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Flashcards in CK Deck (1030):
1

Subarachnoid hemorrhage --> and other realted consequences by timeline !

rebleeding 24hrs

 

vasospasm - first week

circle of willis by-products from degraded blood causes vasospasm and meningeal irritation(stiff neck)

2

Hydrocephalus from any reason

see multiple neurodeficits

3

tods palsy

happens after a focal motor seizure

4

Back pain that's exacerbated by standing And Relieved with "sitting" and "hyperflexion" Of the hips?

Spinal stenosis

5

Rheumatod Athritis and what joints of hand effected

Meta carpals and Proximals distal joints are spared

6

Joint pain and stiffnes = gets worst by the course of the day

Osteoarthritis

7

Multiple fractures and blue sclera

Osteogenesis imperfecta

8

Hip Pain Back pain plus stiffness= that improves by the course of the day and gets worst at rest ? diagnosis test?

Ankylosing Spondylitis Test for HLA-B27

9

Young men comes and has problems with urination (urethritis) red eyes (conjunctivitis) Bone pain (Arthritis)

Reactive Reiters M/c Chlamydia also Camplylobacter Shigella and Salmonella ,Ureaplasma

10

55 y/o Sudden and excuciating pain MTP After drinking Red wine

Gout (N&N) Negatively bifringent and needle shaped

11

Positively bifringent

pseudogout = rhomboid shaped

12

Anemia and Increased ESR Elderly woman Hip and shoulder joint pain and stiffness

Polymyalgia Rheumatica

13

Fall on outstretched hand= what bone fractured

Distal radius=colles also check scaphoid

14

Humoral fracture= what signs present if radial nerve damaged

Wrist drops Thumb cant abduct

15

Most common " primary" and "malignant" tumor of bone?

Multiple Myeloma

16

Unilateral "PeriOrbit pain" Tearing and "Erythema" on conjuctiva

Clustered by Cluster Headache

17

Unilateral "PeriOrbit pain" Tearing and "Erythema" on conjuctiva

Clustered by Cluster Headache

18

SubArachnoid Hemorrhage Most Common Cause is

TRAUMA second m/c cause is Aneurysm

19

Middle age man with Acute broken speech What type of aphasia? What Lobe? What Is the Artery?

Broca Frontal Lobe Left Middle Carotid Artery Distribution

20

Hyperdensity is Crescent shaped Does not cross Midline Which hemorrhage

Subdural Bridging Vein Torn

21

Initially, Altered mental status Then a Lucid Interval

Epidural Hematoma Middle Meningeal Artery Treatment = Neurosurgical Evacuation

22

CSF in SubArachnoid Hemorrhage

Increased ICP RBC Xanthochromia

23

TCA Overdosed Effect on heart?

Anticholinergic effect Tachycardia Hypotension Wide P and R Wide QRS Wide Q and T Arrhythmia

24

Anticholinergic Overdose Therapy

Supplemental Oxygen and Intubation IV Sodium Bicarbonate for QRS widening or Ventricular Arrhythmia

25

Hypotension with Respiratory Depression Tachycardia and/or with Arrhythmia Dry mouth Dilated Pupil Blurry Urinary retention flushing and hyperthermia

TCA overdose Anticholinergic effects

26

problem initiating swallowing

Oropharyngeal Dysphagia-- drools, nasal regurgitation, lungs regurgitation, recurrent aspirational Pneumonia ( mostly right lobe) usually liquids parkinson stroke Myasthenia prolonged intubation zenkers test -Do VideoFluorodic Barium Swallow

27

Swalloing is ok but after few seconds feels sensation of food getting stuck

Esophageal Dysmotility or obstruction Achalasia Scleroderma spasm obstruction from goiter, strictures, Atrial enlargement

28

Swalloing is ok but after few seconds feels sensation of food getting stuck

Esophageal Dysmotility or obstruction Achalasia Scleroderma obstruction from goiter, strictures, Atrial enlargement

29

Hydralazine and Nitrates dilate what?

Hydralazine dilate ARTERIOLES Nitrates dilate VEINS

30

Radiation Anthracycline chemo

Can cause pericarditis and it can take upto 20 years

31

shiga toxin--> how does it causes hemolysis

activates platelets (due to renal endothelial damage) ---> platelets form microthrombi--->microangiolytic hemolysis

32

AVPR2

Hereditary Nephrogenic DI

33

AVPR2

Hereditary DI

34

renal artery stenosis and hypertension--> how to diagnose?

doppler ultrasound duplex, only if abnormal urianalysis or high creatinine

35

factors that precipitate HEPATIC ENCEPHALOPATHY

Hypokalemia sedatives, narcotics infecttion porto systemic shunt

36

Alkalosis and nitrogen (LIVER problem)

excess bicarbonates converts nh4 to nh3 NH3 enters brain

37

Beta 2

Releases insulin

38

uvea

middle layer-->between sclera and retina

39

Bipolar 1 Drugs = How many?

four drugs for bipolar 1 Lithium and valproate Quietapine and Lamotrigine

40

Lithium ContraIndication?

If Creatinine is more than 1.2

41

Headache and momentarily vision loss and increasing blind spot

Increasing blond spot means OPTIC NERVE HEAD is INCREASING. Normally optic nerve head is a blindspot. ICP and Vision loss= pappilaedema

42

Elderly and aldosterone relation

Increased Aldosterone elderlies-->decreased baroreceptor reflex(autonomic crash) --> hypotension-->orthostatic Syncope--->Renal Hypoperfusion-->RAAS activated in response

43

Severe coughing paroxysm?

can cause subcutaneous emphysema increased idntraalveolar pressure causes the air to leak out -->pneumothorax-->chest x ray

44

Hemoptysis systemic causes

Wegener goodpasture SLE Vasculitis

45

Hemoptysis Cardiac cuases

Mitral stenosis Acute Pulmonary Edema

46

Low PLATELETS Elevated liver enzymes Hypertension Anemia

HELLP Don't worry about elevated Alkaline Phosphatase (pregnancy related elevation)

47

HELLP

See Anemia Low platelets elevated liver enzymes--> causes swelling of liver capsule

48

Tilted uterus tender

Adhesions caused by ectopic endometrial implanted tissue ENDOMETRIoasis

49

M Tuberoculosis Lymphadenopathy

Non Tender Mostly cervical

50

papule and tender lymphadenopathy and pet exposure

Bartonella hansellae

51

Bloor Urea Nitrogen

7-18

52

TSH

0.5 to 5.0

53

white, grey or tan discharge

Bacteria

54

alpha 3 chain of collagen 4

goodpasture

55

IgM Cold Aggluttins

EBV Mycoplasma WaldenStrom

56

Hematocrit Male

41% to 53%

57

Hematocrit female

36% to 46%

58

fork in middle of head

weber test vibration heard better and compensatory amplified my middle hear in absence of air conducted ambient sound. person lateralizes to the affected ear in web

59

WIdened Medistinum + Pericardial effusion + Syncope

Aortic Dissection

60

Silent murmur

Ovale

61

Most common infant cyanotic

Transposition of great vessels Give indomethacin to keep Arteriosis open to mix oxygenated blood into pulmonary artery

62

Av Nodal Acting drugs for fibrillation

Digoxin Adenosine Beta blockers Calcium blockers They act on problem that arises from Av node in wolf -->there is accessory pathway and AV is bypassed--> give Procainamide or Ibulitide

63

tet spell

Pulmonary stenosis in TOF-->spasmed during tension--> cyanosis due to increased PVR-->blood flows through VSD from Right ventricle to LEft VEntricle

64

acuminata ( condiluminata)

6 and 8 = low risk hpv they bleed

65

lichen planus

T cell-mediated reaction against epithelial cells.

66

HIGH FEVER leukopenia thrombocytopenia Elevated liver enzymes and also Lactate Dehydrogenase + TICK BITE

Ambylomomma Ehrlichiosis monocytes got mulberry like inclusions Empiric = Doxicycline

67

Athlete/ runner/ dancer Underweight woman Point tenderness on bone/leg

Stress fracture of tibia overweight = diffuse pain ( not point )--> shin splints

68

CRYSTALS in tubules after drug intake

Acyclovir Sulfonamides methotrexate ethylene gycol protease inhibitors in hiv

69

Frothy and yellowish or greenish discharchage with malodorous tinge to it

Motile truckomonas Give metro

70

Offwhite fishy odor

gardarenella clue

71

normal chloride

95-105

72

perisistent vomiting and nystagmus

give thiamine

73

sudden glaucoma>

closed angle

74

african with diabetes and cupping of optic disk

gradual open angle glaucoma

75

social anxiety DSM5 = Perfomance related

Beta blockers on as needed basis benzo can be given but sedation will impact the presentation or performances try to control the symptoms like tremors, tachycardia and diaphoresis by a beta blocker

76

Anteverted Uterus

curves down to push the bladder--> incontinence

 

A image thumb
77

DKA

monitor serum Anion gap give iv insulin iv potassium

78

barky cough rhinorrhea congested

Croup steepling -->laryngotracheitis parainfluenza virus give steroid for milder case add nebulized epinephrine for stridor at rest (serious)

79

drooling, dysphagia, resp dristressed

Epiglotittis = H.I tripod sign

80

age less than 5 lips or tongue mucositis conjuctivits fever not responding to anti pyretics strawberry tongue blanching maculopapular rash

kawasaki disease

81

3 hurtz wave on eeg no postictal period lost in staring Easily provoked by hyperventilation lasts about 20 seconds

