)
Skin lesions may be single, multiple, or generalized
-transmitted through blood products & sexual intercours and may occur 20 yrs after exposure

Back 208

Adult T cell leukemia/Lymphoma
(neoplasma caused by HTLV-1)

Front 209

White macular lesion found in the buccal mucosa
Predisposing factors: Tobacco use, alcohol use, HPV, syphilus
Leads to squamous cell carcinoma

Back 209

Oral Leukoplakia

Front 210

Dry, rough, adherent, scaly lesions occuring in sun-exposed areas of adults
Premalignant lesions & may develop into squamous cell carcinoma

Back 210

Actinic (solar) keratoses

Front 211

Solitary, well-demarcated plaque

Back 211

Bowen's disease or Squamous Cell Carcinoma

Front 212

What is it called when Bowen's disease occurs on the glans penis, may lead to a fungating and ulcerating squamous cell carcinoma

Back 212

Erythroplasia of Queyrat

Front 213

Most common type of skin cancer, invasive & aggresive but rarely metastasizes
Lesions are usually round, firm, glistening (pearly), and shiny
Histologically, have palisading nuclei

Back 213

Basal cell carcinoma

Front 214

Discrepancy

Back 214

N. Lack of consistency; difference.

Hint 214

There are certain discrepancies between the two versions of the story
The police notive some discrepancies in his description of the crime and did not beelive him.

Front 215

Weber test lateralizes the deaf ear in ____ hearing loss
Weber test lateralizes to better ear in ____ hear loss

Back 215

Deaf Ear: Conductive hearing loss
Better Ear: Sensorineural hearing loss

Front 216

Rinne Test
(1) AC > BC
(2) AC < BC

Back 216

(1) Normal/Positive Rinne Test
(2) Conductive hearing loss

Front 217

What type of hearing loss when Rinne is normal but Weber lateralizes to the better ear

Back 217

Sensorineural hearing loss

Front 218

Sx: Hearing loss, ear fullness, ear pain, dizziness, tinnitus
Eardrum appears retracted or scarred, & a clear fluid is visible in the middle ear
Pain and fever are usually absent
May follow an episode of acute respiratory tract infection or acute otitis media
Dx and Tx

Back 218

Dx: Otitis media with effusion
Tx: aimed at facilitating drainage of the effusion, ABX are generally not necessary

Front 219

Eye test that allows only paraxial parallel light rays through and improves visual acuity if refractory errors are present (most commonly myopia)

Back 219

Pinhole Test

Front 220

Eye exam that is a direct visualization of the eye and its components

Back 220

Slit-lamp examination

Front 221

Detects color blindness

Back 221

Pseudochromatic plate test

Front 222

Determines if pt has any blind spots

Back 222

Visual field testing

Front 223

Screens for macular degeneration

Back 223

Amsler grid test

Front 224

Measures the intraocular pressure

Back 224

Schiotz tonometry

Front 225

Used to detect abrasions of the cornea
A cobalt blue light is used to detect foreign bodies after the fluorescein is instilling into the affected eye

Back 225

Fluorescein staining

Front 226

Infection of the external ear canal, may be due to trauma or water in the ear canal (Swimmer's ear)
May lead to maceration of the epithelium and subsequent colonization by bacteria or fungi
PE: Erythematous ear occluded with debris
Pt complain of pain when examiner pulls on the pinna or tragus
Dx and Tx

Back 226

Dx: Otitis Externa
Tx: Removal of debris with ABX otic drops or placement of a wick to facilitate drainage

Front 227

Severe, unrelenting otorrhea & otalgia & foul-smelling discharge
Often seen in diabetic pts and usually due to Pseudomonas
Dx & Tx

Back 227

Dx: Malignant Otitis
Tx: Systemic ABX for nearly 2 months

Front 228

Leading cause of conduction hearing loss

Back 228

Cerumen blockage

Front 229

An arterial embolus that originates from an atheromatous plaque in a more proximal vessel, usually the internal carodtis.
Plaques are bright, refractile, and yellow when visualized on fundoscopic exam
Appear to migrate down the vessel (carefully massaging the eye can facilitate migration)

Back 229

Hollenhorst Plaque

Front 230

Blood in the anterior chamber of the eye, caused by rupture of the small blood vessels lying close to the cornea
A common sequela of blunt force trauma to the eye

Back 230

Hyphema

Front 231

Misalignment of the eye

Back 231

Strabismus

Front 232

A kind of strabismus in which one eye is deviated inward

Back 232

Esotropia

Front 233

Lazy eye
Loss of visual acuity in an otherwise healthy eye, happens b/c the healthy eye closes to compensate for the deviating eye to avoid discomfort of diplopia

Back 233

Amblyopia
Treatable if discovered early

Front 234

Bleeding between the conjunctiva and sclera, causes the sudden appearance of a bright red spot

Back 234

Subconjunctival hemorrhage

Front 235

Crepitus & air bubbles due to air escaping from fractured sinus
Inability to gaze upward & diplopia due to entrapment of inferior rectus muscle

Back 235

Blow-out Fx of the floor of the orbit

Front 236

Cellulitis that involves only the eyelids
Ocular motility remains normal

Back 236

Preseptal cellulitis

Front 237

Pus in the anterior chamber

Back 237

Hypopyon

Front 238

Eyes appear to be misaligned, but in reality they are straight

Back 238

Pseudostrabismus

Front 239

Acquired color blindness due to optic nerve disease or degenerative disease of the macula

Back 239

Dyschromatopsia

Front 240

Pts w/ Hx of diabetes or HTN (underlying vascular disease)
Disc is pale and swollen w/ splinter hemorrhages
Due to occlusion of posterior ciliary arteries with subsequent production of edema

Back 240

Ischemic optic neuropathy

Front 241

Due to infarction from a thrombus or embolus and causes the retina to become pale
It is sudden and painless
The thin tissue of the macula appears like a cherry red spot

Back 241

Central artery occlusion

Front 242

Occurs from slow venous blood flow and thrombosis
Pt complains of slowly progressive loss of vision
Fundoscopic image often described as "Blood and Thunder:

Back 242

Occlusion of the Retinal vein

Front 243

The fundus appears elevated & often has folds
Pts complain of acute vision loss after noticing flashing lights, floaters, and then a shade over the eye

Back 243

Retinal Detachment

Front 244

Retinal findings include microaneurysms, dot-and-blot hemorrhages, hard exudates, and macular edema

Back 244

Nonproliferative (background) Diabetic Retinopathy

Front 245

Neovascularization with the formation of the fragile vessels is a response to continuous retinal ischemia and is responsible for most of the blindness seen with diabetes mellitus

Back 245

Proliferative Diabetic Retinopathy

Front 246

Hypertensive retinopathy is classified by the Keith-Wagener-Barker Classification

Back 246

Grade 1: Arteriolar narrowing and copper wiring
Grade 2: Grade 1 changes and A-V nicking
Grade 3: Grade 2 changes with the addition of hemorrhages & exudates
Grade 4: Grade 3 changes with the addition of papilledema

Front 247

Involvement of the geniculate ganglion by herpes zoster (involves CN VII & causes paralysis of facial muscles)
Pts may present with facial paresis, hyperacusia, unilateral loss of taste, reducing tear formation, reduced salivation, pain in the ear, &amp; vesicles in the ear canal

Back 247

Ramsay Hunt Syndrome

Front 248

Inflammation of the tympanic membrane due to the presence of vesicles
Pts complain of earache, hearing loss, and bloody dischage
Occurs in several viral & bacterial infections (assoc w/ Mycoplasma pneumoniae)

Back 248

Bullous myringitis

Front 249

Characterized by a port wine stain nevus on the scalp and vascular abnormalities that may lead to seizures and cerebral calcifications
Examination of the ear may reveal auricle ecchymoses

Back 249

Sturge-Weber syndrome

Front 250

Characterized by dark red nodules that are often ulcerated, located over the hands, face, arms, & legs
Seen in pts with leukemia or other proliferative disorders

Back 250

Sweet Syndrome

Front 251

Characterized by the presence of aphthous ulcers of the mouth & genitalia
The ulcers are associated with arthritis, uveitis, & neurological disorders

Back 251

Behcet Syndrome

Front 252

Thickening of the nasal skin
May appear mildly erythematous & is covered with multiple telangiectasia
May be due to excessive alcohol intake or to cold exposure

Back 252

Rhinophyma

Front 253

Chronic, nonblanching purple discoloration of the nose seen in active sarcoidosis
May be seem with erythema nodosum

Back 253

Lupus pernio

Front 254

A red, painful nodule visible in the nasal septum
The result of trauma

Back 254

Septal hematoma

Front 255

Destruction of the bony nose, may be acquired or congenital
May be a complication of Wegener's granulomatosis or congenital syphilus

Back 255

Saddle Nose Deformity

Front 256

Pseudo-saddle nose deformity
Cartilage is destroy and not the bone

Back 256

Polychondritis

Front 257

Pt present with severe pain & significant anterior bilateral epistaxis, follows trauma
Complications: Periorbital ecchymoses, septal hematoma, septal deviations
Dx and Tx

Back 257

Dx: Nasal Fractures
Tx: Require ABX to prevent osteomyelitis

Front 258

Sign that is elicited by asking the pt to sit w/ the head extended while grasping the cricoid cartilage & applying upward pressure
A downward tug of the trachea synchronous with each systole reveals the presence of an aortic arch aneurysm
This occurs due to the anatomic position of the aortic arch, which overrides the left main bronchus

Back 258

Tracheal tug sign (Oliver's sign)

Front 259

Sign that is elicited by pressing on the thyroid cartilage and displacing it to the pt's left; this increases contact b/w the left bronchus & the aortia, making a tracheal pulsation palpable

Back 259

Cardelli's sign

Front 260

Occurs when the cleaning mechanism, namely, the ciliary activity through the sinuses into the nasal passages fail
Pt complain of HA, facial pain, nasal congestion, & purulent discharge
Facial pain is worsened w/ percussion of affected sinus & cloudiness may be seen w/ transillumination
Predominantly due to S. pneumoniae, H. influenzae, M. catarrhalis

Back 260

Acute Sinusitis

Front 261

What is the best method of making a definitive Dx of Acute Sinusitis and when should it be done

Back 261

CT films of the sinuses (air-fluid levels)
Should only be done if pt fails to respond to a 2-week course of ABX therapy

Front 262

Occurs after adequate treatment of an Acute Sinusitis has failed to eradicate the symptoms
Common organisms include anaerobes & S. aureus

Back 262

Chronic Sinusitis

Front 263

Rare accumulation of pus in the floor of the mouth (cellulitis) and causes induration of the neck

Back 263

Ludwig's angina

Front 264

May follow ethmoid or maxillary sinusitis
Causes the upper eyelid to become swollen, red, and tender

Back 264

Orbital Cellulitis

Front 265

Necrotizing ulcerative gingivitis

Back 265

Vincent's Angina (Trench mouth)

Front 266

What is the normal range of Intraocular Pressure & how is it determined

Back 266

Normal range is 10-21.5 mmHg
Determined by the outflow of aqueous humor from the eye; the greater the resistance to outflow, the higher the outflow
Important in the Dx of glaucoma
Shiotz tonometer is used to measure IOP

Front 267

Represents the light reflected from the retina
It means that all of the light-transmitting media of the eye will be transparent & visbile
Cataracts & retinal detachment obscure its presence

Back 267

Red Reflex

Front 268

Emitted from the retinal arterioles
Their walls are transparent & the bright ligh occupies approximately 25% of the diameter of the arterial column of blood
and when do changes in this occur?

Back 268

Light Reflex
Changes occur w/ HTN or w/ aging (walls thicken & more light is reflected, resembling copper wires)

Front 269

White, indistinct, opaque areas of inner or superficial retina
Represent microinfarctions and are due to HTN, DM, infections, collagen vascular diseases, AID, & severe anemia

Back 269

Cotten-Wool Spots (soft exudates)

Front 270

Yellowish, well-demarcated, deep retinal lesions
Result of leaky & damaged vessels, not microinfarcts
Most commonly due to HTN & DM

Back 270

Hard Exudates

Front 271

Yellow, deep epithelial pigment deposits located in the macular
Earliest sign of macular degeneration

Back 271

Drusen Bodies

Front 272

Optic cup is enlarged to > 30% in?

Back 272

Glaucoma

Front 273

Due to leaky & damaged retinal capillaries
Different presentation and cause depending on their retinal layer

Back 273

Retinal Hemorrhages

Front 274

cause of Blot-and-dot retinal hemorrhages

Back 274

due to DM & HTN

Front 275

Cause of flame-and-splinter retinal hemorrhages

Back 275

due to intracranial hemorrhage, papilledema, glaucoma

Front 276

Cause of white-centered retinal hemorrhages (Roth spots)

Back 276

Seen in endocarditis, leukemia, and diabetes

Front 277

Outpouchings of retinal capillares & almost always associated with DM

Back 277

Microaneurysms

Front 278

The fundi are covered with bony spicule formation

Back 278

Retinitis pigmentose

Front 279

An illusion of movement
Most common due to BPPV
Each attack last several secondas & is provoked by head movements
Caused by detachment of calcium carbonate crystals from the affected side into the semicircular canal

Back 279

Vertigo

Front 280

Reproducing the vertigo by having the pt go from a sitting position to a supine position while quickly turning the head to the side, will reproduce the vertigo of BPPV

Back 280

Nylen-Barany Maneuver

Front 281

Disorder of endolymph control
Pts often complain of vertigo, tinnitus & have sensorineural hearing loss

Back 281

Meniere's disease (hydrops)

Front 282

Area that may house tumors, such as schwannomas (acoustic neuromas)
Pts compain of vertigo, tinnitus, hearing loss, & facial numbness, & weakness as the tumor compresses on the adjacent CN's (CN VIII) and brainstem

Back 282

Cerebellopontine angle

Front 283

Sustained spasm of jaw muscles
Seen in tetanus and other infectious disease

Back 283

Trismus or Lockjaw

Front 284

Paralysis of CN VII (LMN) causes IL drooping of mouth & facial muscles, inability to close IL eye, & difficulty eating & speaking (due to mouth droop or weakness)
May be idiopathic or due to trauma, MS, or infections (HSV), Lyme disease

Back 284

Bell's Palsy

Front 285

Caused by lack of sympathetic innervatino to one side of the face & neck
Pupils become constricted, eyelip droops, & loss of sweating on IL side of sympathetic loss

Back 285

Horner Syndrome

Front 286

What is Horner Syndrome often secondary to

Back 286

Pancoast Tumor

Front 287

Opacity of the lens
Pt present complaing of disturbance in vision
Red reflex is diminished

Back 287

Cataract

Front 288

Present w/ central vision loss & drusen bodies (yellow white lesions)
Fundoscopic Exam: retinal atrophy & neovasculization

Back 288

Macular degeneration

Front 289

Decreased ability to focus on near objects (b/c of loss of accomodation) that occurs w/ aging

Back 289

Presbyopia

Front 290

Insidious disease, Sx occur late in the disease
Pts complain of peripheral vision loss (central vision may be spared till late in the disease), & scotomas
IOP may be elevated

Back 290

Glaucoma

Front 291

Result of edema or swelling of the larynx or vocal cords or to external compression of the larynx on the recurrent laryngeal nerve
Dx & mnemonic

Back 291

Hoarseness
VINDICATE
-Vascular (thoracic aneursym)
-Inflammation
-Neoplasm
-Degenerative (i.e ALS)
-Intoxication (smoking, alcohol)
-Congenital (laryngeal web)
-Allergies
-Trauma
-Endocrine (thyroiditis)

Front 292

Bilateral loss of smeel
May be seen in pts w/ asthma, sarcoidosis, diabetes, chronic renal failure, cirrhosis, MS, & Parkinson's disease

Back 292

Kallman Syndrome

Front 293

Sx: Runny nose, pruritus, sneezing, itchy throat, congestion, stuffiness, conjuntival erythema, tearing & frequent thraot clearing
PE: Nasal mucosa is boggy (pale & swollen) or blue-gray (severe), Tubinates may be swollen, polyps visible
-50% of pts have a Fx

Back 293

Allergic Rhinitis (AR)

Front 294

Transverse crease across the nose from resulting from repeated rubbing

Back 294

Nasal Salute

Front 295

Allergic Shiners

Back 295

Dark circles under the eyes

Front 296

Folds below the margin of the inferior eyelids

Back 296

Dennie-Morgan lines

Front 297

Pt present w/ hot potato voice, fever, cervical lymphadenopathy, trismus, & displaced uvual due to a unilaterally enlarged tonsil
Pts complain of dysphagia, odynophagia, otalgia
Accumulation of pus b/w the tonsilar capsule and the superior constrictor muscle of pharynx

Back 297

Peritonsillar abscess

Front 298

Pt is often a young child who present with fever, cerical lymphadenopathy, neck pain, neck swelling, torticollis (rotation to the affected side), difficulty breathing, & stridor
Infection of the space of the neck (from the base of the skull to the tracheal bifurcation)

Back 298

Retropharyngeal abscess

Front 299

Sx: fever, cervical lymphadenopathy, bilateral tonsillar enlargement, erythema, edema of the midline uvula, & discrete tonsillar exudate

Back 299

Exudative Pharyngitis

Front 300

Complication of chronic otitis media & consist of keratinized squamous epithelium that has entered the middle ear through perforation from the external ear canal
Form in relationship to a perforation and can become infected, leading to bone (ossicular chain) destruction

Back 300

Cholesteatomas (sac)

Front 301

Arise from cranial nerve VIII (vestibular division), & their growth w/in the auditory ear canal produces tinnitus & hearing loss

Back 301

Acoustic Neuromas or Schwannomas

Front 302

Most common cause of red eye
Highly contagious keratoconjunctivitis usually accompanied by periauricular adenopathy

Back 302

Viral conjunctivitis due to adenovirus

Front 303

Usually assoc w/ purulent discharge but no adenopathy
Allergic insult may cause itching & watery discharge of the eyes, but usually the pt complains of hypersensitivity to a specific agent

Back 303

Bacterial conjuntivitis

Front 304

Inflammation of the iris & ciliary muscle
May be a systemic marker for ankylosing spondylitis, Reiter syndrome, or sarcoidosis
Pt complains of eye pain & photophobia
Eye Exam: Ciliary flush & irregular pupil

Back 304

Iritis (uveitis or iridocyclitis)

Front 305

Engorgement of the deep pericorneal blood vessels in Iritis (uveitis or iridocyclitis), never seen in superficial infections

Back 305

Ciliary FLush

Front 306

Pts complain of diminished visual acuity, photophobia, and sensation of foreign body in eye
They are at risk for further vision loss
May be due to trauma, including overuse of contact lenses

Back 306

Keratitis or Corneal inflammation

Front 307

Infection (pustule) of the eyelid gland, usually due to S. aureus, which causes pain & swelling of the lid margin (stye)

Back 307

Hordeolum

Front 308

Swelling of the lid margin

Back 308

Stye

Front 309

Chronic inflammation of the eyelid margins that causes burning, itching, and irritation of the lids
Pt often complain of sticky eyelids on awakening in the morning

Back 309

Blepharitis

Front 310

Pupil is usually miotic and almost always bilateral
The pupil does not react to light but will react to accomodation
Suggestive of a neurosyphilus infection that affects the light reflex pathway

Back 310

Argyll Robertson Pupil

Front 311

Hyperemic & swollen disc
Inflammation of the optic nerve sometimes seen in pts w/ MS

Back 311

Optic neuritis

Front 312

Dx requires swinging flashlight test
Bright light is moved from one eye to the other and pupillary rxns are observed
In lesions of the optic nerve the brainstem center perceives the light as being brighter the normal eye & affected pupil will dilate continuously

Back 312

Marcus Gunn Pupil

Front 313

Dysfunction of the constrictor muscle in which the pupil does not respond to direct light or accomodation
Often the pt has absent deep tendon reflexes

Back 313

Adie tonic pupil

Front 314

Implies pupils of unequal size and is found in up to 20% of normal subjects

Back 314

Anisocoria

Front 315

Abnormal involuntary rhythmic eye movement that be induced by having the pt follow a rapid finger movement or can occur at rest
It consists of a slow component (vestibular) as the eye deviates in one direction, followed by a rapid corrective movement (cerebral) in the opposite direction
-type is named based on rapid component

Back 315

Nystagmus

Front 316

Type of nystagmus produced when person is asked to gaze too far laterally

Back 316

End-point nystagmus

Front 317

Type of nystagmus that occurs in only one direction of lateral gaze & is seen in pts will vestibular disease

Back 317

Asymmetric lateral nystagmus

Front 318

Type of nystagmus seen in pts w/ brainstem disease, & congenital nystagmus that typically disappears w/ convergence & is seen in newborns

Back 318

Up-beating, Down-beating, and rotary nystagmus

Front 319

Type of nystagmus in which the eye moves at equal speeds in both directions

Back 319

Pendular nystagmus

Front 320

Acquired disease that causes abnormal dilation of the bronchi leading to pooling of secretions in the airways and reccurent infections
Pts present w/ cough & production of purulent sputum
Lung auscultation may be normal or remarkable for wheezes, rhonchi, or crackles
CXR: normal or the damaged, dilated airways will appear as tram tracks or ring shadows

Back 320

Bronchiectasis
-may be a sequela of foreign body aspiration, cystif fibrosis, rheumatic disease (RA, Sjogren's disease), Pulmonary infections (TB, pertussis, mycoplasma), AIDS, or allergic bronchopulmonary aspergillosis

Front 321

A pt in the hospital for 48 hours or more is most likely to develop what type of pneumonia & what are the most likely organisms

Back 321

Hospital-Acquired Pneumonia
-P. aeruginosa, S. aureus, Enterobacter, Klebsiella pneumoniae, E. coli

Front 322

What is the rule for recumbent position in lung disease and why?

