Associations 5 Flashcards Preview

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Flashcards in Associations 5 Deck (162):
1

Cause basophilic stippling

Lead poisoining
Thalassemia
Alcohol use

2

Anemia + neurological symptoms

Lead poisoning (microcytic)
B12 deficiency (macrocytic)

3

Sickle cell + aplastic anemia crisis

Parvovirus B19

4

Pancytopenia with hypocellularity and fatty infiltrates on BM biopsy

Aplastic anemia

5

Thalassemia more prevalent in which races

Alpha - African and Asian
Beta - Mediterannean

6

"Hair on end" skull x-ray

BM hyperplasia in sickle cell disease

7

Salmonella osteomyelitis

Assoc w/ sickle cell disease

8

Encapsulated organisms

Strep pneumo
H. influenzae
N. meningitidis
Klebsiella
Salmonella

9

Complication of 10% sideroblastic anemia

Acute leukemia

10

Causes of eosinophilia

DNAAACP
Drugs
Neoplasms
Allergies/asthma (Churg Strauss)
AIN
Adrenal insufficiency (Addisons)
CVD
Parasites

11

Type I hypersensitivity rxn

IgE / mast cell degranulation
Hives, pruritis, allergic rhinitis
Asthma, bronchospasm, angioedema
Anaphylaxis

12

Type II hypersensitivity rxn

Cell-mediated / Complement cascade / IgM and IgG react w/ cellular antigens
Drug-induced or immune hemolytic anemia
Hemolytic disease of the newborn
Graves
Myasthenia gravis
ITP
Acute rheumatic fever
Goodpasture's
Bullous pemphigoid
Pemphigous vulgaris

13

Type III hypersensitiviy rxn

Immune complexes deposit in tissue and activate complement/ IgM and IgG bind soluble antigens
Arthus rxn
(serum sickness)
Glomerulonephritis

14

Type IV hypersensitivity rxn

Delayed / T-cell mediated
Transplant rejection
Contact dermatitis
PPD

15

von Willebrand disease

AD
vWF and sometimes factor VIII deficiency
+PTT and +BT (NORMAL platelet number)

16

Hemophilia

X-linked recessive
Factor VIII (A) or IX (B) deficiency
+PTT, normal PT/BT/platelet number

17

+Fibrin split products, +D-dimer

DIC

18

Common causes DIC

STOP Making Thrombi
Sepsis
Trauma (including surgery)
Ob complications
Pancreatitis
Malignancy
Transfusions

19

MC inherited hypercoagulability disorder

Factor V Leiden mutation (40-50%)

20

SIRS criteria

2/4 for diagnosis
Temp >38.3 or 90
RR >20 or PaCO2 12K or 10% bands

21

Sepsis

SIRS = 2/4 criteria
Sepsis = SIRS + infection
Septic shock = Sepsis + hypotension

22

MCC malaria

Plasmodium falciparum

23

Common areas for malaria

Sub-Saharan Africa
SW/SE Asia (India)
Tropical S. America

24

India ink stain

Stain of CSF = cryptococcal meningitis

25

HIV + purple subcutaneous nodules or hemoptysis

Kaposi sarcoma (HHV-8) skin or lung lesions

26

HIV + diarrhea

Isospora, strongyloides
Cryptosporidium

27

HIV + Cough, fever, dyspnea

CD4 <200, non-productive cough: PCP
Acid-fast bacilli: TB

28

HIV + ataxia, apathy, tremor, intellectual decline

AIDS dementia, CD4 <100

29

HIV + odynophagia

Candida esophagitis
CD4 <200, gram stain on lesion scrapings

30

HIV + fever, weight loss, fatigue, abdominal pain, GI bleeding, skin lesions, dyspnea, meningitis or adrenal insufficiency

Histoplasmosis
CD4 <150
Bilateral infiltrates on CXR, positive serum/urine antigen

31

HIV + focal neurologic symptoms, HA, AMS

CD4 <50: Cryptococcal meningitis

32

HIV + vision loss, esophagitis, cellulitis, ulcers

CMV
CD4 <50, yellow infiltrates + hemorrhage on fundoscopy, viral titer to confirm