Absence seizure both hemispheres

82

Lost in stare plus a postictal state 2-3 minute episode normal eeg

Focal seizure

83

HyperEsthesia

Excessive sensitivity to the touch to skin

84

Rash head to trunk spares palms and soles darkens/coalescense high fevers longer duration

ola measle

85

fever leaves but rash comes

roseola

86

pinkish rash head to trunk well appearing child milder fever

ella-rub

87

most common cause of spontaneous lobar hemorrhage in elderlies

Amyloid angiopathy amyloid protein gets deposited in the vessel walls and causes the weakening of the vessels --> leads to formation of the hematoma ( increased ICP ) or Rupture most common lobes are parietal lobe and occipital lobe parietal lobe rupture=somatosensory zone affected-->contralateral Hemisensory loss

88

high cholesterol low sodium

hypothyroidism it is hypotheized that low thryoid slows metablosim of cholesterol and increases adh or decreases gfr

89

Normal albumin

4

90

below 200 cells in HIV whats the prophylaxis

TMP-SMX for =PCP and tox Azithromycin = Avium

91

ELDERLY+ diabetic+ gradual decline in sensorium

hyperosmlolar = Hyperosmolar hyperglycemic state due to hopovolemic state led decrease in gfr

92

pulsus paradox

Q image thumb

systemic blood pressure that drops during inspiration is more than 10 1) heart constricted due to cardiac temponade, the pericardial sac 2) lyngs hyperinflated and pushe heart from both sides and not let it accomodate blood so, during inspiration the venous return comes to the right heart --> pushes the interventricular septum in to the left ventricle-->decreases stroke volume

93

Acute Unilateral swollen lump on neck non toxic appearcing age less than 5 years

Lymphadenitis due to aureus no systemic symptoms Bilteral is EBV with systemic

94

Crystal violet dye on PERIPHERAL SMEAR

detects insoluble hemoglobin precipitated in rbc , in wake of g6pd deficiency

95

pain on hip 'flexion' pain on hip extension

septic joint psoas sign

96

Tocolytics

Indomethacin B2 agonist nifedipine Magnesium= weak tocolytic but used for fetal Neuroprotection in <32 weeks

97

unilateral swelling of a lymph node plus tender

Q image thumb

aureus adenitis

 

Markedly tender and Erythematous

 

Unilateral = Bacterial

 

Bilateral = Viral = Adenovirus, EBV, CMV

98

African American

urinating frequently despite decreasing intake

 

Hyposthenuria

Sickle cell trait or disease

if trait, cells sickle in hypoxic and hyperosmolar conditions of vasa recta in renal medulla------>impairs free water reabsorption and also impairs counter-current exchange ( low gravity urine/unconcentrated)

99

CoPD AND Edema Relation

Copd = hypoxic lung problem--->Vasoconstricted pulmonary vasculature----->pressure backs up >>Pulmonary Artery>>>Right Ventricle>>>>Veins>>>>>>Edematous conditions

 

Isolated Right heart failure due to Pulmonary Disorder--> Cor Pulmonale

 

see =

Jugular Wave AKA a wave

Congested Liver

tricuspid regurgitates

100

Q image thumb

Pulmonary capillary wedge pressure

 

measures left ventricular end diastolic pressure

101

Poisoning case

pills on the floor

Opacities seen on abdomen Xray

Hypotensive and Hematemesis

Labs show low CO2

 

Iron ( Not Aspirin)

Biggest clue= Opaque

30 mins= Abdominal pain, Vomits, diarrhea and Hypotensive shock

 

2 days= liver necrotic

 

2-8 weeks = Pyloric Stenosis

 

Iron = vasodilatory--> hypotensive--> unperfused body-->lactic acid buildup--> anion gap acidosis---> respiratory compensation

102

Painless monoocular vision loss

and

Painful monocular vision loss

Painless = emboli with matching history

 

Painful = Angle-closure Glaucoma ( will see red eye too)

 

Embolized Central retinal Artery= Retina Whitening---> ocular massage with high flow oxygen is most rapid

 

for close angle glaucome==Topical pilocarpine or beta blocker topically

103

Monospot Heterophile test

Comes negative in first week (25%)

104

catching or locking feeling

no pain on rotation/extension/flexion of the knee

no ligamentous laxity

patient played soccer and came with joint pain-->later had a swelling

meniscal tear

A image thumb
105

Vertical cesarean

or

history of myomectomy

precaution on uterus rupturing

106

lack of empathy

entitlement

Narcisstic

107

Dramatic

Seeks Attention

Histrionic

108

Chaotic relationships

Labile mood

Impulsive

Inner emptiness and self harm

Border

109

Odd Thoughts

odd perceptions

odd Beliefs

Schizotypal

110

apgar scores

A image thumb
111

VDRL

RPR

Treponema Pallidum syphilis

112

Rhinorrhea

Abnormal long bone radiographs

Diffuse MaculoPapular rash that desquamates

congenital Syphilis

see blueberry muffin =due to extramedullary hematopoiesis

jaundice and hepatosplenomegaly-->due to activated reticuloendothelial system

113

Toddler with UTI

Treated for and now is well

what next?

do Ultrasound of bladder and kidneys to rule out any anatomic problems

114

Pertusis case in family

give macrolides to every family member

azithromycin

clarithromycin

Erythromycin

115

Q image thumb

Lobar pneumonia = increased fremitus

Strep

Klebsiella in alcoholics

Legionella = severe pneumonia

116

Herniated disk pain

Radiates to the thighs

Positive straight leg test

117

Lumbosacral strain

back pain with 

negatives

negative = straight leg test

Negative = Babinski

Deep tendon reflexes = normal

118

Compression fracture of Vertebrae

Intense back pain

+

Local spinal Tenderness

Postmenopausal or senile cases

119

Urine Sodium is more than (----) in hyopvolemic patient in (----)

& FENa is (----),

along with urine osmolarity of (-----)

see what casts

20

In Acute Tubular Necrosis

FENa = more than 2%

Urine Osmolarity is always more than 300

Dark ( muddy brown cast)

120

Muddy Brown cast

what urine osmolarity is mostly seen ?

Always more than 300

case of Acute Tubular Necrosis

121

Chronic Renal Failure and what casts

Broad casts ( waxy)

CRF---> Reduces renal Mass--->Tubules dilate and nephrons enlarge to compensate-->This is where broad casts originate

122

Fatty casts

Nephrotic syndrome

123

subtract the risk (exposed) from risk (unexposed) 

divide it by risk (exposed)

Attributable risk percent

124

Attributable Risk

a/a+b    -    c/c+d

 

The difference in risk between exposed and unexposed

125

 Relative Risk?

Risk of developing the disease in the exposed group

Divided by

risk of developing the disease in the unexposed group

a/a+b  divided by c/c+d

Cohort

126

Cohort Studies

Compares two groups

one group has a risk factor or a exposure

second group is totally without it

Exposed vs non exposed

127

Unable to respond to protein C

Factor 5 Leiden

Autosomal Dominant

White Population

128

Erythema Nodosum

Q image thumb

Inflammation of fat cells under the skin

results in

tender red nodules or lumps

 

IBD, behcet, Sarcoidosis (african)

infection= strep, mycoplasma,ebv,histo,cocco,yersinia,catscratch

129

ST depression in Lead I & aVL 

Posterior MI

RCA

130

Left Anterior Descending artery

Leads V1-V6 ---->Anterior Heart ischemia

131

Bacterial Meningitis above 50 y/o

Listeria         (Ampicillin)

Strep    (Cefepime-pseduomonas,HI,neisseria)

neisseria

Cefepime, Vancomycin, Ampicilin

132

Incomplete fusion of MULLERIAN duct

Q image thumb

Bicornuate or a heart shaped uterus --> more chances of Cornuate/ interstitial ectopic pregnancy

 

Cornuate area has abundant blood supply--> Uterine and ovarian vessels ---> hemorrhage here can be life-threatening

A image thumb
133

Infant sneezing

tachypneic

diaphoretic

irritated

poor sleep

tremors

mom abused Heroin

 

Opioids have the most dramatic effects of withdrawal seen on infant

 

Mother addicted to heroin should be put on Methadone---> later infant can be controlled

134

Infant showing jitteriness

Hyperactive Moro Refelx

excessive sucking

Cocaine

 

Placental Abruption

135

Q image thumb

Painless Bright blood bleeding that ceases in 1-2 hours with or without uterine contractions

Transabdominal/Transvaginal ultrasonography

first give tocolytics if premature

then give betamethason

and deliver with C-section

136

TNF and Interleukin 1 inhibitor

Sulfasalazine ( liver toxic and hemolytic anemia, stomatitis)

hydroxychloroquine ( Retinopathy )

137

Tissue Necrosis Factor Inhibitors

Certoli

Etanercept

Infliximab

Golimumab

Adalimumab

138

Collision---> Direct blow ---> lower abdomen and pelvis

 

diffuse pain in the abdomen

dull pain in the shoulder

CT scan of the abdomen and pelvis will most likely has impact on

Dome of the bladder ( bordered by the peritoneal cavity-->phrenic nerve-->shoulder)

Increased intravesical pressure-->crushes

 

 

cure is always obtained upon suturing without sequelae 

139

High riding prostate on digital rectal exam

Q image thumb

Posterior Urethral injury (---> bulbourethral junction or membranous urethra)

 