Back 322

Good side down
-Gravity will increase perfusion to the good lung, which will maximize gas exchange, allowing for improved oxygenation, V/Q matching, and more comfortable respiration
-CI in unilateral lung disease (chance blood or pus could spill from bad to good lung)

Front 323

Disorder of granulation tissue proliferation within the small ducts and airways
Usually pts present w/ an acute illness followed by exertional dyspnea

Back 323

Idiopathic Bronchiolitis Obliterans with Organizing Pneumonia (BOOP), a.k.a. Cryptogenic organizing pneumonia

Front 324

Pt has a Hx asthma & peripheral eosinophilia, elevated IgE levels, skin reactivity to Aspergillus antigen, precipitating Abs to Aspergillus antigen
CXR: transient or fixed infiltrates, and central bronchiectasis

Back 324

Allergic Bronchopulmonary Aspergillosis (ABPA)

Front 325

Disease that typically involves the upper airways (i.e. Nasal ulcers, sinus infections), lungs, joints, kidneys, and antineutrophil cytoplasmic antibodies (c-ANCA) is positive

Back 325

Wegener's granulomatosis

Front 326

Syndrome that causes glomerulonephritis and pulmonary hemorrhage
Pt has antibodies to renal & lung alveolar basement membranes

Back 326

Goodpasture Syndrome

Front 327

In pts who have a decreased level of conscious, the tongue may fall posteriorly to obstruct the oropharynx and cause airway obstruction
What maneuver may be used to correct this

Back 327

Head tilt-chin lift maneuver

Front 328

What is the most frequent presenting clinical sign and the most common cause of pulmonary embolism

Back 328

Clinical Sign: Shortness of breath (can additionally present w/ pleuritic chest pain, hemoptysis, & tachycardia)
Cause: Deep venous thrombosis (DVT: embolus from a thrombus in the lower extremity)

Front 329

In what common setting is PE seen in?

Back 329

Prolonged immobilization, use of oral contraceptives, obesity, recent surgery, burns, severe trauma, CHF, malignancy, pregnancy, sickle cell anemia, polycythemias, inherited deficiences of anticoagulating proteins (protein C, protein S, antithrombin III), & the Leiden Factor V mutation

Front 330

How can a PE present on CXR

Back 330

-Normal
-A peripheral wedge-shaped density above the diaphragm (Hampton's hump)
-Focal oligemia (Westermark sign)
-Abrupt occlusion of a vessel (cutoff sign)

Front 331

A peripheral wedge-shaped density above the diaphragm seen in CXR in pts w/ PE

Back 331

Hampton's hump

Front 332

Sign that represents a focus of oligemia (vasoconstriction) seen distal to a pulmonary embolus (PE) on CXR

Back 332

Westermark sign

Front 333

Sign that represents an abrupt occlusion of a vessel due to PE on a CXR

Back 333

Cutoff sign

Front 334

What are diagnostic findings and diagnostic exams used for PE

Back 334

-A loud S2 is often heard in disorders that cause pulmonary HTN, such as PE
-Ventilation-Perfusion (V/Q) scan, if results are low or indeterminate probability the pt may need further studies (i.e. pulmonary arteriogram or venous ultrasonography of LE)
-Absence of D-dimer is strong evidence against thromboembolism
-Helical (spiral) CT scares (comparable to V/Q scans) may the 1st step in Dx PE

Front 335

What are the pathogens responsible for Community Acquired Pneumoina

Back 335

Streptococcus pneumoniae, Mycoplasma pneumoniae, Viruses, Chlamydia pneumonia
-In smokers even w/o documented lung disease, Haemophilus influenzae must be considered

Front 336

What changes are seen in fremitus, vocal fremitus, percussion, & auscultation in pts with pneumonia

Back 336

-Fremitus (vibrations perceived in a tactile maneuver): Increase in pts w/ consoldidation from pneumonia
-Vocal Fremitus --> bronchial breath sounds: increased
-Increased dullness to percussion
-Fine crackles may be heard

Front 337

What changes are seen in fremitus, vocal fremitus, percussion, & auscultation in pts with Atelectasis

Back 337

-Fremitus: Decreased
-Breath Sounds: Decreased
-Dullness to percussion
-Trachea is shifted to side of the atelectasis
-Limited area of egophony is heard about the atelectasis

Front 338

Where at the best areas to listen for Right Middle Lobe findings

Back 338

(1) Right anterior midclavicular line b/w 5th & 6th ribs
(2) Right midaxillary line b/w 4th & 6th ribs
-Right middle lobe is not heard posteriorly

Front 339

Inheritable disorder of dextrocardia, chronic sinusitis (w/ formation of nasal polyps) and bronchiectasis
Pt may also present w/ situs inversus
Disorder is due to a defect that causes the cilia w/in the respiratory tract epithelium to become immotile (cilia of sperm also affected)

Back 339

Kartagener Syndrome

Front 340

Disorder w/ a fixed increased resistance to pulmonary blood flow
Pulmonary fcn is usually normal, but the elevation in the pulmonary artery pressure causes a decrease in cardiac output and eventually RV failure
Pts become dyspneic & hypoxemia due to V/Q mismatch & decreased CO
PE: signs of RV hypertrophy, R- & L-sided HF, & tricuspid & pulmonic regurgitation

Back 340

Primary Pulmonary HTN (PPH)
-unknown etiology
-primarily affects women in their 30's or 40's
-mean survival is 2-3 years fro time of Dx

Front 341

What characterizes massive life-threatening hemoptysis

Back 341

>100 mL of blood in 24 hours

Front 342

What is the most common cause for non-massive hemoptysis (< 30 mL/day) in smokers & nonsmoking pts w/ normal CXR

Back 342

Bronchitis

Front 343

Characterized by excessive secretions manifested by productive cough, often purulent or bloody, for 3 months or more for 2 consecutive years in the absence of other disease to explain the symptoms
Pts are often obese and cyanotic

Back 343

Chronic Bronchitis
-Cyanotic & obese (blue bloater)
--> BBB = Bronchitis/Blue Bloater

Front 344

Chronic obstruction of airflow due to chronic bronchitis or emphysema

Back 344

COPD

Front 345

When does an exacerbation of COPD occur

Back 345

Pt develops acute onset on marked dyspnea & tachypnea requiring the use of accesory muscles that is unresponsive to medications

Front 346

Nonsmokers who present w/ COPD of the lung bases in their 50's w/o any predisposing history (i.e. occupational exposure) to supprt the Dx
-rare, seen in African-americans & Asian-Pacific islanders

Back 346

Alpha-1 anti-trypsin deficiency

Front 347

Low-grade malignant neoplasm
Resistant to radiation & chemotherapy
Pts are usually below the age of 60
Sx: hemoptysis, chronic cough, focal wheezing, and recurrent pneumonia (Due to obstruction & atelectasis)
CXR may be normal
Tumors on centrally located, bronchoscopy reveals a tumor in central airway

Back 347

Carcinoid & Bronchial gland tumors, called Bronchial adenomas

Front 348

Classic presentation of Carcinoid Syndrome

Back 348

Flushing, diarrhea, wheezing, & hypotension

Front 349

Trachea is deviating away from the side of traumatized lung
Occurs secondary to trauma or during mechanical ventilation
Breath sounds will be faint or distant
Percussion will be hyperresonant, fremitus will be decreased
Increased air on affected side is in the pleural space, not in the lung

Back 349

Tension Pneumothorax

Front 350

Disorder that affects tall, thin men & may be recurrent
Thought to be due to a rupture of subpleural blebs in response to high negative intrapleural pressures
PE: unilateral chest expansion, decreased fremitus, hyperresonance, diminished breath sounds
Pts w/ COPD, CF, PCP, & TB may have blebs & are at risk for this secondarily

Back 350

Spontaneous pneumothorax

Front 351

What characterizes the pleural effusion of rheumatoid arthritis

Back 351

Typically has a high LDL, low complement level, low glucose level, high rheumatoid factor, & characteristic cholesterol crystals
The fluid is usually greenish-yellow in color, not grossly bloody (seen w/ pulm infarction & w/ malignancy)

Front 352

What produces pleural effusions that have elevated amylase levels, and are typically left-sided

Back 352

Pancreatic & Esophageal ruptures

Front 353

How do pts with pleural effusions present

Back 353

Have bronchial breath sounds (increased fremitus) immediately above the pleural effusion
Dullness to percussion
Trachea may be shifted to the opposite side of the effusion

Front 354

Pts are usually elderly, immunocompromised, or have chronic lung disease
Air conditioners, whirlpools, water-using machinery, & cooling towers have all be linked to outbreaks
Sx: fever, relative bradycardia, abdominal complaints, scanty cough, laboratory abnormalities

Back 354

Legionnaire's disease

Front 355

Acute, self-limited, flu-like illness due to Legionella, but does not cause pneumonia

Back 355

Pontiac Fever

Front 356

Pneumonia associated with the handling of birds

Back 356

Psittacosis

Front 357

May occur days after intubation & is a sequela of the ballon cuff of the tracheal tube pressing against the tracheal wall causing necrosis & scar tissue formation
Pts are typically hoarse & dyspneic

Back 357

Tracheal Stenosis

Front 358

Acute Aspiration of gastric contents

Back 358

Mendelson syndrome

Front 359

What can develop from acute aspiration of gastric contents & what are the consequences

Back 359

The more acidic the gastric contents, the greater the degree of chemical pneumonitis, and the more extensive the desquamation of the bronchial epithelium and subsequent pulmonary edema

Front 360

If a pt aspirates while supine, what is the most likely segment of the lung to be affected?

Back 360

Posterior Segment of the Right Upper Lobe
-The right main stem bronchus is wider, shorter, & vertically placed

Front 361

What three segments are referred to as the aspiration segments of the lung?

Back 361

Posterior Segment of the Right Upper Lobe, Superior Segments of the right lower and left lower lobes (if the pt aspirates while supine)
-the basilar segments of both lungs are susceptible to aspiration if the pt aspirates while erect or sitting up

Front 362

Bilateral disease that starts at the bottom of the thorax and works upward
Pt develops pulmonary fibrosis, scarring (plaques), and calcifications, clubbing may be present
At risk for lung CA, mesothelioma, pharyngeal, gastric & colon CA
At risk prs: mining, shipbuilding, construction, insulation, automobile break repair, pipe fitting, plumbing, electrical repair, railroad engine repair; Persons handling these ppl's clothes

Back 362

Asbestosis

Front 363

Results from exposure to moldy hay containing spores

Back 363

Farmer's lung

Front 364

Causes bilateral hilar adenopathy
Pts have Hx of occupational exposure to nuclear weapons, fluorescent lights, ceramics

Back 364

Breylliosis

Front 365

CXR: Eggshell calcification of the hilar nodes
Pts who work as miners, sandblasters, stonecutters, or foundry or quarry workers are at risk for exposure to what?

Back 365

Silica

Front 366

Occurs with exposure to cotton, flax, or hemp

Back 366

Byssinosis

Front 367

What does the Apgar score reveal and what is it based on

Back 367

Tells you a great deal about newborn's respiratory effort, but have no predictive value regarding long-term outcome
A = Appearance
P = Pulse
G = Grimace
A = Activity
R = Respirations

Front 368

Systemic disease of unknown cause
Histologic Hallmark: Noncaseating granulomas
CXR: Bilateral Hilar Adenopathy
Lymphadenopathy is found in 70-90^ of all pts

Back 368

Sarcoidosis

Front 369

CXR: reveals fibrosis
Found more in males than females
Age of onset is in 50's or 60's

Back 369

Hamman-Rich Syndrome, a.k.a. Idiopathic Pulmonary Fibrosis (IPF)

Front 370

Hypersensitivity pneuomonitis due to exposure to sugar cane

Back 370

Bagassosis

Front 371

Disorder of unknown etiology that causes acute pneumonia with peripheral blood eosinophilia

Back 371

Loeffler Syndrome

Front 372

What is the most common cause of chronic cough in adults

Back 372

Postnasal drip due to sinusitis or rhinitis (allergic, vasomotor, irritant, perennial nonallergic)

Front 373

Pts often complain of having to clear their throat or a feeling of something dripping in the back of their throat
PE: reveals mucopurulent secretions and a cobblestone appearance of mucosa

Back 373

Postnasal drip

Front 374

Raspy, grating sound heard on both inspiration and expiration due to inflammed surfaces rubbing against each other

Back 374

Pleural Friction rub

Front 375

Rarely presents with an PE findings that distinguish it from other pneumonias
CXR: may reveal bilateral interstitial infiltrates
Pts are often hypoxemic
Pt Hx w/ risk factors for HIV

Back 375

Pneumocystis carinii pneumonia (PCP)

Front 376

Abrupt onset, with fever, pleuritic chest pain, and purulent sputum

Back 376

Pneumococcal pneumonia

Front 377

In yonug ,otherwise healthy pts who present with a localized pneumonia of gradual onset accompanied by dry cough and a predominance of extrapulmonary Sx (i.e. malaise, HA, diarrhea)
Pts often complain of sore throat at the beginning of the illness and a protracted course of Sx
PE is unimpressive compared to radiographic findings

Back 377

Atypical pneumonia due to Chlamydia pneumoniae or Mycoplasma pneumoniae

Front 378

Atypical pneumoniae in pts will renal & hepatic abnormalities, hyponatremia, and mental status changes

Back 378

Legionella pneumoniae

Front 379

Pts with emphysema have what pattern of breathing?

Back 379

Deep and Shallow
-There is destruction of the alveolar speta and reduced elastic recoil, which causes the collapse of the small airways and prolongs the expiratory phase of respiration
-during the prolonged expiration, pts will purse their lips to avoid collapse of small airways (causes auto-positive end-expiratory pressure)
-RR is increased by having a markedly shortened respiratory interval

Front 380

Fast and deep respirations to increase the tidal volume and combat the metabolic acidosis seen in pts with diabetic ketoacidosis

Back 380

Kussmaul respirations

Front 381

Respirations seen in pts with increased intracranial pressure
They are irregular, unpredictable periods of apnea alternating with periods of noisy hyperventilation

Back 381

Biot respirations

Front 382

A rhythmic gradually changing pattern of apnea and hyperpnea that is cardiac or neurologic in origin

Back 382

Cheynes-Stokes respirations

Front 383

Breathing characterized by a long period of inspiration or gasping with almost no expiratory phase

Back 383

Apneustic breathing

Front 384

Death from suffocation after submersion

Back 384

Drowning

Front 385

Complication of near drowning (survival after suffocation from submersion)
Result of direct pulmonary injury, loss of surfactant, and contaminants in water

Back 385

Noncardiogenic Pulmonary edema

Front 386

Three most common threats to life after submersion

Back 386

Respiratory failure, severe hypothermia, and neurologic injury

Front 387

Pts w/ severe long bone injuries are at risk for developing this
Several days after the trauma, pt develops restlessness, hypoxemia, delerium, seizures, retinal and conjunctival hemorrhages, visible fat in the retinal vessels, a petechial chest rash, bilateral interstitial infiltrates, fat globules in the urine & renal failure

Back 387

Fat Embolism Syndrome

Front 388

Increased thickness of the thorax (barrel chest)
Exerternal dyspnea
Pursed-lip breathing (learned behavior to prolong the expiration phase & prevent sudden collapse of small airways)
Asthenic body habitus since energy expenditure is in excess of caloric intake
Often hypertrophy of the accessory muscles of respiration
Breath sounds diminished, hyperresonance with percursion
Often Hx of smoking

Back 388

Emphysema

Front 389

What is the pattern of development of Emyphsema

Back 389

Begins as a centriacinar process, but eventually becomes panacinar involving both the central and peripheral tissues

Front 390

Hx of loss of consciousness due to seizure, alcoholism or illicit drug use
Pts complain of several days or weeks of malaise and fever, eventually complain of chills, cough, pleuritic chest pain, and cough productive of putrid sputum
Posterior segment of RUL & superior segments of both lower lobes are most often involved
Pts w/ poor dental hygeine are prone to developing anaerobic infections if aspiration occurs

Back 390

Lung abscesses

Front 391

Can occur due to conditions unrelated to pulm disease, (i.e. burns, transfusion, or trauma, sepsis or shock)
Due to severe & widespread inc alveolar capillary permeability 2' to injury of alveolar & capillary epithelium
Leads to accumulation of protein-rich edematous fluid w/in septal walls, followed by escape of fluid into alveolar memb where it coagulates to form hyaline memb lining the alveoli
Marked impairment of gas exchange that causes severe dyspnea, diffuse crackles, tachypnea, hypoxemia, and cyanosis (may be refractory to O2 Tx)
CXR: bilateral infiltrates

Back 391

Acute Respiratory Distress Syndrome (ARDS)

Front 392

Hemoglobin oxygen desaturation in the upright positon

Back 392

Orthodeoxia

Front 393

Supine respiration
Due to bilateral lower lobe lung disease, not cardiac disease
An upright position increases perfusion to the lower lobes and worsens V/Q mismatching
Described in pts w/ PE, bibasilar pneumonia, & diseases w/ bibasilar AV shunting (i.e. cirrhosis & Osler-Weber-Rendu disease)

Back 393

Platypnea

Front 394

Due to either cardiac or pulm disease
the upright position decreases venous return to the heart and effectively reduces lung congestion

Back 394

Orthopnea

Front 395

When the abdomen collapses in inspiration instead of rising
Sign of respiratory muscle weakness and fatigue

Back 395

Abdominal paradox

Front 396

Airway disease characterized by a hyperreactive tracheobronchial tree that manifests physiologically as narrowing of the airway passage
Sx: Dyspnea, cough, wheezing
Attacks are episodic & nocturnal, often follow exposure to specific allergens, exertion, viral infection, or emotional excitation
Expiration becomes prolonged & pt develops tachycardia & mild systolic HTN

Back 396

Asthma

Front 397

What is the classic triad of Sx in asthma?

Back 397

Dyspnea, cough, wheezing

Front 398

How is the wheezing of asthma described

Back 398

Described as whistling and is typically heard in both inspiration and expiration

Front 399

If asthma attack is severe enoguh
An inspiratory drop in systolic BP more than 10 mmHg

Back 399

Pulus Paradoxus

Front 400

Present w/ fever, drooling, and dysphagia
Lung examination is normal

Back 400

Epiglottitis

Front 401

Present with labored breathing and stridor
Use accessory muscles to assist w/ breathin

Back 401

Croup or laryngotracheobronchitis

Front 402

What do all pts with a positive PPD receive

Back 402

Isoniazid chemoprophylaxis

Front 403

What can cause a false positive PPD

Back 403

Nontuberculosis mycobacterium

Front 404

What is the area b/w the pleural sac

Back 404

Mediastinum
-Anterior mediastinum
-Middle mediastinum
-Posterior mediastinum

Front 405

What are the most common masses found in the anteroir mediastinum

Back 405

4 T's
-Thyomas
-Teratomas
-Thyroid masses
-paraThyroid masses

Lymphomas may also be found here

Front 406

What are the most common masses found in the middle mediastinum

Back 406

Enlarged lymph nodes
Lymphomas
Vascular Masses
Pleuropericardial cysts
Bronchogenic cysts

Front 407

are the most common masses found in the posteroir mediastinum

Back 407

Neurogenic tumors
Lymphomas
Pheochromocytomas
Myelomas
Meningoceles
Meningomyeloceles
Gastroenteric cysts
Diverticula

Front 408

Congenital, hereditary malformation characterized by depression of the sternum below the clavicular-manubrial jcn with symmetric inward bending of the costal cartilages
May affect pulm and heart fcn

Back 408

Pectus Excavatum or funnel breast

Front 409

Deformity where the sternum protrudes from the narrow thorax

Back 409

Pectus carinatum or pigeon breast

Front 410

Posterior deviation of the spine

Back 410

Kyphosis

Front 411

Laterial deviation of the spine

Back 411

Scoliosis

Front 412

Exaggerated convex curvature of the lumbar spine

Back 412

Lordosis

Front 413

Present complaining of disruptive snoring and daytime hypersomnolence
Obesity is a risk factor
Pts have upper airway narrowing from enlarged soft tissues and good respiratory effort occurs against the airway obstruction

Back 413

Obstructive Sleep Apnea Syndrome (OSAS)

Front 414

Dx is best made by overnight polysomnography to document apneic periods (10 to 15 events per hour of sleep, each event > 10 s duration)

Back 414

Obstructive Sleep Apnea Syndrome (OSAS)

Front 415

How does obesity effect the respiratory system

Back 415

Obesity represents a mechanical load to the respiratory system, since excess weight reduces chest wall compliance

Front 416

Pt deomonstrate a dec in central respiratory drive (no respiratory effort), esp during sleep (sleep-induced hypoventilation), since vital capacity is further reduced in the recumbant position

Back 416

Obesity Hypoventilation Syndrome

Front 417

Excessive daytime sleepiness assoc w/ abnormalities in REM sleep
Attacks are brief and may occur during sedentary periods when pt is driving, eating, or conversing

Back 417

Narcolepsy

Front 418

Occurs when strong emotion (i.e. laughing or crying) precipitates sudden loss of muscle tone

Back 418

Cataplexy

Front 419

Sleepwalking

Back 419

Somnambulism

Front 420

The pericardium is a double-walled sac that protects the heart, inflammation and roughening of the sac may result in the formation of?

