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846 Cards in this Set
- Front
- Back
What is the key workup when a patient presents with:
30yo F has wrist pain and a black eye after tripping, falling, and hitting her head on the edge of a table. She looks anxious and give an inconsistent story |
- XR - wrist
- CT - head - Urine toxicology |
|
What are the key elements of the patient history when a patient presents with abuse?
|
- Establish confidentiality; directly question about physical, sexual, or emotional abuse and about fear, safety, backup plan
- History of frequent accidents/injuries, mental illness, drug use - Firearms in the home |
|
What are the key elements of the patient physical when a patient presents with abuse?
|
- Vital signs
- Complete exam +/- pelvic |
|
What is the key differential when a patient presents with:
- 30yo F presents with wrist pain and a sensation of numbness and burning in her palm and the first, second and third fingers of her right hand. The pain worsens at night and is relieved by loose shaking of the hand. There is sensory loss in the same fingers. Exam reveals a positive Tinel's sign. |
- Carpal tunnel syndrome
- Median nerve compression in forearm or arm - Radiculopathy of nerve roots C6 & C7 in cervical spine |
|
What is the key workup when a patient presents with:
- 30yo F presents with wrist pain and a sensation of numbness and burning in her palm and the first, second and third fingers of her right hand. The pain worsens at night and is relieved by loose shaking of the hand. There is sensory loss in the same fingers. Exam reveals a positive Tinel's sign. |
- Nerve conduction study
- EMG |
|
What is the key differential when a patient presents with:
- 28 yo F presents with pain in the interphalangeal joints of her hands together with hair loss and a butterfly rash on her face. |
- Systemic lupus erythematosus (SLE)
- Rheumatoid arthritis - Psoriatic arthritis - Parvovirus B19 infection |
|
What is the key workup when a patient presents with:
- 28 yo F presents with pain in the interphalangeal joints of her hands together with hair loss and a butterfly rash on her face. |
- ANA, anti-dsDNA, ESR, C3, C4, rheumatoid factor (RF), CBC
- XR - hands - UA |
|
What is the key differential when a patient presents with:
- 28 yo F presents with pain in the matacarpophalangeal joints of both hands. Her left knee is also painful and red. She has morning joint stiffness that lasts for an hour. Her mother had rheumatoid arthritis. |
- Rheumatoid arthritis
- SLE - Disseminated gonorrhea - Arthritis associated with inflammatory bowel disease - Osteoarthritis |
|
What is the key differential when a patient presents with:
- 28 yo F presents with pain in the matacarpophalangeal joints of both hands. Her left knee is also painful and red. She has morning joint stiffness that lasts for an hour. Her mother had rheumatoid arthritis. |
- ANA, anti-dsDNA, ESR, RF, CBC
- XR - hands, left knee - Cervical culture - Arthrocentesis & synovial fluid analysis |
|
What is the key differential when a patient presents with:
18yo M presents with pin in the interphalangeal joins of both hands. He also has scaly, salmon-pink lesions on the extensor surface of his elbows and knees. |
- Psoriatic arthritis
- Rheumatoid arthritis - SLE |
|
What is the key workup when a patient presents with:
18yo M presents with pin in the interphalangeal joins of both hands. He also has scaly, salmon-pink lesions on the extensor surface of his elbows and knees. |
- RF, ANA, ESR
- CBC - XR - hands - XR - pelvis/sacroiliac joints - Uric acid |
|
What is the key differential when a patient presents with:
65yo F presents with inability to use her left leg and bear weight on it after tripping on a carpet. Onset of menopause was 20 years ago and she did not receive HRT or calcium supplements. her left leg is externally rotated, shortened, and adducted, and there is tenderness in her left groin. |
- Hip fracture
- Hip dislocation - Pelvic fracture |
|
What is the key workup when a patient presents with:
65yo F presents with inability to use her left leg and bear weight on it after tripping on a carpet. Onset of menopause was 20 years ago and she did not receive HRT or calcium supplements. her left leg is externally rotated, shortened, and adducted, and there is tenderness in her left groin. |
- XR - hip/pelvis
- CT or MRI - hip - CBC - Serum calcium & Vit. D - Bone density scan (DEXA) |
|
What is the key differential when a patient presents with:
40yo M presents with pain in the right groin after a motor vehicle accident. His right leg is flexed at the hip. adducted, and internally rotated. |
- Hip dislocation - traumatic
- Hip fracture |
|
What is the key workup when a patient presents with:
40yo M presents with pain in the right groin after a motor vehicle accident. His right leg is flexed at the hip. adducted, and internally rotated. |
- XR - hip
- CT or MRI - hip - CBC - PT/PTT - Blood type & cross match - Urine toxicology and blood alcohol level |
|
What are the key elements of patient history when a patient presents with low back pain?
|
- Location, quality, intensity, radiation
- Context: moving furniture, bending/twisting, trauma - Timing: disturbs sleep - Associated symptoms: especially constitutional, incontinence - Exacerbating & alleviating factors - History of cancer - Recurrent UTIs, diabetes, renal stones, IV drug use, smoking |
|
What are the key elements of patient physical when a patient presents with low back pain?
|
- Vital signs, neurologic exam (esp. L4-S1 nerve roots)
- Back palpation & range of motion - Hip exam - Rectal exam |
|
What are the key elements of patient history when a patient presents with a child with fever?
|
- Severity, duration
- Associated localizing symptoms - Appetite - Rash - Sick contacts - Day care - Immunizations - Past history |
|
What are the key elements of patient history when a patient physical with a child with fever?
|
- Vital signs
- HEENT - Neck - Heart & Lungs - Abdominal - Skin exam |
|
What are the key elements of patient history when a patient presents with a child with behavioral problems?
|
- Onset
- Severity - Duration - Triggers - Physical violence or use of weapons - Substance use - Developmental history - Changes in environment/school performance |
|
What are the key elements of patient physical when a patient presents with a child with behavioral problems?
|
- Vital signs
- Neurological exam |
|
What is the key differential in a patient that presents with:
56yo obese F presents with right knee stiffness and pain that increases with movement. Her symptoms have gradually worsened over the past 10 years. She noticed swelling and deformity of the joint and is having difficulty walking. |
- Osteoarthritis
- Pseudogout - Gout - Meniscal or ligament damage |
|
What is the key workup in a patient that presents with:
56yo obese F presents with right knee stiffness and pain that increases with movement. Her symptoms have gradually worsened over the past 10 years. She noticed swelling and deformity of the joint and is having difficulty walking. |
- XR - knee
- CBC - ESR - Knee arthrocentesis & synovial fluid analysis: cell count, Gram stain, culture, crystals) - MRI - knee |
|
What is the key differential when a patient presents with:
45yo M presents with right knee pain with swelling and redness. |
- Septic arthritis
- Gout - Pseudogout - Lyme arthritis - Trauma - Reiter's arthritis |
|
What is the key workup when a patient presents with:
45yo M presents with right knee pain with swelling and redness. |
- CBC
- Knee arthrocentesis and synovial fluid analysis (cell count, gram stain, culture, crystals) - Blood, urethral cultures - XR - knee - Uric acid - Lyme antibody |
|
What is the key differential when a patient presents with:
65yo M presents with right foot pain. He has been training for a marathon. |
- Stress fracture
- Plantar fasciitis - Foot sprain or strain |
|
What is the key workup when a patient presents with:
65yo M presents with right foot pain. He has been training for a marathon. |
- XR - foot
- Bone scan - foot - MRI - foot |
|
What is the key differential when a patient presents with:
65yo M presents with pain in the heel of the right foot that is most notable with his first few steps and then improves as he continues walking. He has no known trauma. |
- Plantar fasciitis
- Heel fracture - Splinter/foreign body |
|
What is the key workup when a patient presents with:
65yo M presents with pain in the heel of the right foot that is most notable with his first few steps and then improves as he continues walking. He has no known trauma. |
- XR - heel
- Bone scan |
|
What is the key differential when a patient presents with:
55yo M presents with pain in the elbow when he plays tennis. His grip is impaired as a result of the pain. There is tenderness over the lateral epicondyle as well as pain on resisted wrist dorsiflexion (Cozen's test) with the elbow in extension. |
- Tennis elbow (lateral epicondylitis)
- Stress fracture |
|
What is the key workup when a patient presents with:
55yo M presents with pain in the elbow when he plays tennis. His grip is impaired as a result of the pain. There is tenderness over the lateral epicondyle as well as pain on resisted wrist dorsiflexion (Cozen's test) with the elbow in extension. |
- XR - arm
- Bone scan - MRI - elbow |
|
What is the key differential when a patient presents with:
27yo F presents with painful wrists and elbows, a swollen and hot knee joint that is painful on flexion, a rash on her limbs, and vaginal discharge. She is sexually active with multiple partners and occasionally uses condoms. |
- Disseminated gonorrhea
- Rheumatoid arthritis - SLE - Psoriatic arthritis - Reiter's arthritis |
|
What is the key differential when a patient presents with:
27yo F presents with painful wrists and elbows, a swollen and hot knee joint that is painful on flexion, a rash on her limbs, and vaginal discharge. She is sexually active with multiple partners and occasionally uses condoms. |
- Knee arthrocentesis & synovial fluid analysis (cell count, Gram stain, culture)
- ANA, anti-dsDNA, ESR, RF, CBC - Blood, cervical cultures - XR - knee |
|
What is the key differential when a patient presents with:
60yo F presents with pain in both legs that is induced by walking and is relieved by rest. She had cardiac bypass surgery 6 months ago & continues to smoke heavily. |
- Peripheral vascular disease (intermittent claudication)
- Leriche's syndrome (aortoiliac occlusive disease) - Lumbar spinal stenosis (pseudoclaudication) - Osteoarthritis |
|
What is the key workup when a patient presents with:
60yo F presents with pain in both legs that is induced by walking and is relieved by rest. She had cardiac bypass surgery 6 months ago & continues to smoke heavily. |
- Ankle-brachial index
- Doppler U/S - lower extremity - Angiography - MRI - lumbar spine |
|
What is the key differential when a patient presents with:
45yo F presents with right calf pain. Her calf is tender, warm, red, and swollen compared to the left side. She was started on OCPs 2 months ago for dysfunctional uterine bleeding. |
- DVT
- Baker's cyst rupture - Myositis - Cellulitis - Superficial venous thrombosis |
|
What is the key workup when a patient presents with:
45yo F presents with right calf pain. Her calf is tender, warm, red, and swollen compared to the left side. She was started on OCPs 2 months ago for dysfunctional uterine bleeding |
- Doppler U/S - right leg
- CBC - CPK - D-dimer - PT, aPTT, fibrinogen - XR - right leg |
|
What is the key differential when a patient presents with:
60yo F c/o left arm pain that started while she was swimming and was relieved by rest. |
- Angina/MI
- Tendonitis - Osteoarthritis - Shoulder dislocation |
|
What is the key workup when a patient presents with:
60yo F c/o left arm pain that started while she was swimming and was relieved by rest. |
- CPK-MB, troponin, ECG
- CBC - ESR - XR - shoulder - CXR - Echocardiography - Stress test |
|
What is the key differential when a patient presents with:
50yo M presents with right shoulder pain after falling onto his outstretched hand while skiing. He noticed deformity of his shoulder and had to hold his right arm. |
- Shoulder dislocation
- Fracture of the humerus - Rotator cuff injury |
|
What is the key workup when a patient presents with:
50yo M presents with right shoulder pain after falling onto his outstretched hand while skiing. He noticed deformity of his shoulder and had to hold his right arm. |
- XR - shoulder
- XR - arm - MRI - shoulder |
|
What is the key differential when a patient presents with:
55yo M presents with crampy bilateral thigh & calf pain, fatigue, and dark urine. He is on simvastatin and clofibrate for hyperlipidemia. |
- Rhabdomyolysis due to simvastatin or clofibrate
- Polymyositis - Inclusion body myositis - Thyroid disease |
|
What is the key workup when a patient presents with:
55yo M presents with crampy bilateral thigh & calf pain, fatigue, and dark urine. He is on simvastatin and clofibrate for hyperlipidemia. |
- CBC
- CPK - Aldolase - UA - Urine myoglobin - TSH |
|
What is the key differential when a patient presents with:
45yo F presents with low back pain that radiates to the lateral aspect of her left foot. Straight leg raising is positive. The patient is unable to tiptoe. |
- Disk herniation
- Lumbar muscle strain - Tumor in the vertebral canal |
|