33

HIV + fatigue, weight loss, fever, diarrhea, abdominal pain, hepatosplenomegaly

MAC
CD4 <50, blood cultures

34

Thrombosis + erythromelalgia + pruritis (esp after warm bath)

Polycythemia vera (also facial plethora, hepatosplenomegaly, visual disturbances, tinnitus)

35

CRAB symptoms
hyperCalcemia
Renal insufficiency
Anemia
Back pain

Multiple myeloma

36

Bence Jones proteins

Multiple myeloma (UPEP)

37

M spike on SPEP

Multiple myeloma

38

Painless cervical lymphadenopathy

Hodgkin lymphoma

39

MC type Hodgkin lymphoma

Nodular sclerosis (men = women)

40

MC lymphoma in US

Diffuse large B cell (NHL)

41

EBV related lymphoma (Africa)

Burkitt (NHL)

42

Reed-Sternberg cells on LN biopsy

Hodgkin lymphoma

43

"Starry sky" pattern

Burkitt lymphoma (NHL)

44

T cell lymphoma

Peripheral (NHL)

45

14:18 translocation

Follicular small cell lymphoma (NHL)

46

8:14 translocation

Burkitt lymphoma (NHL)

47

B symptoms in lymphomas

Fever, night sweats, weight loss

48

Cleaved cells in LN biopsy

Follicular small cell lymphoma (NHL)

49

MC cancer in children

ALL

50

Pancytopenia in Down syndrome patient

ALL

51

Aeur rods + notched nuclei

AML

52

Smudge cells

CLL

53

BM biopsy w/ abundant blasts, +PAS, +tdt

ALL

54

Leukemia + bone pain

ALL

55

BM biopsy w/ abundant blasts, -PAS, +myeloperoxidase

AML

56

WBC > 50-100K

CML or CLL

57

Leukemia and lymphoma that are same disease

CLL and small lymphocytic lymphoma

58

Progresses to fatal blast crisis

CML

59

Leukemia in adults >65

CLL

60

Leukemia in adults 50-60

AML, CML

61

Numerous lymphocytes with irregular cytoplasmic projections

Hairy cell leukemia

62

t 9:22

Philadelphia chromosome (BCR-ABL)
CML
15% adult ALL (5% ALL overall), rare in AML

63

Short stature + abnormal skin pigmentation + horseshoe kidney + thumb abnormalities + fatigue + infections + pancytopenia on labs

Fanconi anemia (autosomal recessive)

64

Fatigue + dyspnea + craniofacial and thumb abnormalities + heart murmur + MR + hypogonadism + decreased Hgb/Hct but normal WBC/plt

Diamond-Blackfan anemia (congenital)

65

HTN + abdominal pain + diarrhea with no hematuria in kid: next step?

Neuroblastoma (check VMA and homovanillic acid in 24 hr urine; then CT)

66

Mass in soft tissue/muscle in child: next step?

Rhabdomyosarcoma (MC soft tissue sarcoma in children) (CT/MRI to see extent, biopsy afterwards is diagnostic)

67

Fall on outstretched hand

Colles fx

68

Fall on flexed wrist

Smith fx

69

Fall on outstretched hand, snuffbox tenderness

Scaphoid fx

70

Pain in hand after punching hard surface

Boxer fx (5th metacarpal)

71

Radial head dislocation w/ ulnar fx

Monteggia fx

72

Ulnar dislocation (DRUJ) w/ radial fx

Galeazzi fx

73

Complication of scaphoid fx

AVN

74

Complication of anterior shoulder dislocation

Axillary nerve injury

75

Complication of boxer fx

Infection, tendon laceration

76

Complication of humerus fx

Radial nerve injury

77

Complication of hip fx

AVN

78

Complication of femur fx

Fat embolism, blood loss

79

Complication of tibial fx

Compartment syndrome

80

Complication of pelvic fx

Hypovolemic shock (massive blood loss)

81

6Ps of compartment syndrome

Pain, Pallor, Poikilothermia, Pulselessness, Paresthesia, Paralysis

82

Unhappy triad

ACL + MCL + lateral meniscus

83

Hat doesn't fit anymore

Paget's disease of bone (much more common; bone scan)
Osteopetrosis (anemia; X-ray)

84

Blue sclerae

Osteogenesis imperfecta

85

Sudden severe pain and swelling in one joint (first MTP, ankle, foot, knee MC)