Extraperitoneal 

A image thumb
140

Normal Potassium values

3.5 -->5.0

 

Beta agonists and Insulin causes Hypokalemia ---> by shifting potassium into the cells

 

K+ channel blocking antiarrhythmics=

Ibutilide, sotalol, dofetilide, Amiodarone

141

Normal Bicarbonate

22-28

142

Back pain or Abdominal Pain

hypotension

Syncope

Possible Abdominal Aortic Aneurysm

can spill into RetroPeritoneum-->can cause aortocaval fistula-->with Inferior Vena Cava---> Venous Congestion in retroperitoneum--->like bladder--->fragile and distended veins in bladder rupture---> Gross Hematuria

143

Chronic blockade of Dopamine receptors

leads to D2 receptor upregulation and supersensitivity-----> Tardive Dyskinesia

 

(TD, or could be from Excitotoxic destruction of GABA neurons in Striatum)

144

Preoccupied with details

sense of control

preoccupation with orderliness and perfectionism

Obsessive-compulsive personality disorder

versus

OCD = ritualistic behaviour

145

how to evaulate fetus hypoxia or not

( in case if there is lesser fetal movements reported by mother )

Biophysical profiling

Non-stress test= fetus showing an increase of at least 15 beats to its normal graph upon stimulation (mother should be monitored on lateral tilt)

Contraction test= FHR is monitored via spontaneous or induced ( nipple/oxytocin)-->good if negative -->no late decelerations

Contraction test contraindicated in volatile membrane cases

 

BPP = scoring -->Fetal tone, fetal breath, fetal movement, amniotic fluid Volume, Fetal NST

score of 2 for all== 8 or above is ok

146

Utero-placental insufficiency

causes fetal decelerations 

147

Barky Cough

Inspiratory stridor

rhinorrhea

congested

Q image thumb

Croup --> URI-->Subglottic space narrowed---> Steeple sign-->inflammation of Larynx-->Laryngotracheobronchitis---> Hoarse Voice & Inspiratory stridor that worsens with agitation

IM Corticosteroid & Nebulized Epinephrine

Single stranded

negative sense

helical

ParaInfluenza

148

Time of the year= Fall/Winter

Crackles and coarse sounds (washing machine)

Increased Respiratory Rate

CXR may show hyperinflated Lungs, Interstitial infiltrates & Atelectasis

 

RSV--> Bronchiolotis

2-4 days of prodromal fever with rhinorrhea

MILD fever vs bacterial pneumonia(toxic looking)

Lower Respiratory Track

 

Corticosteroid no help

A image thumb
149

Inspiratory and Expiratory Stridor (Biphasic)

Improves with Neck Extension (decreases tracheal compression)

Worsens when prone

Vascular Sling

Stridor plus dysphagia, Vomiting and difficulty feeding

seen very early at age = <1 y/o

A image thumb
150

Chronic Inspiratory only stridor that improves with prone position

Q image thumb

Laryngomalacia

collapse of supraglottic structures

A image thumb
151

drooling and stridor

difficulty in handling oral secretions

swelling of epiglottis

H.influenzae nontypable and strep

serious & progressive(lifethreatening)

dysphagia,muffled voice

cyanosis

inspiratory retractions

To maximize air entry --> patients sit like sniffing dog position ---> tripod --> neck extended and chin protruding

DO not examine the throat (may cause laryngospasm) in absense of anesthesiologisy/otolaryngologist

Xray-->Thumb print sign

true emergency --ABC--> secure airway-->intubate/tracheostomy-->IV antibiotic( ceftriaxone/cefuroxamine

A image thumb
152

Glomerular hematuria facts

Microscoping and not Gross

PSGN

IGA nephropathy

Alport

Dysmorphic RBC cast

153

BRCA

BRCA 1 = 60%

Breast and ovarian cancer

after birth, do bilateral prophylactic Salpingo-Oophorectomy (BSO)

154

secondary Raynaud

caused by 

SLE (ANA)

Scleroderma( Anti TP-1)

Thromboangiitis obliterans

155

tugging on ear

ear pain

Bulging or Retraction Of TM

Acute Otitis Media

High Dose Amoxicillin

Chronic Otitis Media--->Tympanostomy Tube

156

Otitis Media Complications

Meningitis

TM perforation

Mastoiditis

Cholesteatomas

157

-1 Station

A image thumb
158

Breech fetus

A image thumb
159

Anovulation

Progesterone defect

Progestin challenge--> WIthdrawal bleed--->if bleeds than due to nonCyclic GnRH problem or PCOS

160

Progestin Challenge

give for 10 days--> 

if bleeds--->

Then noncyclic gnrh or PCOS

 

If doesnt bleed--> ovaries not secreting estrogen

161

Exenatide

Liraglutide

Glucagon-Like peptidase--->decreases the release of Glucagon

Weight loss also is seen

no HYPOGLYCEMIC risk

given mostly after Metformin failure

Pancreatitis (Ar)

162

Action on Glucagon 

(Antidiabetic)

Exenetide

Liraglutide

Adverse reactions--> Weight loss, Pancreatitis

163

Adverse Reactions

Edema

Fractures

Heart Failure

Glitazone

Pioglitazone

Rosiglitazone

164

AntiDiabetic Contraindicated in Renal Failure

Acarbose

Miglitol

(Intestinal Brush Border)

165

CXR = Enlarged Pulmonary Arteries

Echo=RVH--> comes with RHF-->Edema, JVD, Abdominal Distention

Cor pulmonale

Due to 

Idiopathic Pulmonary Htn

M/c is due to COPD

 

166

Envelop Shaped

or 

Dumbbell-shaped

Stone

Q image thumb

Calcium Oxalate

Ethylene Glycol, crohns

 

Happens when citrate is sent less to the kidneys

(Hypocitarturia)

167

Anion Gap

S-BC = 10 to 14 is normal

Sodium  minus

Total of (HCO3 and Chloride)

168

hemolysis

leukopenia

fever

jaundice

hepatosplenomegaly

tonsils with exudates

EBV

Viral suppresses WBC

splenic congestion-->platelet sequestration-->thrombocytopenia

hemolysis-->jaundice

EBV induced cross-reactivity-->antibodies also act on RBC & platelets ( increased reticulocytes and thrombocytopenia)

169

Macroglossia

hemyHYPERPLASIA

hyperinsulinism

Omphalocele

Beckwith-Wiedemann syndrome

plus 

Wilms Tumor

WT 2 mutation

170

Early sclerosis-->diffuse-->of mesangium-->early age Nephrotic

plus

dysgenesis of gonads(pseudohermaphroditism)

plus 

Wilms tumor

Denys-drash

Syndrome

171

Unilateral

Palpable mass (flank)

Wilms

 

loss of function of WT1 or 2 on chromosome 11

 

172

cherry red spot

Q image thumb

Macula 

receives blood supply from ciliary arteries that arise from the ophthalmic artery

rest of the eyeball receives from the central retinal artery that also branches off from the Ophthalmic artery

173

Peripheral nerve disorders?

Guillain Barre

diabetic neuropathy

Myeloma-->Amyloid neuropathy 

Lead poisoning

 

174

Upper Motor Neuron Disorders

Q image thumb

Vasculitis

Leukodustrophy

B12 deficiency

Brain Mass

 

175

Q image thumb

tonsillar exudate

cervical adenitis

strep

176

post Anesthesia-->major hypertension

tachycardia

pale

History of hypertension and headaches

 

Pheochromocytoma

Paraganglionomas

produce catecholamines from chromaffin cells

Episodes can be brought on by pressure on the stomach like from palpation or position changes//Anesthetic drugs//Surgical procedures

177

syphilis plus antibiotic treatment

Q image thumb

problem Post Spirochetal treatment --->

Jarisch-herxheimer reaction

Rapid destruction of spirochetes-->febrile illness--->typically within 12 hrs--> headache, sweating,hypotension

plus syphilitic rash--> diffuse and macular on palms and soles

178

Premenopausal Woman

premenstrual pain of breast

bilateral

multifocal

Fibrocystic change' case

fluid filled--> duct dilation-->simple cysts that are nonproliferative lesions

179

Most common cause of nipple discharge---> serous or bloody

Intraductal papilloma

A image thumb
180

Estrogen containg drugs for migraine patient!

contraindicated

181

Four most common drugs that cause WBC to increase in urine with maculpapular rash

Interstitial nephritis

TMP-SMX

Cephalosporin

NSAID

Penicillin

182

Tender Warm Erythematous Rash

Raised boundaries

Fever

Erysipelas 

Group A pyogenes 

183

Otitis Media vs Externa

Media= Haemophilus influenzae, Strep, Moraxella

 

Externa = Pseudomonas Aeruginosa

184

Bilateral Patchy inflitrates post trauma

ARDS

A image thumb
185

Nikolsky positive

SJS

Toxic epidermal Necrolysis- more than 20% of the body plus mucus gland involvement

Pemphigus Vulgaris

Staphylococcal scalded skin syndrome

186

Meningitis case

management

LP-->IV antibiotics

187

Waking up with headche

blurry

nausea

vomiting

DO MRI

(not just the migraine case)

188

Cluster 

Oxygen and verapamil

189

COPD family

Bronchitis (Mucus glands hypertrophied and at least 3 months of a productive cough)

Emphysema

Asthma

FEV1/FVC --> less than .7

Maximum inspiration-->expire maximally=VC

190

Renal failure plus creatinine very high and parathyroid mechanism

Excess Phosphorus & low calcium-->secondary HyperParathyroid---->raises calcium from bones and excretes phosphorus