Back 420

Pericardial rub

Front 421

What does the sound of a Pericardial rub represent and where is is best heard

Back 421

This sound represents heart movement against the inflammed pericardium (pericarditis)
The scratchy nature of the triphasic sound represent systole and diastrole of the ventricle and atrial systole
Best heard w/ the diaphragm of the stethoscope placed over the left lower sternal border with the pt leaning forward

Front 422

What does ECG in pericarditis look like?

Back 422

ST elevation and PR depression early and T wave inversion later
Tx: anti-inflammatory agents

Front 423

S1 consists of

Back 423

Mitral valve closure followed by tricuspid valve closure
-Splitting of S1 is selfom heard, b/c in most cases the valves close together and make a single sound

Front 424

When right ventricular contraction is delayed, as in the cause of right bundle branch block (RBBB), closure of the tricupsid valve occurs long after the mitral valve has closed, what is heard?

Back 424

Splitting of S1

Front 425

Innocent murmurs that occur in 25% of young adults
Caused by flow through the internal jugular vein
Heard best in sitting position and disappear lying down, w/ Valsalve maneuver or w/ compression of the IL jugular vein

Back 425

Venous Hums

Front 426

Often confused w/ venous hums
Seen w/ anemia, pregnancy, and hyperthyroidism
Usually heard in systole

Back 426

Carotid Bruits

Front 427

Murmur that transmits to the neck and are used accompanied by a precordial murmur

Back 427

Systolic heart murmur

Front 428

Late systolic murmur preceded by a midsystolic click that increases with standing
Dx in 10% of all healthy women, many are thin, and some have a minor chest wall abnormalies
Most have benign course and complications are rare

Back 428

Mitral Valve Prolapse

Front 429

Serious complication of mitral valve prolapse in pts w/ thickened leaflets often due to rupture of the chordae tendiae

Back 429

Mitral regurgitation

Front 430

Mitral regurgitation, endocarditis (require prophylactic ABX), supraventricular arrhythmias, and sudden death due to ventricular arrhythmias (rare) are all complications of

Back 430

Mitral valve prolapse

Front 431

Occurs when an atherosclerotic plaque ruptures or ulcerates
Pts are typically anxious, restless, and uncomfortable secondary to the extreme pain
May be demonstrating the Levine sign
Risk Factors: male gender, (+) FHx, HTN, DM, tobacco use, hyperlipidemia
ECG shows ST elevations
Cardiac enzymes (troponin, CPK-MB fraction, LDH) are elevated

Back 431

Myocardial infarction

Front 432

Sign that represent clenching of the fist over sternum to demonstrate severity of pain

Back 432

Levine sign

Front 433

Recurrent attacks of chest pain at rest on while asleep (unstable angina) due to focal spasm of epicardial coronary artery
Dx is confirmed by detecting the spasm after provocation during coronery arteriography

Back 433

Prinzmetal's angina

Front 434

Complication of inferioposterior MI
Pts present w/ JVD, Kussmaul sign, and hypotension
Dx is made by right-sided EKG in which leads are placed to the right of the sternum instead of the left

Back 434

RV infarction

Front 435

Sign that
The increased venous return of inspiration increases muumurs to the right sides of the heart (vs expiration, inc murmurs to left side of heart)
-manuever where the pt is sucking in with the nares held closed)

Back 435

Muller manuever

Front 436

Holosystolic murmur heard best at the left lower sternal border that increases with inspiration
Pts have distended neck veins, prominent v waves, hepatomegaly, pulsatile liver, edema, postive hepatojugular reflex

Back 436

Tricuspid Regurgitation

Front 437

Reflex that represents pressure applied to the liver causes increased distension of the neck veins

Back 437

Postive hepatojugular reflex

Front 438

IV drug users at risk
Due to S. aureus colonization on tricuspid valve
Splinter hemorrhages (subungal streaks), Roth Spots, Osler nodes, Janeway lesions, clubing, splenomegaly

Back 438

Bacterial Endocarditis

Front 439

Tender nodules on finger or toe pads

Back 439

Osler nodes

Front 440

Oval retinal hemorrhage w/ pale center

Back 440

Roth Spot

Front 441

Small hemorrhages on the palms and soles

Back 441

Janeway lesions

Front 442

Predisposing factors for Endocarditis

Back 442

Rheumatic heart disease
Mitral valve prolapse
IV drug abuse

Front 443

What is the most common organism causing bacterial endocarditis and was is the valve that is commonly involved

Back 443

Streptococcus viridans
Mitral valve

Front 444

Often referred to as an S7
Due to tachycardia reducing diastole, thus leading to fusions of S3 and S4 into a loud S7
May be heard in fluid overload states

Back 444

Summation Gallop

Front 445

Characterized by the presence of oth S3 & S4, each seperately audible

Back 445

Quadruple rhythm

Front 446

In what pathologies can subcutaneous nodules be seen

Back 446

Rheumatic fever
Gout
Rheumatoid Arthritis
Syphilis

Front 447

Due to group A streptococci
Often presents w/ migratory polyarthritis
Pt have Hx of sore throat weeks to presentation
Dx using Jones minor and Jones major (requires demonstration of previous streptococcal infection & either 2 major or 1 major & 2 minor critera)
Aschoff bodies

Back 447

Rhematic Fever

Front 448

Jones minor criteria for Rhematic Fever

Back 448

Minor (FEAR)
-Fever
-prolonged PR interval on Electrocardiogram
-Arthralgia
-blood results indicating an elevated acute phase Reactant

Major (CASES)
-Carditis
-migratory polyArthritis
-Syndenham's chorea
-Erythema marginatum
-Subcutaneous nodules

Front 449

Characteristic rash of Lyme disease

Back 449

Erythema migrans

Front 450

Whenever the pulse is found to be irregularly irregular this is almost always the Dx
Common dysrhythmia that can occur in normal ppl, esp during emotional stress, after surgery or exercise, in pts who have hyperthyroidism, in pts w/ underlying heart disease, or following an alcoholic binge
Also seen in CV disease, rheumatic HD, MV disease, cardiomyopathy, ASD, thyroid disease, PE, chronic lun disease

Back 450

Atrial Fibrillation

Front 451

Atrial Fibrillation following an alcoholic binge

Back 451

Holiday Heart Syndrome

Front 452

Formation of mural thrombi, which may embolize to cerebral vessels causing stroke or transient ischemic attacks

Back 452

Major complication of Atrial Fibrillation

Front 453

Double wave pulse
Seen in AI and in hypertrophic cardiomyopathy (HCM)
In HCM the first wave or percussion wave is due to the rapid flow rate of initial contraction, and the second wave or tidal wave is due to the slower rate of continued contraction

Back 453

Pulsus bisferiens

Front 454

Head bobbing with heartbeat

Back 454

de Musset sign
(assoc sign of AI)

Front 455

Rapidly rising pulse

Back 455

Water-hammer pulse
(assoc sign of AI)

Front 456

Collapsing pulse that follows rising pulse

Back 456

Corrigan pulse
(assoc sign of AI)

Front 457

an increase of > 20 mmHg in femoral artery systolic BP compared to brachial artery BP

Back 457

Hill Sign
(assoc sign of AI)

Front 458

Blanching of the root of the nail when pressure is applied to the tip

Back 458

Quincke Pulse
(assoc sign of AI)

Front 459

Booming sound heard over the femoral arteries

Back 459

Pistol Shots
(assoc sign of AI)

Front 460

Pts have a wide pulse pressure & a rumbling bruit, Austin Flint murmur
Pulsus bisferiens, de Musset sign, Water-hammer pulse, Corrigan pulse, Hill Sign, Quincke Pulse, capillary pulsations, pistol shots, Duroziez sign are all associated signs of this pathology due to increased stroke volume

Back 460

Aortic Insufficiency

Front 461

Bruit auscultated over the femoral artery when compressed

Back 461

Duroziez sign
(assoc sign of AI)

Front 462

From aortic regurgitant flow displacing the mitral valve

Back 462

Austin Flint murmur

Front 463

Dissecting aorta, Marfan Syndrome, Bicuspid Aortic valve, Rheumatic Heart Disease, Ankylosing spondylitis, Endocarditis, Syphilus are all possible etiologies of what patholgy

Back 463

Aortic Insufficiency

Front 464

Two palpable pulses, but one is in systole and the other is in diastole

Back 464

Dicrotic pulse

Front 465

An alteration in pulse amplitude that follows a ventricular premature beat

Back 465

Pulsus bigeminus

Front 466

Regular alternating pulse amplitude due to alternating LV contractile force
Usually seen with severe LV decompensation and cardiac tamponade

Back 466

Pulsus alternans

Front 467

Represents a delayed systolic peak due to obstruction to LV ejection
Seen in aortic stenosis

Back 467

Pulsus parvus et tardus (small and slow rising)

Front 468

Inability of the ventricle to contract normally (hypodynamic)

Back 468

Systolic Dysfunction

Front 469

Pts (esp older pts) w/ HTN & DM are predisposed to this pathology
Inability of the ventricles to relax for filling and typically have an S4 gallop, elevated filling pressures, and a hyperdynamic (ejection fraction > 50%) ventricle

Back 469

Diastolic Dysfunction

Front 470

Pts present with pulmonary congestion (i.e. crackles)

Back 470

Left heart Failure

Front 471

Pt present with JVD, an S3 gallop, hepatomegaly, ascites, and peripheral edema

Back 471

Right Heart Failure

Front 472

Benign tumors of the heart that may embolize systemically
Pts present w/ fever, malaise, weight loss, leukocytosis, and emboli
If tumor is large signs of low cardiac output may result
Tumor plop is hallmark sound

Back 472

Atrial Myxomas

Front 473

Hallmark sound of atrial myxomas, it is a diastolic sound that is variable from cycle to cycle (related to the motion of the tuomr)
It represents the diastolic prolapse of the myxoma through an opened mitral or tricuspid valve

Back 473

Tumor plop

Front 474

Characterized by an opening snap just prior to a low-pitched rumbling diastolic murmur
(mid-to-late diastolic murmur best heard at the apex, immediately preceeding the murmur is a loud extra sound)

Back 474

Mitral Stenosis

Front 475

Characterized by a high-pitched diastolic murmur

Back 475

Aortic Regurgitation

Front 476

Consists of a midsystolic click with a late diastolic murmur

Back 476

MVP

Front 477

Characterized by a systolic murmure

Back 477

ASD

Front 478

What causes murmurs & how are they graded

Back 478

Caused by turbulent blood flow
Graded using the Levine scale and are based on intensity from grades 1 to 6:
Grade 1: Faint and just audible
Grade 2: Quiet but audible w/ a stethoscope
Grade 3: not loud but are easily heard & should not be missed
Grade 4: Loud w/ a palpable thrill
Grade 5: very load & can be heart with the chest piece tilted
Grade 6: Heard w/ stethoscope off the chest

Front 479

Narrowing of the aorta usually just distal to the origin of the ductus arteriosus and subclavian artery
Pt may complain of epistaxis, HA, cold peripheral extremities, and claudication
Absent, delayed, or markedly diminished femoral pulses also may be found
The lower arterial pressure in the legs in the face of HTN in the arm is also a clue
CXR: Rib notching secondary to dilated collateral arteries

Back 479

Coarctation of the Aorta

Front 480

Associated w/ a loud, continuous murmur

Back 480

PDA

Front 481

Consists of VSD, pulmonic stenosis, dextroposition of the aorta, and right ventricular hypertrophy

Back 481

Tetralogy of Fallot

Front 482

An early mid-diastolic sound due to constrictive pericarditis

Back 482

Pericardial knock

Front 483

Pericardinal knock
CT or MRI show thickened pericardium
Tx is pericardiectomy
May be idiopathic, or due to TB, mediastinal irradiation or cardiac surgery

Back 483

Constrictive Pericarditis

Front 484

Least common form of cardiomyopathy
Potential etiologies include sarcoidosis, amyloidosis, and hemochromatosis
Often pts presents with other signs of systemic illness

Back 484

Restrictive Cardiomyopathy

Front 485

Inspiratory distension of the neck veins
-Inspiration normally generates a negative intrapleural pressure, which sucks blood into the heart, when there is an impairment in right heart filling and blood cannot enter the heart, it causes venous pressure to rise
--> in these pts inspiration will cause a paradoxical rise in venous pressure

Back 485

Kussmaul sign (never seen in uncomplicated pure cardiac tamponade)

Front 486

What pathologies is the Kussmaul sign present in

Back 486

Right ventricular infarction, Right heart failure, Constrictive pericarditis, Superior Vena cava syndrome, Tricuspid stenosis

Front 487

30% of inferior wall infarctions
Pts present with hypotension and raised venous pressure (Kussmaul sign)

Back 487

Right ventricular infarction

Front 488

Pts may asymptomatic or may complain of dyspnea, palpitations, and exercise intolerance
The pulse pressure is usually widened and pulses are bounding due to the runoff blood through the ductus
Continuous machinery murmur is best heart in the 1st & 2nd ICS below the left clavicle

Back 488

PDA

Front 489

Continuous murmur due to increased blood flow in the internal jugular vein
Disappears with compression of the vein

Back 489

Cervical Venous Hum

Front 490

Continuous murmur that disappears with compression of epigastrium

Back 490

Hepatic venous hum

Front 491

Continuous murmur heard over the breast due to increased blood flow in pregnancy

Back 491

Mammary souffle

Front 492

Ventricular tap (a.k.a. Lift or Heave) should be palpated for at the left parasternal border at the 3rd, 4th, and 5th ICS
Nondiagnostic finding, and results from any etiology of?

Back 492

Right Ventricular Hypertropy

Front 493

A heave that is palpavle at the apex is consistent with

Back 493

LVH

Front 494

A palpable murmur that may accompany heart disease
Considered always pathologic and may be felt during systole (i.e. AS, VSD, MR, PDA, Tetralogy of Fallot) or Diastole (i.e AI, MS)
Its presence characterizes a murmur of at least a grade 4 in intensity

Back 494

Precordial thrill

Front 495

Occurs when the intima is interrupted so that blood enters the wall of the aorta and separates its layers, forming a second lumen
Almost always fatal if left undiagonised
Anything that weakens the media can lead to it, but HTN is the most common risk factor
Major cause of morbidity in Marfan Syndrome

Back 495

Dissection of the Aorta

Front 496

What are the possible etiologies of Dissection of the Aorta and what is the treatment

Back 496

Marfan Syndrome, Cystic medial necrosis (described in pts w/ bicuspid aortic valves), Syphilus, Ehlers-Fanlos syndrome, trauma, bacterial infections
Tx: control the BP and HR to prevent extention of the disseection

Front 497

When is a tracheal tug considered positive

Back 497

If the pulsating aorta is felt when the trachea is pulled forward

Front 498

Exaggerated a waves
Due to the right atrium contracting against increased resistance (PS, TS, complete heart blocks)

Back 498

Cannon waves

Front 499

The activity of the right side of the heart is normally transmitted through?

Back 499

The jugular vein as a visualized pulse

Front 500

Wave that is due to venous distension caused by atrial contraction
The most dominant wave, esp during inspiration
It is not present during atrial fibrillation

Back 500

a wave

Front 501

wave of the venous pressure curve that occurs as a result of ventricular contraction, which forces the tricuspid valve (TV) back toward the atrium
It is simultaneous with the carotid pulse
It TV is imcompetent this wave will be increased

Back 501

c wave

Front 502

wave that is the result of atrial filling while the AV valves are closed
It becomes large with TR

Back 502

v wave

Front 503

downward slope that is caused by atrial filling

Back 503

x slope

Front 504

slope that is caused by the opening TV and the rapid filling of the ventricle
It is abolished in cardiac tamponade

Back 504

y slope

Front 505

Squatting to standing and the Valsalva maneuver both decrease RV filling and decrease venous return (b/c of pooling of blood in the lower extremities caused by gravity), thereby increasing the murmurs of?

Back 505

Hypertrophic Cardiomyopathy (HCM) and MVP
-Standing decreases all other murmurs

Front 506

MR murmurs are increased by?

Back 506

Hand grip or squatting (increases systemic vascular resistance)

Front 507

Right sided heart murmurs are increased by

Back 507

Inspiration

Front 508

Accumulation of fluid in the pericardial sac in amounts sufficient to cause obstruction of blood flow back to the heart
Classic Signs: Pulsus alternans, pulsus paradoxus, JVD, distant heart sounds
May also present w/ hypotension
ECG shows low voltage & pulsus alternans
CXR: cardiac shadow
it may follow trauma or surgery, may be a complication of malignancy (i.e. lung, breast, lymphoma), chronic renal failure, or hypothyroidism

Back 508

Cardiac tamponade

Front 509

In what pathologies can Pulsus Paradoxus be seen

Back 509

Cardiac tamponade, Asthma, Constrictive Pericarditis

Front 510

Usually due to atherosclerosis, and >90% originate below the renal arteries
Are typically asymptomatic until they rupture
Pts may complain of lower back or hypogastric pain
May be associated with emboli to the feet & kidney
Can enlarge diameter of aorta to > 4.5 cm

Back 510

Abdominal Aortic Aneurysm

Front 511

An automimmunr complication of MI
It occurs 3 days to 6 weeks after the infarction & usually responds w/ salicylates
Sx: Fever, pericarditis, leukocytosis, elevated ESR, pleural effusion

Back 511

Post-MI Syndrome or Dressler Syndrome

Front 512

What are the two ways that inspiration can normally increase the split of S2

Back 512

(1) There is delayed pulmonic valve closyre which is due to prolonged RV ejection time from inc SV
(2) Inspiration inc the compliance of the pulm vasculatur & thereby dec the return of blood to the left heart & shortens its ejection time

Front 513

Short systolic murmur that peaks early in systole with S2 normal in intensity
Found in 65% of pts > 65 yo
Approx 25% progress to signif aorotic stenosis

Back 513

Aortic Sclerosis

Front 514

Acute illness of uncertain etiology that affects young M > F, asians high risk
Present with fever, conjunctival injection, cervical lymphadenopathy, rash, edema
Cardiac Involvement: MI, aneurysm, generalized vasculitis of small vessels of the heart
Dx and Tx

Back 514

Dx: Kawasaki disease (mucocutaneous lymph node syndrome)
Tx: Gamma globulin (steroids may worsen aneurysm dilatation)

Front 515

Mumur that is generated by flow abnormalities (systolic ejection), not structural heart abnormalities
> 50% of children
> 50% of pts > 50 yo

Back 515

Functional or innocent murmurs

Front 516

What sign represents a palable brachial or radial artery when the cuff is inflated above systolic pressure

Back 516

Olser's sign

Front 517

What does Olser's sign indicate

Back 517

Older pts may have noncompressible vessels & falsely elevated BP readings by sphygmomanometry and it may be necessary to measure intraarterial pressure

Front 518

Occurs in both inspiration and expiration
Delayed closure of the pulmonic valve due to a right bundle branch block, pulmonic stenosis, or mitral regurgitation causes this type of splitting

Back 518

Wide splitting of S2

Front 519

Splitting that is unaffected by respiration
Due to ASD or a VSD with right-to-left shunting

Back 519

Fixed Splitting of S2

Front 520

Splitting that is caused by anything that delays A2 or speeds up P2 to the point where P2 occurs prior to A2
Expiration prolongs the LV ejection and shortens RV ejection
Caused by left bundle branch block and aortic stenosis, both of which prolong LV outflow

Back 520

Paradoxical (reverse) Splitting of S2

Front 521

What conditions are associated with a widened pulse pressure

Back 521

Associated with a high stroke volume
-AI, PDA, Fever, Pregnancy, Hyperthyroidism, Beriberi, Anemia, Paget's disease

Front 522

What conditions are associated with a narrowed pulse pressure

Back 522

Associated with Low Stroke Volume
-Pericardial tamponade, Constrictive Pericarditis, AS, Tachycardia

Front 523

Present with Sx of angina, syncope, dyspnea, or CHF
Etiologies: Rheumatic Fever and Congenital Bicuspid Valve
Murmur: Crescendo-decrescendo systolic murmur heard best at the 2nd left ICS that radiates to the carotid a., soft S2 heart sound
PE: normal BP w/ narrowed pulse pressure

Back 523

AS

Front 524

Most common cause of suffent cardiac death in young adults
Pts may be asymptomatic and over half have a (+) FHx of sudden death
PE: rapid, brisk carotid upstroke
Murmur: holosystolic murmur heard best at left sternal border, inc w/ Valsalve maneuver

Back 524

Hypertrophic Obstructive Cardiomyopathy

Front 525

Two defects that both may cause a left-to-right shunt which may lead to pulmonary HTN and pulmonary obstruction (Eisenmenger Syndrome)

Back 525

ASD (common anomaly in adults) and VSD (anomaly or complication from MI)

Front 526

Heart Exam:
-S2 is widely split and does not change with respiration
-Crescendo-decrescendo systolic murumur heard best in the left 2nd ICS

Back 526

ASD

Front 527

Finding of abruptly arresting inspiration with palpation of the right upper quandrant
Sign & Dx

Back 527

Sign: Murphy's Sign
-Liver & gallbladder move inferiorly as the gallbladder contracts on deep inspiration, & inferior movement of the diaphragm causes the inflamed gallbladded to become compressed against the inverted wall
Dx: Cholecystitis

Front 528

An automimmunr complication of MI
It occurs 3 days to 6 weeks after the infarction & usually responds w/ salicylates
Sx: Fever, pericarditis, leukocytosis, elevated ESR, pleural effusion

Back 528

Post-MI Syndrome or Dressler Syndrome

Front 529

What are the two ways that inspiration can normally increase the split of S2

Back 529

(1) There is delayed pulmonic valve closyre which is due to prolonged RV ejection time from inc SV
(2) Inspiration inc the compliance of the pulm vasculatur & thereby dec the return of blood to the left heart & shortens its ejection time

Front 530

Short systolic murmur that peaks early in systole with S2 normal in intensity
Found in 65% of pts > 65 yo
Approx 25% progress to signif aorotic stenosis

Back 530

Aortic Sclerosis

Front 531

Acute illness of uncertain etiology that affects young M > F, asians high risk
Present with fever, conjunctival injection, cervical lymphadenopathy, rash, edema
Cardiac Involvement: MI, aneurysm, generalized vasculitis of small vessels of the heart
Dx and Tx

Back 531

Dx: Kawasaki disease (mucocutaneous lymph node syndrome)
Tx: Gamma globulin (steroids may worsen aneurysm dilatation)

Front 532

Mumur that is generated by flow abnormalities (systolic ejection), not structural heart abnormalities
> 50% of children
> 50% of pts > 50 yo

Back 532

Functional or innocent murmurs

Front 533

What sign represents a palable brachial or radial artery when the cuff is inflated above systolic pressure

Back 533

Olser's sign

Front 534

What does Olser's sign indicate

Back 534

Older pts may have noncompressible vessels & falsely elevated BP readings by sphygmomanometry and it may be necessary to measure intraarterial pressure

Front 535

Finding of abruptly arresting inspiration with palpation of RUQ
Sign and Dx

Back 535

Murphy's sign
-Liver & GB move inferiorly as the diaphragm contracts on deep inspiration, the inferior movement of the diaphragm causes the inflammed GB to become compressed against the inverted wall
Dx: Cholecystitis

Front 536

What are the risk factors for Cholecystitis?