What is the key workup when a patient presents with:
45yo F presents with low back pain that radiates to the lateral aspect of her left foot. Straight leg raising is positive. The patient is unable to tiptoe. |
- XR - L-spine
- MRI - L-spine |
|
What is the key differential when a patient presents with:
45yo F presents with low back pain that started after she cleaned her house. The pain does not radiate, & there is no sensory deficit or weakness in her legs. Paraspinal muscle tenderness and spasm are also noted. |
- Lumbar muscle strain
- Disk herniation - Abdominal aortic aneurysm - Vertebral compression fracture |
|
What is the key workup when a patient presents with:
45yo F presents with low back pain that started after she cleaned her house. The pain does not radiate, & there is no sensory deficit or weakness in her legs. Paraspinal muscle tenderness and spasm are also noted. |
- XR - L-spine
|
|
What is the key differential when a patient presents with:
45yo M presents with pain in the lower back and legs during prolonged standing and walking. The pain is relieved by sitting and leaning forward (e.g. pushing a grocery cart). |
- Lumbar spinal stenosis
- Lumbar muscle strain - Tumor in the vertebral canal - Peripheral vascular disease |
|
What is the key workup when a patient presents with:
45yo M presents with pain in the lower back and legs during prolonged standing and walking. The pain is relieved by sitting and leaning forward (e.g. pushing a grocery cart). |
XR - L-spine
MRI - L-spine (preferred) CT - L-spine Ankle-brachial index |
|
What is the key differential when a patient presents with:
17yo M presents with low back pain that radiates to the left leg and began after he fell on his knee during gym class. He also describes areas of loss of sensation in his left foot. The pain and sensory loss do not match any known distribution. He insists on requesting a week off from school because of his injury. |
- Malingering
- Lumbar muscle strain - Disk herniation - Knee or leg fracture - Ankylosing spondylitis |
|
What is the key workup when a patient presents with:
17yo M presents with low back pain that radiates to the left leg and began after he fell on his knee during gym class. He also describes areas of loss of sensation in his left foot. The pain and sensory loss do not match any known distribution. He insists on requesting a week off from school because of his injury. |
- XR - L-spine/knee
- MRI - L-spine |
|
What is the key differential when a patient presents with:
20-day old M presents with fever, decreased breast/feeding, and lethargy. He was born at 36 weeks as a result of premature rupture of membranes. |
- Neonatal sepsis
- Meningitis - Pneumonia - UTI |
|
What is the key workup when a patient presents with:
20-day old M presents with fever, decreased breast/feeding, and lethargy. He was born at 36 weeks as a result of premature rupture of membranes. |
- Physical exam
- CBC, electrolytes - UA - Urine culture - Blood culture - CXR - LP - CSF analysis |
|
What is the key differential when a patient presents with:
3yo M presents with a 2-day history of fever and pulling on his right ear. He is otherwise healthy, and his immunizations are up to date. His older sister recently had a cold. The child attends a day care center. |
- Acute otitis media
- URI - Meningitis - UTI |
|
What is the key workup when a patient presents with:
3yo M presents with a 2-day history of fever and pulling on his right ear. He is otherwise healthy, and his immunizations are up to date. His older sister recently had a cold. The child attends a day care center. |
- Physical exam (including pneumatic otoscopy)
- CBC - UA |
|
What is the key differential when a patient presents with:
12-month-old M presents with fever for the last 2 days accompanied by maculopapular rash on his face and body. He has not yet received the MMR vaccine. |
- Measles (or other viral exanthem)
- Rubella - Roseola - 5th disease - Varicella - Scarlet fever - Meningitis |
|
What is the key workup when a patient presents with:
12-month-old M presents with fever for the last 2 days accompanied by maculopapular rash on his face and body. He has not yet received the MMR vaccine. |
- Physical exam
- CBC - Viral antibodies/titers - Throat swab for culture - LP |
|
What is the key differential when a patient presents with:
4yo M presents with diarrhea, vomiting, lethargy, weakness, and fever. The child attends a day care center where several children have had similar symptoms. |
- Gastroenteritis (viral, bacterial, parasitic)
- Food poisoning - UTI - URI - Volvulus - Intussusception |
|
What is the key workup when a patient presents with:
4yo M presents with diarrhea, vomiting, lethargy, weakness, and fever. The child attends a day care center where several children have had similar symptoms. |
- Physical exam
- Stool exam & culture - CBC - Electrolytes - UA, urine culture - AXR |
|
What is the key differential when a patient presents with:
9yo M presents with a 2-year hisotry of angry outbursts both in school and at home. His mother complains that he runs around "as if driven by a motor". His techer reports that he cannot sit still in class, regularly interrupts his classmates, and has trouble making friends. |
- Attention-deficit hyperactivity disorder (ADHD)
- Oppositional defiant disorder - Manic episode - Conduct disorder |
|
What is the key workup when a patient presents with:
9yo M presents with a 2-year hisotry of angry outbursts both in school and at home. His mother complains that he runs around "as if driven by a motor". His techer reports that he cannot sit still in class, regularly interrupts his classmates, and has trouble making friends. |
- Physical exam
- Mental status exam |
|
What is the key differential when a patient presents with:
12yo F presents with a 2-month history of fighting in school, truancy, and breaking curfew. Her parents recently divorced, and she just started school in a new district. Before her parents divorced, she was an average student with no behavioral problems. |
- Adjustment disorder
- Substance intoxication/abuse/dependence - Manic episode - Oppositional defiant disorder - Conduct disorder |
|
What is the key workup when a patient presents with:
12yo F presents with a 2-month history of fighting in school, truancy, and breaking curfew. Her parents recently divorced, and she just started school in a new district. Before her parents divorced, she was an average student with no behavioral problems. |
- Physical exam
- Mental status exam - Urine toxicology |
|
What is the key differential when a patient presents with:
15yo M presents with a 1-year history of failing grades, school absenteeism, and legal problems, including shoplifting. His parents report that he spends most of his time alone in his room, adding that when he does go out, it is with a new set of friends. |
- Substance abuse
- Conduct disorder - Oppositional defiant disorder - Adjustment disorder |
|
What is the key workup when a patient presents with:
15yo M presents with a 1-year history of failing grades, school absenteeism, and legal problems, including shoplifting. His parents report that he spends most of his time alone in his room, adding that when he does go out, it is with a new set of friends. |
- Urine toxicology
- Mental status exam |
|
What is the key differential when a patient presents with:
5yo M presents with 6-month history of temper tantrums that last 5-10 minutes and immediately follow a disappointment or a discipline. He has no trouble sleeping, has had no change in appetite, and does not display these behaviors when he is at day care. |
- Age-appropriate behavior
- ADHD - Oppositional defiant disorder |
|
What is the key workup when a patient presents with:
5yo M presents with 6-month history of temper tantrums that last 5-10 minutes and immediately follow a disappointment or a discipline. He has no trouble sleeping, has had no change in appetite, and does not display these behaviors when he is at day care. |
- Physical exam
- Mental status |
|
Which hep virus is a circular, partially double-stranded DNA virus?
|
Hep B
|
|
What is the incubation period & route of transmission for Hep B?
|
- Incubation: 1-6m
- Transmission: parenteral, sexual, perinatal |
|
What are the 2 markers of HBV infection?
|
- HBsAg
- IgG anti-HBc Ab |
|
What hep virus is ss(+) RNA virus?
|
HCV
|
|
What is the incubation period & route of transmission for HCV?
|
- 15-150 days
- Parenteral, Sexual, Perinatal |
|
What Hep virus is incomplete RNA and requires co-infection or superinfects with HBV?
|
HDV (Deltaviridae)
|
|
Where is HDV usually contracted?
|
- Amazon Basin
- Central Africa - Mediterranean Basin - Middle East |
|
What is the difference in diagnosis between and HDV co-infection with HBV & a superinfection (also with HBV)?
|
Co-infection: IgM anti-HBc Ab (+)
Superinfection: IgM anti-HBc Ab (-) |
|
Which Hep virus has recent be found in solid organ-transplant recipients?
|
HEV
|
|
Which Hep viruses require more than symptomatic therapy?
|
- Hep B - IF infection is severe
- Hep C - (PEG)INF-alpha - Hep D - Vaccination against HBV i.e. Hep A & E are symptomatic only |
|
Which Hep is especially dangerous for pregnant women?
|
Hep E
|
|
What are the extrahepatic manifestations of HBV infection?
|
- Polyarteritis nodosa
- Glomerulonephritis - Cryogobulinemia |
|
What are the extrahepatic manifestations of HCV infection?
|
- Glomerulonephritis
- Cryogobulinemia - Idiopathic thrombocytopenia purpura - Lichen Planus - Raynaud syndrome - Sjogren's syndrome - Porphyria cutanea tarda - Necrotizing cutaneous vasculitis - Non-Hodgkin's lymphoma |
|
What is the DOC for chronic Hep B?
|
interferon (W/O ribavirin)
|
|
What is the 2nd choice treatment for Hep B?
|
Choose an oral analog:
- Lamivudine - Adefovir - Entecavir - Tenofovir - Tebivudine |
|
What is the best choice treatment of chronic Hep C?
|
PEG-INF + RBV
|
|
What are the 2 top causes of cirrhosis in the USA?
|
- Hep C
- Alcoholic Liver disease - Hep C + alcoholic liver disease |
|
What type of vaccine is the HBV vaccine and what is the schedule?
|
- HBsAg
- 0-1-6 month schedule - Protective immunity: anti-HBsAb greater than 10IU/L |
|
What is the preventive therapy for perinatal HBV transmission?
|
- HbIg (0.06mL/kg)
- HBV vaccine within 12 hours of birth (then 1-6-12m later) - Efficacy = 95% |
|
What are the 2 causes of reactive lymphadenopathy?
|
- Infectious disease
- Noninfective disease - Infiltrative disease |
|
What types of infectious orgs can cause lymphadenopathy?
|
- Viral: mono, rubella
- Bac: cat-scratch - Mycobac: TB - Spirochetal: syphilis, leptospirosis - Chlamydial: lymphogranuloma venerum - Fungal: Coccidioidomycosis - Parasitic: Toxo |
|
What noninfectious diseases cause lymphadenopathy?
|
- Sarcoidosis
- Connective tissue diseases: SLE - Kawasaki's disease - Drug hypersensitivity: phenytoin - Silicone breast implantation |
|
What types of diseases result in infiltrative lymphadenopahty?
|
Malignant: mets, melanoma, germ cell tumor, leukemia
- Lipid storage diseases: Gaucher's - Amyloidosis |
|
What are the 2 causes of primary lymphoproliferative lymphadenopahty?
|
- Lymphoma: Hodgkin's, non-Hodgkin's
- Malignant histiocytosis |
|
What causes lymphadenopathy in 60% of cases of adults over 50 years of age?
|
malignancy
|
|
What are the causes of inguinal lymphadenopathy?
|
- Chacroid
- Lymphogranulma venerum - Syphilis - Genital herpes - Granuloma ingiunale |
|
What are the major causes of mediastinal & hilar lymphadenopathy?
|
- TB
- Endemic mycoses: Histo, Coccidio, Paracoccidio |
|
What are the 2 main causes of acute suppurative lymphadenitis?
|
1) Staph aureus
2) Group A strep Nodes involved: submandibular, cervical, ingiunal, axillary |
|
What causes Cat-scratch disease?
|
Bartonella henselae
|
|
What is Parinaud's sign?
|
conjunctivitis with ipsilateral preauricular lymphadenitis
- seen in Cat-Scratch disease |
|
What is the most common form of extrapulmonary TB?
|
- mycobacterial lymphadenitis
- if cervical = called scrofula - location: unilateral on upper border of sternocleidomastoid muscle or supraclavicular, sometimes in the axilla |
|
Is mycobacterial lymphadenitis painful?
|
no: uliateral, firm, red & painLESS
|
|
What are the top 3 causes of mycobacterial lyphadenitis?
|
1) M. bovis
2) M. tuberculosis 3) M. avium complex (MAC) |
|
What are the symptoms of miliary TB?
|
- Systemic
- Generalized lymphadenopathy outside of the cervical chain |
|
What are the 2 diseases that can cause inguinal lymphadenopathy?
|
- STDs: chancroid (H. ducreyi), C. trachomatis, syphilis, herpes, donovanosis
- Metastaic genital neoplasms |
|
What often co-infects with H. ducreyi (Chancroid)?
|
- HSV or C. trachomatis
|
|
What is the inguinal lymphadenopathy of chancroid like?
|
- enlarged, painful, tender,(mostly unilateral) nodes
|
|
What is the inguinal lymphadenopathy of lymphogranuloma venerum like?
|
C. trachomatis
- vesicular lesion 1st - 1-6 weeks later: unilateral, painful nodes - IF untreaded: nodes rupture & a nonhealing fistula forms |
|
What is the Groove sign?
|
- Cleavage of the enlarged nodes by the inguinal ligament
- Seen in lymphogranuloma venerum (C. trachomatis) |
|
What are the symptoms of 2ndary syphilis?
|
- Generalized lymphadenopathy
- Skin lesions - Appear 2-8 weeks after chancre heals |
|
When does the chancre of syphilis appear?
|
14-30 days post inoculation
|
|
What are the lesions of genital herpes?