Secondary hyperparathyroidism ( chrnonically, in ESRD--> does lead to tertiary primary hyperparathryodism)

191

TB mimicking infections living in granulomas

Histoplasmosis

Blastomycosis

192

Hilar Lymphadenopathy

Mediastinal lymphadenopathy

erythema nodosum

caseating granuloma

Histoplasmosis = Mississippi and Ohio river basin

Organism targets histiocytes and reticuloendothelial system--->Lymphadenopathy, pancytopenia, and hepatosplenomegaly

193

Patient with splenectomy and tick

fever

chils and sweats

tender and palpable liver edge

 Babesiosis case

Hemolytic Anemia-->

Intravascular hemolysis -->dark urine,jaundice, reticulocytosis, increased lactate dehydrogenase, Indirect Hyperbilirubinemia

Thrombocytopenia

Organisms live in rbc-->MALTESE cross

Atovaquone plus azithromycin

severe-->clindamycin plus quinine

194

fever

rash that spreaded centripetally

on 

palms and soles

RMSF

195

Juvenile Idiopathic Arthritis

young patients come with multiple joint pain

Chronic Inflammation of more than one joints-->symmetric-->atleast 6 weeks

Inflammation-->hepcidin hides iron-->anemia

hyperferritinemia

Hypergammaglobulinemia

chronic inflammation-->vitamins and iron used up by WBC-->anemia

thrombocytosis

increased ESR

Increased CRP

196

Which one is gall bladder in this ct scan

Q image thumb

Round green is gall bladder

A image thumb
197

Pan tri regurg  (systolic murmur)

Parasternal heave

Ascites

Hepatomegaly

JVD

Abdominal Distention/pain

Right heart failure

could be due to Pulmonary Hypertension

PH could be due to COPD, Raynaud's

198

Structural abnormalities

in

Orbitofrontal cortex

and

basal ganglia ?

seen in

Obsessive Compulsive Disorder

199

Infant 

with

accelerated head growth

Increased head volume

Autism

200

Atrophied ( red in picture)

Q image thumb

Huntington CAG

decreased Ach and GABA

Increased Dopamine

Aggression depression and then dementia

A image thumb
201

Schizophrenia 

Plus 

Mood

SchizoAffective

hallucinations/delusions (schizophrenia)

happened at least once

in

The absence of MOOD symptoms

202

narrowed airways or inflammation

whistling sound

--> wheezing

203

Chronic Cough

post nasal drip (Airway cough Syndrome)

GERD

Asthma

ace i

NonAsthmatic eosinophilic bronchitis

Chronic Bronchitis

Bronchiectasis

Malignancy

Parenchyma of Pulmonary problems

204

Bleeding ectopic pregnancy-->where to see the blood 

the pouch of Douglas ( cul-de-sac)

Recto-Uterine Pouch

do culdocentesis

A image thumb
205

Ageing man

central vision problem 

versus

peripheral vision problem

Central aka Scotoma--> Macular degeneration (oxidatve,chroidal neovascularization VEGF)-->distortion/metamorphsia

peripheral pressure---> Glaucoma ( open angle--> years)

opacification of lens-->(diabetes) Cataract

206

progesterone analogs

magstrate

medroxyprogesterone

for cachexic patients to increase appetite

207

Metoclopramide

Prokinetic for gastroparesis

and 

Antiemetic too

Erythromycin ---> IV -->acute exacerbation of diabetic gastroparesis

208

209

Promethazine

Antihistamine

210

M3

Gq

Increases secretions

Increases Gut Peristalsis

Increases Bladder Contractions

releases insulin

miosis

constricts bronchioles(methcholine-->challenge test for asthma)

Used by -->Ach,Neostigmine,Bethanecol

Carbachol(open angle glaucoma)-->constrics pupil-->humor lets flow

Pilocarpine->for closed angle-->contracts sphincter of pupil

and cililary muscle-->for open angle

211

Too much of lucency of lungs on CXR

Air filled lungs-->too much lucency means extra air in lungs--> emphysema

 

Lower bases--> Panacinar -->AAT deficiency

Upper base-->Centrilobular-->Smoking

212

Marfanoid 

fair skin and hair and blue eyes

slurry speech w/ left sided weakness

seen ophthalmologist 

Homocystinuria

( fair skin and hair)

marfanoid habitus

ectopic lentis

chances of thromboembolic events --> stroke

213

seizuric patient

urine labs show-->large blood but low or non rbc

 

Rhabdomyolysis

standard urinalysis cannot differentiate between myoglobin and hemoglobin

Large amount of myoglobin -->leads to renal failure

214

4 Month Old

Severe Hypoglycemia

Increased Lactic Acid

Round face like a doll

history-->episodes of infection/otitis media

physical-->lethargic & flat anterior fontanelle

Glucose-6-phosphatase deficiency

Glucose --- X---> Glucose 6 Phosphate

Glycogen stored up

Hepatomegaly

Renomegaly

Severe Hypoglycemia-->Seizures 

The liver does not pump out Glucose--> increased lactic acid and triglycerides

Increased Uric Acid--> Gout

215

Infant-->infection-->

-->hypoglycemic-->

-->sudden death

MCAD

can't use fatty acids to make ketones 

during fasting

or 

during infection ( increased demand)

216

MCAD deficiency

See what on lab

Hyperammonemia

fatty acyl carnitines in blood

seizures

coma

Liver dysfunction

Avoid fasting

217

What two deficiencies cause

Hypoketotic

Hypoglycemia

 

Systemic primary Carnitine deficiency

Medium Chain Acyl-CoA Dehydrogenase Deficiency

218

Cell Type

Infection or Drug----> hemolytic anemia 

Cells without cental pallor=

Spherocytosis

A image thumb
219

Howell-Jolly Bodies

Spleen Problem

Nuclear Remnants 

Normally removed by the spleen

 

seen in

#Asplenia or functional #hyposplenia

220

Excess Iron in Mitochondria

Sideroblastic Anemia

Basophilic Stipple--> peripheral smear

 

Directly in Bone Marrow-->special stain-->Prussian Blue

221

Bone Pain

Cytopenia

Hepatosplenomegaly

GlucoCEREBROsidase def--> Gaucher

222

Normal Blood Urea and Nitrogen

7-18

223

Prothrombin Time

1

5

7   EXTRINSIC

10 

INR--> Measures PT--> if increased PR--> Extrinsic 7 defect

1 is normal

 

aPTT--> all factors except 7 and 13 --> Intrinsic  defect if increased 

A image thumb
224

Partial Thro

225

Cirrhotic patient

comes with variceal bleed

Volume repletion with IV

--> Give antibiotics to gastrointestinal bleed for infection complications

---> Give octeoride to inhibit vasodilatory hormones

--> Endoscopy-->in 12hrs--> to diagnose and treat active bleed

-->Uncontrollable bleed case-->put temporary balloon tamponade

226

Myeloblasts

peroxidase positive

227

Mouth ulcers

Nonbloody diarrhea

Abdominal Pain

arthritis

Rash-->erythema nodosum

Crohns

cobble stone and skip

strictures and bowel wall thickens

 

228

SBO

proximal

Early Vomiting

Abnormal Contrast filling on CXR

229

Mid or Distal SBO

Colicky Abdominal Pain

Prominent Abdominal Distension

Dilated Loops on CXR

Hyperactive bowel sounds

Constipation-Obstipation

 

230

SBO 

Most common cause

Adhesions

-->Post surgery or inflmmation processing

 

COngenital--> Ladd in Infants

A image thumb
231

Fundal Placenta

Attached at top of the uterus

232

pain on heel

most intense in morning -->first steps-->gets better later

patient is a runner or stood for long time on hard surface

Plantar fasciitis

 

A image thumb
233

ELderly Patient 

acute ankle pain

swelling and warm

progressive pain

involved joint has effusion

articular cartilage has chronic calcification

Q image thumb

Pseudogout

acute cases

Calcium pyrophosphate-->Positive bifringent

Rhomboid shaped

Chondrocalcinosis usually present

effusion has inflammatory cells-->inflammation causes warmth and tenderness

234

Synovial fluid Analysis

effusion 

15000-30,000 cells/mm3

Pseudogout

235

Synovial fluid 

effusion

WBC --> upto 50,000 cells/mm3

Urate Gout

 

More than 50,000 cells/mm3 --> Septic Arthritis

236

Cauda equina roots

Not part of spinal cord

counts in the Peripheral Nervous system

Below L1-L2

-->L4 to S5

Send out Parasympathetic flow--> bladder and lower bowel

Urethral and Anal Sphincter

sensorium to saddle area

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237

Cauda equina vs Conus Medullaris

Cauda equina -->L4 to S3

Gradual--> Lower tail like fibers--> Assymetric involvment of ROOTS--> LMN roots-->peripheral-->hyporefelxia

--> Saddle anesthesia,leg involvement and radiculopathy --> most likely Cauda equina

Conus-->ENds at L3-->Bladder dysautonomia-->Injury to the spinal region and also the roots-->UMN and peripheral -->

238

Bacterial endocarditis management

Obtain serial blood cultures

from 

three different Venipuncture sites

prior to starting an antibiotic therapy

to ensure

the microorganism is identified

239

Patient with history of

PVD +atherosclerosis (High Cholesterol) or Alcohol

comes with

epigastric pain

increased amylase or lipase

mottled skin

 

 

Pancreatitis

Atheros-->give antiplatelet only-->IV only-->nothing given by mouth

supportive care

240

Antiarrhythmic drugs

slow binding

and

slow rate of dissociation

1C

Flecainide & Propafenone 

Binds to tissue in action and potentiate QRS widening

Contraindicated in Post-MI

&

Structural heart abnormalities

241

Patient in emergency

Post trauma

respiratory distress in 10 hrs

no rash

 

Pulmonary contusion

Non-lobular pneumonia--> not dependent on anatomic landmarks

 

more than 10 hrs--> plus rash = fat emboli from broken bone--> Rash accompanies too

242

Fever

leukocytosis

bloody stool with mucus

Abdominal Distension

Xray

check for toxic megacolon post difficile or IBD

A image thumb
243

Normal Oxygen Saturation 

95--->100%

PAo2= Alveolar

Pao2=Arterial

244

Passive VAccine!!