Back 536

4 F’s:
-Fat
-Forty
-Female
-Fertile

Also diabetes, (+) FHx, Oral contraceptives

Front 537

What is the most sensitive test for detecting gallstones?

Back 537

HIDA: 98% sensitive, 81% specific, it shows obstruction of the cystic duct
-Plain films detects gallstones in 15% of cases
-Abdominal US has a sensitivity of 67% and a specficity of 82%

Front 538

Intense pain in the LUQ that radiates to the top of the left should, due to diaphragmatic irritation by blood from a ruptured spleen

Back 538

Kehr Sign
-Spinal levels supplying most of the sensory fibers in the diaphragm, C3-C5, and phrenic nerve are at the same levels of sensory supply to the should

Front 539

Positive Kehr sign
Blood loss causes Shock, including hypotension and orthostatic changes

Back 539

ruptured spleen

Front 540

Metastatic nodule of the umbilicus

Back 540

Sister Mary Joseph Nodule

Front 541

B/c of its vascular and embryolic connects, the umbilicus is susceptible to metastatic disease, what are the primary sites of umbilical metastasis?

Back 541

Stomach, Ovary, Colon, Rectum, Pancreas (in descending order)

Front 542

Abdomen that appears hollow or concave
-Implies malnourishment or is seen normally in really thin patients

Back 542

Scaphoid Abdomen
-Normal boatlike appearance: Costal margins, Anterior iliac spines, and pubis represent the sides of the boat, while the bottom is represented y the abdominal wall, which appears sunken in the supine pt in response to gravity

Front 543

Complications of Pancreatitis

Back 543

Necrotizing pancreatitis
Pseudocyst abdomem
Phlegmon

Front 544

Sign that represents periumbilical discoloration suggesting a hemoperitoneum

Back 544

Cullen Sign

Front 545

Sign that represents discoloration of the flanks

Back 545

Turner Sign

Front 546

When the pt experiences pain as the hands of the examiner are abruptly withdrawn from the abdomen

Back 546

Rebound tenderness
-Sign that represents peritonitis
--> decreased bowel sounds are another sign of peritonitis

Front 547

Risk factors for acute pancreatitis

Back 547

Alcohol use, trauma, hyperlipidemia, gallstones, and medications

Front 548

Abdominal x-ray shows sentinel loop and colon cutoff sign

Back 548

acute pancreatitis

Front 549

Air-filled small intestine in the LUQ on abdominal x-ray represents

Back 549

sentinel loop
-can be seen in acute pancreatitis

Front 550

Air in the transverse colon on abdominal x-ray represents

Back 550

colon cutoff sign
-can be seen in acute pancreatitis

Front 551

Pt presents with bouts of abdominal pains and signs of pancreatic insufficiency (weight loss, steatorrhea, and diabetes)
Abdominal x-ray: calcifications in the pancreas

Back 551

Chronic Pancreatitis

Front 552

What abdominal x-ray finding is pathognomonic of Chronic Pancreatitis

Back 552

Calcifications in the pancreas

Front 553

What are the etiologies for Small Bowel Obstruction

Back 553

Adhesions (past abdominal surgeries)
Incarcerated Hernia
Stricture
Malignancy

Front 554

What are physical findings when air is under pressure in the viscera and intestinal fluid is present (i.e. obstruction)
What will the abdominal radiographs revel in this situation

Back 554

High pitched bowel sounds (peristaltic rushes)
Tympany with percussion
X-rays may reveal dilated loops of bowel in a ladder-like pattern and air-fluid levels

Front 555

Hallmarks of intestinal obstruction

Back 555

Abdominal pain, distension, vomiting, and obstipation

Front 556

What are the etiologies for Large Bowel Obstruction

Back 556

Malignancy
Diverticulitis
Volvulus

Front 557

Causes of abdominal distension (mnemonic)

Back 557

Six F's
Fat
Fluid
Food
Fetus
Feces
Flatus

Front 558

What are the three collateral venous circulations that may be seen in the abdominal wall

Back 558

Obstruction of the Inferior Vena Cava (veins that drain upward)
Obstruction of the Superior Vena Cave (veins w/ flow directed downward)
Obstruction of the Portal System (development of periumbilical veins that drain both upward & downward)

Front 559

How can the flow of collateral veins be demonstrated

Back 559

By placing the two index fingers over the engorged vein, then sliding the fingers apart leaving a stretch of empty vein b/w the fingers
Refilling direction can be ID'd by releasing first the caudal end & then the cephalad end

Front 560

Sign the represents a positive area of hyperesthesia over the right costophrenic angle

Back 560

Boas Sign

Front 561

What does an audible rub of the edge of the GB indicate

Back 561

A sign of acute cholecystitis

Front 562

Enlarged nontender GB in a pt w/ painless jaundice
Dx and Cause

Back 562

Dx: Courvoiseier's GB
Cause: not due to cholecystitis but to CA of the biliary tract or head of the pancreas

Front 563

Guarding, rigidity, absent or diminished bowel sounds, rebound and referred tenderness, and pt lying perfectly still
Dx and Tests

Back 563

Dx: Peritonitis
Tests: Plain film of abdomen might show free peritoneal air under the diaphragm (75% of pts) with perforated ulcer

Front 564

An acute inflammatory process caused by bacteria in an outpouching of the mucosa or submucosa
-Usually left-sided sinced the diameter of the sigmoid colon is the smallests of the colon (higher wall tension and intraluminal pressure)

Back 564

Diverticulitis
-may occur in 50% of pts w/ diverticulosis

Front 565

Complications of Diverticular disease

Back 565

Diverticulitis and GI bleeding

Front 566

Tenderness upon abrupt withdrawl of the hand in a location away from the area of tenderness
-pt experiences pain in the area of stated tenderness rather than the site where the test is performed

Back 566

Referred Rebound Test

Front 567

Sign the represents when palpation of the LLQ causes pain in the RLQ

Back 567

Rovsing sign

Front 568

A maneuver to detect peritoneal irritation, it is tested by the heel jar test
-pt stands one his or her toes, then allows heels to hit hit the floor, thus jarring the body and causing abdominal pain in peritonitis

Back 568

Markel Sign

Front 569

Sign the represents when pain is occuring when the bent leg is rotated laterally and medially

Back 569

Obturator sign

Front 570

Sign the represents when the ot tries to raise the leg up against the hand of the examiner pushing down against the leg above the knee

Back 570

Iliopsoas sign

Front 571

Rovsing sign, Markel Sign, Obturator sign, Iliopsoas sign are all seen in

Back 571

Appendicitis
-may also have pain on rectal examination if posterior appendix is involved

Front 572

Sign the represents a palpable nontender gallbladder, which suggests neoplasm

Back 572

Courvoisier sign

Front 573

Sign the represents the absence of bowel sounds in the RLQ due to intussusception

Back 573

Dance Sign

Front 574

The point in the abdomen that overlies the anatomic position of the appendix & is the site of max tenderness in pts w/ appendicitis
-located 1.5-2 in from the anterior spinous process of the inleium on a straight line drawn from the process to the umbilicus

Back 574

McBurney's point

Front 575

Clinical manifestations range from mild chronic Sx to acute catastrophic event causing rectal bleeding, peritonitis and shock
Sx: Postprandial pain, Anorexia from fear of eating, Weight loss
Typically intermittant, occurs 30 min after eating & persists up to 3 hr
Dx, Tests, and Tx

Back 575

Dx: Intestinal ischemia (a.k.a. abdominal angina)
Tests: Angiography
Tx: Embolectomy or surgery

Front 576

Mild intestinal ischemia is characterized by a triad of Sx

Back 576

Postprandial pain
Anorexia from fear of eating
Weight loss

Front 577

A nonrhythmic, asymmetric lapse in a sustain position of an extremity
-nonspecific for cirrhosis and may be seen in other metabolic derangements (i.e. renal disease & metabolic acidosis)

Back 577

Asterixis (a.k.a. Liver flap or flapping tremor)

Front 578

Must odor of the breath and urine due to mercaptans and is part of hepatic encephalopathy

Back 578

Fetor hepaticus

Front 579

Dilated abdominal veins (i.e. reopened umbilical veins) seen in pts w/ portal HTN

Back 579

Caput Medusae

Front 580

Stage of hepatic encephalopathy characterized by:
Euphoria/Depression, mild confusion, slurred speech, disordered speech, +/- asterixis

Back 580

Stage 1

Front 581

Stage of hepatic encephalopathy characterized by:
Lethargy, moderate confusion, + asterixis

Back 581

Stage 2

Front 582

Stage of hepatic encephalopathy characterized by:
Marked confusion, incoherent speech, sleeping but arousable, + asterixis

Back 582

Stage 3

Front 583

Stage of hepatic encephalopathy characterized by:
Comatose, - asterixis

Back 583

Stage 4

Front 584

Longitudinal tears in the mucosa of G-E jcn due to prolonged violent retching or vomiting

Back 584

Mallory-Weiss Tears

Front 585

Transmural tear of the esophagus that causes gastric contents to escape into the mediastinum

Back 585

Boerhaave Syndrome

Front 586

Rupture of an aberrently large artery in the submucosa of either the stomach or duodenum
Rare lesion that is often missed at endoscopy
Cause of bleeding is related to pressure necrosis of the epithelium overlying the lesion

Back 586

Dieulafoy lesion

Front 587

Most common presenting Sx in infectious esophagitis

Back 587

Odynophagia (painful swallowing)

Front 588

Premalignant lesions for adenocarcinoma of the esophagus
Replacement of the squamous epithelium by columnar epithelium and may result in esophagitis

Back 588

Barrett's Esophagus

Front 589

Failure of the lower esophageal sphincter to relax (motor disorder of smooth muscle)
Pts complain of dysphagia (difficult swallowing) to liquids & solids

Back 589

Achalasia

Front 590

Middle-age women
Present with dysphagia and iron-deficiency anemia

Back 590

Plummer-Vinson syndrome (hypopharyngeal web)

Front 591

Weblike constriction near the lower esophageal sphincter that produces dysphagia to solids

Back 591

Schatzki ring

Front 592

What is the first step in the workup of dysphagia

Back 592

Barium swallow

Front 593

Uniform throughout the liver
Nodules are less than 1 mm in size
Due to metabolic insult such as alcohol use

Back 593

Micronodular Cirrhosis (Laennec's Cirrhosis)

Front 594

Nodules are less uniform in the liver, > 1 mm in size
Due to drugs or infection

Back 594

Macronodular cirrhosis

Front 595

Early satiety, bloating, and nausea after meals
Diabetic pts esp w/ poor control
Often have a succession splash (splash heard w/ the stethoscope when shaking the pt due to air-fluid level)
Dx and Confirmation

Back 595

Dx: Delayed Gastric Emptying (autonomic dysfunction)
Confirmation: Gastric emptying study

Front 596

Present w/ bloating, diarrhea, and excessive flatus
Have signs of malabsorption such as hypoalbuminemia, iron-deficiency anemia, hypocholesterolemia, decreased carotine level
Dx, Confirmation, Tx

Back 596

Dx: Celiac sprue (a.k.a. gluten-sensitive enteropathy)
Test: Bowel Bx
Tx: Wheat-free diet

Front 597

Multisystemic disorder characterized by arthralgias, abdominal pain, fever, weight loss, lymphadenopathy, heart disease, and neurologic disease
Dx, Confirmation, Tx

Back 597

Dx: Whipple's disease
Test: Finding PAS positive staining foamy macrophages in tissues
Tx: ABX (for Tropheryma whippelii)

Front 598

What can cause a false-negative fecal occult test

Back 598

Vitamin C, ASA, NSAIDS, poultry, fish, red meat, and vegetables w/ peroxide activity (horseradish & turnings)
-Abstain for 72 hrs before testing

Front 599

Risk factors for GERD

Back 599

Obesity, pregnancy, scleroderma, diet (caffeine, alcohol, nicotine, chocolate, fatty foods)

Front 600

Most common etiology of GERD

Back 600

Transient lower esophageal sphincter relaxation
-may also be due to hiatal hernia & acidic gastric contents

Front 601

What is the sour taste of GERD often referred to as

Back 601

Water brash

Front 602

Atypical Sx of GERD

Back 602

Asthma, chronic cough, chronic laryngitis, sore throat, chest pain

Front 603

Produces epigastric pain and typically improves with eatting

Back 603

Peptic Ulcer disease

Front 604

Present with bloating, cramps, and diarrhea after ingesting a milk product

Back 604

Lactose intolerance

Front 605

Disorder characterized by absence of enteric neurons in the submucosal and myenteric plexuses
The contracted segment of bowel is unable to relex, and a mass may become palpable
May lead to megacolon
Dx and Tx

Back 605

Dx: Hirschsprung's disease (aganglionic megacolon)
Tx: Resection of the affected bowel is curative

Front 606

AD, characterized by hamartomatous polyps in the small intestine and perioral melanin deposits
Risk factor for colon cancer

Back 606

Peutz-Jeghers syndrome

Front 607

AD, familial adenomatous polyposis syndrome
Risk factor for colon cancer

Back 607

Gardner Syndrome

Front 608

Infants present with bilious vomiting, blood stools, rigid and discolored abdomen, and shock
Malrotation of intestine that leads to gangrene
Usually seen in the 1st yr of life

Back 608

Volvulus

Front 609

Present w/ a hyperexcitable state (i.e. HTN, tachycardia, flushing, sweating, and mydriasis) and have tremors, disordered perceptions, seizures and delirium tremors

Back 609

Alcohol withdrawl

Front 610

Occur 2-4 days after alcohol abstinence and are characterized by halluncinations that may lead to dangerous, combative, and destructive behavior

Back 610

Delerium Tremors (DTs)

Front 611

Have skip lesoins and rectal sparing
Less rectal bleeding and rarely have tenesmus

Back 611

Crohn's disease

Front 612

Rectal bleeding w/ blood and pus
Tenesmus
Barium enema shows involvement of the colon

Back 612

Ulcerative colitis

Front 613

Pts complain of abdominal pain w/ altered frequency or consistency of stool but no weight loss or bleeding
-more than 1/2 of pts have psychiatric disorders

Back 613

Irritable Bowel Syndrome

Front 614

Saclike protrusions of the mucosa through the muscularis
Usually older pts and are asymptomatic
-only a small % have hemorrhages occur

Back 614

Diverticulosis

Front 615

May be found in immonocompromised workers, day care workers, male homosexuals, individuals who drink from untreated water (hikers and campers) and international travels (esp to Russia)

Back 615

Giardiasis

Front 616

Pts may have erythema of the palms, spider angiomas, dec body hair, gynecomastia, testicular atrophy or menstrual irregularities and parotid and lacrimal gland enlargement, clubbing, portal HTN (caput medusae), splenomegaly, ascites, jaundice, & signs of hepatic encephalopathy (asterixis)
-Many of these changes are due to hormonal imbalances (production of estrogen)

Back 616

Cirrhosis

Front 617

What is Child's classification

Back 617

A factor that determines survival in pts w/ end-stage liver disease

Front 618

Bilirubin: < 2.5
Albumin: > 3.5
Ascites: none
Neurologic: none
Nutrition: Excellent
Describes what class of cirrhosis based on Child's classification

Back 618

Class A

Front 619

Bilirubin: 2.0-3.0
Albumin: 3.0-3.5
Ascites: Easily controlled
Neurologic: minimal
Nutrition: Good
Describes what class of cirrhosis based on Child's classification

Back 619

Class B

Front 620

Bilirubin: > 3.0
Albumin: < 3.0
Ascites: Not controlled
Neurologic: Advanced (coma)
Nutrition: Wasting
Describes what class of cirrhosis based on Child's classification

Back 620

Class C (6 month survival 50%)

Front 621

Pts w/ Hx of ulcer surgery
Occurs 30 min after eating
Present w/ palpitations, tachycardia, lightheadedness, and diaphoresis after eating a meal

Back 621

Dumping Syndrome
-due to rapid emptying of hyperosmolar gastric contents into the small intestine

Front 622

Dilated submucosal veins
Develop in pts w/ portal HTN
Have the highest morbidity and motality rate of all causes of GI bleeding
Pt may present with acute onset of hematemesis after heavy drinking, jaundice, and ascites

Back 622

Esophageal varices

Front 623

Type of hepatitis that is almost exclusively transmitted via fecal-oral route and is spread from person-to-perons
Outbreaks have been traced to contaminated food, water, milk and shellfish

Back 623

Hepatitis A (RNA virus)

Front 624

Type of hepatitis that is transmitted sexually, perinatally, and through blood products

Back 624

Hepatitis B (DNA virus)

Front 625

Type of hepatitis that is transmitted primarily through blood products.
Perinatal & sexual transmission < 5%
Most common cause of chronic hepatitis in the US

Back 625

Hepatitis C (RNA Virus)

Front 626

Type of hepatitis that is Endemic in pts w/ HBV in the Mediterranean countries, in the US it is confined to blood products

Back 626

Hepatitis D (RNA virus)

Front 627

Type of hepatitis that resembles HAV, transmitted fecal-oral route
Found primarily in Africa, Asia and Central America

Back 627

Hepatitis E (RNA Virus)

Front 628

Type of hepatitis that is blood borne
Mode of transmission parallels that of HCV

Back 628

Hepatitis G (RNA Virus)

Front 629

What are the best physical examination findings for diagnosing ascities and how are they performed

Back 629

Shifting Dullness and Positive Fluid Wave
In pts w/ ascites, the border of dullness shifts (shifting dullness) to the dependent side (approaches midline) as the fluid resettles with gravity when the pt rolls to the side
A fluid wave occurs when a sharp tap at one end of the abdomen is felt on the other side

Front 630

What is the sign that represents asking the pt to go into the uncomfortable position of being on all fours and percussing the umbilicus for dullness when looking for ascites

Back 630

Puddle Sign (Low sensitivity & Specificity)

Front 631

What represents when flanks are pushed outward
it is seen in obese pts as well as pts with ascites

Back 631

Bulging Flanks

Front 632

Complication of ulcerative colitis
Pts have fibrosing inflammation of the intrahepatic and extrahepatic bile ducts
70% of pts present w/ the Charcot Triad (fever, jaundice, RUQ pain) & possible Reynolds pentad (Charcot + Shock & altered mental status)
Dx, Test, Tx