|
- vesicles: macules & papules followed by vesicles & ulcers
- Inguinal lymphadenopathy (uni or bilateral) |
|
What sites in women are affected by genital herpes?
|
- Vulva + cervix
- Perineum - Vagina - Buttocks - Perineal region |
|
What sites in men are affected by genital herpes?
|
- Buttocks
- Anal & perianal area |
|
What causes granuloma inguinale?
|
Calymmatobacterium granulomatis
|
|
What are the symptoms of grauloma inguinale (donovanosis)
|
- Papules on the penis within days of inoculation
- Rapidly ulcerate to form red, granulomatous painless ulcers that bleed easily on contact |
|
What is oculogradular syndrome?
|
Tularemia symptom:
- conjunctivits - conjunctival ulceration & papules on the eyelids - inflammation of the Head & Neck lymph nodes. |
|
What type of lymphadenopathy is almost universal in kids with primary TB?
|
Ipsilateral
|
|
What areas have endemic histoplasmosis?
|
- Mississippi river valley
- OhiO river valley |
|
What areas have endemic coccidioidomycosis?
|
- Southwest US, Mexico & Central & South America
- Mediastinal & hilar lymph nodes |
|
What areas have endemic paracoccidioidomycosis?
|
- Mexico, Central & South America
- Cervical, axillary & mediastinal with/out fistual formation |
|
What often accompanies the bilateral symmetric hilar lymphadenopathy of sarcoidosis?
|
Paratracheal adenopathy
|
|
If a patient with aids presents with generalized lymphadenopathy, what should you think about?
|
- Lymphoma
- Kaposi's sarcoma |
|
What drugs can cause lymphadenopathy?
|
- Phenytoin
- Carbamazepine |
|
What vaccines can cause lymphadenopathy?
|
- Measles
- BCG |
|
What autoimmune diseases can cause lymphadenopahty:
|
- Rheumatoid arthritis
- Juvenile rheumatoid arthritis - active SLE |
|
What is mucocutaneous lymph node syndrome?
|
lymphadenopathy due to Kawasaki's disease
|
|
What is ulcerograndular syndrome?
|
Tularemia infection: ulcer or pustule develops after up to 10 days post-exposure
|
|
What are the 4 main causes of generalized lymphaedenopathy?
|
1) Infective mono
2) HIV 3) Human T-lymphocyte leukemia virus 1 4) Tropical diseases |
|
What tropical diseases cause lymphadenopathy?
|
- Leishmaniasis
- Filariasis - Onchocerciasis - Wuchereria bancrofti - African trypanosomiasis - (Chagas') tyrpanosomiasis |
|
What are the sites (2+) where lymph node enlargement equals generalized lymphadenopathy?
|
- Posterior cervical
- Occipital - Submandibular - Axillary |
|
What are the signs/symptoms of HTLV-1?
|
- Lymphadenopathy (most common)
- Skin lesions - Hepatosplenomegaly - Hypercalcemia - Lymphocytosis - Hyperimmunoglobulinemia |
|
EKG "Sawtooth" P waves
|
- Classic ECG finding in atrial flutter.
|
|
Define unstable angina.
|
- Angina is new, is worsening, or occurs at rest
|
|
ACEI =
|
- Antihypertensive for a diabetic patient with proteinuria.
|
|
Beck's triad for cardiac tamponade.
|
- Hypotension, distant heart sounds, and JVD
|
|
3 Drug types that slow AV node transmission.
|
- β-blockers
- Digoxin - Calcium channel blockers |
|
What hypercholesterolemia treatment that → flushing and pruritus?
|
Niacin
|
|
What is the treatment for atrial fibrillation?
|
Anticoagulation, rate control, & cardioversion
|
|
What is the treatment for ventricular fibrillation?
|
Immediate cardioversion
|
|
What is the autoimmune complication occurring 2-4 weeks post-MI?
|
Dressler's syndrome: fever, pericarditis, ↑ ESR
|
|
IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
|
Treat existing heart failure and replace the tricuspid valve
|
|
What is the diagnostic test for hypertrophic cardiomyopathy?
|
Echocardiogram (showing thickened left ventricular wall and outflow obstruction).
|
|
A fall in systolic BP of > 10 mmHg with inspiration is called ____.
|
Pulsus paradoxus (seen in cardiac tamponade)
|
|
Low-voltage, diffuse ST-segment elevation are _____
|
- Classic ECG findings in pericarditis.
|
|
What is the definition of hypertension?
|
BP > 140/90 on three separate occasions two weeks apart
|
|
What are the eight surgically correctable causes of hypertension?
|
- Renal artery stenosis
- Coarctation of the aorta - Pheochromocytoma - Conn's syndrome - Cushing's syndrome - Unilateral renal parenchymal disease - Hyperthyroidism - Hyperparathyroidism |
|
What tests are used to evaluate a pulsatile abdominal mass and bruit?
|
Abdominal ultrasound and CT
|
|
What are the indications for surgical repair of abdominal aortic aneurysm?
|
> 5.5 cm, rapidly enlarging, symptomatic, or rupture
|
|
What is the treatment for acute coronary syndrome?
|
Morphine, O2, sublingual nitroglycerin, ASA, IV β-blockers, heparin
|
|
What is metabolic syndrome?
|
- Abdominal obesity
- High triglycerides - Low HDL - Hypertension - Insulin resistance - Prothrombotic or proinflammatory states |
|
Exercise stress treadmill with ECG
What is the appropriate diagnostic test? - A 50-year-old male with angina can exercise to 85% of maximum predicted heart rate. |
Exercise stress treadmill with ECG
|
|
What is the appropriate diagnostic test?
- A 65-year-old woman with left bundle branch block and severe osteoarthritis has unstable angina. |
Pharmacologic stress test (e.g., dobutamine echo)
|
|
What are the signs of active ischemia during stress testing?
|
Angina, ST-segment changes on ECG, or ↓ BP
|
|
What ECG findings suggest an MI?
|
ST-segment elevation (depression means ischemia), flattened T waves, and Q waves
ECG findings suggesting MI. |
|
What's the dx?
- A young patient has angina at rest with ST-segment elevation. Cardiac enzymes are normal. |
Prinzmetal's angina
|
|
What are the common symptoms associated with silent MIs?
|
CHF, shock, and altered mental status
|
|
What is the best diagnostic test for pulmonary embolism?
|
V/Q scan
|
|
What agent reverses the effects of heparin?
|
Protamine
|
|
What coagulation parameter is most affected by warfarin?
|
PT
|
|
What is the Dx?
- A young patient with a family history of sudden death collapses and dies while exercising. |
Hypertrophic cardiomyopathy
|
|
Describe endocarditis prophylaxis regimens.
|
- Oral surgery—amoxicillin
- GI or GU procedures—ampicillin and gentamicin before and amoxicillin after |
|
What are the 6 P's of ischemia due to peripheral vascular disease?
|
- Pain
- Pallor - Pulselessness - Paralysis - Paresthesia - Poikilothermia |
|
What is Virchow's triad?
|
- Stasis
- Hypercoagulability - Endothelial damage |
|
What is the most common cause of hypertension in young women?
|
OCPs
|
|
What is the most common cause of hypertension in young men?
|
Excessive EtOH
|
|
What skin lesion has a "Stuck-on" appearance?
|
Seborrheic keratosis
|
|
What presents with red plaques with silvery-white scales and sharp margins?
|
- Psoriasis
|
|
What is the most common type of skin cancer?
|
Basal cell carcinoma: the lesion is a pearly-colored papule with a translucent surface and telangiectasias.
|
|
What's the Dx?
- Honey-crusted lesions. |
- Impetigo
|
|
What is the Dx?
- A febrile patient with a history of diabetes presents with a red, swollen, painful lower extremity. |
- Cellulitis
|
|
+ Nikolsky's sign =
|
- Pemphigus vulgaris
|
|
- Nikolsky's sign =
|
- Bullous pemphigoid
|
|
What's the Dx?
- A 55-year-old obese patient presents with dirty, velvety patches on the back of the neck. |
- Acanthosis nigricans.
- NB: Check fasting blood sugar to rule out diabetes |
|
Dermatomal distribution = ____
|
- Varicella zoster
|
|
Flat-topped papules =
|
Lichen planus
|
|
Iris-like target lesions = ___
|
Erythema multiforme
|
|
What's the Dx?
- A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry. |
- Contact dermatitis
|
|
What's the Dx?
- Presents with a herald patch, Christmas-tree pattern. |
- Pityriasis rosea
|
|
What's the Dx?
- A 16-year-old presents with an annular patch of alopecia with broken-off, stubby hairs. |
- Alopecia areata (autoimmune process)
|
|
What's the Dx?
- Pinkish, scaling, flat lesions on the chest and back. KOH prep has a "spaghetti-and-meatballs" appearance. |
- Pityriasis versicolor
|
|
What's the Dx?
- Premalignant lesion from sun exposure that can → squamous cell carcinoma. |
- Actinic keratosis
|
|
What's the lesion?
- "Dewdrop on a rose petal." |
Lesions of 1° varicella
|
|
What's the Dx?
- "Cradle cap." |
- Seborrheic dermatitis
- Treat with antifungals |
|
What's the Dx?
- Associated with Propionibacterium acnes and changes in androgen levels. |
- Acne vulgaris
|
|
What's the Dx?
- A painful, recurrent vesicular eruption of mucocutaneous surfaces. |
- Herpes simplex
|
|
What's the Dx?
- Inflammation and epithelial thinning of the anogenital area, predominantly in in postmenopausal women. |
- Lichen sclerosus
|
|
What's the Dx?
- Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer. |
- Squamous cell carcinoma
|
|
What's the most common cause of hypothyroidism?
|
- Hashimoto's thyroiditis
|
|
What's the Dx?
- High TSH, low T4, antimicrosomal antibodies |
- Hashimoto's thyroiditis.
|
|
What's the Dx?
- Exophthalmos, pretibial myxedema, and ↓ TSH. |
- Graves' disease
|
|
What's the most common cause of Cushing's syndrome?
|
- Iatrogenic steroid administration.
- The second most common cause is Cushing's disease. |
|
What's the Dx?
- A patient presents with signs of hypocalcemia, high phosphorus, and low PTH. |
- Hypoparathyroidism
|
|
What's the Dx?
- "Stones, bones, groans, psychiatric overtones." |
- Hypercalcemia
|
|
What's the Dx?
- A patient complains of headache, weakness, and polyuria; exam reveals hypertension and tetany. Labs reveals hypernatremia, hypokalemia, and metabolic alkalosis. |
- 1° hyperaldosteronism (due to Conn's syndrome or bilateral adrenal hyperplasia)
|
|
What's the Dx?
- A patient presents with tachycardia, wild swings in BP, headache, diaphoresis, altered mental status, and a sense of panic. |
- Pheochromocytoma
|
|
Should α- or β-antagonists be used first in treating pheochromocytoma?
|
- α-antagonists: phentolamine and phenoxybenzamine
|
|
What's the Dx?
- A patient with a history of lithium use presents with copious amounts of dilute urine. |
- Nephrogenic diabetes insipidus (DI)
|
|
What's the treatment of central DI?
|
- Administration of DDAVP ↓ serum osmolality and free water restriction
|
|
What's the Dx?
- A postoperative patient with significant pain presents with hyponatremia and normal volume status. |
- SIADH due to stress
|
|
Which antidiabetic agent is associated with lactic acidosis?
|
- Metformin
|
|
What's the Dx & Tx?
- A patient presents with weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show hyponatremia and hyperkalemia. |
- 1° adrenal insufficiency (Addison's disease).
- Treat with replacement glucocorticoids, mineralocorticoids, and IV fluids. |
|
What's the goal hemoglobin A1c for a patient with DM?
|
< 7.0
|
|
What's the treatment of DKA?
|
- Fluids, insulin, and aggressive replacement of electrolytes (e.g., K+)
|
|
Why are β-blockers contraindicated in diabetics?
|
They can mask symptoms of hypoglycemia.
|
|
What bias is introduced into a study when a clinician is aware of the patient's treatment type?
|
Observational bias
|
|
Name the bias.
- Introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death. |
- Lead-time bias
|
|
Name the bias.