 

Preformed Antibodies

IgG --> crosses placenta

IgA--> in breast milk

Humanized Monoclonal Antibodies

245

Passive Vaccinations for--?

Tetnus

Diptheria

Hepatitis B

Rabies

Varicella

Botuli

246

Oscillopsia--->?

Gentamicin

Aminiglycoses

 

next level of vertigo

ototoxicity/cochlea cells damaged +

motion sensitive vestibular cells

in the inner ear damaged

aka vestibulopathy-->both end organs damaged-->No left right imbalance-->patients don't feel vertigo

Oscillopsia--> see the objects moving

Abnormal head thrust test-->eyes miss the target-->get to the target after a bit

247

whats the fracture-->

of what bone-->

what important structures -->

Q image thumb

Supracondylar fracture

of the Humerus

Median nerve and Brachial artery at risk

A image thumb
248

FInger Clubbing Mechanism

Megakaryocytes skip the Pulmonary route 

-->That fragments them

Instead goes to the microcirculation -->nail beds

-->gets stuck in there due to size-->

release --> PDGF & VEGF

Cases

Right --> Left Shunt

Cystic FIbrosis

Lung MAlignancies

249

Humid vacation

comes back with hypopigmented spots

Q image thumb

Tinea Versicolor

Malassezia Globosa

if multiple

Malassezia Multicularis

250

A patient comes in winter

no erythema

no exudates

Q image thumb

Icthyosis Vulgaris

attributed to dryness at young age

gets worse as you age

a defect in a filaggrin gene

give keratolytics or topical retinoids

251

Progressive muscle weakness

difficulty making facial expressions

atrophy of thenar and hypothenar

Testicular Atrophy

Delayed relaxation on the contraction of thenar and hypothenar

CTG Myotonic Chromosome 19

Arrhythmia

Balding

Cataract

Infertility

death from respiratory failure or cardiac

--> Weakness of Skeletal(face forearm foot drops), Cardiac(conduction) and Smooth muscles(Dysphagia)

252

Becker vs dystrophin

Both XLR

Dystrophin starts earlier-->age2

Becker at 6

Both have Cardiomyopathy-->Dystrophin has scoliosis too

253

X linked Dominant

Big testes

Fragile X

Long face and Large Jaw with MVP

Hypermethylated FMR1 Gene-->stops expressing

Most Common cause of -->Inherited --Intellectual Disability

254

Chronic Major depression with psychosis

Patient won't eat or drink

ECT

or antidepressive with antipsychotic

255

M3

BronchoConstriction

AntiMuscarinics-->Ipratropium, Toptropium (Long Acting) ------------->COPD

Antimuscarinic AR (Mioisis blocked-->dilated pupil, accomodation blocked-->glaucoma danger)

256

Anti-Saccharo myces cerevisiae antibody

Th1-->Non Caseating-->Crohns

257

Crypt Abscesses

P-ANCA

Blood in stool or tissue

Ulcerative colitis

( Check for colorectal carcinoma--both crohn and UC)

258

woman gravida 5

Coughing/laughing--->Pee

Stress with normal post voidal urine vol

little voiding post sneezing/cough

-->weak pelvic floor

levator ani damaged -->u shaped sling that holds--> urthera and bladder in place

damaged sling--> hypermobile or prolapsing urethra or bladder

259

Performance anxiety

tremors and tachycardia

to use as need basis

 

Beta-blocker propranolol

sole perfomance anxiety

avoid drowsiness of benzos

260

Chronic Sinopulmonary infections

with

infertility

Cystic fibrosis--> absent vas deferens-->Azoospermia

 

Primary ciliary dyskinesia--->immotile sperm

261

Prophylactic therapy for ARF

Benzathine IM Penicillin G

Every 4 weeks

262

Loud S1

atrial doors delay in natural closing during end of ventricular diastole---> ventricular systole then closes it

delay-->either by

increased atrial pressure or

short diastole in tachycardia

stenotic valve

263

Breast swelling

w/pain

diffusely warm & erythematosus

with 

dimpling

Inflammatory Breast Carcinoma

Rapid onset Edematous cutaneous thickening

Rare but aggressive

Next step is to screen-->Mammography & Ultrasound

but biopsy confirms

peau de orange

A image thumb
264

Prostate Cancer bone lesions ?

Osteoblastic

 

Osteolytic-->Multiple Myeloma

265

Toddler--> 12th month old

Pincer Grasp

Stands well

Walks first step in independence

Says more than mama and dada

 

 

18th month----> runs and kicks a ball (10-25 words)

A image thumb
266

Radioactive Iodine Therapy

taken up by thyroid or extra tthyroid tissue( toxic nodula or adenoma)

Beta emission -->induces slow necrosis of follicular cells--> 90% get permanent hypothyroid ( in case thyroid uptake -->extra tissue case stays normal)

267

Brain stem models

T-->M-->P--->M

Thalamus-->Midbrain-->Pons-->Medulla

Basilar Artery-->P-->M-->Lower medulla

Basilar-->AICA-->Pons-->Facial Droop

 

Subclavian-->Vertebral-->PICA-->Lateral Medulla--=

 9/10/11->Hoarseness)

( spinothalamic-> pain & temp from contralateral)

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268

Hoarseness

and

Contralateral Pain and Temperature loss

PICA-->Lateral Medulla smoked

Subclavian---------->Vertebral--->PICA

9-10-11 Smoked--------->Dysphagia+Hoarseness

ST smoked--------->Contralateral Pain and temp

 

Sympathetic fibers smoked--->Ipsilateral Horners

 

Inferior cerebellar peduncle smoked---> Dysmetria, Ipsilatera Ataxia

269

Patient C/W

Decreased sweating

droopy eyelid

Arm undershooting or overshooting-->missing target

Vomiting and vertigo

Lateral Medulla smoked

PICA ( basilar)

Intraprenchymal bleed

 

Also -->labyrinthe artery impacted-->ipsilateral sensorineural deafness-->Vertigo

270

Patient c/w

tongue falling onto one side

and paralysis of other side of body

Medial Medulla smoked

Anterior spinal artery

Lateral Cortico Spinal tract( c/paralysis)

Medial Leminiscus ( c/proprioception)

271

272

Lateral Medulla

 

cranial Nerves 9 --10----11

 

 

PICA

273

Smoked -->

Sympathetic fibers

9 10 11 CN

Labyrinth artery

 

Lateral Medulla

PICA

274

Patient C/w

Contralateral paralysis

But w/

The absence of cortical signs-->aphasia or visual loss

Lentriculostriate artery

Chronic HTN----->hyalinized----->Charcot-Bouchard Aneurysm--->Lacunar Infarct

A image thumb
275

Patient c/w

atrophied hand muscles

and ischemic pain

Thoracic outlet syndrome

A image thumb
276

Nonreactive fetal stress test

with normal fetal movements-->possibly fetal sleep

h/ of no fetal movements-->placental insufficiency

umbilical cord compression

277

Holosystolic Murmurs

Tr

Mr

VSD

Handgrip ---->Increased Afterload---->Increases sound of Holosystolic Murmurs

278

Inspiration-->Murmur

Increases Right heart sounds

Increased Venous Return 

279

280

HIT

Take it off heparin

give direct thrombin inhibitors-->Argatroban,Dabigatran

or factor Xa inhibitors-->Fondaparinux

if platelets are down 150,000-->

dont give warfarin 

281

Polycythemia Vera

normally 

hypoxia-->EPO-->jak-->proliferation

 

PV-->jak mutated-->turned on

low EPO

282

Patient c/w

spasticity and fasciculations

also with

hyperreflexia 

and atrophy of same muscles

but no

bladder or bowel dysfunction

ALS

283

treatment-resistant schizophrenia

Clozapine

284

2 Week old infant

mild eyelid swelling

bilaterally draining eyes

Chalmydia Conjuctivitis

PO Macrolide 

285

FIrst week of life for infant

Profusely draining eyes

markedly eyelid swelling

corneal ulceration or edema

Gonococcal conjuctivits

IM 3rd gen cephalosporin-->single dose (cefotaxime)

severer than chlam(macrolide)

286

draining ulcers but odorless

patient is gardener

none lymphadenopathy

lesions were seen along the line of lymphatic drainage

Sporotrichosis

dimorphic fungus that sits on decaying plants

Several months of Itraconazole cures it

 

A image thumb
287

Fever and sore throat

after fish bone scratched the throat

posterior pharyngeal wall-->red-->& Bulging

The neck is stiff w/ reduced motion

Neck's lateral radiographing-->shows increased thickening of Paravertebral soft tissue

Trauma to the posterior pharynx------->Retropharyngeal Abscess

 

buccopharyngeal fascia-->Pharynx--> retropharyngeal space-->Alar Fascia-->Danger space-->paravertebral fascia

if it passes through alar fascia-->it can rapidly transmit to posterior mediastinum--> to the level of diaphragm-->Acute necrotizing mediastinitis

288

Drooling

Dysphagia

Odynophagia

fever

the case of infected tooth

Ludwig Angina

see the red and warm mouth

w/ bilateral cellulitis

of submental, sublingual and submaxillary spaces

289

Shoulder Dystocia Management

BE CALM

Breath ( dont push)

Elevate legs--> thighs against abdomen

Call for help

Apply suprapubic pressure

Larger vaginal opening-->epsiotomy

Maneuvers

290

Be Calm Maneuvers ?