Back 632

Dx: Sclerosing cholangitis
Test: Best Dx by ERCP (shows multifocal strictures of the extrahepatic biliary tree)
Tx: Life-threatening illness & requires emergency bile duct decompression

Front 633

What is the Charcot Triad & Reynolds pentad seen in pts with Sclerosing cholangitis

Back 633

Charcot Triad: fever, jaundice, RUQ pain
Reynolds pentad: Charcot Triad PLUS Shock & altered mental status

Front 634

Pt present w/ generalized pruritis, asymptomatic cholestasis, or an isolated alkaline phosphatase level
Occurs most frequently in women
> 90% have anti-mitochondiral antibodies (AMAs) present

Back 634

Primary Biliary Cirrhosis (PBC)

Front 635

Dx by low ceruloplasmin level
Pts have Kayser-Fleisher rings (yellow-brown) in the Descemet memb & neurological involvement (i.e. Unsteady gait, tremors, involuntary chorea-like movements)

Back 635

Wilson's Disease

Front 636

Dx by an elevated serum iron level, elevated ferritin level, and elevated transferrin saturation
Present w/ suntan-like pigmentation (bronze pigmentation), degenerative arthritis of hands and fingers (PIPs), impotence, amenorrhea, testicular atrophy, cardiac disease, liver disease, and gluocose intolerance

Back 636

Hemachromatosis
(Bronze Diabetes)

Front 637

Hx of recurrent duodenal ulcer disease
Gastrinomas may be signle or multiple, (up to 2/3 are malignant)
25% associated w/ MEN-1 & may be found in the pancrease or duodenum

Back 637

Zollinger-Ellison Syndrome

Front 638

Characterized by liver disease and emphysema

Back 638

Alpha-1 Antitrypsin defiency

Front 639

Why is AST is elevated 2x as much in than ALT in alcoholic hepatitis

Back 639

Alcohol inhibits ALT synthesis more than AST synthesis

Front 640

Occlusion of the inferior vena cava or hepatic veins

Back 640

Budd-Chiari Syndrome

Front 641

What is the most common malignancy of the liver

Back 641

Metastatic
-Colon, Pancreas, Breast, and Lung (in order of decreasing frequency)

Front 642

Most common cause of mild unconjugated hyperbilirubinemia
Found in up to 10% of the population and is due to partial deficiency of Glucuronosyltransferase
Pt may present w/ mild, persistant jaundice
Jaundice is exacerbated by fasting, surgery, fever, infection, & alcohol ingestion

Back 642

Gilbert's disease

Front 643

Pts develop jaundice w/ stress (i.e. pregnancy, time of illness), but it is primary conjugated bilirubin
Black pigment is present in the hepatocytes, may have mild hepatomegaly

Back 643

Dubin-Johnson syndrome

Front 644

Similar to Dubin-Johnson syndrome (Pts develop jaundice w/ stress, but it is primary conjugated bilirubin) but no black pigment is present in the hepatocytes

Back 644

Rotor Syndrome

Front 645

Pts typically have bilirubin levels > 20 mg/dL
Severe disorder due to tha absence of Glucuronosyltransferase

Back 645

Crigler-Najjar type 1 syndrome

Front 646

Relatively benign disorder due to partial deficiency of Glucuronosyltransferase
Pts present as adolescents with bilirubin levels of 6-20 mg/dL

Back 646

Crigler-Najjar type 2 syndrome

Front 647

Most common tumors in men b/w the age of 20-35 yo

Back 647

Germ cell tumors

Front 648

Present w/ a testicular mass and elevated serum alpha fetal protein

Back 648

Nonseminomatous testicular cancer

Front 649

Male pt present with elevated human chorionic gonadotropin (hCG)

Back 649

Seminomona (more common than nonseminomas)

Front 650

What is true off all germ cell tumors, even when they are advanced

Back 650

They are all curable with chemotherapy

Front 651

Tumors that tend to produce estrogen, causing gynecomastia and impotence

Back 651

Leydig and Sertoli cell tumors

Front 652

Presents as a painful, nonhealing ulceration and is often found in uncircumsiced men w/ poor hygeine

Back 652

Squampus cell carcinoma of the penis

Front 653

What testicular mass presents bilaterally

Back 653

Testicular lymphoma

Front 654

What testicular swellings will transluminate

Back 654

Swellings containing serous fluid will transluminate, those containing blood and tissues will not

Front 655

When inspecting for hernia, the mass strikes the lateral aspect of the examining finger when the pt coughs, when the right inguinal area over the internal ring is compressed, & pt coughs again, and the examining finger does not sense any mass striking it

Back 655

Indirect Hernia (a hernia that lies withIN the inguinal canal)
-most common of all hernias

Front 656

A Hernia through the posterior wall of the inguinal canal
If present the viscus (mass) is felt medial to the external canal on digital examination

Back 656

Direct Hernia

Front 657

All hernias are more common in males than females except

Back 657

Femoral hernias

Front 658

What can be found in a hernial sac

Back 658

The appendix, or any visceral organ

Front 659

When do hernias become surgical emergencies

Back 659

If they become incarerated and irreducible
-When the circ is compromised due to the incarceration, the hernia is strangulated

Front 660

Most common disorder of sexual differentiation (1 in 500), XXY
Characterized by tall statue, hypogonadism or small scrotum w/ pea-sized tests (normal are 5 cm long), a female distribution of pubic hair, & gynecomastia

Back 660

Klinefelter syndrome

Front 661

Presence of a patent processus vaginalis allows communication of intraperitoneal contents w/ the scrotum. The presence of clear intraperitoneal fluid in the testes can form

Back 661

Hydrocele

Front 662

What can cause a hot scrotum

Back 662

Purulent material from a ruptured appendix

Front 663

Polymicrobial infection of the subcutaneous tissues of the scrotum
often seen in diabetic pts

Back 663

Fournier's gangrene

Front 664

Abdominal trauma can disrupt intraabdominal contents and the blood can migrate through a patent processus vaginalis (which allows comm of intraperitoneal contents w/ the scrotum)
The scrotal blood will not transilluminate and will be gravity dependent

Back 664

Hematocele

Front 665

Generalized body edema

Back 665

Anasarca

Front 666

What describes the "grape clusters" that can be seen in an urinalysis under LM

Back 666

Lipid deposits or oval fat bodies in sloughed tubular epithelial cells
-Appear as Maltese crosses under polaritzed light

Front 667

1/3 of Pts w/ Nephrotic Syndrome has a systemic disease (i.e. DM, SLE) what will the other 2/3 have

Back 667

(1) Membranous nephropathy due to hepatitis C, SLE, syphilus, or medications
(2) Minimal change disease
(3) Focal glomerular sclerosis (HIV or heroin use)
(4) Membranoproliferative GN

Front 668

Pts present w/ a nephritic syndrome (HTN, hematuria, edema)

Back 668

Glomerulonephrits

Front 669

How pts w/ Acute interstitial nephritis from drugs or infection present

Back 669

Rash, arthralgias, eosinophilura, eosinophilia

Front 670

Typically occurs after an insult, such as ischemia or exposure to mephrotoxin (i.e. contrast media, paraproteins in multiple myeloma, ABX)
-Myoglobinuria is a consequence of rhabdomyolysis that can lead to this

Back 670

Acute tubular Necrosis

Front 671

Condition in which the foreskin in an uncircumscribed pt cannot be retracted
-may occur normally in the 1st 6 yrs of life
-usually congenital but may be due to recurrent infections or balanoposthitis

Back 671

Phimosis

Front 672

Inflammation of the glans penis and prepuce

Back 672

Balanoposthitis

Front 673

Inflammation of the glands penis that only occurs in uncircumsiced persons

Back 673

Balantitis

Front 674

Hair pattern associated w/ genitalia

Back 674

Escutcheon

Front 675

White, cheeselike material that collects around the glans penis in an uncircumcised man

Back 675

Smegma

Front 676

Painful, prolonged penile erection not associated w/ sexual desire
-most often occurs in pts w/ Sickle cell disease (may benefit from exchange transfusion), Sickle cell trait, or Leukemia
-may be due to local abnormalities such as malignancy or inflammatory diseases of the shaft

Back 676

Priapism

Front 677

Appear as small lumps in the scrotal skin
May enlarge and dischage an oily material

Back 677

Epidermoid or sebaceous cysts

Front 678

Appear as pearly white, umbilicated, dome-shaped papules caused by the poxvirus

Back 678

Molluscum contagiosum

Front 679

Soft, flesh-colored (may also be pink or red) growths or projections found on various parts of the penis
Etiologic agent is HPV
-associated w/ dysplasia (i.e. SCC of the cervix, penis, anus, vagina, and vulva)
Transmitted w/ an incubation period of 1 to 6 months

Back 679

Condylomata acuminata

Front 680

Soft, flat-topped, moist, pale nodules and papules of 2' syphilus
Appear 2-6 months after the primary chancre
Contagious lesions and can be seen anywhere on the body

Back 680

Condylomata lata

Front 681

Unilateral deviation of the penis caused by a fibrous band in the corpus cavornosum
Results in deviation and often pain of the penis during an erection

Back 681

Peyronie's disease

Front 682

STD characterized by a painful group of vesicles on an erythematous base

Back 682

Genital herpes

Front 683

Uncommon occurance except as a sequela of infection w/ mumps in young males
Most often unilateral & testicular atrophy occurs in 50% of cases

Back 683

Orchitis

Front 684

Most common neoplasms in men b/w ages 15-30

Back 684

Testicular Tumors
-nontender, fixed to the testicle, and do not transilluminate

Front 685

What is the size of normal kidneys

Back 685

Normally extend from T12 to L3, 11 cm long
Right kidney is lower than the left kidney due to the liver above it
Left kidney is usually not palpable

Front 686

What do bilateral large kidneys suggest

Back 686

Polycystic kidney disease or bilateral hydronephrosis

Front 687

Most common inherited disorder in the US
-AD due to a defect on the short arm of chrom 16
Pts develop HTN & renal cysts & often require dialysis or transplant by 40 yo
Extrarenal Sx: MVP, berry aneurysms in circle of Willis, diverticulosis, diverticulitis, and liver cysts

Back 687

Polycystic Kidney Disease (PKD)

Front 688

Benign condition seen in older pts (40-50 yo)
Almost never leads to renal failure

Back 688

Medullary Sponse Kidney

Front 689

Kindey that can be palpated crossing the midline

Back 689

Horseshoe Kidney

Front 690

Enlarged bilateral Kidneys
Present with signs of infection such as fever, hematuria, dysuria

Back 690

Bilateral Hydronephrosis

Front 691

Severe episodic pain localized to the flank that often radiates to the groin and genitalia
Often accompanied by n/v
Pt move about to trie and find a more comfortable position

Back 691

Renal Colic

Front 692

What is the most common composition of stones

Back 692

Calcium oxalate (radiopaque on abdominal film)

Front 693

Presnt with fever, dysuria, frequency, and pain (suprapubic, perineal, and sacral)
Rectal Exam reveals a warm, exquisitely tender prostate gland

Back 693

Acute Bacterial Prostatitis

Front 694

Tunica valginalis normally attaches posterolateral surfaces of testicle to the scrotum, anchoring it & preventing rotation
When these attachments are missing the testicle is free to rotate around the spermatic cord & critical vascular pedical

Back 694

Testicular Torsion

Front 695

Most commonly occurs in pts b/w 10-20 yo
Onset of pain is sudden w/ no urinary complains, may be accompanied by n.v
Lost of cremasteric reflex

Back 695

Testicular Torsion

Front 696

Occurs when the foreskin cannot be returned to the extended position
May lead to gangrene of the penis

Back 696

Paraphimosis

Front 697

Congenital abnormality in which the urethra is situated on the ventral surface of the penis

Back 697

Hypospadias

Front 698

Congenital defect in which the urethral meatus appears on the dorsum of the penis

Back 698

Epispadias

Front 699

Generalized defect in the proximal tubule transport involving amio acids, glucose, uric acid, potassium, phosphate, sodium, & bicarbonate
May be 2' to multiple myeloma, amyloidosis, or heavy metal toxicity
-Type 2 (proximal) renal tubular acidosis (RTA)

Back 699

Fanconi syndrome

Front 700

Type of renal tubular acidosis that causes a metabolic acidosis w/ an alkaline (> 5.5) urine pH

Back 700

Type 1 (distal) RTA

Front 701

Type of renal tubular acidosis that causes hyperkalemia and is due to inadequate aldosterone production from DM, sickle cell disease, obstructive uropathy, or medication use (heprin, NSAIDs, ACEI)

Back 701

Type 4 RTA

Front 702

Specific type of nephropathy that diabetics develop, in which Kimmelstiel-Wilson lesions are found histologically

Back 702

Glomerulosclerosis

Front 703

Nodules that stain PAS (+) & are deposited in periphery of the glomerulus

Back 703

Kimmelstiel-Wilson lesions seen in diabetic glomerulosclerosis

Front 704

Occurs in pre-teen children, thought to be secondary to reflux of sterile urine causing an inflammatory rxn
Tenderness of the posterolaterally positioned epididymis w/ a normal testicle palpated anteriorly
Prehn sign is positive

Back 704

Epididymitis

Front 705

Sign that represents when the pt experiences relief from pain on elevation of the testicle

Back 705

Prehn sign
-seen in Epididymitis, but is not reliable & must rule out testicular torsion

Front 706

Characterized by flank pain, fever, dysuria, frequency
Often experience suprapubic and CVA tenderness

Back 706

Pyelonephritis (infection of the kidney & renal pelvis)

Front 707

Pt present w/ dysuria, frequency, urgency, & suprapubic tenderness, but are afebrile w/ normal physical exam

Back 707

Acute cystitis

Front 708

Organisms responsible for urinary tract infections

Back 708

SEEK PP
Serratia marcescens
E. coli
Enterobacter cloacae
Klebsiella pneumonia
Proteus mirabilis
Pseudomonas aeruginosa

Front 709

Embryonic ductal system remnants
Irregularity on the cephalad surface of the epididymis
The two intrascrotal appendages may undergo torsion, peak incidence is b/w age 10-15
Onset of pain can be sudden or gradual
Infarcted appendage can often be seen as a blue dot on the superior pole of the testes, transillumination highlights the appearance

Back 709

Appendix testis and Appendix epididymis

Front 710

Collection of dilated veins of the pampinoform plexus
Compression of the left renal v. (most common on left side) at the level of the aorta causes venous stasis and reflux into the spermatic vein
Often seen during puberty
"bag of worms"

Back 710

Varicocele

Front 711

How is the American Urologic Associaton use a symptom index in Dx BPH

Back 711

Score is based on pts response to 7 questions
0 = not at all
1 = < 1/5 of the time
2 = < 1/2 of the time
3 = 1/2 of the time
4 = > 1/2 of the time
5 = almost alwats
-0-7 indicates mild BPH
-8-19 moderate BPH
-20-35 severe BPH

Front 712

Most commonly encountered form of focal GN worldwide
Pts will often have microhematuria
May follow an Upper RT infection or physcial exertion

Back 712

IgA nephropathy (Berger's)

Front 713

Common cause of asymptomatic microhematuria
Usually found in pts > 50 yo
Risk factors: aniline, rubber, other organic solvents, industrial dyes, tobacco use

Back 713

Bladder CA

Front 714

Presents w/ severe proteinuria & erythrocyte casts

Back 714

Minimal Change disease

Front 715

Nephritic syndrome & hearing loss

Back 715

Alport Syndrome

Front 716

Indications for Dialysis (mnemonic)

Back 716

AEIOUS
Acidosis (pH < 7.2)
Electrolyte anormality (hyperkalemia w/ EKG changes)
Ingestion of certain drugs (barbiturates, bromide, chloral hydrate, ethanol, ethylene glycol, isopropyl alcohol, lithium, methanol, procainamine, theophylline, salicylates, heavy metals)
fluid Overload unresponsive to diuretics
Uremic symptoms (pericarditis, encephalopathy, or coagulopathy)

Front 717

accounts for < 5% of HTN
Most common cause is atherosclerosis, but in young F the etiology is often fibromuscular dysplasia
Pts present w/ a high-pitched epigastric bruit
Postive captopril test
Dx and Test

Back 717

Dx: Renal artery stenosis
Test: Subtration renal arteriogram, Doppler US, magnetic resonance angiogram

Front 718

Test that represents when renin values inc greatly after a dose the ACEI b/c drug magnifies the impairment of blood flow and in the GFR caused by the RAS

Back 718

Captopril test

Front 719

Pts present w/ sudden episodes of HTN, HA, profuse sweating, anxiety, & palpitations
Dx made by 24-hr urine collection for catecholamines or catecholamine metabolites

Back 719

Pheochromocytoma

Front 720

Present w/ delayed or absent femoral pulses and complain of claudication
-HTN due to

Back 720

Coarctation of the aorta

Front 721

Pts present w/ HTN, fatigue, polyuria, and muscle weakness due to potassium depletion
Etiology is usually bilateral adrenal hyperplasia

Back 721

Primary Hyperaldosteronism (Conn Syndrome)

Front 722

Characterized by central deposition of adipose tissue, muscle weakness, amenorrhea, impotence, psychiatric abnormalities, and HTN

Back 722

Cushing's disease

Front 723

Noninflammatory disorder that affects young and middle-aged men
Pts present complaining of a lifelong Hx of difficulty voiding
Prostate is normal, & urinalysis is (-) for bacteria & leukocytes
Prostatic secretions show a normal # of leukocytes
Dx and Tx

Back 723

Dx: Prostatodynia
Tx: Alpha blocking agents

Front 724

Caused by Chlamydia, Mycoplasma, Ureaplasma, and viruses
Will have increased #'s of leukocytes in prostatic secretions w/ negative culture

Back 724

Nonbacterial prostatitis

Front 725

Have (+) prostatic secretion leukocytosis & a (+) culture

Back 725

Chronic bacterial prostatitis

Front 726

Osmotically induced demyelination due to overly rapid correction of serum sodium
Pts develop paraplegia, quadriplegia, & coma

Back 726

Central Pontine Myelinosis

Front 727

Work-up for hematuria (mnemonic)

Back 727

"If you doctor does not know how to work up hematuria, you should SWITCH GPS"
S = stones, sickle cell disease, sickle cell train, scleroderma, SLE, sulfonamindes
W = Wegener's granulomatosis
I = Infections, insturmentation, iatrogenic, interstitial nephritis
T = Trauma, TB, tubulointerstital disease, tumor, thrombocytopenic thrombotic purpur (TTP)
C = Cryoglobulinemia, cyclophosphamide
H = Hemolytic-uremic syndrome, hypercalciuria, hemophilia, Henoch-Schonlein purpura
G = Goodpasture's disease, GN
P = Papillary necrosis, PKD, Polyarteritis nodosa
S = Schistosomiasis, Sponge disease (medullary sponse disease)

Front 728

95% of tumors in the kidney
Present w/ hematuria, abdominal mass
Strong associated with cigarette smoking and obesity

Back 728

Renal Cell Carcinomas

Front 729

Strongly associated w/ cigarette smoking and chemical compounds (aromatic hydrocarbons)
Chimney sweepers and dry cleaners are at risk
-25% is occupationally related

Back 729

Bladder Cancer

Front 730

Associated w/ chronic phenacetin use, cigarette smoking, hydrocarbon chemical exposure

Back 730

Cancer of the Ureter (transitional cell like bladder)

Front 731

Occurs secondary to corticosteroid use, nonpituitary neoplasms (i.e. small cell carincoma of the lung), adrenal adenomas, adrenal carcinomas, & bilteral nodular hypoplasia

Back 731

Cushing syndrome

Front 732

Hypercortisolism due to ATCH hypersecretion by the pituitary gland, usually a small (< 1 cm) benign pituitary microadenoma
Sx: central obesity, striae, hirsutism, easy bruisability, proximal myopathy, osteoporosis, amenorrhea, HTN, glucose intolerance and hypokalemia
Dx & screening test

Back 732

Dx: Cushing's disease
Screening Test: Urinary cortisol

Front 733

Alcoholic pts and depressed pts may have hypoercortisolism

Back 733

Pseudo-Cushing state

Front 734

Causes increased levels of testosterone, hirsutism, infertility, and menstrual irregularity

Back 734

Polycystic ovary disease (Stein-Leventhal syndrome)

Front 735

Hypersecretion of GH aftere closure of the epiphyses
Almost always caused by pituitary adenoma (99% benign)
Present w/ tall stature, large hands, large feet, prominent mandible, prognathism, coarse facial features, wide tooth spacing, deep voice, macroglossia, and carpal tunnel syndrome
Pts may have HA, visual field defects, hypertrophy of laryngeal tissues causing obstructive sleep apnea, HTN, cardiomegaly, mult skin tages, premaliginant colonic polyps, and DM

Back 735

Acromegaly

Front 736

Hypersecretion of GH before the closure of the epiphyses

Back 736

Gigantism

Front 737

Group of disorders characterized by infiltration of various organs (kidney, heart, intestine, endocrine) by protein fibrils
Pts may have macroglossia and carpal tunnel syndrome

Back 737

Amyloidosis

Front 738

In what pathologies is marcoglossia seen in

Back 738

Acromegaly
Hypothyroidism

Front 739

Sign that represents redness and itchiness of the skin of the neck overlying the thyroid gland