Gout

86

Sudden severe pain and swelling in one joint (ankle, wrist MC)

Pseudogout

87

Needle-shaped negatively birefringent crystals (yellow)

Gout

88

Rhomboid-shaped positively birefringent crystals (blue)

Pseudogout

89

MCC septic arthritis

S. aureus
N. gonorrhea in young, sexually active

90

Joint aspirate w/ <2000 WBC

Osteoarthritis
Trauma

91

Joint aspirate w/ 5-50,000 WBC

Inflammatory (RA, gout, pseudogout, etc)

92

Joint aspirate w/ >50,000 WBC

Septic joint

93

MCC osteomyelitis

S. aureus
Consider Salmonella in sickle cell
Consider Pseudomonas in IVDU, old tennis shoe/nail

94

Radiology for osteomyelitis

MRI most useful

95

Erythema chronicum migrans

Lyme disease

96

B/L Bell's palsy

Think Lyme disease

97

Heberden nodes

Osteoarthritis, DIP joints

98

Bouchard nodes

Osteoarthritis, PIP joints

99

MC adult bone tumor

Metastases
(Lung = lytic, Prostate = blastic, Breast = both; Thyroid, Lymphoma, RCC)

100

MC primary malignant bone tumor

Osteosarcoma

101

MC benign bone tumor

Osteochondroma

102

Sunburst bone lesion +/- Codman's triangle

Osteosarcoma (more common in adolescents)
(Codman = new periosteal bone formation at diaphyseal end of lesion)

103

Onion skin lesion +/- Codman's triangle

Ewing sarcoma (5-15 yo)
(Codman = new periosteal bone formation at diaphyseal end of lesion)

104

Complications of scleroderma

Pulmonary fibrosis
Heart failure
ARF from renal hypertension

105

Complications of polymyositis and dermatomyositis

Interstitial lung disease
Increased risk of several malignancies

106

Associated w/ polymyalgia rheumatica

Temporal arteritis

107

Positive Barlow or Ortalani maneuver

Developmental hip dysplasia

108

Positive Galeazzi sign

Developmental hip dysplasia (knees at unequal heights when hips and knees are flexed)

109

Radiology to dx developmental hip dysplasia

Ultrasound (X-ray not useful until >4 months)

110

JIA w/ <4 joints and uveitis or iridocyclintis

Pauciarticular

111

JIA w/ >4 joints, symmetric, and hand deformities

Polyarticular

112

JIA w/ systemic symptoms usu before joint pain

Systemic (Still's disease)

113

MC fracture in children

Clavicular

114

Difficulty walking + Gower maneuver + calf pseudohypertrophy

Duchenne muscular dystrophy (x-linked)

115

MCC cellulitis

S. aureus, GAS (pyrogenes)

116

Apocrine gland inflammation (axilla, groin, perineum)

Hirdradenitis suppurativa

117

S/Sx necrotizing fasciitis

Extreme pain w/o cellulitis or outside borders
Erythema + bulla or blisters
Crepitus
DM w/ foot ulcer w/ systemic symptoms
Perineal cellulitis w/ abrupt onset and rapid spread (Fournier's gangrene)

118

Dry gangrene cause, s/sx

Gradual skin necrosis from vascular insufficiency
Ache/cold/pallor -> bluish/black/hard/dry

119

Wet gangrene cause, s/sx

Necrosis from infection or acute vascular obstruction
Bruised, swollen, blistering, +pus

120

Gas gangrene cause, s/sx

C. perfringens
Pale/swelling around injury -> dark purplish-red, tense, tender, +crepitus w/ systemic symptoms

121

Yellow crusted lesion around mucocutaneous surfaces

Impetigo

122

Causes of impetigo

S. aureus, GAS (pyrogenes)

123

Cause of necrotizing fasciitis

GAS (pyrogenes) or multiple pathogens

124

Herpes simplex virus types

HSV 1 - oral ulcers
HSV 1 - genital ulcers
(herpes zoster) - VZV

125

Tzanck smear

Finds multi-nucleated giant cells on sample of lesion in HSV or VZV

126

Teardrop vesicles

Chicken pox (VZV)

127

Grouped vesicles

Shingles (VZV) or HSV

128

Temporal lobe encephalitis

Herpes (esp newborn)