Posterior arm--> deliver

Rotate posterior shoulder--> apply pressure to anterior aspect of the posterior shoulder-->woods screw

apply pressure to the posterior aspect of the posterior shoulder-->Adduct posterior fetal shoulder

 

Mother on All Four

Re place fetal head into the mothers pelvis

 

291

Prenatal visit tests

RhoD and hemoglobin and hct, MCV

Viral -->Vdrl,RPR,Hiv

Immunity to rubella vericella

vaccine to influenza

PAP AND PCR FOR CHLAM

Urine culture and protein

292

Toddler Patient c/w

failure to thrive--> not been able to gain weight

weight is <5percentile

Urine labs show alkaline urine

Family Hx of nephrolithiasis

All type of RTA-->failure in growth

 

RTA -----> body is acidic----> Cells cant grow and divide properly in an acidic environment

either due to increased excretion of hco3 (RTA2)

or 

decreased excretion of acid (RTA1)

 

Type 2 is linked with Fanconi --> along with hco3 expulsion--> aciduria and phosphaturia

293

294

hydroxyurea side effects

Myelosuppression

neutropenia

anemia

thrombocytopenia

295

Increased Conversion

 

Fe2+ ------>fe3+

Methemoglobinemia

oxidizing fe2+===>Fe3+

fe3+ does not dissociate from o2 -->Cyanotic

Dapsone

Anesthetics-->Benzocaine

Methemo-->is created to hold and trap cyanide

 

Tx--> methylene blue, Vit C

296

Anion Gap caused by what?

>12

Mud Piles

Methanol

uremia

diabetic ketoacidosis

propylene glycol

iron tabs

isoniazid tx

lactic acidosis

salicylates

297

Pralidoxime is given with

Atropine

298

Multiple lesions

on

Liver

Metastatic

seeded from some other primary cancer

299

Unobliterated processus Vaginalis-->

Infant-->

patent processus vaginalis-->

hydrocele or Inguinal hernia

300

Patient w/ HIV

floaters and blurry vision

 

CMV 

                                    Retinitis

 

Full-thickness retinal inflmmation-->Moves centripetally--> along the vessels-->edema and scarring-->Blurring, floaters & photopsia

scarring/edema--> retinal detachment

 

Intravitreal Injection if the lesion is close to the fovea or optic nerve

 

Photopsia= sensation of flashing lights

centripetally= moving towards the center

 

301

Toxoplasmosis eye

chorioretinitis

Nonvascular pattern

comes with EYE PAIN

302

Chorioretinitis

Toxoplasmosis -->with eye pain, congenitally comes with a triad

CMV-->congenital-->sexual or organ transplant-->c/w hearing loss, periventricular calcifications

 

Syphilitic--> c/w uveitis and almost always w/ Meningitis

 

Herpes-->Simplex-->keratitis-->Corneal, tearing and discharge

 

Herpez-->zoster-->Cornea or Iris--> Vesicular Eruption

 

303

304

Cholecystectomy

postoperative diarrhea

due to

Insufficient bile absorption 

by

terminal ileum

 

CholeDOcholithiasis-->stone in CBD-->ERCP to remove stone-->then do cholecystectomy

stone from CBD-->travels to vater-->can block both pancreatic and gall flow to intestine

305

Bronchiectasis

Q image thumb

dilated airways///& or Bronchial wall damage

due to

chronic inflammation from 

Infections

or 

structural airway defect

Inflammation//structural defect//masses --> cause obstruction

Do high res CT scan

==>> Obstructive disease

A image thumb
306

Q image thumb

Achrocordon

skin tag

307

Q image thumb

seborrheic keratosis

stuck on

can be flat, raised or velvety and greasy

308

Q image thumb

actinic keratosis

premalignant lesion

dry and scaly

base is erythematous

sun exposed areas

309

Q image thumb

Basal cell carcinoma

pearly or waxy//shiny

BCC flat or rolled border

((SCC ==>>firm red pimple))

papule --> or a nodule

Overlying Telangiectasia

Ulcerates

310

Seborrheic keratosis

vs 

Melanoma

Seborrheic keratosis

quite similar to melanoma

but

melanoma is on sun-exposed areas

and its not greasy

and melanoma does not have rubbery texture

311

Normal WBC in CSF

0-5 wbc per mm3

312

post cardiac surgery -->CABG

patient has

increased diastolic pressures in right heart

and

increased PCWP

plus sign of Cardiogenic Shock

the patient is in cardiac tamponade

rare, but Important situation post CABG

 

Fluid accumulated in pericardial sac

Management

Echocardiograph to size up-->Immediate percutaneous or surgical drainage

313

Tumor lysis

cells are destroyed

--> Intracellular ions--> potassium and phosphate--> are liberated

hyperkalemia--> arrhytmia

Hyperphosphatemia --> Binds and traps calcium--> hypocalcemia

uric acid increased too due to increased destructions of cells and nucleic acids

314

Patient was treated for lung malignancy

before the age of

30

Lung cancer treatment in patient <30 y/0

 

18.2 % chances to secondary malignancy from chemo or radiation therapy

 later in life

315

Q image thumb

Post radiation-->fibrosis

lungs lose volume

A image thumb
316

Q image thumb

Lung cancer X-Ray

317

Q image thumb

aspergilloma

occur in normal immunity patients with structurally defect lungs ( pre-existing cavities// Cysts )

Air crescent is seen along the periphery of the cyst

318

Q image thumb

Apical Cavities

comes with consolidation

and

Lymphadenopathy-->Lobar pneumonia

 

319

facial plethora

and

Hypertension

Cushing Syndrome

with central obesity

and

proximal muscle weakness

320

Parathyroid

increased

calcium and kidney stones

w/

Neuropsychiatry--> confusion, depression,psychosis

321

Pericarditis

 

MI & dressler

Aortic Dissection

Rheumatic fever

viral

Uremic

Neoplasms

Collagen Vascular disease -->RA, SLE

322

323

Petechial rash-->vesicles, bullae

 

progressed to gangrenous

Pt has fever and vomiting

 

 

Q image thumb

Meningococcemia

324

Q image thumb

Macule

m/c

Rubella

measles

Tuberous sclerosis

actinic keratosis

 

325

Q image thumb

papule

A image thumb
326

Q image thumb

bulla

327

Pulmonary EMbolism

ABG

will show

Hypocapnia (response -->tacgypnea)

hypoxemia --> less O2 in arterial blood

increased alveolar to arterial gradient

 

Massive embolism -->hypercapnia

328

Postoperative pulmonary complications

Atelactasis

Bronchospasm

Prolonged ventilation

329

acanthosis nigrican

 

skin folds --> thick and velvety

DM

PCOS

Obesity

Cushing Disease

Paraneoplastic Adenocarcinoma

Metabolic syndrome-->NAFLD

330

MAcrovascular fat deposition

-->peripheral displacement of nuclei

NAFLD

331

A pervasive distrust and suspiciousness

personality-->that subtly has that kind of impact

Paranoid "personality"

332

Gallstones with no symptoms

tx

No treatment 

 

elective laparoscopic cholecystectomy-->if some symptoms present

 

urgent cholecystectomy-->if choledocholithiasis, cholecystitis, gall stone pancreatitis

333

cervic bleeds on swab

Q image thumb

cervicits due chlam or gonorrhea

334

Breastfeeding contradictions

Active Varicella

herpetic breast

active untx tb

active substance abuse

maternal hiv

chemo/radiation

335

Alcoholic Cirrhotic patient

w/ flapping tremor

comes with fever and

Gas

in Small and Large Bowel

SPontaenous bacterial peritonitis

do paracentesis to verify 

336

normal b cells

low immunoglobins

Common Variable

 

Delayed presentation--> after 2nd year or later

sinopulmonary infections

bronchiectasis

337

migratory arthralgia

variable joint pain

months ago-->went to NE usa

 

Lyme

 

Lyme's several months-years later-->

Arthritis =years

Encephalitis==years

Peripheral Neuropath===years

 

some months=

carditis

Meningitis

CN 7 palsy

338

Q image thumb

crusted sores

beneath

which ulcers form

339

elderly patient on medication

factor X inhibitors

hx of htn

altered consciousness

focal occipital headache

 

 

stroke

non-contrast ct scan ( contrast is difficult to differentiate from blood--> do non contrast)

white hyperdense

 

340

341

Irregular bump

Normal overlying epidermis (skin)

doesn't regress

A image thumb
342

firm nodule

on lower extremities

the fibrous component that causes dimpling when pinched

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343

Firm and freely movable 

nodule with central punctum

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semisolid core

keratin and lipid

epidermis lodged in dermis due to trauma or comedones

can increase in size or cheezy white discharge

usually, resolve spontaneously

 