Back 739

Maranon's Sign

Front 740

Common cause of thyrotoxicosis or hyperthyroidism
Sx: Heat intolerance, menstrual irregularity, weight loss, pretibial myxedema, anxiety, highly energetic, tachycardia, bilateral proptosis, stare & lid retraction, weakness in quadriceps muscle, fine tremors
Thyroid PE: diffuse enlargement w/ audible bruit, nontend
May have a (+) Maranon's Sign
Present b/w 20-40 yo, F > M
Serum T3, T4, Free thyroxine, & thyroid resin uptake usually increased

Back 740

Grave's disease
-due to Abs that bind to TSH-R causing it to stimulate the thyroid gland to hyperfunction

Front 741

What is the best test for thyrotoxicosis

Back 741

A reliable sensitive TSH assay

Front 742

Autonomous toxic adenomatous disease of the thyroid
-pts do not present w/ ophthalmopathy or dermapathy

Back 742

Plummer's disease

Front 743

Chronic lymphocytic thyroiditis
Autoimmune disease (+ Anti-microsomal Abs & + Anti-thyroid peroxidase Abs) that causes hypothyroidism
Pts present w/ a diffuse, firm, nontender goitor
Susceptible to postpartum thyroiditis

Back 743

Hashimoto's thyroiditis

Front 744

Thyroid tissue contained in a dermoid ovarian tumor

Back 744

Struma ovarii

Front 745

due to the release of preformed thyroglobulin and follows a viral infection
Thyroid gland is painful and tender to palpation
Dx and Tx

Back 745

Dx: Granulomatous or subacute (de Quervan's) Thyroiditis
Tx: Aspirin or NSAIDs

Front 746

Sx include constipation, depression, edema, tongue thickening, cold intolerance, Queen Anne Sign, muscle cramps, weight gain, goiter, amenorrhea, galactorhhea, pleural effusion, pericardial effusion, cardiomegaly, bradycardia, hypothermia, hyponaturemia, anemia and HTN
Hung up reflexes (prolonged relaxation phase)

Back 746

Symptoms of Hypothyroidism

Front 747

Sign that represents pt is missing lateral 1/3 of eyebrow

Back 747

Queen Anne Sign

Front 748

What drug, due to its high iodine content causes hypothyroidism in 8% of pts

Back 748

Amiodarone

Front 749

Rare complication of hypothyroidism
Pt presents w/ coma, severe hypotension, hypothermia, hypoventilation, hypoxemia

Back 749

Myxedema

Front 750

Congenital (infantile) hypothyroidism

Back 750

Cretinism

Front 751

A pituitary tumor may impinge on the optic chiasm. The temporal field fibers are damaged as they decussate at the optic chiasm,
what is the resulting visual field defect

Back 751

Bitemporal Hemianopsia

Front 752

Sign that represents tapping on CN VII as it exits the parotid gland & will cause spasm or contraction of the facial muscles on the same side of the face that is being tapped in states of hypocalcemia (tetany)

Back 752

Chvostek sign

Front 753

Clinical Signs: Paresthesia, neuromuscular irritiability, (+) Trousseau's phenomenon, prolonged QT interval
Caused by Rickets, Osteomalacia

Back 753

Hypocalcemia

Front 754

Sign that represents carpal spasm after the application of a blood pressure cuff

Back 754

Trousseau's phenomenon
-seen in states of Hypocalcemia

Front 755

Clinical Presentation:
Bones (Fx, osteitis fibrosa)
Stones (renal caniculi)
Abdominal groans (anorexa, constipation, vomiting, peptic ulcers, pancreatitis)
Psychic overtones (anxiety, depression, insomnia)

Back 755

Hypercalcemia

Front 756

Present w/ muscle weakness, muscle cramps, and flaccid paralysis

Back 756

Hypokalemia

Front 757

May lead to areflexia, flaccid paralysis, EKG abnormalities such as peaked T waves, prolongation of the PR interval, widening of the QRS complex, and ventricular tachycardia

Back 757

Hyperkalemia

Front 758

Midline neck structure
Remnent of the passage of the thyroid gland from the base of the tongue into the neck

Back 758

Thyroglossal ductal cyst

Front 759

Arises from the carotid body at the bifurcation of the common carotid artery

Back 759

Carotid body tumor

Front 760

Fatty tumor that can be found anywhere in the subcutaneous tissue

Back 760

Lipoma

Front 761

Usually seen w/ Grave's disease
Tubulent blood flow heard with a stethoscope over the thyroid

Back 761

Thyroid bruit

Front 762

Enlarged thyroid gland

Back 762

Goiter

Front 763

Lateral neck structure
Usually located near the upper 1/3 of the sternocleidomastoid muscle
Remnant of embryological development

Back 763

Brachial cleft cyst

Front 764

Lateral neck swellings that increase in size w/ Valsalva maneuver

Back 764

Laryngoceles

Front 765

90% of adrenal gland must be destroyed for development
-Glucocorticoids, mineralocorticoids, and androgens ar all affected
Sx: weakness, hypotension, anorexia, weight loss, hyperpigmentation of the skin, may have hyponatremia, hyperkalemia, & eosinophilia

Back 765

Addison's Disease (Hypoadrenalism)

Front 766

What are the possible etiologies of Addison's disease

Back 766

Etiologies: TB, malignancy, sarcoidosis, trauma, histoplasmosis, hemochromatosis, amyloidosis, septis, CMV, medications (Ketoconazole, Rifampin, Anti-coag, Anti-convulsants)
Pts w/o a clear etiology have idiopathic hypoadrenalism

Front 767

Present w/ HA, visual problems, papilledema, personality changes, and hypopituitarism

Back 767

Craniopharyngioma

Front 768

Postpartum hemorrhage and necrosis of the pituitary gland

Back 768

Sheehan syndrome

Front 769

Occurs when CSF fills the sella space and flattens the pituitary gland, which continues to fcn normally
Seein in obese, hypertensive, multiparous women

Back 769

Empty Sella Syndrome

Front 770

Combination of Hashimoto's thyroiditis with Addison's disease

Back 770

Schmidt syndrome

Front 771

Occurs in < 5% of pts w/ pituitary macroadenoma (> 1 cm)
Pts complain of HA, neck stiffness, fever, and visual disturbances and may present w/ acute adrenal insuffiency

Back 771

Pituitary apoplexy

Front 772

Not linked to menopause-induced estrogen deficiency
May be secondary to medication use (diphenylhydantoin, CS, heparin), hyperthyroidism, anorexia nervosa, malabsorptive disease, hyperparathyroidism, multiple myeloma, immobilization, tobacco use, & alcoholism
Pts have a reduced bone mass w/ normal mineral matrix

Back 772

Premature Osteoporosis

Front 773

Disorder with reduced mineralization of the matrix
Pts need to be evaluated for vitamin D deficiency

Back 773

Osteomalacia

Front 774

Inflammatory disorder seen in pts w/ RA assoc w/ chemosis & scleral-conjunctival inflammation

Back 774

Scleromalacia

Front 775

Increased bone turnover w/ the formation of disorganized bone
Present w/ pain, enlarging skill bones (increasing hat size and hearing loss), skeletal deformitis (bowing of the lower extremitis) and increased warmth of the skin overlying the tibias

Back 775

Paget's Disease

Front 776

What are the steps in managment of hypercalcemia

Back 776

Treated with intensive hydration using IV saline
Bisphosphonates (inhibitors of bone resorption) would be the initial pharmacotherapy
-Hydrochlorothiazide diuretics should be avoided

Front 777

Growth of coarse, male-pattern hair in women
Sign of androgen excess

Back 777

Hirsutism

Front 778

What is the most common form of congenital adrenal hyperplasia

Back 778

21-Hydroxylase deficiency
(will have elevated 17-OH progesterone)

Front 779

Pts present with galactorrhea, reduced libido, erectile dysfunction, amenorrhea, infertility, and visual field defects

Back 779

Prolactinomas (pituitary tumors)

Front 780

Cleft palate, impaired sense of smell, short 4th metacarpal bones, hypogonadism and infertility

Back 780

Kallman Syndrome

Front 781

What must always be considered in any pt who presents w/ ammenorhea

Back 781

Pregnancy
-it is normal for prolactin levels to be elevated in pregnancy

Front 782

Pts present w/ episodic Sx of HA, sweating, and palpitations
May be associated w/ von Recklinghausen syndrome, neurofibromatosis, and von-Hippel-Lindau's diseas
10% are bilateral and 10% are extraadrenal
Dx and Test

Back 782

Dx: Pheochromocytoma
Test: 24-h urine for catecholamine and metanephrines

Front 783

Increased levels of 5-HIAA
Sx of facial flushing and diarrhea from a tumor located in the lung or ileum

Back 783

Carcinoid Syndrome

Front 784

Present w/ nausea, diarrhea, jaundice, fever, dyspnea, shortness of breath, diaphoresis, delerium, and tachycardia

Back 784

Thyroid Storm

Front 785

Combination of DM, HTN, Obesity, Insulin resistance, dyslipidemia (inc VLDL, inc triglyceride, dec HDL)

Back 785

Syndrome X

CHAOS
Coronary artery disease
Hypertension
Atherosclerosis
Obesity
Stroke

Front 786

Sign the represents when a pt elevates the arms above the head (obstructing the thoracic inlet and preventing venous return), facial plethora and dizziness occur

Back 786

Pemberton's sign
-A reversible Superior Vena Cava Syndrome

Front 787

What can a simple goiter cause if it is sufficently large

Back 787

Tracheal compression, esophageal compression, dysphagia, odynophagia, mediastinal obstruction, and SVC syndrome

Front 788

What can a retrosternal goiter cause

Back 788

Mediastinal Obstruction and SVC syndrome

Front 789

Most common cause of hypercalcemia in an outpt setting
Seen more frequent in F than M
Usually due to one parathyroid adenoma (usually the inferior lobe)
Pts have a Hx of hypophosphatemia, fatigue, HTN, depression, PUD, pancreatitis, bone bone, hypercalciuria, and nephrolithiasis from calcium oxalate stones

Back 789

Primary Hyperparathyroidism

Front 790

Most common cause of hypercalcemia in hospitalized pts

Back 790

Malignancy (i.e. Breast, Lung, multiple myeloma, head & neck, renal cell) dur to the secretion of PTH-related peptide (PTHrp)

Front 791

Pts have hypocalciuria, (+) FHx, and no end organ damage

Back 791

Familial Hypocalciuric Hypercalcemia (FHH)

Front 792

Replacement of bone w/ fibrous tissue
Bone abnormality seen with hyperparathyroidism

Back 792

Osteitis Fibrosa Cystica

Front 793

What Tanner stage describes the following: Young child penis, scrotum, testesl no pubic hair

Back 793

Tanner 1

Front 794

What Tanner stage describes the following: Enlargement of the scrotum & testes; penis is the same; scrotal skin becomes more red, thinner, & wrinkled; some straight pubic hair at the base of the penis

Back 794

Tanner 2

Front 795

What Tanner stage describes the following: Enlargement of penis & testes; scrotum descends; dark, curly pubic hair

Back 795

Tanner 3

Front 796

What Tanner stage describes the following: Further penile enlargement; increased pigmentation of scrotum; scupturing of the glands; adult pubic hair but not beyond inguinal fold

Back 796

Tanner 4

Front 797

What Tanner stage describes the following: Ample scrotum; penis reaches to bottom of scrotum; hair spreads to medial surface of thighs

Back 797

Tanner 5

Front 798

Seen in pts w/ Type 2 DM & is usually precipitated by an illness
Pts residual insulin prevents lipolysis and ketogenesis

Back 798

Hyperosmolar Hyperglycemia Nonketotic State (HHNKS)

Front 799

Absolute deficiency of insulin relative to the counterregulatory hormones
Result is gluconeohenesis, ketogenesis, lipolysis, and decreased glucose uptake causing hyperglycemia and a metabolic acidosis

Back 799

Diabetic Ketoacidosis

Front 800

Occurs in 3% of pregnancies
Women should be screen b/w the 24th and 28th weeks of pregnancy
Complications if not Dx, macrosomia and neonatal hypoglycemia

Back 800

Gestational Diabetes

Front 801

Defined as a 2 hr plasma glucose of 140-200 mg/dL after a glucose load of 75 g in a pt whose fasting blood glucose is normal

Back 801

Impaired glucose tolerance

Front 802

Due to a combination of insulin resistance and impair insulin secretion

Back 802

Glucose intolerance

Front 803

Rash seen in pts w/ Type 1 DM
Oval-shaped plaques with well demarcated borders and a glistening yellow surface located on the legs and ankles

Back 803

Necrobiosis Lipoidica Diabeticorum

Front 804

Velvety, hyperpigmented, thickened skin lesion over the dorsum of the neck, axillae, and groin
Often precedes the Dx of an endocrine (insulin-resistant) disorder

Back 804

Acanthosis nigrans

Front 805

Macrovascular complications associated w/ DM

Back 805

CAD, cerebral vascular disease, peripheral vascular disease

Front 806

Microvascular complications associated w/ DM

Back 806

Retinopathy, Nephropathy, Neuropathy

Front 807

Autonomic neuropathies associated w/ DM

Back 807

Fixed tachycardia, inability of HR to inc when pt stands, orthostatic hypotension, delayed gastric emptying, impotence, diarrhea, bladder dysfcn

Front 808

Peripheral neuropathies associated w/ DM

Back 808

Stocking-glove pattern, absent ankle jerk, Charcot joint

Front 809

Mononeuropathy associated w/ DM

Back 809

Involvement in distribution of one or several nerves

Front 810

Amyotrophy associated w/ DM

Back 810

Muscle atrophy and asymmetric motor neuropathy

Front 811

Most common type of familial hyperlipoproteinemia
Heterozygous carries present w/ a FHx of coronary events & often tendon xanthomas

Back 811

Type 2A Hyperlipoproteinemia
-elevated LDL

Front 812

Hyperlipoproteinemia where pts often present with palmar xanthomas and tuberous xanthomas

Back 812

Type 3 dysbetalipoproteinemia
-normal LDL w/ elevated IDL & VLDL

Front 813

An opaque ring, gray to white in color, that surrounds the periphery of the cornea. It is caused by deposits of cholesterol in the cornea or hyaline degeneration

Back 813

Arcus Senilis
-before the age of 40 it is consistent with yperlipoproteinemia

Front 814

Rare fungal disease limited to persons w/ preexisting illness
Pt present w/ fever, nasal congestion, sinus pain, diploplia, and coma
PE: Necrotic nasal turbinate, reduced ocular motion, proptosis, and blindness

Back 814

Mucormycosis

Front 815

AD, consisting of tumors of the Pancreas, Pituitary, and Parathyroid gland

Back 815

MEN 1 (Wermer Syndrome)
(PPP)

Front 816

Syndrome consisting of Pheochromocytoma, hyperParathyroidism, medullary carcinoma of the Thyroid

Back 816

MEN 2A (Sipple Syndrome)
(PPT)

Front 817

Syndrome that presents w/ Pheochromocytoma, Neuromas, medullary carcinoma of the Thyroid

Back 817

MEN 2B syndrome

Front 818

Have high levels of both C peptide and insulin

Back 818

Insulinoma

Front 819

Diabetics with peripheral neuropathy are susceptible
The insensitivity of the feet predisposes the pt to multiple silent Fxs causing a derformed joint

Back 819

Charcot joint

Front 820

Noctural hypoglycemia which stimulates a surge of counterregulatory hormones to produce a high fasting blood sugar in the morning

Back 820

Somogyi effect

Front 821

Morning hyperglycemia from reduced sensitivity to insulin the morning hours evoked by spikes of GH during sleep

Back 821

Dawn Phenomenon

Front 822

Whipple Triad
-characterisitic of hypoglycemia

Back 822

(1) Hypoglycemic Sx
(2) Low fasting blood glucose
(3) immediate recovery after administration of glucose

Front 823

Could be caused by trauma to the posterior pituitary stalk causing a lack of vasopression
Dx and Test

Back 823

Dx: Central diabetes insipidus
Test: Made by raising the pts serum osmolality through water restriction, then observing the urine osmolality through water restriction
-Nephrogenic DI will not respond to the stim by vasopressin

Front 824

Nocturnal penile tumescence occurs during REM sleep
Man gives Hx of rigid erections under any circumstance what is the most likely etiology of ED

Back 824

Psychological (i.e. depression, disinterest, anxiety)

Front 825

What are the drugs that may can impotence

Back 825

Antidepressants, Anticholinergics, alcohol, methadone, heroin, tobacco, antiHTN, and sedatives

Front 826

Neoplasm characterized by proliferation of plasma cells, typically in pts > 50 yo
May lead to bone pain, pathologic Fx, anemia, susceptibility to infections, renal failure and hypercalcemia
Bone pain worsens w/ movement (worse at night)
Have increased serum globulin & monoclonal IgA or IgG spike (M component) on electrophoresis
Monoclonal Ig causes rouleaux formation on blood smear
Bence-Jones proteinuria
Osteolytic lesions seen in many bones on x-ray
Bone sace is normal

Back 826

Multiple myeloma (B cell malignancy)

Front 827

B cell malignancy w/ an IgM monoclonal protein and both lymphocytosis and plasmocytosis in the bone marrow
Pts present w/ bleeding, cytopenia, lympadenopathy, hyperviscosity crisis

Back 827

Waldenstrom's macroglobulinemia

Front 828

What does progressive (solids to liquids) difficulty swallowing or dysphagia accompanied by rapid weight loss and odynophagia (painful swallowing) often indicate

Back 828

Esophageal carcinoma
-Adenocarcinoma is more common in whites
-Sqaumous cell is more common in blacks

Front 829

Pts have intermittent dysphagia to solids

Back 829

Schatzki's ring (lower esophageal web)

Front 830

Neuromuscular disorder of esophageal relaxation
Pts often present w/ respiratory Sx from aspiration
Esophagram reveals dilated esophagus w/ a beaklike tapering distal to the esophageal contraction

Back 830

Achalasia

Front 831

Hereditary disorder where the median age of adenocarcinoma of the colon is 50 yo
Most common site is proximal colon
AD, should undergo biennial colonoscopy at 25 yo

Back 831

Hereditary nonpolyposis colon cancer (HNPCC)

Front 832

AD disorder chacterized by small polyps that develop during the 2nd dacade of life and undergo malignant transformation before the age of 40
-prophylactic colectomy is recommmened

Back 832

Familial Adenomatous Polyposis

Front 833

Superior vena cava obstruction is due to what type of cancer in 85% of cases

Back 833

Lung cancer
-tumors that can cause this include small cell carcinoma of the lung, SCC of the lung, lymphoma, thymoma, and germ cell tumor

Front 834

Occurs when malignancies are extremely responsive to chemotherapy
Results in hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia, and renal failure hours after receiving the treatment
Dx and prevention

Back 834

Dx: Tumor lysis syndrome
Prevention w/ allopurinol prophylaxis prior to chemo to prevent hyperuricemia

Front 835

Complication of lung cancer when it extends into the apex
Pts have compression of C8, T1, and T2 nerves
and often complain of arm and should pain

Back 835

Pancoast Syndrome (Superior Sulcus Tumor)

Front 836

Most common inherited bleeding disorder (AD)
Abnormality in the quantity or quality of vWF
Most bleeding is mucosal (epitaxis, gingival bleeding, menorrhagia), or GI, bleeding is exacerbated by aspirin use

Back 836

von Willebrand's disease
Type I (80%) caused by a quantitative dec in vWF
Type IIA and Type IIB vWD are qualitative
Type III vWD is a rare AR where vWF is nearly absent

Front 837

Spontaneous hemarthroses
Dx is made by finding dec level of factor VIII:C
X-linked pattern of inheritance

Back 837

Hemophilia

Front 838

Rare platelet disorder in which platelets can't adhere to the endothelim since they lack receptors for vWF
Pts present w/ severe bleeding, esp po-op
Platelets appear abnormally large on peripheral smear
Measurements of vWF are normal

Back 838

Bernard-Soulier syndrome

Front 839

Antineoplastic agent
Has both estrogen receptor agonist and antagonistic properties
Most common side effect is hot flashes, also may cause DVT, PE, and cataracts
Assoc w/ an inc risk in endometrial CA

Back 839

Tamoxifen

Front 840

Side effects of radiotherapy

Back 840

Short-term: fatigue, skin rxn, n/v/d, dysphagia, mucositis, xerostomia
Long-term: pericarditis, pneumonitis, hepatitis, sterilization, nephropathy

Front 841

When blood is trapped in the spleen leading to further splenic enlargement and anemia
Pts w/ hemoglobin SC disease & children w/ sickle cell disease are at risk

Back 841

Splenic sequestration crisis

Front 842

Eczematous scaly eruption on nipple
Erythematous & crusted lesion
< 1% of all breast CA
Is either an infiltrative ductal carcincome usually well differentiated or a ductal carcinoma in siut
Dx and Test

Back 842

Dx: Paget's carcinoma
Test: Bx of erosion

Front 843

Differential Dx for Microcytic Hypochromatic Anemia (mnemonic)