129

Complications of VZV

Adult PNA, encephalitis
Newborn varicella

130

Myalgia, malaise, HA, fever proceeding to lesions in

Chicken pox (VZV)

131

HPV types

1-4 - skin warts
6, 11 - genital warts
16, 18, 31, 33 - cervical cancer

132

Painless, small, shiny/pearly, flesh colored papules w/ central umbilication

Molluscum contagiosum

133

Macules that do not tan w/ "spaghetti and meatballs" on KOH prep (short hyphae + spores)

Tinea versicolor / Pityriasis versicolor
(Malassezia furfur)

134

Irritant rash vs intertrigo (candida albicans)

Intertrigo MC in skin creases, irritant usu avoids
Intertrigo can have 'satellite' lesions away from rash
Intertrigo KOH prep has pseudohyphae

135

Infectious causes of EM/SJS/TEN

HSV and Mycoplasma pneumonia

136

Drug causes of EM/SJS/TEN

Penicillins, sulfonamides
NSAIDs
OCPs
Anticonvulsant medications

137

EM vs SJS vs TEN

EM = mild disease, macules, plaques, vesicles, target lesions, esp palms/soles
SJS = EM involving mucous membranes, skin sloughing 30% surface area

138

Pruritic, erythematous plaques w/ yellow, greasy scales most commonly on face or scalp

Seborrheic dermatitis (or cradle cap in babies)

139

Dry skin patches w/ papules most commonly on flexor surfaces, face/scalp in infants

Atopic dermatitis (eczema)

140

Well-defined red plaques w/ silvery scales on extensor surfaces that bleed easily w/ scale removal (Auspitz sign)

Psoriasis

141

Herald patch + pruritic papules covered with white scale in "christmas tree" pattern

Pityriasis rosea

142

Subcutaneous fat inflammation -> painful, erythematous nodules esp on anterior tibias

Erythema nodosum

143

Conditions associated w/ erythema nodosum

SPUD BITS
Strep infections
Pregnancy
Unknown/idiopathic
Drugs
Behcet's
IBD
TB
Sarcoidosis

144

Pruritic, purple, polygonal papules and plaques that are shiny and flat, most commonly on flexor surfaces of extremities, possibly on mucus membranes/genitals

Lichen Planus

145

Infections associated w/ lichen planus

HIV (younger patients)
Hep C (older patients)

146

Decubitus ulcer stages

I - color/consistency/temp change of skin
II - superficial skin abrasion, shallow crater
III - full thickness skin loss + SQ damage, deep crater
IV - muscle, bone or supporting structure damage

147

Eczematous dermatitis w/ inflammatory papules, scaly and crusted erosions, increased pigmentation, stippling w/ recent and old hemorrhages, possible ulceration

Stasis dermatitis

148

Flaccid, easily ruptured bullae (+Nikolsky sign) w/ oral lesions

Pemphigus vulgaris (anti-desmosome Abs)

149

Tense, hard, difficult to rupture bullae w/o oral lesions

Bullous pemphigoid (anti-hemidesmosome Ab)

150

Chronic blistering lesions on sun-exposed skin

Porphyria cutanea tarda

151

Porphyria cutanea tarda associations

Hep C, alcoholism
Iron overload, estrogen use, smoking

152

Pigmented plaques that appear to be stuck onto skin

Seborrheic keratosis

153

Black velvety plaques on flexor surfaces, body folds

Acanthosis nigricans

154

Acanthosis nigricans associated with what

Obesity
DM
Malignancies

155

Rough lesions on sun-exposed skin that are easier to feel than see

Actinic keratosis

156

Circular rash w/ central clearing on trunk/arms

Tinea corporis

157

Sharply demarcated patches of hypopigmentation

Vitiligo

158

Hyperpigmentation in pregnancy

Melasma

159

Vitiligo associated comorbidities

Thyroid disease (30%) - Graves, AI
Pernicious anemia, DM I, primary adrenal insufficiency, hypopituitarism, alopecia areata, AI hepatitis

160

Asymptomatic, inflammatory, non-scarring areas of complete hair loss

Alopecia areata

161

Stress-related diffuse hair loss

Telogen effluvium

162

Male-pattern baldness (men or women)

Androgenic alopecia