344

patient with Micrognathia

Lymphopenia

Q image thumb

Normal Thymic Sail Sign

 

absence --> 22q11 microdeleted

===>> DiGeorge

Conotruncal defect

Abnormal face

Hypocalcemic

===>>> tetany, Seizures, Arrhythmia

345

valsalva

leaning forward

cough

increases intracranial pressure

 

346

Coarctation of aorta

ovarian failure

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Turner

347

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Crown to Rump length

w/ 

first trimester Ultrasound

is most accurate method to determine gestational age

348

Antipsychotic patient

highly febrile and stiff

NMS

post dopamine blockage by antipsychotics

 

Tx of NMS===>Dopaminergic--->Bromocriptine, Amantadine

349

Very Short

acting

Depolarizing

muscle relaxant

to induce--->Paralysis during anesthesia

Succinylcholine

 

Anesthetics A/r -->Malignant Hyperthermia

350

Cholinesterase Inhibitor

Saves Ach from acetylcholinesterase

=====>>>Ach increases

 

Physostigmine===>>>>>>Ach

351

young patient

hypertensive

bruits

Increased Renin and Aldosterone

 

Fibromuscular Dysplasia

or Renal Artery Stenosis

===> both decreases renal perfusion

 

FMD-->Bruits can be closer to mandible angle-->Vertebral 

or at renal

FMD==>>>>>> Renal--Vertebral--Carotid

352

EBV Lymphadenopathy

Tender and mobile

Patient==>>>Hemolytic anemia & Thrombocytopenia

353

>25% of Lymphoblasts

ALL

see in 

Down syndrome

t 12:21

===>>>>CNS testes

 

T cell ALL---->>>>Medistinal mass

354

adhd

do not deceit ppl 

do not act violently

355

>40 y/o patient

c/w

Dysmenorrhea

Menorrhagia

w/ no Adnexal Mass

Adenomyosis

Endometrial glands==IN==>> uterus muscle

Symmetrically enlarged Uterus + >40y/o

=Adeno

356

Cystic mass on ovary

young woman

Noncyclic pain exacerbated by movement//exercise

Dysmenorrhea

Chronic pelvic pain--->>reproductive woman

-->>cystic

Endometriosis

Infertility>>Dyschezia

 

Locations

Recto-Vaginal Septum

posterior cul-de-sac

Uterosacral Ligament

357

Pelvic mass

Calcified and hyperechoic

Mature Teratoma

no infertility concern

358

Sickle cell bugs

Encapsulated bugs

Neisseria

streptococcus

haemophilus

vaccine===>>> fixed Neisseria and haemophilia cases

But 

Strep is difficult to trap for an SCD patient

359

Sickle bone pain

Aureus or salmonella-->osteomyelitis

360

Patient comes w/Renal Dysfunctioning & fragmented cells

Fever ,Neurologic signs

w/

Low wbc ,Low Platelets

and 

Low hemoglobin

Thrombotic Thrombocytopenic Purpura

Microangiopathic hemolysis==>> Decreased haptoglobin

fever+renal+neuro+hemolysis

Emergent plasma exchange

361

Young patient

-->>High serum Calcium

-->>High-Normal Parathyroid Hormone

 

But

Low urine Calcium

Familial hypocalciuric Hypercalcemia

 

Calcium-sensing receptor problem

362

363

Acquired Genetic defect leading to hemolysis and hypercoagulability

-->>>abdominal pain and dark urine

Paroxysmal nocturnal hemoglobinuria

 

Procoagulant microparticles generated through complement dependent damage of platelets and venous endothelium

364

Prosthetic joint

==>>>Joint pain

===>> 3 to 12 months

Coagulase Negative Staph Epidermidis

365

granulomas

Q image thumb

Non caseating -- occupational

Sarcoidosis

Crohns

 

Caseating===>> Central necrosis===>>>Infectious cases

366

The whole fetus is small==>>

Symmetric FGR

Congenital insults

 

Asymmetric -->>Placental insufficiency 

Asymmetric -->>Various sizing paramenters tell different gestation age

367

toddler

arches the back

during or after feeding

GERD

368

Opioid Antagonist

No to opioids

Naloxone

Naltrexone

Methyl-Naltrexone

369

Opioid Partial Agonist

BuproNorphine

 

 

Heroin Maintainance===>>>Give w/ opioid antagonist OR Methadone

370

Actinomyces

Not like Nocardia

Not Aerobic

Not Acid-fast

 

Tx with Penicillin G

Act==>> Filamentous and gram-positive

371

Irregular uterus

Globular and Firm mass

pelvic pressure

several protuberances on the mass

Leiomyomata uteri

===>> fibroids

 

Palpated Nodular & immobile uterus==> endometriosis

372

Intermenstrual Spotting

Uterus Enlarged

No prolonging of Menses

Polyps in the uterus ( Endometrium)

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373

costal MArgin

T8

T10 Umbilicus

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374

Decreased

Maternal Serum Alpha-Fetoprotein

Aneuploidy

18 & 21

375

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Adenopathy===>> Large and Swollen Lymph Nodes

Bilateral==>>> Sarcoidosis

376

CXR shows Thickening at hilum bilaterally

Erythema nodosum 

Migratory Polyarthralgia

Fever

Sarcoidosis--->>LofGren Syndrome

377

Reproductive woman

comes w/

Sudden lower abdomen pain

=====>>>>>> Unilateral

without

====>>>>Leukocytosis

Ovarian Torsion

differential

appendicitis or ectopic ==>> have leukocytosis

378

Glasgow

==>>Eye Opening --> out of 4

 

==>> Verbal Response---> out of 5

 

==>>Motor Response--> out of 6

379

Myasthenia Gravis

The 3rd decade in a woman

6th or 8th in Man

 

Ach receptor destroyed

 

Bulbar-->>Chewing difficulty, nasal speeching

Ocular

Proximal Limbs-->Arms

Respiratory muscles

 

MG===>> Gets precipitated By drugs--> Quinolones, Macrolides, Beta Blockers and Infections

 

380

Live attenuated vaccine

contradiction 

for CD4 cells

below===??

CD4 <200

381

OCD

Intrussive

ritualistic thoughts

382

depressed looking patient

mask like facial expressation

withdrawn

less energetic

stiff walk

stooped posture

resists passive flexion

Parkinson

rigidity with bradykinesia 

stooped posture and hypokinetic stiff walk--> short steps walk

383

Hypomania vs MAnia

patient is able to perform with more energy at the office in hypomania

 

Mania--->>>patient ends up in hospital or gets noticed for highly jubilant 

384

smaller plateles

cytoskeletan defect

====>>> Antigen not presented

Wiskott

IgA IgE increased but 

Low===>>> IgG IgM

385

Staph infection alongside Strep

the patient comes w/ peripheral neuropathy

Chediak

Lysosomal trafficking problem

Lysosomal unable to fuse with ==>Phagolysome

 

progressive neurodegeneration

&

Albinism (partial)

 

-->LymphoHistioCytosis

---> Milder COagulation problems too

386

hyperpigmented macules vs hypopigmented

Hyperpigmented ===>>>Neurofibramotosis

 

HyPopigmented====>>>Ash leaf==>>Tuberous

387

NF1 Vs NF2

Nf2 ==> 2 ears ringing

2 Intracranial tumor====>>Meningioma Ependymoma

2 eyes==>> Juvenile Cataract

 

the heavier load is on NF1==>>

Eyes nodules,

peripheral sheath tumors

freckles

Intracranial mass

Pheochromocytoma

388

Microcephaly

13atau

Cri-Du-Chat 5p-

Maternal PKU

Zika

Xrays

Fetal Alcohol w/ smooth philtrum

Fetal Anticonvulsant Hydantoin w/ hirsutism Microephaly & cleft -->Phenytoin

389

Patient comes w/ 

dark urine & abdominal pain

plus

Scleral ICTERUS

 

RUQ    ===>>>>   Palpable Mass

 

No fever or any other concerns

 

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Cyst

BiLiarY ==>> Intra or Extrahepatic

Most Common===>>Extrahepatic type 1

 

===>>>Congenital Dilation of BiLiary Tree

Presents w/ Cholangitis

And maybe accompanied w/ Pancreatitis in older children

 

Biliary Cysts  ====>>> Cholangiocarcinoma

A image thumb
390

Recent UTI

elevated ESR

Normal Leukocytes

Normal Temperature

Vertebral Osteomyelitis

MRI

391

A pulsating Headache

Papilledema

Increased CSF opening pressure

Worse at night

awaken her from sleep

 

pseudotumor cerebri

IIH

392

ELevated Direct Hyperbilirubinemia

Elevated Alkaline Phosphatase

 

 

Cholestasis===>>>>

 

Bile Duct Obstruction

 

Bile duct = Alkaline Phosphatase

 

393

Eye Pain

Sensitivity to light

blurry

Repeated attacks

Anterior

Uveitis

 

Turbidity of aqueous 

Ciliary muscle spasm===>> pain

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394

Stepwise decline in

===>>>Executive functioning ( decisions )

===>>>>forgetfulness

 

Vascular dementia 

White matter==>>cortex //subcortical Infarctions

versus

 

Early & Insidious onset of dementia==>>Alzheimer

395

Medial Temporal Lobe Atrophy

 

Early onset memory loss

slowly progresses

 