Back 843

TICS
Thalasemmia
Iron Deficiency
Chronic Disease
Sideroblastic

Front 844

In what pathologies are target cells seen

Back 844

Thalassemia, Lead poisoning, liver disease, hyposplenism, hemoglobin C deficiency

Front 845

Most common microcytic anemia

Back 845

Iron deficiency

Front 846

Seen in alcoholics, pts taking anti-TB meds or chloramphenical, or pts w/ lead poisoning
A failure to incorporate heme into protoporphyrin
Bone marrow staining will demonstrate iron deposits encirling the nucleus

Back 846

Sideroblastic anemia

Front 847

Coarse basophilic stippling of the RBCs on peripheral smear is characteristic of

Back 847

Lead poisoning

Front 848

Characterized by fever, dyspnea, leukocytosis, pulmonary infiltrate, and hypozemia, and pulmonary fat embolus from infarcted marrow
Affects 30% of pts w/ sickle cell disease

Back 848

Acute Chest Syndrome

Front 849

What does the B19 virus cause in pts w/ sickle cell disease

Back 849

Aplastic anemia

Front 850

What is the most common reason for DVT in pregnancy

Back 850

Factor V Leiden mutation or Activated C protein resistance

Front 851

RBCs are unable to deal w/ oxidative stress
Acute hemolysis occurs when affected pts are exposed to an infection or an oxidizing drug (dapson, primaquine, sulfonamides, nitrofurantoin, quinine)
Hemolytic episodes are self-limited even if offending agent is still present b/c older red cells w/ low activity are removed and replaced w/ younger red cells w/ adequate levels

Back 851

G6PD deficiecy, X-linked

Front 852

Autoimmune disorder in which an IgG autoantibody binds to platelets
Destruction of platelets takes place in the spleen, where macphs bind to the Ab-coated platelets
Usually 20-50 yo, F > M
Dx of exclusion
Megathrombocytes are often seen on peripheral smear
Can develop petechiae

Back 852

Idiopathic thrombocytopenic purpura (ITP)

Front 853

Idiopathic thrombocytopenic purpura (ITP) with co-existing hemolytic anemia

Back 853

Evans system

Front 854

Coagulation disorder that can be accompanied by thrombocytopenia
May be 2' to transfusion, infection, malignancy, or obstetric complications

Back 854

DIC

Front 855

TTP presents w/ a pentad of Sx in 40% of Pts

Back 855

FAT R.N.
Fever
Autoimmune hemolytic anemia
Thrombocytopenia
Renal disease
Neurologic disease

Front 856

Henoch-Schönlein Purpura occurs in children presents w/ AGAR

Back 856

AGAR
Abdominal pain
Glomerulonephritis
Arthralgia
Rash that is purpuric

Front 857

Presents w/ painless regional lymphadenopathy and the constitutional Sx of fever, drenching night sweats, and weight loss
Occasionally pts may present w/ pruritus or pain in an involved lymph node after ingestion of alcohol
Bimodal age distribution: 1st peak in 20's, 2nd peak > 50 yo
Reed-Sternberg cells ("owl eyes") seen in LN Bx

Back 857

Hodgkin's Lymphoma

Front 858

Present w/ pancytopenia, massive splenomegaly
Hairy cells on peripheral blood smear

Back 858

Hairy cell leukemia

Front 859

Acquired myeloproliferative disorder characterized by a primary erythrocytosis, but there is overproduction of all 3 cell lines
Hct > 54% in M, > 51% in F
Present w/ Sx related to an inc in blood volume & viscosity
Pruritis after a warm bath or shower due to histamine release by basophils
Splenomegaly
Dx and Tx

Back 859

Dx: Polycythemia vera
Tx: phlebotomy

Front 860

Spleonmegaly, dry bone marrow taps, and peripheral blood smears showing abnormal and bizarre morpholigies and immature forms

Back 860

Myelofibrosis

Front 861

Platelet counts > 2 million

Back 861

Essential thrombocythemia

Front 862

What is the most common rxn to blood transfusion

Back 862

Febrile, nonhemolytic rxn
-pts develop fever & chills severe hrs after transfusion b/c of recipient Abs to donor leukocyte antigens

Front 863

What describes the hemolytic rxns due to erythrocyte (ABO) incompatibility

Back 863

Fever, chills, hemoglobinuria, back pain, flank pain, dyspnea, anxiety, renal failure, DIC, multiorgan failure, and death)

Front 864

Philadelphia chromosome t(9,22)
bcr/abl fusion protein

Back 864

CML

Front 865

Tumor secondary to H.pyloria

Back 865

Mucosa-associated lymphoid tissue (MALT) tumor

Front 866

Hep B, Hep C, Hemochromatosis, aflatoxin exposure, being from the Far East or Africa are risk factors for what type of cancer

Back 866

Hepatocellular carcinoma

Front 867

Cigarette smoking is the most consistently observed risk factor for what type of cancer

Back 867

Pancreatic CA

Front 868

Schistomiasis is associated w/ what type of cancer

Back 868

Squamous cell carcinoma of the bladder

Front 869

Pts w/ BTCA1 gene on chromosome 17

Back 869

Present w/ breast CA at a young age w/ a FHx of breast or ovarian CA

Front 870

Vinyl chloride exposure is a risk factor for what type of cancer

Back 870

Hemiangiosarcoma of the liver

Front 871

Epstein-Barr virus is associated with what types of cancer

Back 871

Burkitt's lymphoma and Nasopharyngeal cancer
pts often present w/ enlarging neck mass

Front 872

HTLV-1 is associated w/ what type of cancer

Back 872

adult T-cell leukemia

Front 873

Most common lung cancer
Usually found in the periphery
Often occurs in the absence of smoking Hx

Back 873

Adenocarcinoma of the Lung

Front 874

Usually found centrally and is associated w/ a Hx of tobacco use & production of ectopic hormones such as ADH, PTH, and ACTH
20% of all new cases of lung CA

Back 874

Small cell carcinoma of the lung

Front 875

Central lung lesion associated w/ PTH production

Back 875

Squamous cell carcinoma of the lung

Front 876

Found in asplenic or hyposplenic pts

Back 876

Howell-Jolly bodies

Front 877

Preccipitants of denatured oxidizaed hemoglobin in G6PD deficiency

Back 877

Heinz Bodies

Front 878

Dx tumor cell of Hodgkin's disease

Back 878

Reed-Sterberg cell

Front 879

Benign inherited trait resulting in neutrophils w/ bilobed nuclei

Back 879

Pelger-Huet anomaly

Front 880

Seen in B12 or folic acid deficiency

Back 880

Hypersegmented polymophonuclear cells

Front 881

Represents fragments of ribosome-rich ER and seen in immature neutrophils in bacterial infections

Back 881

Toxic granulations and Dohle bodies

Front 882

Eosinophilic inclusions seen in AML

Back 882

Auer rods

Front 883

Seen in microangiopathic hemolytic anemia

Back 883

Schistocyte
Helmet cells
Burr cells
Triangular cells
Spherocytes

Front 884

cells seen in thalassemia

Back 884

Pappenheimer cells

Front 885

Tumor marker associated with colon and breast cancer

Back 885

CEA

Front 886

Tumor marker associated with ovarian cancer

Back 886

CA-125

Front 887

Prognostic factor for Hodgkin's disease

Back 887

Lactate dehydrogenase (LDH)

Front 888

Most important prognostic factor for multiple myeloma

Back 888

Beta2-microglobulin

Front 889

LDH, AFP, and hCF are all associated with what type of CA

Back 889

Testicular CA

Front 890

5-HIAA is associated with what syndrome

Back 890

carcinoid syndrome

Front 891

AFP is associated with what type of CA

Back 891

Hepatocellular carcincoma

Front 892

PSA is associated with what type of CA

Back 892

Prostate cancer

Front 893

Most commonly used marker for Pancreatic Cancer

Back 893

CA 19-9

Front 894

Test used to ID pts with RBC membrane defects (i.e. Hereditary spherocytosis)

Back 894

Osmotic Fragility Test

Front 895

Screening tests for Paroxysmal Nocturnal Hemoglobinuria (PNH)

Back 895

Acid Hemolysis Test
Sugar Water Test

Front 896

Enzyme that is elevated in Polycythemia vera, Hodgkin's lymphoma, Hairy cell leukemia, Aplastic anemia, Myelofibrosis, Leukomoid rxns, but decreased in CML

Back 896

Leukocyte alkaline phosphatase

Front 897

Affects weight-bearing joints, assoc w/ obesity or other forms of mechanical stress
no systemic manifestations
F > M, onset after 50 yo
Pain occurs on exertion and is relieved w/ rest, after which the joint may become stiff
DIP may be involved w/ production of Heberden nodes
Bouchard nodes are often found at PIP
Crepitus felt on exam of involved joint

Back 897

Osteoarthritis

Front 898

Systemic disease of women under 40 yo
Symmetric onvolvement of PIP & MCP

Back 898

Rheumatoid Arthritis

Front 899

Softening of the cartilage
Pts present w/ anterior knee pain and tenderness over the undersurface of the patella
Pain is worse when sitting for long periods of time or when climbing the stairs

Back 899

Chondromalacia (Chrondromalacia patellae)

Front 900

Asymmetric oligoarthritis that involves the knees, ankles, shoulders, or digits of the hands & feet and occurs in 50% of pts w/ psoriasis

Back 900

Psoriatic arthritis

Front 901

Nonbacterial atypical verrucous endocarditis
May occur on any valve but is rarely assoc w/ any valvular insufficiency
Probably assoc w/ antiphospholipid antibody syndrome
Source of cerebral emboli

Back 901

Libman-Sacks endocarditis

Front 902

AD, characterized by brittle bones that often lead to multiple Fx's
Blue scleras, short stature, deformed skull, hearing loss, and dental abnormalities

Back 902

Osteogensis Imperfecta

Front 903

Disorder of defective mineralization of the organic matrix of the skeleton
Due inadequate uptake or metab of vit D
Pts susceptible to Fx's, weakness, disturbances in growth, & skeletal deformitis

Back 903

Osteomalacia (Ricket's in children)

Front 904

Due to excessive resorption of bone by osteoclasts
Pts present after the age of 40 w/ swelling or deformity of a long bone or enlargement of the skull

Back 904

Paget's disease of the bone or Osteitis Deformans

Front 905

Results from a decrease in the proliferation of cartilage in the growth plate and results in dwarfism

Back 905

Achrondroplasia

Front 906

Pts may develop oligoarthritis of the large peripheral joints that is usually eliminated after controlling the GI Sxs

Back 906

Pts w/ Crohn's disease and UC
-Arthritis is the 2nd most common extraintestinal manifestation, Anemia is the 1st

Front 907

HLA-B27 diseases (Seronegative Spodylarthropies)

Back 907

PAIR
Psoriasis
Ankylosing spondylitis
Inflammatory Bowel Disease
Reiter Syndrome

Front 908

What can aortitis in Ankylosing spondylitis cause

Back 908

Aortic insufficiency (diastolic rumbling murmur)
-manifests itself early in the course of the spinal disease and may lead to CHF

Front 909

Chronic and progressive inflammatory disease that commonly affects the spinal, sacroiliac, and hip joints
All pts have symptomatic sacroiliitis
Other Sx: uveitis & aortitis
Men 30's, strong assoc w/ HLA-B27 in white pts

Back 909

Ankylosing spondylitis

Front 910

Test that indicates diminished anterior flexion of the lumbar spine

Back 910

Schober test

Front 911

Present w/ a Hx of conjunctivitis, urethritis, arthritis, Enthesopathy (achilles tendinitis)

Back 911

Reiter's syndrome

Front 912

At risk for venous and artherial thrombotic events, due to Ab reactivity w/ platelets or endothelial cell phospholipids
Pts have a Hx of miscarriages, leg ulcers, Raynaud's phenomenon, & Livedo reticularis
Lab: (+) lupus anticoagulant, thrombocytopenia, prolonged PTT, elevated titers of anticardiolipin antibodies, and an abnormal dilute Russell's viper venom

Back 912

Antiphospholipid Syndrome

Front 913

Granulomatous arteritis, F > M
Pts usually 40 yo
Typically affects the aorta and its major branches, including the arteries that supply the upper extremities
Pts have absent pulses in the upper arm and complain of arm claudication

Back 913

Takayasu's arteritis (pulseless disease)

Front 914

Characterized by reddish or bluish mottling of the extremities
Is usually idopathic and requires no treatment
May be 2' to atheroembolism-induced emboli following an intraarterial procedure

Back 914

Livedo reticularis

Front 915

Occurs in the midline of the popliteal fossa & is often a complication of RA
Respresents a diverticulum of the synovial sac that protrudes through the joint capsule of the knee

Back 915

Baker's cyst

Front 916

Occurs w/ inflammation of the bursa on the medial side of the proximal tibia
Localized tenderness and swelling over the knee

Back 916

Anserine bursitis

Front 917

Housemaid's knee
Characterized by inflammation of the bursa anterior to the patella

Back 917

Prepatellar bursitis

Front 918

Clergyman's or carpet layer's knee

Back 918

Intrapatellar bursitis

Front 919

Sign that represents pain with dorsiflexion of the foot, may be seen in DVT

Back 919

Homan sign

Front 920

Systemic disease characterized by violaceous rash of the eyelids and periorbital areas (helitrope) and flat, violaceous papules over the knucles (Gottron sign)

Back 920

Dermatomyositis

Front 921

Rash seen in ulcerative colitis
Painful large & irregular ulcers that drain a purulent, hemorrhagic exudate

Back 921

Pyoderma gangrenosum

Front 922

Multiple firm, red, painful plaques that are bilateral and most frequently distributed on the legs

Back 922

Erythema nodosum

Front 923

Small vessel vasculitis that affects mostly children
Purpura, fever, arthralgias, abdominal pain, hematochezia, and hematouria are a result of the vasculitis
Histo: deposition of IgA in the walls of mall blood vessels

Back 923

Henoch-Schonlein purpur

Front 924

Mucocutaneous LN syndrome
Uncommon in children over 8 yo
Characterized by fever, desquamating rash, edematous, blotchy-appearing, mucocutaneous erythema, cervical lymphadenitis, & aneurysm of coronary arteries

Back 924

Kawasaki disease

Front 925

Causes palpable purpura, abdominal pain, & GN
Assoc w/ Hep B or Hep C

Back 925

Cryoglobulinemia

Front 926

Characterized by the finding in synovial fluid of monosodium urate crystals that are needle shaped and strongly negative birefringent (bright yellow when parallel to axis)
May be ppt by trauma, meds that inhibit tubular secretion of uric acid (aspirin, hydrochlorothizaine), surgery, stress, alcohol, or high protein diet
Accumulation of tophi in and around the joints & earlobes
X-rays: "rat bite" erosions

Back 926

Topheceous gout

Front 927

Due to calcium pyrophosphate dihydrate (CPPD) deposition
Crystals are rhomboid-shaped and weakly positive birefringent (blue when parallel to the axis)

Back 927

Pseudogout

Front 928

Calcific tendinitis or Milwaukee should cause what type of deposition

Back 928

Calcium phosphate

Front 929

Deposition disease usually seen in pts w/ end-stage renal disease

Back 929

Calcium oxalate

Front 930

Radiographic finding of destructive arthropathy assoc w/ pseudogout or CPPD crystals

Back 930

Chondrocalcinosis

Front 931

Involves the upper airways (nasopharynx and sinuses) and the lungs, kidneys, and joints
(+) c-ANCA
Bx: necrotizing granulomas
Causes systemic necrotizing arteritis

Back 931

Wegener's granulomatosis

Front 932

Allergic angiitis and granulmatosis
Asthma followed by systemic vasculitis w/ eosinophilia

Back 932

Churg-Stauss Syndrome

Front 933

Benign form of sarcoidosis tat causes bilateral hilar adenopathy, periarthritis of the ankles and erythema nodosum of the anterior tibial regions of the lower extremities

Back 933

Lofgren Syndrome

Front 934

Life-threatening vasculitis of the medium sized vessels that causes visceral ischemia, esp in GI tract
Involves the GU system (kidneys and testes)
Involves neurologic system (mononeuritis multiplex manifesting itself as wristdrop or footdrop)

Back 934

Polyarteritis nodosa (PAN)

Front 935

Associated w/ SLE, RA, CA (esp multiple myeloma), & Hashimoto's thyroiditis
Skin Bx reveals inflammation and chondrolysis
Noncartilagenous manifestations: Fever, uveitis, deafness, aortic insufficiency, and GN
Pts present w/ destructive lesions of cartilaginous structures (nose, ears, trachea)

Back 935

Relapsing polychondritis

Front 936

Predominantly affects females
Pt complain of insomnia, easy fatigability, widespread musculoskeletal pain & stiffness
Up to 18 symmetrical bilateral tender point occuring in the same locations on all pts

Back 936

Fibromyalgia syndrome

Front 937

Multisystem disorder that involves the eyes and causes painful oral and genital ulcerations
Nondeforming arthritis that affects the knees and ankles

Back 937

Behcet Syndrome

Front 938

Inflammatory peripheral vascular disease of the upper and lower extremities
usually affects men under the age of 40 yo who smoke
Pts complain of extremity claudication or Raynaud's phenomenon

Back 938

Buerger's disease (Thromboangiitis obliterans)

Front 939

Drugs that may cause lupus

Back 939

Dilantin, Procainamide, Quinidine, Hydralazine, Isoniazid

Front 940

Affects older pts
they present w/ weight loss, profound fatigue, pain & stiffness of the neck, shoulders, thighs, and hips
PE: typically normal

Back 940

Polymyalgia rheumatica

Front 941

Pts w/ RA who develop splenomegaly and neutropenia

Back 941

Felty Syndrome

Front 942

Autoimmue disease that causes proximal muscle weakness that involves the skin

Back 942

Dermatomyositis
-Polymyositis spares the skin

Front 943

Pt w/ disc herniation at L5-S1 may present w/ S1 nerve root compression (herniated disk affects the nerve root below the lesion)
What are they unable to do

Back 943

Unable to stand on toes
has an absent Achilles reflex (S1)
Positive straight leg test

Front 944

Defect of the lumbar vertebra (lack of ossification of the articular processes)
Rarely causes Sx

Back 944

Spondylolysis

Front 945

Occures when the vertebra slips forward from its position and is generally a consequence of Spondylolysis or degenerative joint disease w/o Spondylolysis
Usually ASx

Back 945

Spondylolisthesis

Front 946

Injury to ligament or muscle in the back
may mimic disc disease
Neuro exam and straight-leg raising test generally remain normal

Back 946

Back strain

Front 947

Back pain made worse by lying down or at night may be sign of

Back 947

Malignancy of infection

Front 948

may occur rapidly after lifting heavy objects akwardly or with poor technique
usually resolves w/ a short period of rest & NSAIDs
If pt develops significant neurologic deficit after initial pain has resolved then new Dx

Back 948

Lumbar disc herniation

Nerve impingement due to a herniation of the disc

Front 949

May occur due to weight-bearing exercises or training errors
They cause anterior tibial pain not not weakness

Back 949

Tibial stress Fx's (shin splints)

Front 950

Occur after weight-bearing exercise that may cause neuropraxia of the peroneal nerve leading to footdrop

Back 950

Anterior compartment syndrome

Front 951

Occurs suddenly after rapid dorsiflexion of the ankle & cause severe midcalf pain
In a few days, the calf characteristically develops a bluish discoloration

Back 951

Gastrocnemius muscle tear

Front 952

Loss of Passive ROM in the shoulder indicates
-etiology could be impingement of the rotator cuff causing inflammation, degeneratuin, and possibly a tear

Back 952

Stiffening shoulder (frozen shoulder or adhesive capsulitis)

Front 953

Muscles that form the rotator cuff

Back 953

SITS
Supraspinatus
Infraspinatus
Teres minor
Subscapularis muscle

Front 954

Results in decreased sensation, strength, and relfexes all matching one root level of the upper extremity

Back 954

Cervical Radiculopathy

Front 955

Seen w/ overuse and trauma
Pain is typically felt over the anterior aspect of the shoulder and palpation of the biceps tendon in the bicipital groove elicits tenderness
Postive Yergason sign

Back 955

Bicipital tendinitis

Front 956

Sign that represents pain produced on supination of the forearm against resistance

Back 956

Yergason sign
confirms Bicipital tendinitis

Front 957

Due to calcium deposits in the subacromial region and is esp common in the supraspinatus tendon near its insertion

Back 957

Calcific tendinitis

Front 958

Uncommon disorder that affects boys more than girls b/w the ages of 2-12
Hallmark is avascular necrosis of the capital femoral epiphysis, which has the potential to regenerate new bone
Children are of short stature and present w/ a painless limp

Back 958

Legg-Calve-Perthes disease

Front 959

Occurs in adolescence and is usually self-limiting
due to patellar tendon stress which causes pain in the region of the tibial tuberositiy esp when pt extends knee against resistance

Back 959

Osgood-Schlatter disease

Front 960

Attributed to vit D deficiency
Manifested by bowing of the long bones, enlargement of the epiphyses of the long bones, delayed closure of the fontanels, and enlargement of the costochondral hcns of the ribs (rachitic rosary)

Back 960

Rickets

Front 961

Inflammatory disorder that begins in childhood and may produce extraarticular Sx including iridocyclitis, fever, rash, anemia, and pericarditis