- If you want to know if race affects infant mortality rate but most of the variation in infant mortality is predicted by socioeconomic status, then socioeconomic status is a _____. |
- Confounding variable
|
|
The number of true positives divided by the number of patients with the disease is _____.
|
- Sensitivity
|
|
Sensitive tests have few false negatives and are used to rule _____ a disease.
|
- Out
|
|
PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a +PPD. Highly sensitive or specific?
|
Highly sensitive for TB
|
|
Chronic diseases such as SLE—higher prevalence or incidence?
|
Higher prevalence
|
|
Epidemics such as influenza—higher prevalence or incidence?
|
- Higher incidence
|
|
Cross-sectional survey—incidence or prevalence?
|
- Prevalence
|
|
Cohort study—incidence or prevalence?
|
- Incidence and prevalence
|
|
Case-control study—incidence or prevalence?
|
Neither
|
|
Describe a test that consistently gives identical results, but the results are wrong.
|
High reliability, low validity.
|
|
What's the difference between a cohort and a case-control study.
|
Cohort studies can be used to calculate relative risk (RR), incidence, and/or odds ratio (OR). Case-control studies can be used to calculate an OR.
|
|
Attributable risk?
|
The incidence rate (IR) of a disease in exposed − the IR of a disease in unexposed.
|
|
Relative risk?
|
The IR of a disease in a population exposed to a particular factor ÷ the IR of those not exposed.
|
|
Odds ratio?
|
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
|
|
Number needed to treat?
|
1 ÷ (rate in untreated group − rate in treated group)
|
|
In which patients do you initiate colorectal cancer screening early?
|
- Patients with IBD
- Those with familial adenomatous polyposis (FAP)/hereditary nonpolyposis colorectal cancer (HNPCC) - Those who have first-degree relatives with adenomatous polyps (< 60 years of age) or colorectal cancer |
|
The most common cancer in men and the most common cause of death from cancer in men.
|
Prostate cancer is the most common cancer in men, but lung cancer causes more deaths.
|
|
The percentage of cases within one SD of the mean? Two SDs? Three SDs?
|
68%, 95.5%, 99.7%
|
|
Birth rate?
|
Number of live births per 1,000 population
|
|
Fertility rate?
|
Number of live births per 1000 women 15-44 years of age
|
|
Mortality rate?
|
Number of deaths per 1000 population
|
|
Neonatal mortality?
|
Number of deaths from birth to 28 days per 1000 live births
|
|
Postnatal mortality?
|
Number of deaths from 28 days to one year per 1,000 live births
|
|
Infant mortality?
|
Number of deaths from birth to one year of age per 1,000 live births (neonatal + postnatal mortality)
|
|
Fetal mortality?
|
Number of deaths from 20 weeks' gestation to birth per 1,000 total births
|
|
Perinatal mortality?
|
Number of deaths from 20 weeks' gestation to one month of life per 1,000 total births
|
|
Maternal mortality?
|
Number of deaths during pregnancy to 90 days postpartum per 100,000 live births
|
|
True or false: Once patients sign a statement giving consent, they must continue treatment.
|
False. Patients may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and patients without decision-making capacity.
|
|
A 15-year-old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
|
No. Parental consent is not necessary for the medical treatment of pregnant minors.
|
|
What's the ethical issue?
- A doctor refers a patient for an MRI at a facility he/she owns. |
- Conflict of interest
|
|
Involuntary psychiatric hospitalization can be undertaken for which three reasons?
|
The patient is a danger to self, a danger to others, or gravely disabled (unable to provide for basic needs)
|
|
True or false: Withdrawing life-sustaining care is ethically distinct from withholding sustaining care.
|
False. Withdrawing and withholding life are the same from an ethical standpoint.
|
|
When can a physician refuse to continue treating a patient on the grounds of futility?
|
When there is no rationale for treatment, maximal intervention is failing, a given intervention has already failed, and treatment will not achieve the goals of care.
|
|
What should you do?
- An eight-year-old child is in a serious accident. She requires emergent transfusion, but her parents are not present. |
Treat immediately. Consent is implied in emergency situations.
|
|
Conditions in which confidentiality must be overridden.
|
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
|
|
Involuntary commitment or isolation for medical treatment may be undertaken for what reason?
|
When treatment noncompliance represents a serious danger to public health (e.g., active TB).
|
|
A 10-year-old child presents in status epilepticus, but her parents refuse treatment on religious grounds.
|
Treat because the disease represents an immediate threat to the child's life. Then seek a court order.
|
|
What's to do?
- A son asks that his mother not be told about her recently discovered cancer. |
A patient's family cannot require that a doctor withhold information from the patient
|
|
Patient presents with sudden onset of severe, diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
|
Emergent laparotomy to repair perforated viscus, likely stomach
|
|
The most likely cause of acute lower GI bleed in patients > 40 years old is _____.
|
- Diverticulosis
|
|
Diagnostic modality used when ultrasound is equivocal for cholecystitis.
|
HIDA scan
|
|
Sentinel loop on AXR.
|
Acute pancreatitis
|
|
What are risk factors for cholelithiasis?
|
Fat, female, fertile, forty, flatulent
|
|
Inspiratory arrest during palpation of the RUQ means ____.
|
Murphy's sign, seen in acute cholecystitis
|
|
Identify key organisms causing diarrhea:
- Most common organism |
- Campylobacter
|
|
Identify key organisms causing diarrhea:
- Recent antibiotic use |
- Clostridium difficile
|
|
Identify key organisms causing diarrhea:
- Camping |
Giardia
|
|
Identify key organisms causing diarrhea:
- Traveler's diarrhea |
ETEC
|
|
Identify key organisms causing diarrhea:
- Church picnics/mayonnaise |
- S. aureus
|
|
Identify key organisms causing diarrhea:
- Uncooked hamburgers |
E. coli O157:H7
|
|
Identify key organisms causing diarrhea:
- Fried rice |
- Bacillus cereus
|
|
Identify key organisms causing diarrhea:
- Poultry/eggs |
- Salmonella
|
|
Identify key organisms causing diarrhea:
- Raw seafood |
Vibrio, HAV
|
|
Identify key organisms causing diarrhea:
- Patient has AIDS |
- Isospora
- Cryptosporidium - Mycobacterium avium complex (MAC) |
|
Identify key organisms causing diarrhea:
- Pseudoappendicitis |
- Yersinia
|
|
A 25-year-old Jewish male presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibias.
|
- Crohn's disease
|
|
Inflammatory disease of the colon with ↑ risk of colon cancer.
|
Ulcerative colitis
|
|
Extraintestinal manifestations of IBD =
|
- Uveitis
- Ankylosing spondylitis - Pyoderma gangrenosum - Erythema nodosum - 1° sclerosing cholangitis |
|
Medical treatment for IBD.
|
5-aminosalicylic acid +/− sulfasalazine and steroids during acute exacerbations
|
|
The difference between Mallory-Weiss and Boerhaave tears is
|
- Mallory-Weiss: superficial tear in the esophageal mucosa
- Boerhaave: full-thickness esophageal rupture |
|
Charcot's triad =
|
RUQ pain, jaundice, and fever/chills in the setting of ascending cholangitis
|
|
Reynolds' pentad:
|
Charcot's triad plus shock & mental status changes, with suppurative ascending cholangitis
|
|
Medical treatment for hepatic encephalopathy.
|
- ↓ protein intake
- lactulose - neomycin |
|
What is the 1st step in the management of a patient with acute GI bleed?
|
Establish the ABCs
|
|
Most likely diagnosis and cause?
- A four-year-old child presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. |
Hemolytic-uremic syndrome (HUS) due to E. coli O157:H7
|
|
Post-HBV exposure treatment.
|
HBV immunoglobulin
|
|
Classic causes of drug-induced hepatitis.
|
- TB medications (INH, rifampin, pyrazinamide)
- Acetaminophen - Tetracycline |
|
What's the Dx?
- A 40-year-old obese female with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine, and clay-colored stools. |
Biliary tract obstruction
|
|
Hernia with highest risk of incarceration—indirect, direct, or femoral?
|
- Femoral hernia
|
|
A 50-year-old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?
|
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids, O2, analgesia, and "tincture of time"
|
|
Four causes of microcytic anemia.
|
TICS:
- Thalassemia - Iron deficiency - anemia of Chronic disease - Sideroblastic anemia |
|
An elderly male with hypochromic, microcytic anemia is asymptomatic. Diagnostic tests?
|
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
|
|
Precipitants of hemolytic crisis in patients with G6PD deficiency:
|
- Sulfonamides
- Antimalarial drugs - Fava beans |
|
The most common inherited cause of hypercoagulability.
|
Factor V Leiden mutation
|
|
The most common inherited hemolytic anemia.
|
Hereditary spherocytosis
|
|
The diagnostic test for hereditary spherocytosis is ___.
|
Osmotic fragility test
|
|
Diamond-Blackfan anemia is ___
|
- Pure RBC aplasia.
|
|
Which anemia is associated with absent radii and thumbs, diffuse hyperpigmentation, café-au-lait spots, microcephaly, and pancytopenia?
|
- Fanconi's anemia
|
|
Medications and viruses that → aplastic anemia.
|
MEDS: Chloramphenicol, sulfonamides, radiation, chemotherapeutic agents
VIRUSES: HIV, hepatitis, parvovirus B19, EBV |
|
How to distinguish polycythemia vera from 2° polycythemia.
|
Both have ↑ hematocrit and RBC mass, but polycythemia vera should have normal O2 saturation and low erythropoietin levels
|
|
Thrombotic thrombocytopenic purpura (TTP) pentad?
|
Pentad of TTP—"FAT RN":
- Fever - Anemia - Thrombocytopenia - Renal dysfunction - Neurologic abnormalities |
|
HUS triad?
|
Anemia, thrombocytopenia, and acute renal failure
|
|
Treatment for TTP.
|
Emergent large-volume plasmapheresis, corticosteroids, antiplatelet drugs
|
|
What is the treatment for idiopathic thrombocytopenic purpura (ITP) in children?
|
Usually resolves spontaneously; may require IVIG and/or corticosteroids
|
|
Which of the following are ↑ in DIC: fibrin split products, D-dimer, fibrinogen, platelets, and hematocrit.
|
Fibrin split products and D-dimer are elevated; platelets, fibrinogen, and hematocrit are ↓.
|
|
An eight-year-old boy presents with hemarthrosis and ↑ PTT with normal PT and bleeding time. Diagnosis? Treatment?
|
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements.
|
|
A 14-year-old girl presents with prolonged bleeding after dental surgery and with menses, normal PT, normal or ↑ PTT, and ↑ bleeding time. Diagnosis? Treatment?
|
- von Willebrand's disease
- Treat with desmopressin, FFP, or cryoprecipitate |
|
A 60-year-old African-American male presents with bone pain. His workup for multiple myeloma might reveal?
|
Monoclonal gammopathy, Bence Jones proteinuria, "punched-out" lesions on x-ray of the skull and long bones
|
|
Hodgkin's lymphoma histo =
|
Reed-Sternberg cells
|
|
A 10-year-old boy presents with fever, weight loss, and night sweats. Examination shows anterior mediastinal mass. Suspected diagnosis?
|
Non-Hodgkin's lymphoma
|
|
Microcytic anemia with ↓ serum iron, ↓ total iron-binding capacity (TIBC), and normal or ↑ ferritin.
|
- Anemia of chronic disease
|
|
Microcytic anemia with ↓ serum iron, ↓ ferritin, and ↑ TIBC.
|
Iron deficiency anemia
|
|
An 80-year-old man presents with fatigue, lymphadenopathy, splenomegaly, and isolated lymphocytosis. Suspected diagnosis?
|
Chronic lymphocytic leukemia (CLL)
|
|
A late, life-threatening complication of chronic myelogenous leukemia (CML).
|
Blast crisis (fever, bone pain, splenomegaly, pancytopenia)
|
|
Auer rods on blood smear.
|
Acute myelogenous leukemia (AML)
|
|
AML subtype associated with DIC.
|
M3
|
|
Electrolyte changes in tumor lysis syndrome:
|
↓ Ca2+
↑ K− ↑ phosphate ↑ uric acid |
|
What's the treatment for AML M3?
|
Retinoic acid
|
|
A 50-year-old male presents with early satiety, splenomegaly, and bleeding. Cytogenetics show t(9,22). Diagnosis?
|
CML
|
|
Intracellular inclusions seen in thalassemia, G6PD deficiency, and postsplenectomy?
|
- Heinz bodies
|
|
An autosomal-recessive disorder with a defect in the GPIIbIIIa platelet receptor and ↓ platelet aggregation.
|
Glanzmann's thrombasthenia
|
|
Virus associated with aplastic anemia in patients with sickle cell anemia.
|
Parvovirus B19
|
|
A 25-year-old African-American male with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?
|
- O2
- Analgesia - Hydration - and, if severe, transfusion |
|
A significant cause of morbidity in thalassemia patients. Treatment?
|
Iron overload; use deferoxamine
|
|
The three most common causes of fever of unknown origin (FUO).
|
Infection, cancer, and autoimmune disease
|
|
Four signs and symptoms of streptococcal pharyngitis.
|
Fever, pharyngeal erythema, tonsillar exudate, lack of cough
|
|
A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1° infection.
|
Postinfectious glomerulonephritis
|
|
Asplenic patients are particularly susceptible to these organisms.
|
Encapsulated organisms:
- Pneumococcus - Meningococcus - Haemophilus influenzae - Klebsiella |
|
The number of bacterial culture on a clean-catch specimen to diagnose a UTI:
|
- 105 bacteria/mL
|
|
Which healthy population is susceptible to UTIs?
|
- Pregnant women
- Treat this group aggressively because of potential complications |
|
A patient from California or Arizona presents with fever, malaise, cough, and night sweats. Diagnosis? Treatment?
|
- Coccidioidomycosis.
- Rx: Amphotericin B |
|
Nonpainful chancre.
|
1° syphilis
|
|
A "blueberry muffin" rash is characteristic of what congenital infection?
|
- Rubella
|
|
Meningitis in neonates. Causes? Treatment?
|
- Dx: Group B strep, E. coli, Listeria.
- Tx: ampicillin & gentamicin |
|
Meningitis in infants. Causes? Treatment?
|
Causes: Pneumococcus, meningococcus, H. influenzae.
Tx: cefotaxime & vancomycin |
|
What should always be done prior to LP?
|
Check for ↑ ICP; look for papilledema
|
|
Bacterial meningitis CSF findings:
|
Low glucose
PMN predominance |
|
Aseptic (viral) meningitis
CSF findings: |
- Normal glucose
- Lymphocytic predominance |
|
Subarachnoid hemorrhage (SAH)
CSF findings: |
- Numerous RBCs in serial CSF samples
|
|
MS CSF findings:
|
- ↑ gamma globulins
|
|
Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7-10 days. Treatment?
|
- Cutaneous anthrax.
- Treat with penicillin G or ciprofloxacin |
|
Findings in 3° syphilis.
|
Tabes dorsalis, general paresis, gummas, Argyll Robertson pupil, aortitis, aortic root aneurysms.
|
|
Characteristics of 2° Lyme disease.
|
- Arthralgias
- Migratory polyarthropathies - Bell's palsy - Myocarditis |
|
Cold agglutinins =
|
Mycoplasma
|
|
A 24-year-old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
|
- Candidal thrush.
- Workup should include an HIV test. - Treat with nystatin oral suspension |
|
Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV-positive patient at what CD4 count? Mycobacterium avium-intracellulare (MAI) prophylaxis?
|
≤ 200 for PCP (with TMP); ≤ 50-100 for MAI (with clarithromycin/azithromycin)
|
|
Risk factors for pyelonephritis.
|
- Pregnancy
- Vesicoureteral reflux - Anatomic anomalies - Indwelling catheters - Kidney stones |
|
Neutropenic nadir postchemotherapy.
|
7-10 days
|
|
Lesion of 1° Lyme disease:
|
- Erythema migrans.
|
|
Classic physical findings for endocarditis.
|
- Fever
- Heart murmur - Osler's nodes, - Splinter hemorrhages - Janeway lesions - Roth's spots |
|
- Aplastic crisis in sickle cell disease.
|
- Parvovirus B19
|
|
Ring-enhancing brain lesion on CT with seizures:
|
Taenia solium (cysticercosis)
|
|
Name the organism:
- Branching rods in oral infection. |
Actinomyces israelii
|
|
Name the organism:
- Painful chancroid. |
Haemophilus ducreyi
|
|
Name the organism:
- Dog or cat bite. |
Pasteurella multocida
|
|
Name the organism:
- Gardener. |
Sporothrix schenckii
|
|
Name the organism:
- Pregnant women with pets. |
Toxoplasma gondii
|
|
Name the organism:
- Meningitis in adults. |
Neisseria meningitidis
|
|
Name the organism:
- Meningitis in elderly. |
Streptococcus pneumoniae
|
|
Name the organism:
- Alcoholic with pneumonia |
Klebsiella
|
|
Name the organism:
- "Currant jelly" sputum. |
Klebsiella
|
|
Name the organism:
- Infection in burn victims |
Pseudomonas
|
|
Name the organism:
- Osteomyelitis from foot wound puncture. |
Pseudomonas
|
|
Name the organism:
- Osteomyelitis in a sickle cell patient. |
Salmonella
|
|
A 55-year-old man who is a smoker and a heavy drinker presents with a new cough and flulike symptoms. Gram stain shows no organisms; silver stain of sputum shows gram-negative rods. What is the diagnosis?
|
Legionella pneumonia
|
|
A middle-aged man presents with acute-onset monoarticular joint pain and bilateral Bell's palsy. What is the likely diagnosis, and how did he get it? Treatment?
|
- Dx: Lyme disease
- Cause: Ixodes tick - Rx: Doxycycline |
|
A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?
|
S. aureus or S. epidermidis
|
|
A patient presents with pain on passive movement, pallor, poikilothermia, paresthesias, paralysis, and pulselessness. Treatment?
|
All-compartment fasciotomy for suspected compartment syndrome
|
|
Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.
|
Spinal stenosis
|
|
Joints in the hand affected in rheumatoid arthritis.
|
MCP and PIP joints
DIP joints are spared |
|
Joint pain and stiffness that worsen over the course of the day and are relieved by rest.
|
Osteoarthritis
|
|
Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
|
Osteogenesis imperfecta
|
|
Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
|
Suspect ankylosing spondylitis. Check HLA-B27
|
|
Arthritis, conjunctivitis, and urethritis in young men. Associated organisms?
|
- Campylobacter
- Shigella - Salmonella - Chlamydia - Ureaplasma |
|
A 55-year-old man has sudden, excruciating first MTP joint pain after a night of drinking red wine. Diagnosis, workup, and chronic treatment?
|
Gout. Needle-shaped, negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
|
|
Rhomboid-shaped, positively birefringent crystals on joint fluid aspirate.
|
Pseudogout
|
|
An elderly female presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and ↑ ESR.
|
Polymyalgia rheumatica
|
|
An active 13-year-old boy has anterior knee pain. Diagnosis?
|
Osgood-Schlatter disease
|
|
Bone is fractured in fall on outstretched hand.
|
Distal radius (Colles' fracture)
|
|
Complication of scaphoid fracture.
|
Avascular necrosis
|
|
Signs suggesting radial nerve damage with humeral fracture.
|
Wrist drop, loss of thumb abduction
|
|
A young child presents with proximal muscle weakness, waddling gait, and pronounced calf muscles.
|
Duchenne muscular dystrophy
|
|
A first-born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
|
Developmental dysplasia of the hip. If severe, consider a Pavlik harness to maintain abduction
|
|
An 11-year-old obese, African-American boy presents with sudden onset of limp. Diagnosis? Workup?
|
Slipped capital femoral epiphyses. AP and frog-leg lateral view
|
|
The most common 1° malignant tumor of bone.
|
Multiple myeloma
|
|
Unilateral, severe periorbital headache with tearing and conjunctival erythema.
|
Cluster headache
|
|
Prophylactic treatment for migraine.
|
β-blockers, Ca2+ channel blockers, TCAs
|
|
The most common pituitary tumor. Treatment?
|
Prolactinoma. Dopamine agonists (e.g., bromocriptine)
|
|
A 55-year-old patient presents with acute "broken speech." What type of aphasia? What lobe and vascular distribution?
|
- Broca's aphasia
- Frontal lobe, left MCA distribution |
|
The second most common is berry aneurysm.
The most common cause of SAH. |
Trauma
|
|
A crescent-shaped hyperdensity on CT that does not cross the midline.
|
Subdural hematoma—bridging veins torn
|
|
A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely etiology? Treatment?
|
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
|
|
CSF findings with SAH.
|
Elevated ICP, RBCs, xanthochromia
|
|
Albuminocytologic dissociation.
|
Guillain-Barré (↑ protein in CSF with only a modest ↑ in cell count)
|
|
Cold water is flushed into a patient's ear, and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
|
Normal
|
|
The most common 1° sources of metastases to the brain.
|
Lung, breast, skin (melanoma), kidney, GI tract
|
|
May be seen in children who are accused of inattention in class and confused with ADHD.
|
Absence seizures
|
|
The most frequent presentation of intracranial neoplasm.
|
Headache
|
|
The most common cause of seizures in children (2-10 years).
|
Infection, febrile seizures, trauma, idiopathic
|
|
The most common cause of seizures in young adults (18-35 years).
|
Trauma, alcohol withdrawal, brain tumor
|
|
First-line medication for status epilepticus.
|
IV benzodiazepine
|
|
Confusion, confabulation, ophthalmoplegia, ataxia.
|
Wernicke's encephalopathy due to a deficiency of thiamine.
|
|
What % lesion is an indication for carotid endarterectomy?
|
Seventy percent IF the stenosis is symptomatic.
|
|
The most common causes of dementia.
|
Alzheimer's and multi-infarct
|
|
Combined UMN and LMN disorder.
|
ALS
|
|
Rigidity and stiffness with resting tremor and masked facies.
|
Parkinson's disease
|
|
The mainstay of Parkinson's therapy.
|
Levodopa/carbidopa
|
|
Treatment for Guillain-Barré syndrome.
|
IVIG or plasmapheresis
|
|
Rigidity and stiffness that progress to choreiform movements, accompanied by moodiness and altered behavior.
|
Huntington's disease
|
|
A six-year-old girl presents with a port-wine stain in the V2 distribution as well as with mental retardation, seizures, and leptomeningeal angioma.
|
- Sturge-Weber syndrome.
- Treat symptomatically. Possible focal cerebral resection of affected lobe |
|
Café-au-lait spots on skin.
|
Neurofibromatosis 1
|
|
Hyperphagia, hypersexuality, hyperorality, and hyperdocility.
|
Klüver-Bucy syndrome (amygdala)
|
|
Administer to a symptomatic patient to diagnose myasthenia gravis.
|
Edrophonium
|
|
1° causes of third-trimester bleeding.
|
Placental abruption & placenta previa
|
|
Classic ultrasound and gross appearance of complete hydatidiform mole.
|
Snowstorm on ultrasound. "Cluster-of-grapes" appearance on gross examination.
|
|
Chromosomal pattern of a complete mole.
|
46,XX
|
|
Molar pregnancy containing fetal tissue.
|
Partial mole
|
|
Symptoms of placental abruption:
|
Continuous, painful vaginal bleeding
|
|
Self-limited, painless vaginal bleeding
|
Symptoms of placenta previa.
|
|
When should a vaginal exam be performed with suspected placenta previa?
|
Never
|
|
Antibiotics with teratogenic effects.
|
- Tetracycline
- Fluoroquinolones - Aminoglycosides - Sulfonamides |
|
Shortest AP diameter of the pelvis.
|
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
|
|
Medication given to accelerate fetal lung maturity.
|
Betamethasone or dexamethasone × 48 hours
|
|
The most common cause of postpartum hemorrhage.
|
Uterine atony
|
|
Treatment for postpartum hemorrhage.
|
Uterine massage; if that fails, give oxytocin
|
|
Typical antibiotics for group B streptococcus (GBS) prophylaxis.
|
IV penicillin or ampicillin
|
|
A patient fails to lactate after an emergency C-section with marked blood loss.
|
Sheehan's syndrome (postpartum pituitary necrosis)
|
|
Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
|
Inevitable abortion
|
|
Uterine bleeding at 18 weeks' gestation; no products expelled; cervical os closed.
|
Threatened abortion
|
|
The first test to perform when a woman presents with amenorrhea.
|
β-hCG; the most common cause of amenorrhea is pregnancy
|
|
Term for heavy bleeding during and between menstrual periods.
|
Menometrorrhagia
|
|
Cause of amenorrhea with normal prolactin, no response to estrogen-progesterone challenge, and a history of D&C.
|
Asherman's syndrome
|
|
Therapy for polycystic ovarian syndrome.
|
Weight loss and OCPs
|
|
Medication used to induce ovulation.
|
Clomiphene citrate
|
|
Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.
|
Endometrial biopsy
|
|
Indications for medical treatment of ectopic pregnancy.
|
Stable, unruptured ectopic pregnancy of 3.5 cm at 6 weeks' gestation
|
|
Medical options for endometriosis.
|
OCPs, danazol, GnRH agonists
|
|
"Chocolate cysts," powder burns
|
Laparoscopic findings in endometriosis.
|
|
The most common location for an ectopic pregnancy.
|
Ampulla of the oviduct
|
|
How to diagnose and follow a leiomyoma.
|
Ultrasound
|
|
Natural history of a leiomyoma.
|
Regresses after menopause
|
|
A patient has ↑ vaginal discharge & petechial patches in the upper vagina and cervix.
|
Trichomonas vaginitis
|
|
Treatment for bacterial vaginosis.
|
Oral or topical metronidazole
|
|
The most common cause of bloody nipple discharge.
|
Intraductal papilloma
|
|
Unopposed estrogen is contraindicated in which cancers?
|
Endometrial or estrogen receptor- breast cancer
|
|
A patient presents with recent PID with RUQ pain.
|
Consider Fitz-Hugh-Curtis syndrome
|
|
Breast malignancy presenting as itching, burning, and erosion of the nipple.
|
Paget's disease
|
|
Annual screening for women with a strong family history of ovarian cancer.
|
CA-125 and transvaginal ultrasound
|
|
A 50-year-old woman leaks urine when laughing or coughing. Nonsurgical options?
|
Kegel exercises, estrogen, pessaries for stress incontinence
|
|
A 30-year-old woman has unpredictable urine loss. Examination is normal. Medical options?
|
Anticholinergics (oxybutynin) or β-adrenergics (metaproterenol) for urge incontinence.
|
|
Lab values suggestive of menopause.
|
↑ serum FSH
|
|
The most common cause of female infertility.
|
Endometriosis
|
|
Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow-up evaluation?
|
Colposcopy and endocervical curettage
|
|
Breast cancer type that ↑ the future risk of invasive carcinoma in both breasts.
|
Lobular carcinoma in situ
|
|
Nontender abdominal mass associated with elevated VMA and HVA.
|
Neuroblastoma
|
|
The most common type of tracheoesophageal fistula (TEF). Diagnosis?
|
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
|
|
Not contraindications to vaccination.
|
Mild illness &/or low-grade fever, current antibiotic therapy, and prematurity
|
|
Tests to rule out shaken baby syndrome.
|
Ophthalmologic exam, CT, and MRI
|
|
Diagnosis?