Back 961

Juvenile RA

Front 962

Characterized by progressive weakness and muscle atrophy

Back 962

Muscular dystrophy

Front 963

Due to forceful abduction, external rotation or extension
Typically a flattening of the deltoid and loss of the greater tuberosity, causing a squared-off appearance of the shoulder
pt is usually in severe pain and holds the arm in slight abduction and external rotation

Back 963

Anterior Glenohumeral dislocation

Front 964

Type of dislocation seen following a seizure

Back 964

Posterior Glenohumeral dislocation

Front 965

Causes a bulge in the lower half of the arm and pain on elbow flexion

Back 965

Rupture of the long head of the biceps

Front 966

Occurs as a result of a fall on an outstretched hand
Heal poorly due to poor blood supply in that area
Radiographs done early may e (-) but when done later may show evidence of healing (callus Fx)

Back 966

Scaphoid Fxs

Front 967

Causing pain, numbness, and tingling from the neck to the hand

Back 967

Cervical (C6-C8) Radiculopathy

Front 968

Occurs at the tendon sheath of the extensor pollicis brevis and abductor pollicis longus
Causes swelling and tenderness of the anatomic snuffbox
Usually found in middle aged women who perform repetitive activity
Positive Finkelstein Test

Back 968

de Quervain's disease or tenosynovitis

Front 969

Test that represents: pt makes a fist around their own thumb, pain is produced w/ adduction toward the ulnar side

Back 969

Finkelstein Test
-positive in de Quervain's disease

Front 970

Surgical emergency due to tight case or swelling causing compression of blood vessels and nerves

Back 970

Compartment syndrome

Front 971

Causes flattening or loss the 5th knuckle prominence due to displacement of the metacarpal toward the palm
usually the result of striking an object w/ a clenched fist

Back 971

Boxer's Fx

Front 972

Ankle injury that occurs when foot twists as it lands on the ground or consequence of walking on uneven ground
The injured ligament is tender to palpation, ecchymotic, and swollen
What ligament is most commonly affect by eversion, and which one by inversion

Back 972

Eversion: Medial ligament
Inversion: Lateral ligament

Front 973

Occurs after long periods of running or walking
Pain is typically in the middle of the forefoot

Back 973

Metatarsal stress Fx (March Fx)

Front 974

May occur w/ running and jumping
Causes a palpable defect, swelling and tenderness over the tendon
Thompson test is positive

Back 974

Rupture of the Achilles tendon

Front 975

Test
Pt lies w/ knee flexed at 90 degrees and the examiner squeezes the calf muscle, if the Achilles tendon is ruptures the foot will not move, but if the tendon is intact the foot will plantarflex

Back 975

Thompson test

Front 976

Causes pain over the medial aspect of the plantar fasvia
Usually starts slowly and is of long duration
Positive Windlass Test

Back 976

Plantar fasciitis

Front 977

Sign that represents pain increasing with ankle and great toe dorsiflexion

Back 977

Windlass Test

Front 978

Occurs w/ entrapment of the posterior tibial nerve
Pt complains of burning and numbness that extends from the sole of the foot and toes to the medial malleolus

Back 978

Tarsal Tunnel Syndrome

Front 979

Most common cause of sciatica

Back 979

Herniate disc along L4-L5 or L5-S1 levels
-straight-leg raising test is usually positive in sciatic nerve irritation
-Cross-Leg raising test may also be positive

Front 980

Sign that represents pain produced w/ elevation of <70 and worsened with dorsiflexion of the foot

Back 980

Straight-leg raising test

Front 981

Test:
Elevation of unaffected leg causes pain in the affected leg

Back 981

Cross-Leg raising test

Front 982

Progressive weakness and numbness of the lower extremities bilaterally w/ urinary retention
Perineal and perianal sensory loss (saddle anesthesia) and a lax anal sphincter
True surgical emergency

Back 982

Cauda Equina Syndrome

Front 983

Smooth and rounded backward convexity of the thoracic region

Back 983

Kyphosis (hunchback)

Front 984

What may be injured as a result of humeral Fx, esp those involving the distal third of the humerus

Back 984

Radial nerve (C6-C8) supplies the extensor muscles of the wrist
-damage to it results in wrist drop, condition in which pt is unable to extend the wrist

Front 985

What is clawhand due too

Back 985

due to paralyzed interosseous and lumbrical muscles from the ulnar nerve (C8-T1) injury

Front 986

What nerve injury will cause thenar atrophy

Back 986

Median nerve (C6-T1) supplies most of the flexors of the forearm (motor branches) and supplies the sensory branches to the radial part of the hand

Front 987

Test
The pt is placed in the supine position w/ knee flexed at 15 degress while the examiner stabilizes the dital thigh w/ one hand and grasp's the pts leg distal to the tibiofemoral joint with the other hand
This test is positive if the examiner is able to move the tibia anteriorly

Back 987

Lachmen Test

Front 988

Test
the foot is immobilized while the hip and knee are flexed, then the tibia is moved anterior relative to the femur
Positive test occurs when forward displacement of the tibia is more than .5 cm

Back 988

Anterior Drawer Test

Front 989

Positive Lachmen Test & Anterior Drawer Test
Aspirated joint fluid is usually bloody

Back 989

ACL injury

Front 990

Pt complais of knee ctaching, locking, and clicking
Postive McMurray Test
Usually caused by twisting injury
More gradual swelling

Back 990

Torn medial meniscus

Front 991

Test
W/ the pt supine, flex the knee and hold the foot with one hand, rotate the leg and slowly extend the knee while palpating the posteromedial margins of the joit for a palpable click as the femur passes over the torn meniscus

Back 991

McMurray Test

Front 992

A Hx of pain that increases in severity, worsens at night, and is relieved by aspirin
Benign tumor, M > F b/w 20-30 yo
Proximal femur is the mos tcommon site

Back 992

Osteoid ostemoa

Front 993

What bone do osteosarcomas typically involve

Back 993

Distal femur
-may be seen later in life as a complication of Paget's disease

Front 994

Most frequently injured ligament of the knee
Caused by forced valgus bending of the knee
Pts present with pain over the medial aspect of the knee
May in turn cause the medial meniscus to tear since they are attached

Back 994

Medial Collateral Ligament Rupture

Front 995

Risk factors for Carpal tunnel Syndrome

Back 995

DM, pregnancy, hypothyroidism, RA, repetitive activity, and acromegaly

Front 996

Sign
Parestheias or pain reproduced with percussion of the volvar surface of the wirst

Back 996

Tinel sign
(+ in Carpal tunnel Syndrome)

Front 997

Sing
Sx are reproduced by holding the wrist in passive flexion ofr 1 min

Back 997

Phalen sign
(+ Carpal tunnel Syndrome)

Front 998

Fibrotic process of the palmar fascia that causes fixed flexion of the ring finger

Back 998

Dupuytren's contracture

Front 999

Flexion deformity of the DIP joint and is generally the result of traumatic rupture of the extensor tendon of the distal phalanx

Back 999

Mallet finger

Front 1000

Painless, firm cystic mass arising from any joint or tendon sheath

Back 1000

Ganglion

Front 1001

Seen in pts w/ RA
Occurs when enlarged flexor tendon sheath passes through the pulleys of the digits, causing locking or catching

Back 1001

Trigger Finger

Front 1002

Maneuver that is positive for nerve root compression from disk herniation when pain is produced at less than 70 degress of elevation

Back 1002

Straight-Leg Manuever

Front 1003

Straight-leg maneuver of nonpainful leg worsens pain of involved leg
-strong indicator of nerve root compression, but only is pain is produced below the knee

Back 1003

Crossover pain

Front 1004

Usually present w/ fever & tenderness w/ percussion of the affected back afrea

Back 1004

Paravertebral abscess

Front 1005

Common cause of hip pain in the elderly may also be seen in bikers and runners
Pain is exacerbated by standing and by external rotation
Lying on the affected side compresses the inflamed bursa

Back 1005

Trochanteric bursitis

Front 1006

Causes pain in the buttock made worse with sitting and with hop flexion

Back 1006

Ischial bursitis (Weaver's bottom)

Front 1007

May be due to trauma or due to medications such as CS
Pts usually b/w 30-60 yo and often complain of groin pain made worse w/ weight bearing

Back 1007

Avascular necrosis of the hip

Front 1008

Chlid that cannot raise one arm completely due to a small and elevated scapula

Back 1008

Sprengel deformity

Front 1009

Wry neck due to shortening of SCM muscle
Often accompanies Sprengel deformity

Back 1009

Torticollis

Front 1010

Often seen in obese African American lame adolescents
present w/ thigh or knee pain
unknown etiology
causes posterior and medial displacement of the femoral head

Back 1010

Slipped Capital Femoral epiphysis

Front 1011

Nonprogressive disorder resulting from a perinatal insult
Causes either spastic paresis of the limbs or extrapyramidal Sx (chorea, athetosis, ataxia)
Have associated seizure disorder, MR, and speech or sensory deficits

Back 1011

Cerebral Palsy

Front 1012

Characteristic of lumbar spinal stenosis
Arises from compression of the exiting nerve roots by a disk, osteophyte, or narrow canal
Leg pain is most pronounced when walking foreward before resolution
Positive stoop sign

Back 1012

Pseudoclaudication

Front 1013

Sign
Patients w/ Pseudoclaudication who continue to walk with pain will stoop over to relieve the Sx

Back 1013

Stoop sig

Front 1014

Seen in peripheral vascular disease
The pain that occurs w/ walking resolves immediately upon stopping or standing w/o sitting
Peripheral pulses may be compromised

Back 1014

Claudication

Front 1015

Causes calcification of the longitudinal ligaments of the spine
Usually found in pts w/ DM

Back 1015

Diffuse Idiopathic skeletal Hyperostosis

Front 1016

Elevated pressure in a confinsed space compromising nerve, soft tissue, and muscle perfusion
Etiologies: Burn injuries, crush injuries, and Fx's
Disorder of 6 P's (Pain, Pallor, Paralysis, Paresthesias, Poikilothermia, Pulselessness)
Dx and Tx

Back 1016

Dx: Compartment syndrome
Tx: Immediate fasciotomy and restoration of tissue perfusion

Front 1017

Characterized by tenderness of the common extensor muscles at their origin
Passive flexion of the fingers and wrist and have pt extend their wrist against resistance causes pain

Back 1017

Tennis Elbowl or Lateral Epicondylar Tendinitis

Front 1018

Disorder of the common flexor muscle group at its origin

Back 1018

Golfer's elbow or medial Epicondylar Tendinitis

Front 1019

Inflammation of the bursa over the olecranon process caused by acute or chronic trauma or 2' to gout, RA, or infection
There is swelloing or pain on the palpation of the posterior elboew

Back 1019

Olecranon Brusitis

Front 1020

Paralysis of the serratus anterior muscle causes the scapula to protrude posteriorly from the posterior thoracic wall when patient is asked to push against a wall

Back 1020

Winged Scapula

Front 1021

Begin after a Sx-free period following hyperextension or hypoflexion injury
usually in an MVA

Back 1021

Whiplash or Cervical musculoligamental sprain or strain

Front 1022

Improper footware results in lateral deviations of the great toe, extensor and flexor hallicu longus tendons

Back 1022

bunion formation

Front 1023

Often affects the 2nd toe, MTP joint is dorsiflexed and the PIP joint displays plantar flexion

Back 1023

Hammer Toe

Front 1024

Lateral femoral condyles are widely separated when the feet are placed together in the extended position

Back 1024

Genu varum

Front 1025

Flattening and beding of the knee to one side with displacement of the patella

Back 1025

Genu impressum

Front 1026

Flattened longitudinal arch of the foot

Back 1026

Pes Planus (flat foot)

Front 1027

Causes pain in the forefoot that radiates to one or two toes with tenderness b/w 2 metatarsals
Pain may be further aggravated by squeezing the metatarsal together

Back 1027

Morton's neuroma

Front 1028

Nail clubbing accompanied by symmetrical polyarthritis involving the large joints and occasionally the MCP joints
May be seen 2' to malignancy, endocarditis, vasculitis, and other pulm and cardiac disease

Back 1028

Hypertrophic osteoarthopathy

Front 1029

Presentation may be see after peripheral limb injury
Early Sx include pain in the limb and edema
May lead to contractures

Back 1029

Reflex sympathetic dystrophy

Front 1030

Used to test a torn meniscus
Postive test occurs when there is pain, clicking, or locking of the knee w/ rotation

Back 1030

Apley Test

Front 1031

Detect knee effusion
Performed while the knee is extended, downward pressure is applied on the suprapatellar pouch and the patella is pushed backward against the femur
Pressure on the patella is then released and the patella floats out (fluid wave) with an effusion

Back 1031

Ballottement

Front 1032

Detect knee effusion
Occurs when a bulge of fluid returns to the medial aspect of the knee with lateral tapping

Back 1032

Bulge test

Front 1033

Recurring HA accompanied by facial flushing, nasal stuffiness, tearing, and a partial horner syndrome (no anhydrosis)
More common in men (2-50 yo)
Exacerbated by alcohol use

Back 1033

Cluster HA ("suicide HA")

Front 1034

Bilateral, nonthrobbing & symmetric HA
usually located in the frontal or occipital areas of the skill

Back 1034

Tension HA

Front 1035

Paroxysmal severe facial pain over the distribution of the facial nerve
F > M, over the age of 40
pain can be triggered simply by touching the skin near the nostril

Back 1035

Trigeminal neuralgia

Front 1036

Characterized by CL loss of pain and temp, IL spasticity, weakness, hyperreflexia, extensor plant reflex and loss of proprioception

Back 1036

Brown-Sequard Syndrome (cord hemisection)

Front 1037

Bilateral paralysis, muscle atrophy, and fasciculations along with pain & temp sensory loss in a shawl-like distribution

Back 1037

Syringomyelia

Front 1038

Rarely produces coma
Pts do not complain of HA
Have focal deficits that appear abruptly and slowly progress over hours

Back 1038

Intracerebral hemorrhage

Front 1039

Present complaing of severe HA
Neck stiffness and no focal deficits
Common Causes: Ruptured aneurysm, AV malformation

Back 1039

Subarachnoid hemorrhage

Front 1040

Transient paralysis following a seizure

Back 1040

Todd's paralysis

Front 1041

Floppy baby, present w/ fasiculations

Back 1041

Werdnig-Hoffmann disease

Front 1042

Poliomyelitis

Back 1042

LMN disease

Front 1043

Caused by a lesion in the medial longitudinal fasciculus and may be due to glioma in children, MS in young adults, Vascular infarction in the elderly
Causes paresis of adduction of IL eye (can''t look medially)
Horizontal nystagmus in the CL abducting eye
Vertical nystagmus w/ upward gaze
Convergence is intact

Back 1043

Internuclear Ophthalmoplegia

Front 1044

Present w/ HA & papilledema
Often obese F in childbearing yr
LP reveal elevated opening pressure

Back 1044

Pseudotumor cerebri (benign intracranial HTN)

Front 1045

Type pf brain tumors in adults & children

Back 1045

Adults: Supratentorial primary brain tumors
-astrocytoma, glioblastoma multiforme
Children: infratentoria, medulloblastoma is most common

Front 1046

Reflex performed by rapidly rotating the head from side to side
If the brainstem is intact in a comatose pt the eyes will move conjugately in the direction opposite to the head rotation
If not intact eyes will move disconjugately or not at all

Back 1046

Oculocephalic or Doll's eye reflex

Front 1047

Reflex performed by introducing ice water into the external auditory canal
If the brainstem is intact in a comatose pt will respond with deviation of the eyes to the side of irrigation
If not intact the reflex will be absent or the eye will move disonconjugately

Back 1047

Oculovestibular or Caloric Reflex

Front 1048

Causes weakness of the shoulder and elbow and results in the waiter's tip position (arm danagles at the side w/ palm in a backward position w/ fingers flexed)

Back 1048

Erb-Duchenne Palsy (C5-C6)

Front 1049

Triad of claw hand deformitiy, absent triceps reflex, and Horner syndrome

Back 1049

Klumpke-Dejerine Palsy (C8-T1)

Front 1050

Lesions that produce CL hyperpathia and pain (thalmic syndrome) and Gerstmann syndrome (alexia, agraphia, acalculia, right-left confusion, and finger agnosis)

Back 1050

Parietal Lobe lesions

Front 1051

Lesions that produce seizures, lip smacking, olfactory or gustory hallucinations, behavioral changes

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Temporal Lobe lesions

Front 1052

When lesions are detected in only one eye, where is the lesion

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Anterior to the optic chiasm

Front 1053

What do lesions at the optic chiasm produce

Back 1053

produce a bitemporal hemianopsia b/c this is where the nasal retinal fibers decussate

Front 1054

When lesions to the medial longitudinal fasciculus produce

Back 1054

A lesion to the MLF bilaterally will not allow either eye to look medially

Front 1055

Lesions b/w the geniculate body and the visual cortex

Back 1055

Produce a CL upper homonymous quadrantanopsia

Front 1056

Lesion in the visual cortex (occipital lobe)

Back 1056

complete loss of vision, but pupillary reflexes (fibers end in midbrain) and extraocular m movement remain intact

Front 1057

Stoke that causes quadriplegia, sensory loss, and CN involvement
Pts may present w/ coma or locked in syndrome

Back 1057

Basilar artery stroke

Front 1058

Causes IL weakness of the palate and vocal cords, IL ataxia, IL Horner's syndrome, IL loss of facial pain and temperature but CL loss of body pain and temperature sensation
No limb weakness

Back 1058

Wallenberg syndrome or lateral medually syndrome

Front 1059

Stroke that causes unilateral leg weakness and sensory loss

Back 1059

Anterior cerebral artery stroke

Front 1060

Stroke that causes occipital stroke and a homonymous hemianopsia

Back 1060

Posterior cerebral artery stroke

Front 1061

Stroke that causes hemiplegia or hemiparesis greater in the arm than the leg, aphasia, unilateral sensory loss and eyes that deviate towards the side of the hemisphereic lesion

Back 1061

Middle cerebral artery stroke

Front 1062

Occurs w/ root compression from a protruded disk that causes sensory loss, weakness, and hyporeflexia in the distribution of the nerve root

Back 1062

Radiculopathy

Front 1063

Causes severe sensory loss of posterior column sensation (position sense and vibration), spasticity, hyperreflexia, postive babinski

Back 1063

Myelopathy

Front 1064

Abnormal triangular fold of membrane extending from the conjunctiva to the cornea that occurs b/w of irritation secondary to dust, sand, or UV light

Back 1064

Pterygium

Front 1065

Conjunctival edema

Back 1065

Chemosis

Front 1066

Triad of Sx in normal pressure hydrocephalus

Back 1066

Dementia, Incontinence, Ataxia

Front 1067

A specific kind of vascular demential associated w/ demyelination of the cerebral white matter

Back 1067

Binswanger's disease

Front 1068

Dementia w/ alterations in emotion and personality

Back 1068

Pick's disease

Front 1069

Results from sudden reduction in cardiac output usually caused by an arrhythmia

Back 1069

Cardiac syncope

Front 1070

present w/ bradycardia and hypotension due to activation of parasympathetic nervous system
common fainting

Back 1070

Vasovagal or neurocardiogenic syncope

Front 1071

Can initiate Sx by turning head to one side, wearing tight shirt collar, or shaving over the carotid artery

Back 1071

Carotid sinus syncope

Front 1072

Characterized by the loss of small amounts of urine during activities that inc abdominal pressure, such as laughing, sneexing, exercising

Back 1072

Stress incontinence

Front 1073

Painful, superficial cellulitis of the face

Back 1073

Erysipelas

Front 1074

Types of abortion that all present w/ vaginal bleeding and occur at < 20 weeks

Back 1074

Threatened
Incomplete
Complete
Inevitable

Front 1075

Complain of abdominal pain and vaginal bleeding
the membranes remain intact and no products of conception are expelled
the internal cervical os is colsed and the fetus is viable

Back 1075

Threatened abortio

Front 1076

The cervical os is open and some products of conception are expelled

Back 1076

Incomplete abortion

Front 1077

All products of conception are expelled and the cervical os is closed

Back 1077

Complete abortion

Front 1078

The membranes rupture, the internal cervical os is open, and no products of conception are expelled
pts complain of abdominal cramps

Back 1078

inevitable abortion

Front 1079

retained fetal tissue with no cardiac activity in a uterus that is not growing
there is no vaginal bleeding, no products of conception are expelled and the internal cervical os is closed

Back 1079

Missed abortion

Front 1080

placenta adheres to the myometrium w/o an intervening decidual layer
assoc w/ postpartum hemorrhage

Back 1080

Placenta accreta

Front 1081

the fetal vessels assoc w/ the cord transverse the lower uterine segment and present in advance of the fetal present part causing rapid bleeding when disrupted during labor

Back 1081

Vasa previa

Front 1082

Present during 1st trimester vaginal bleeding and signs of preeclampsia (pathognomonic)
Typically have increased beta-hCG titers, rapid enlargement of the uterus w/ absence of fetal heart sounds and structures
Cluster of grapes appearance on gros
Snowstorm appearance on US

Back 1082

Hydatiform mole