- A neonate has meconium ileus. |
CF or Hirschsprung's disease
|
|
Bilious emesis within hours after the first feeding.
|
Duodenal atresia
|
|
A two-month-old presents with nonbilious projectile emesis. What are the appropriate steps in management?
|
- Correct metabolic abnormalities. - Then correct pyloric stenosis with pyloromyotomy
|
|
The most common 1° immunodeficiency.
|
Selective IgA deficiency
|
|
An infant has a high fever and onset of rash as fever breaks. What is he at risk for?
|
Febrile seizures (roseola infantum)
|
|
Acute-phase treatment for Kawasaki disease.
|
High-dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
|
|
Treatment for mild and severe unconjugated hyperbilirubinemia.
|
Phototherapy (mild) or exchange transfusion (severe)
|
|
Sudden onset of mental status changes, emesis, and liver dysfunction after taking aspirin.
|
Reye's syndrome
|
|
A child has loss of red light reflex. Diagnosis?
|
Suspect retinoblastoma
|
|
Vaccinations at a six-month well-child visit.
|
HBV, DTaP, Hib, IPV, PCV
|
|
Precocious puberty
|
Tanner stage 3 in a six-year-old female.
|
|
Infection of small airways with epidemics in winter and spring.
|
RSV bronchiolitis
|
|
Cause of neonatal RDS.
|
Surfactant deficiency
|
|
What is the immunodeficiency?
- A boy has chronic respiratory infections. |
Chronic granulomatous disease
- Nitroblue tetrazolium test is +. |
|
What is the immunodeficiency?
- A child has eczema, thrombocytopenia, & high levels of IgA. |
Wiskott-Aldrich Syndrome
|
|
What is the immunodeficiency?
- A four-month-old boy has life-threatening Pseudomonas infection. |
Bruton's X-linked agammaglobulinemia
|
|
A condition associated with red "currant-jelly" stools.
|
Intussusception
|
|
A congenital heart disease that cause 2° hypertension.
|
Coarctation of the aorta
|
|
First-line treatment for otitis media.
|
Amoxicillin × 10 days
|
|
The most common pathogen causing croup.
|
Parainfluenza virus type 1
|
|
A homeless child is small for his age and has peeling skin and a swollen belly.
|
Kwashiorkor (protein malnutrition)
|
|
Gout, self-mutilation, and choreoathetosis
|
Lesch-Nyhan syndrome
- purine salvage problem with defect in an X-linked syndrome with mental retardation, HGPRTase deficiency |
|
A newborn female has continuous "machinery murmur."
|
Patent ductus arteriosus (PDA)
|
|
First-line pharmacotherapy for depression.
|
SSRIs
|
|
Antidepressants associated with hypertensive crisis.
|
MAOIs
|
|
Galactorrhea, impotence, menstrual dysfunction, and ↓ libido.
|
Patient on dopamine antagonist
|
|
A 17-year-old female has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found.
|
Conversion disorder
|
|
Name the defense mechanism:
- A mother who is angry at her husband yells at her child. |
Displacement
|
|
Name the defense mechanism:
- A pedophile enters a monastery. |
Reaction formation
|
|
Name the defense mechanism:
- A woman calmly describes a grisly murder. |
Isolation
|
|
Name the defense mechanism:
- A hospitalized 10-year-old begins to wet his bed. |
Regression
|
|
Life-threatening muscle rigidity, fever, and rhabdomyolysis.
|
Neuroleptic malignant syndrome
|
|
Amenorrhea, bradycardia, and abnormal body image in a young female.
|
Anorexia
|
|
A 35-year-old male has recurrent episodes of palpitations, diaphoresis, and fear of going crazy.
|
Panic disorder
|
|
The most serious side effect of clozapine.
|
Agranulocytosis
|
|
A 21-year-old male has three months of social withdrawal, worsening grades, flattened affect, and concrete thinking.
|
Schizophreniform disorder (diagnosis of schizophrenia requires ≥ 6 months of symptoms)
|
|
Key side effects of atypical antipsychotics.
|
Weight gain, type 2 DM, QT prolongation
|
|
A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?
|
- Acute dystonia (oculogyric crisis).
- Treat with benztropine or diphenhydramine |
|
Medication to avoid in patients with a history of alcohol withdrawal seizures.
|
Neuroleptics
|
|
A 13-year-old male has a history of theft, vandalism, and violence toward family pets.
|
Conduct disorder
|
|
A five-month-old girl has ↓ head growth, truncal dyscoordination, and ↓ social interaction.
|
Rett's disorder
|
|
A patient hasn't slept for days, lost $20,000 gambling, is agitated, and has pressured speech. Diagnosis? Treatment?
|
Acute mania. Start a mood stabilizer (e.g., lithium)
|
|
After a minor fender bender, a man wears a neck brace and requests permanent disability.
|
Malingering.
|
|
A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C peptide.
|
Factitious disorder (Munchausen syndrome)
|
|
A patient continues to use cocaine after being in jail, losing his job, and not paying child support.
|
Substance abuse
|
|
A violent patient has vertical and horizontal nystagmus.
|
Phencyclidine hydrochloride (PCP) intoxication
|
|
A woman who was abused as a child frequently feels outside of or detached from her body.
|
Depersonalization disorder
|
|
Frotteurism (a paraphilia)
|
A man has repeated, intense urges to rub his body against unsuspecting passengers on a bus.
|
|
A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Diagnosis? Treatment?
|
- Tardive dyskinesia
- ↓ or discontinue haloperidol and consider another antipsychotic (e.g., risperidone, clozapine) |
|
A man unexpectedly flies across the country, takes a new name, and has no memory of his prior life.
|
Dissociative fugue
|
|
Risk factors for DVT.
|
Stasis, endothelial injury and hypercoagulability (Virchow's triad)
|
|
Criteria for exudative effusion:
|
- Pleural/serum protein > 0.5
- Pleural/serum LDH > 0.6 |
|
Causes of exudative effusion.
|
Think of leaky capillaries:
- Malignancy - TB - Bacterial or viral infection - Pulmonary embolism with infarct - Pancreatitis |
|
Causes of transudative effusion.
|
Think of intact capillaries:
- CHF - Liver or kidney disease - Protein-losing enteropathy |
|
Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
|
Fatigue & impending respiratory failure
|
|
Dyspnea, lateral hilar lymphodenopathy on CXR, noncaseating granulomas, increased ACE, and hypercalcemia.
|
Sarcoidosis
|
|
PFT showing ↓ FEV1/FVC.
|
Obstructive pulmonary disease (e.g., asthma)
|
|
PFT showing ↑ FEV1/FVC.
|
Restrictive pulmonary disease
|
|
Honeycomb pattern on CXR. Diagnosis? Treatment?
|
- Diffuse interstitial pulmonary fibrosis.
- Supportive care. - Steroids may help. |
|
Treatment for SVC syndrome.
|
Radiation
|
|
Treatment for mild, persistent asthma.
|
Inhaled β-agonists and inhaled corticosteroids
|
|
Acid-base disorder in pulmonary embolism.
|
Hypoxia & hypocarbia
|
|
Non-small cell lung cancer (NSCLC) associated with hypercalcemia.
|
Squamous cell carcinoma
|
|
Lung cancer associated with SIADH.
|
Small cell lung cancer (SCLC)
|
|
Lung cancer highly related to cigarette exposure.
|
SCLC
|
|
A tall white male presents with acute shortness of breath. Diagnosis? Treatment?
|
- Spontaneous pneumothorax.
- Spontaneous regression. - Supplemental O2 may be helpful |
|
Treatment of tension pneumothorax.
|
Immediate needle thoracostomy
|
|
Characteristics favoring carcinoma in an isolated pulmonary nodule.
|
- Age 45-50 years
- Lesions new or larger in comparison to old films - Absence of calcification or irregular calcification - 2 cm; irregular margins |
|
Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure.
|
ARDS
|
|
↑ risk of what infection with silicosis?
|
Mycobacterium tuberculosis
|
|
Causes of hypoxemia.
|
- Right-to-left shunt
- Hypoventilation - Low inspired O2 tension - Diffusion defect - V/Q mismatch |
|
Classic CXR findings for pulmonary edema.
|
- Cardiomegaly
- Prominent pulmonary vessels - Kerley B lines - "bat's-wing" appearance of hilar shadows - Perivascular and peribronchial cuffing |
|
Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.
|
Type I (distal) RTA
|
|
RTA associated with abnormal HCO3 − and rickets.
|
Type II (proximal) RTA
|
|
RTA associated with aldosterone defect.
|
Type IV (distal) RTA
|
|
"Doughy skin."
|
Hypernatremia
|
|
Differential of hypervolemic hyponatremia.
|
Cirrhosis, CHF, nephritic syndrome
|
|
Chvostek's and Trousseau's signs.
|
Hypocalcemia
|
|
The most common causes of hypercalcemia.
|
Malignancy and hyperparathyroidism
|
|
T-wave flattening and U waves.
|
Hypokalemia
|
|
Peaked T waves and widened QRS.
|
Hyperkalemia
|
|
First-line treatment for moderate hypercalcemia.
|
IV hydration and loop diuretics (furosemide)
|
|
Type of ARF in a patient with FeNa < 1%.
|
Prerenal
|
|
A 49-year-old male presents with acute-onset flank pain and hematuria.
|
Nephrolithiasis
|
|
The most common type of nephrolithiasis.
|
Calcium oxalate
|
|
A 20-year-old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
|
Cerebral berry aneurysms (AD PCKD)
|
|
Hematuria, hypertension, and oliguria.
|
Nephritic syndrome
|
|
Proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, edema.
|
Nephrotic syndrome
|
|
The most common form of nephritic syndrome.
|
Membranous glomerulonephritis
|
|
The most common form of glomerulonephritis.
|
IgA nephropathy (Berger's disease)
|
|
Glomerulonephritis with deafness.
|
Alport's syndrome
|
|
Glomerulonephritis with hemoptysis.
|
Wegener's granulomatosis and Goodpasture's syndrome
|
|
Presence of red cell casts in urine sediment.
|
Glomerulonephritis/nephritic syndrome
|
|
Eosinophils in urine sediment.
|
Allergic interstitial nephritis
|
|
Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
|
Nephrotic syndrome
|
|
Drowsiness, asterixis, nausea, and a pericardial friction rub.
|
Uremic syndrome seen in patients with renal failure.
|
|
A 55-year-old man is diagnosed with prostate cancer. Treatment options?
|
Wait, surgical resection, radiation &/or androgen suppression
|
|
Low urine specific gravity in the presence of high serum osmolality.
|
DI
|
|
Treatment of SIADH?
|
Fluid restriction, demeclocycline
|
|
Hematuria, flank pain, and palpable flank mass.
|
Renal cell carcinoma (RCC)
|
|
Testicular cancer associated with β-hCG, AFP.
|
Choriocarcinoma
|
|
The most common type of testicular cancer.
|
Seminoma: a type of germ cell tumor
|
|
The most common histology of bladder cancer.
|
Transitional cell carcinoma
|
|
Complication of overly rapid correction of hyponatremia.
|
Central pontine myelinolysis
|
|
Salicylate ingestion → in what type of acid-base disorder?
|
Anion gap acidosis and 1° respiratory alkalosis due to central respiratory stimulation
|
|
Acid-base disturbance commonly seen in pregnant women.
|
Respiratory alkalosis
|
|
Three systemic diseases → nephrotic syndrome.
|
DM, SLE, & amyloidosis
|
|
Elevated erythropoietin level, elevated hematocrit, and normal O2 saturation suggest?
|
RCC or other erythropoietin-producing tumor; evaluate with CT scan
|
|
A 55-year-old man presents with irritative and obstructive urinary symptoms. Treatment options?
|
Likely BPH. Options include no treatment, terazosin, finasteride, or surgical intervention (TURP)
|
|
Class of drugs that may cause syndrome of muscle rigidity, hyperthermia, autonomic instability, and extrapyramidal symptoms.
|
Antipsychotics (neuroleptic malignant syndrome)
|
|
Side effects of corticosteroids.
|
- Acute mania
- Immunosuppression - Thin skin - Osteoporosis - Easy bruising - Myopathies |
|
Treatment for DTs.
|
Benzodiazepines
|
|
Treatment for acetaminophen overdose.
|
N-acetylcysteine
|
|
Treatment for opioid overdose.
|
Naloxone
|
|
Treatment for benzodiazepine overdose.
|
Flumazenil
|
|
Treatment for neuroleptic malignant syndrome.
|
Dantrolene or bromocriptine
|
|
Treatment for malignant hypertension.
|
Nitroprusside
|
|
Treatment of AF.
|
Rate control, rhythm conversion, and anticoagulation
|
|
Treatment of supraventricular tachycardia (SVT).
|
Rate control with carotid massasge or other vagal stimulation
|
|
Causes of drug-induced SLE.
|
INH, penicillamine, hydralazine, procainamide
|
|
Macrocytic, megaloblastic anemia with neurologic symptoms.
|
B12 deficiency
|
|
Macrocytic, megaloblastic anemia without neurologic symptoms.
|
Folate deficiency
|
|
A burn patient presents with cherry-red flushed skin and coma. SaO2 is normal, but carboxyhemoglobin is elevated. Treatment?
|
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
|
|
Blood in the urethral meatus or high-riding prostate.
|
Bladder rupture or urethral injury
|
|
Test to rule out urethral injury.
|
Retrograde cystourethrogram
|
|
Radiographic evidence of aortic disruption or dissection.
|
Widened mediastinum (> 8 cm), loss of aortic knob, pleural cap, tracheal deviation to the right, depression of left main stem bronchus
|
|
Radiographic indications for surgery in patients with acute abdomen.
|
Free air under the diaphragm, extravasation of contrast, severe bowl distention, space-occupying lesion (CT), mesenteric occlusion (angiography)
|
|
The most common organism in burn-related infections.
|
Pseudomonas
|
|
Method of calculating fluid repletion in burn patients.
|
Parkland formula
|
|
Acceptable urine output in a trauma patient.
|
50 cc/hour
|
|
Acceptable urine output in a stable patient.
|
30 cc/hour
|
|
Cannon "a" waves.
|
Third-degree heart block
|
|
Signs of neurogenic shock.
|
Hypotension & bradycardia
|
|
Cushing's triad:
|
Signs of ↑ ICP: Hypertension, bradycardia, and abnormal respirations
|
|
Hypovolemic shock
|
↓ CO, ↓ pulmonary capillary wedge pressure (PCWP), ↑ peripheral vascular resistance (PVR).
|
|
↓ CO, ↑ PCWP, ↑ PVR.
|
Cardiogenic shock
|
|
↑ CO, ↓ PCWP, ↓ PVR.
|
Septic or anaphylactic shock
|
|
Treatment of septic shock.
|
Fluids and antibiotics
|
|
Identify cause; pressors (e.g., dobutamine)
|
Treatment of cardiogenic shock.
|
|
Identify cause; fluid and blood repletion
|
Treatment of hypovolemic shock.
|
|
Treatment of anaphylactic shock.
|
Diphenhydramine or epinephrine 1:1000
|
|
Continuous positive airway pressure
|
Supportive treatment for ARDS.
|
|
A patient with chest trauma who was previously stable suddenly dies
|
Signs of air embolism.
|
|
AP chest, AP/lateral C-spine, AP pelvis
|
Trauma series.
|
|
Define Delusion of Reference.
|
Events, objects, or persons in one's environment that are belieed to have particular personal significance
|
|
Define Circumstantial thinking.
|
Communication of unnecessary details before finally arriving at the central idea
|
|
Define delusion.
|
A false belief not supported by fact and cannot be challenged successfully by logic or reasoning
|
|
Define Intermittent explosive disorder.
|
Discrete episodes of aggression and destruction out of proportion with the precipitant stressor. EEG changes in 55%
|
|
Define Illusion.
|
A misinterpretation of a real sensory stimulus. common in ppl w.out psych disorders also. content affected by person's state of mind, wishes, and fears
|
|
Normal pre and postnatal development but lose previously acquired purposeful hand skills between 5-30 mos. Stereotyped hand movements, poor coordination. A PDD
|
Rett's disorder
|
|
Define Orientation.
|
State of awareness of time, place, identity of oneself and others
|
|
Personality disorder
preoccupation with perfection, orderliness, and control. Lose main point of activity because they pay too much attention to details and rules |
OCPD/ obsessive compulsive personality disorder
|
|
IQ 35-55%. function at preschool to second grade level
|
moderate mental retardation
|
|
Lose ability to form abstract concepts. nml in kids, also seen in MR, dementia, and schizophrenia
|
Concrete thinking
|
|
Voluntary assumption of an inappropriate or bizarre posture for long periods of time. usually seen in schizophrenia, esp catatonic type
|
Catatonic posturing
|
|
Psychotherapists transference response to the pt
|
Countertransference
|
|
Perception of a stimulus when none is present. auditory most common in psychosis; tactile, visual, gustatory, olfactory, or kinesthetic in neuro d/o's
|
Hallucination
|
|
Capacity to generalize and formulate concepts
|
Abstract thinking
|
|
Fluctuations in consciousness and disorientation. Also memory, language, sleep-wake disturbances
|
Delirium
|
|
Often precedes squamous cell carcinoma
|
Actinic keratosis
|
|
1° adrenocortical deficiency
|
Addison's disease
|
|
Polyostotic fibrous dysplasia, precocious puberty, café-au-lait spots, short stature, young girls
|
Albright's syndrome
|
|
↑ protein in CSF with only modest ↑ in cell count
|
Albuminocytologic dissociation seen in Guillain-Barré
|
|
Hereditary nephritis with nerve deafness
|
Alport's syndrome
|
|
Anti-basement membrane antibodies
|
Goodpasture's syndrome
|
|
Scleroderma (CREST)
|
Anticentromere antibodies
|
|
Anti-double-stranded DNA antibodies (ANA antibodies)
|
SLE (type III hypersensitivity)
|
|
Anti-epithelial cell antibodies
|
Pemphigus vulgaris
|
|
Antigliadin antibodies
|
Celiac disease
|
|
Drug-induced SLE
|
Antihistone antibodies
|
|
Anti-IgG antibodies
|
Rheumatoid arthritis
|
|
Antimitochondrial antibodies
|
1° biliary cirrhosis
|
|
Antineutrophil antibodies
|
Vasculitis
|
|
Antiplatelet antibodies
|
Idiopathic thrombocytopenic purpura
|
|
Arachnodactyly
|
Marfan's syndrome
|
|
Argyll Robertson pupil
|
Neurosyphilis
|
|
Cerebellar tonsillar herniation
|
Arnold-Chiari malformation
|
|
Aschoff bodies
|
Rheumatic fever
|
|
Atrophy of the mammillary bodies
|
Wernicke's encephalopathy
|
|
Auer rods
|
Acute myelogenous leukemia (especially the promyelocytic type)
|
|
Autosplenectomy
|
Sickle cell anemia
|
|
Babinski's sign
|
UMN lesion
|
|
Baker's cyst in popliteal fossa
|
Rheumatoid arthritis
|
|
Hyperreninemia
|
Bartter's syndrome
|
|
Basophilic stippling of RBCs
|
Lead poisoning
|
|
Becker's muscular dystrophy
|
Defective dystrophin; less severe than Duchenne's
|
|
LMN CN VII palsy
|
Bell's palsy
|
|
Multiple myeloma (kappa or lambda Ig light chains in urine), Waldenström's macroglobulinemia (IgM)
|
Bence Jones proteins
|
|
IgA nephropathy
|
Berger's disease
|
|
Defect in platelet adhesion
|
Bernard-Soulier disease
|
|
Bilateral hilar adenopathy, uveitis
|
Sarcoidosis
|
|
Birbeck granules on EM
|
Histiocytosis X (eosinophilic granuloma)
|
|
Bloody tap on LP
|
Subarachnoid hemorrhage
|
|
"Blue bloater"
|
Chronic bronchitis
|
|
Blue-domed cysts
|
Fibrocystic change of the breast
|
|
Blue sclera
|
Osteogenesis imperfecta
|
|
Tetralogy of Fallot; RVH
|
Boot-shaped heart on x-ray
|
|
PIP swelling 2° to osteophytes
|
Bouchard's nodes found in Osteoarthritis
|
|
Boutonnière deformity
|
Rheumatoid arthritis
|
|
Branching rods in oral infection
|
Actinomyces israelii
|
|
"Brown tumor" of bone
|
Hemorrhage causes brown color of osteolytic cysts: 1. Hyperparathyroidism 2. Osteitis fibrosa cystica (von Recklinghausen's disease)
|
|
Brushfield's spots
|
Down syndrome
|
|
X-linked agammaglobulinemia
|
Bruton's disease
|
|
Posthepatic venous thrombosis
|
Budd-Chiari syndrome
|
|
Small/medium-artery vasculitis
|
Buerger's disease
|
|
8:14 translocation; associated with EBV
|
Burkitt's lymphoma (c-myc activation)
|
|
Burton's lines
|
Lead poisoning
|
|
C-ANCA, P-ANCA
|
Wegener's granulomatosis, polyarteritis nodosa
|
|
Café-au-lait spots on skin
|
Neurofibromatosis
|
|
Gas emboli
|
Caisson disease
|
|
Calf pseudohypertrophy
|
Duchenne's muscular dystrophy
|
|
Call-Exner bodies
|
Granulosa-theca cell tumor of the ovary
|
|
Cardiomegaly with apical atrophy
|
Chagas' disease
|
|
Cerebriform nuclei
|
Mycosis fungoides (cutaneous T-cell lymphoma)
|
|
Chagas' disease
|
Trypanosome infection
|
|
Chancre
|
1° syphilis (not painful)
|
|
Haemophilus ducreyi
|
Chancroid (painful)
|
|
Multiple sclerosis (nystagmus, intention tremor, scanning speech), cholangitis (jaundice, RUQ pain, fever)
|
Charcot's triad
|
|
Charcot-Leyden crystals
|
Bronchial asthma (eosinophil membranes)
|
|
Phagocyte deficiency
|
Chédiak-Higashi disease
|
|
Cherry-red spot on macula
|
Tay-Sachs, Niemann-Pick disease, central retinal artery occlusion
|
|
Central apnea in CHF and ↑ intracranial pressure
|
Cheyne-Stokes respirations
|
|
Endometriosis (frequently involves both ovaries)
|
"Chocolate cysts"
|
|
Predisposition to gastric carcinoma
|
Chronic atrophic gastritis
|
|
facial muscle spasm upon tapping
|
Chvostek's sign due to hypocalcemia
|
|
DES exposure in utero
|
Clear cell adenocarcinoma (CCA) of the vagina and cervix
|
|
Clue cells
|
Gardnerella vaginitis
|
|
Codman's triangle on x-ray
|
Osteosarcoma
|
|
Cold agglutinins
|
Mycoplasma pneumoniae, infectious mononucleosis
|
|
Condylomata lata
|
2° syphilis
|
|
Continuous machinery murmur
|
Patent ductus arteriosus
|
|
Debranching enzyme deficiency
|
Cori's disease
|
|
Cotton-wool spots
|
Chronic hypertension
|
|
Cough, conjunctivitis, coryza
|
Measles
|
|
Councilman bodies
|
Toxic or viral hepatitis
|
|
Cowdry type A bodies
|
Herpesvirus
|
|
Rapidly progressive crescentic glomerulonephritis
|
Crescents in Bowman's capsule
|
|
Congenital unconjugated hyperbilirubinemia
|
Crigler-Najjar syndrome
|
|
Acute gastric ulcer associated with severe burns
|
Curling's ulcer
|
|
Currant-jelly sputum
|
Klebsiella
|
|
Curschmann's spirals
|
Bronchial asthma (whorled mucous plugs)
|
|
Acute gastric ulcer associated with CNS injury
|
Cushing's ulcer
|
|
D-dimers
|
DIC
|
|
basal ganglia disorder--rigidity, resting tremor, bradykinesia
|
Depigmentation of neurons in
Parkinson's disease |
|
Dermatitis, dementia, diarrhea
|
Pellagra (niacin, vitamin B3 deficiency)
|
|
Diabetes insipidus + exophthalmos +
|
Hand-Schüller-Christian disease
|
|
Dog or cat bite
|
Pasteurella multocida
|
|
Donovan bodies
|
Granuloma inguinale
|
|
Congenital conjugated hyperbilirubinemia (black liver)
|
Dubin-Johnson syndrome
|
|
Deleted dystrophin gene (X-linked recessive)
|
Duchenne's muscular dystrophy
|
|
Eburnation
|
Osteoarthritis (polished, ivory-like appearance of bone)
|
|
Rocker-bottom feet, low-set ears, heart disease
|
Edwards' syndrome: Trisomy 18
|
|
Late cyanosis shunt (uncorrected L → R shunt becomes R → L shunt)
|
Eisenmenger's complex
|
|
Elastic skin
|
Ehlers-Danlos syndrome
|
|
Superior trunk brachial plexus injury ("waiter's tip")
|
Erb-Duchenne palsy
|
|
Erythema chronicum migrans
|
Lyme disease
|
|
Proximal tubular reabsorption defect
|
Fanconi's syndrome
|
|
Ferruginous bodies
|
Asbestosis
|
|
Colon polyps with osteomas and soft tissue tumors
|
Gardner's syndrome
|
|
Glucocerebrosidase deficiency
|
Gaucher's disease
|
|
Ghon focus
|
1° TB
|
|
Benign congenital unconjugated hyperbilirubinemia
|
Gilbert's syndrome
|
|
Defect in platelet aggregation
|
Glanzmann's thrombasthenia
|
|
Autoantibodies against alveolar and glomerular basement membrane proteins
|
Goodpasture's syndrome
|
|
Duchenne's (use of patient's arms to help legs pick self off the floor)
|
Gowers' maneuver
|
|
Idiopathic polyneuritis
|
Guillain-Barré syndrome
|
|
β-thalassemia, sickle cell anemia (extramedullary hematopoiesis)
|
"Hair-on-end" appearance on x-ray
|
|
Chronic progressive histiocytosis
|
Hand-Schüller-Christian disease
|
|
Thalassemia major
|
HbF
|
|
HbS
|
Sickle cell anemia
|
|
hCG elevated
|
Choriocarcinoma, hydatidiform mole (occurs with and without embryo)
|
|
Heberden's nodes
|
Osteoarthritis (DIP swelling 2° to osteophytes)
|
|
Heinz bodies
|
G6PD deficiency
|
|
Hypersensitivity vasculitis associated with hemorrhagic urticaria and URIs
|
Henoch-Schönlein purpura
|
|
Heterophil antibodies
|
Infectious mononucleosis (EBV)
|
|
High-output cardiac failure (dilated cardiomyopathy)
|
Wet beriberi (thiamine, vitamin B1 deficiency)
|
|
HLA-B27
|
Reiter's syndrome, ankylosing spondylitis
|
|
HLA-DR3 or -DR4
|
Diabetes mellitus type 1 (caused by autoimmune destruction of β cells)
|
|
Homer Wright rosettes
|
Neuroblastoma
|
|
Interstitial fibrosis
|
Honeycomb lung on x-ray
|
|
Splenectomy (or nonfunctional spleen)
|
Howell-Jolly bodies
|
|
Caudate degeneration (autosomal dominant)
|
Huntington's disease
|
|
Hyperphagia + hypersexuality + hyperorality + hyperdocility
|
Klüver-Bucy syndrome (amygdala)
|
|
Hyperpigmentation of skin
|
1° adrenal insufficiency (Addison's disease)
|
|
Hypersegmented neutrophils
|
Macrocytic anemia
|
|
Hypertension + hypokalemia
|
Conn's syndrome
|
|
Hypochromic microcytosis
|
Iron deficiency anemia, lead poisoning
|
|
Increased α-fetoprotein in amniotic fluid/maternal serum
|
Anencephaly, spina bifida (neural tube defects)
|
|
Increased uric acid levels
|
Gout, Lesch-Nyhan syndrome, myeloproliferative disorders, loop and thiazide diuretics
|
|
Intussusception
|
Adenovirus (causes hyperplasia of Peyer's patches)
|
|
Janeway lesions
|
Endocarditis
|
|
Jarisch-Herxheimer reaction
|
Syphilis—overaggressive treatment of an asymptomatic patient that causes symptoms due to rapid lysis
|
|
Neutrophil chemotaxis abnormality
|
Job's syndrome
|
|
AIDS in MSM (men who have sex with men)
|
Kaposi's sarcoma
|
|
Dynein defect
|
Kartagener's syndrome
|
|
Kayser-Fleischer rings
|
Wilson's disease
|
|
Keratin pearls
|
Squamous cell carcinoma
|
|
Kimmelstiel-Wilson nodules
|
Diabetic nephropathy
|
|
Bilateral amygdala lesions
|
Klüver-Bucy syndrome
|
|
Koilocytes
|
HPV
|
|
Koplik spots
|
Measles
|
|
Gastric adenocarcinoma with ovarian metastases
|
Krukenberg tumor
|
|
Kussmaul hyperpnea
|
Diabetic ketoacidosis
|
|
Lens dislocation + aortic dissection + joint hyperflexibility
|
Marfan's syndrome (fibrillin deficit)
|
|
HGPRT deficiency
|
HGPRT (hypoxanthine-guanine phosphoribosyl transferase) deficiency
|
|
Lines of Zahn
|
Arterial thrombus
|
|
Lisch nodules
|
Neurofibromatosis (von Recklinghausen's disease)
|
|
Low serum ceruloplasmin
|
Wilson's disease
|
|
Lucid interval
|
Epidural hematoma
|
|
"Lumpy-bumpy" appearance of glomeruli on immunofluorescencee
|
Poststreptococcal glomerulonephritis
|
|
Lytic bone lesions on x-ray
|
Multiple myeloma
|
|
Mallory bodies
|
Alcoholic liver disease
|
|
Esophagogastric lacerations
|
Mallory-Weiss syndrome
|
|
Muscle phosphorylase deficiency
|
McArdle's disease
|
|
McBurney's sign
|
Appendicitis
|
|
MLF syndrome (INO)
|
Multiple sclerosis
|
|
Monoclonal antibody spike
|
Multiple myeloma (called the M protein; usually IgG or IgA), MGUS (monoclonal gammopathy of undetermined significance), Waldenström's (M protein = IgM) macroglobulinemia
|
|
Myxedema
|
Hypothyroidism
|
|
Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis
|
Wegener's and Goodpasture's (hemoptysis and glomerular disease)
|
|
Negri bodies
|
Rabies
|
|
Nephritis + cataracts + hearing loss
|
Alport's syndrome
|
|
Sphingomyelinase deficiency
|
Niemann-Pick disease
|
|
No lactation postpartum
|
Sheehan's syndrome (pituitary infarction)
|
|
Nutmeg liver
|
CHF
|
|
Occupational exposure to asbestos
|
Malignant mesothelioma
|
|
"Orphan Annie" nuclei
|
Papillary carcinoma of the thyroid
|
|
Osler's nodes
|
Endocarditis
|
|
Painless jaundice
|
Pancreatic cancer (head)
|
|
Palpable purpura on legs and buttocks
|
Henoch-Schönlein purpura
|
|
Bronchogenic apical tumor associated with Horner's syndrome
|
Pancoast's tumor
|
|
Pannus
|
Rheumatoid arthritis
|
|
Nigrostriatal dopamine depletion
|
Parkinson's disease
|
|
Periosteal elevation on x-ray
|
Pyogenic osteomyelitis
|
|
Benign polyposis
|
Peutz-Jeghers syndrome
|
|
Penile fibrosis
|
Peyronie's disease
|
|
Philadelphia chromosome (t(9;22); bcr-abl hybrid)
|
CML (may sometimes be associated with AML)
|
|
Emphysema (centroacinar [smoking], panacinar [α1-antitrypsin deficiency])
|
"Pink puffer"
|
|
Esophageal webs with iron deficiency anemia
|
Plummer-Vinson syndrome
|
|
Gout (MP joint of hallux)
|
Podagra
|
|
Minimal change disease
|
Podocyte fusion
|
|
Polyneuropathy, cardiac pathology, and edema
|
Dry beriberi (thiamine, vitamin B1 deficiency)
|
|
Polyneuropathy preceded by GI or respiratory infection
|
Guillain-Barré syndrome
|
|
Lysosomal glucosidase deficiency associated with cardiomegaly
|
Pompe's disease
|
|
Positive anterior "drawer sign"
|
Anterior cruciate ligament injury
|
|
Vertebral tuberculosis
|
Pott's disease
|
|
Pseudopalisade tumor cell arrangement
|
Glioblastoma multiforme
|
|
Pseudorosettes
|
Ewing's sarcoma
|
|
Rash on palms and soles
|
2° syphilis, Rocky Mountain spotted fever
|
|
Recurrent vasospasm in extremities
|
Raynaud's syndrome
|
|
Acute glomerulonephritis
|
RBC casts in urine
|
|
Recurrent pulmonary Pseudomonas and S. aureus infections
|
Cystic fibrosis
|
|
Red urine in the morning
|
Paroxysmal nocturnal hemoglobinuria
|
|
Reid index (increased)
|
Chronic bronchitis
|
|
Reinke crystals
|
Leydig cell tumor
|
|
Urethritis, conjunctivitis, arthritis
|
Reiter's syndrome
|
|
Renal cell carcinoma + cavernous hemangiomas + adenomas
|
von Hippel-Lindau disease
|
|
Renal epithelial casts in urine
|
Acute toxic/viral nephrosis
|
|
Rib notching
|
Coarctation of aorta
|
|
Congenital conjugated hyperbilirubinemia
|
Rotor's syndrome
|
|
Rouleaux formation (RBCs)
|
Multiple myeloma
|
|
Russell bodies
|
Multiple myeloma
|
|
S3
|
- Left-to-right shunt (VSD, PDA, ASD)
- Mitral regurgitation - LV failure (CHF) |
|
S4
|
- Aortic stenosis
- Hypertrophic subaortic stenosis |
|
Schiller-Duval bodies
|
Yolk sac tumor
|
|
Cutaneous T-cell lymphoma
|
Sézary syndrome
|
|
Shwartzman reaction
|
Neisseria meningitidis
|
|
Signet-ring cells
|
Gastric carcinoma
|
|
Sipple's syndrome
|
MEN type IIa
|
|
Dry eyes, dry mouth, arthritis
|
Sjögren's syndrome
|
|
"Smudge cell"
|
CLL
|
|
Soap bubble on x-ray
|
Giant cell tumor of bone
|
|
Spike and dome on EM
|
Membranous glomerulonephritis
|
|
Spitz nevus
|
Benign juvenile melanoma
|
|
"Strawberry tongue"
|
Scarlet fever
|
|
String sign on x-ray
|
Crohn's disease
|
|
Subepithelial humps on EM
|
Poststreptococcal glomerulonephritis
|
|
Suboccipital lymphadenopathy
|
Rubella
|
|
Sulfur granules
|
Actinomyces israelii
|
|
Swollen gums, bruising, poor wound healing, anemia
|
Scurvy (ascorbic acid, vitamin C deficiency): vitamin C is necessary for hydroxylation of proline and lysine in collagen synthesis
|
|
Systolic ejection murmur (crescendo-decrescendo)
|
Aortic valve stenosis
|
|
t(14;18)
|
Follicular lymphomas (bcl-2 activation)
|
|
Tendon xanthomas (classically Achilles)
|
Familial hypercholesterolemia
|
|
Thumb sign on lateral x-ray
|
Epiglottitis (Haemophilus influenzae)
|
|
Thyroidization of kidney
|
Chronic bacterial pyelonephritis
|
|
"Tram-track" appearance on LM
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Membranoproliferative glomerulonephritis
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Trousseau's sign
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Visceral cancer, pancreatic adenocarcinoma (migratory thrombophlebitis), hypocalcemia (carpal spasm)
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Left supraclavicular node enlargement from metastatic carcinoma of the stomach
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Virchow's node
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Pulmonary embolism (blood stasis, endothelial damage, hypercoagulation)
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Virchow's triad
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Neurofibromatosis with café-au-lait spots
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von Recklinghausen's disease
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Osteitis fibrosa cystica ("brown tumor")
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von Recklinghausen's disease of bone
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PICA thrombosis
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Wallenberg's syndrome
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Adrenal hemorrhage associated with meningococcemia
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Waterhouse-Friderichsen syndrome
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Waxy casts
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Chronic end-stage renal disease
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WBC casts in urine
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Acute pyelonephritis
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WBCs in urine
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Acute cystitis
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Wermer's syndrome
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MEN type I
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Malabsorption syndrome caused by Tropheryma whippelii
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Whipple's disease
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Hepatolenticular degeneration
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Wilson's disease
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"Wire loop" appearance on LM
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Lupus nephropathy
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"Worst headache of my life"
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Berry aneurysm—associated with adult polycystic kidney disease
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Xanthochromia (CSF)
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Subarachnoid hemorrhage
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Xerostomia + arthritis + keratoconjunctivitis sicca
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Sjögren's syndrome
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Upper GI diverticulum
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Zenker's diverticulum
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Gastrin-secreting tumor associated with ulcers
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Zollinger-Ellison syndrome
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