Language

Visuospatial defects

Alzheimer 

396

ILLness anxiety disorder

No symptoms

but patient keeps worrying

397

A patient was resting comes w/

a new chest pain

===>> Occurs at rest

that is progressively worsening 

==>>>Troponin is normal

Unstable Angina

ST may be seen if not enzymes

Tx==>> ASA, IV nitro,IV morphine

Refractory to therapy===>> IV heparin, Schedule Angiography, Possible revascularization--> PCI, CABG

398

Hypotensive

DIstant Heart Sounds

JVD

Excess fluid in Pericardial sac======>>>>>>

Cardiac Tamponade

Rate of effusion/ fluid formation is important than the size

 

399

Hx of

SLE / Pericarditis / Malignancy / TB / Trauma

 

Fluid forms around the heart

in a pericardial sac

===>>> Tamponade

 

400

Murmur that increases with less preload

Hypertrophic

Cardiomyopathy

401

Lithium===>> Congenital impact on fetus

Malformation of Tricuspid valve===>> atrialized RV

+

Atrial Septal Defect

A image thumb
402

Mood Stabilizers 

Congenital Defects==>>

Cranio-Facial defect

Neural Tube

Genital Anomaly

403

third-trimester patient==>Clear purulent vaginal discharge

w/ fever

uterine fundal tenderness

fetal tachycardia

Maternal Leukocytosis

IAI==>Intraamniotic Infection

 

IAI==>aka==>Chorioamnionitis

Common==>> Patients with premature or prolonged rupture of membranes

404

Macroglossia

Hypothyroid

Beckwith-WiEDEman==>>hemihyperplasia

amyloidosis

mucopolysaccharidosis

neurofibramotosis

Vascular malformations==>>hemangioma

405

Q image thumb

stasis dermatitis

venous valve incompetence==>> pooling of blood

406

2-word phrases

>5o word vocabulary

2 year old

407

Chronic MS care

Ibterferon Beta

Glatiramer

 

Acute exacerbation/flare==>> Steroids 

408

serratia

auerus

burkholderia

plus abscess

===>>>>>>>>>

Chronic Granulomatous disease

Defect in NADPH 

409

Non purulent infections

Leukocyte Adhesion Def

 

Impaired neutrophil migration

410

Gnawing===>>> Insidious epigastric pain

worst at night

weight loss

 

Pancreatic Adenocarinoma

 

Duodenal ulcer==>> relived by food

411

412

Walks upstairs==>>both feet on each step

2nd year

413

Endemic area

Upper lobe cavity

hypoglycemic

hypotensive

eosinophilia

hyperkalemia

Infection-induced  Adrenal damage

TB or fungus ==> adrenal insufficiency==>

Retention of

potassium (alkaline)

&

Hydrogen ( Acidic)

===>>> Normal anion gap hyperkalemic & hyponatremic Acidosis

414

eye pain and blurry

Dilated pupil not reactive to light

Glaucoma

415

416

Hyperkalemia on ECG

Potassium more than 6.5

==>>>> Delayed phase 0==>>Longer Action Potential===>>> Widened QRS

& increased P------>R interval

==>> Seen as Delayed InterVentricular & Atrioventricular communication

=>Apprears==>>>LBBB/RBBB

With

The narrow base of T wave but a Peaked tower

 

==>>As hyperkalemia worsens==>> 

A image thumb
417

arm has higher Blood pressure than legs

Turner

Streaked ovaries==>> Not going to produce Estrogen

418

turner 5 things

1 Horseshoe kidney

2 Straked ovaries

3 Coarctation of aorta==>> upper limbs higher bp

4 palate= narrow with high arch

5 bicuspid

419

Upgoing plantar reflex

Abnormal

 

===>> UMN injury

 

Nociception==>>S1===> Tibial nerve-->Sciatic nerve---> Roots-->L5 S1==>> Synapses at Anterior Horn

Anterior Horn==>> Motor response==>back to the ==>>L5 S1==>>>>>Sciatic nerve-->>bifurcations---> Tibial Flexors and Deep peroneal nerve Extensors===>>>> Loss of ability to suppress Extensor==>> UPGOING FLEXION

A image thumb
420

Leukocyte Alkaline Phosphate 

Higher in Leukomoid rxn 

versus

Lower in CML

 

421

Metamyelocytes

Metamyelocytes higher than Myelocytes==>LEUKOMOID

 

Matures than Myelocytes

higher in Leukomoid

versus

Myelocytes are higher than Metamyelocytes in CML

422

urinary Incontinence

with

contralateral paralysis more pronounced in

Lower Limbs

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Anterior Cerebral artery stroke of frontal lobe mesial 

A image thumb
423

No organized P waves seen

Atrial Fibrillation

 

Narrow complex QRS==Rapid ventricular Response

 

Atrial Fibrillation==>>Supra Ventricle

424

Stroke Suspicion

do what next>

figure out

if stroke is

Hemorrhagic or Ischemic

Hemorrhagic ==> SubArc or Intracranial bleed

Ischemic ==> emboli or clot

425

Statin for LDL?

needs to be more than

190 

426

Hirsutism

In Woman

 

Male pattern hair loss 

and

Male pattern hair growth

427

Period sharp waves on EEG

Hypokinetic= Pyramidal Dysfunction

Nor move nor speak ==> Akinetic Mutism

Rapid dementia

creutzfeldt-jakob

twitching muscles and cerebellar dysfunctions

also visual disturbances

428

Amblyopia

Vision loss from disuse of deviated eye

429

Suprapubic 

Bladder==>>Pain==> Cystitis==>

Nitrofuontain 5 days

TMP-SMX 3 days

Floxacin==for sulfa allergics or resistant

 

Complicated cases like

--> diabetics, catheters, Uobstructions, CKD, pregnancy, Hospital Acquired==>> Do culture in these cases

 

iLiohypogastric nerve

430

High Amylase

high lipase

high BMI

High Alkaline Phosphatase

High Alanine ALT

Acute pancreatitis fue to gall stone

==>>>PAind radiates to the back

431

T3 effect on vessels and heart

T3===>> Decreases SVR

and

Increases Ionotropy

and Increases Chronotropy

By increasing Sensitivity

To 

Circulating Catecholamines

And increases B1 receptor Transcription

432

CURB 65

5

BUN= More than 20

confusion

respirations more than 30

BP if = systole less than 90 or diastole less than 60

Age more than 65

score out 5

more than 1===>>>> Admit in to the hospital

433

NonSpecific signs of congenital Infection

Blueberry muffin

Hepatoplenomegaly

jaundice

Growth restriction

434

undercooked meat and congenital infection

Toxoplasmosis

The mother might have swollen glands only

( Lymphadenopathy )

 

Infant==>> Intracranial calcifications ==> Diffuse

Hydrocephalus

Chorioretinitis

435

Mother had

Rash and Arthritis 

and swollen glands and lymph nodes

Respiratory drops--> Mom-->Rubella-> rash and arthritis

 

Infant--> Pulmonary Artery HYPOPLASIA

Cataracts

Deafness

436

SAAG

 Peritoneal fluid Albumin   -  Serum Albumin

 

==>>> More than 1.1 = Portal Hypertension

437

Q image thumb

Tripod ==>> Epliglottis==> Hemu

Do Endotracheal Intubation

438

Choriocarcinoma

Most commonly after Hyaditiform Mole

 

Can happen after normal delivery or a spontaneous abortion

 

439

Non Stimulatory ADHD medication

 

Non stimulatory medication for Wakefulness and narcolepsy, cataplexy

Atomoxetine (NE)

 

 

Modafinil (D)

440

Second Generation Anti Psychotic

has 

Partial D2 agonism

Ari-piprazole

441

Very painful menses

normal durations and periods

but painful and lot of bleeding

Adenomyosis

==endometrial dinosaur trapped in Myometrium park

 

===>>>Uniformed uterus

442

Tenderness over Anterior Vaginal Wall

Bladder pain syndrome

aka interstitial Cystitis

Bladder hurts when filling up or voiding up

==>> dysuria and increased frequency

443

Irregularly enlarged uterus

with heavy bleeding

but not painful

Fibroids

444

Painful menses

but no heavy bleeding ( Dysmenorrhea)

Endometriosis

progresses to chronic pelvic pain due to accumulations of islands and ==>>adhesions

445

Nuclear

jolly body

446

Heinz

Denatured squished hemoglobin

 

post hemo-lysis

 

autoimmune hemolyziz makes heinz ketchup of hemoglobin

447

COPD and acidosis

COPD cases have "the gradual" increase in PaCO2

 

Gradualness lets kidneys compensate

Renal tubules increase HCO3 retention

448

 1.    TNF & IL1 inhibitor

Adverse reaction

Hydroxycholoroquine

====>>> Retinopathy

449

2. IL 1 and TNF inhibitor

Adverse Reaction

Sulfasalazine

Hemolysis

Hepatotoxic

Stomatitis

450

Only TNF Inhibitors

Adverse RXN

5 TNF inhibitors exist

Goli=Mumab

Adali-Mumab

Certoli-Zumab

Inflixi-Mab

Eta-nercept

Adverse==> Demyelination, CHF

==>> Malignancy

451

Rebound Tenderness

Pain upon removal of pressure

=>Represents aggravation of parietal layer

of Peritoneum

by Stretching or Moving

==>>Indicates Peritonitis-->>Appendicitis//Ulcerative colitis

AKA 

Blumberg Sign

452

Chronic & episodic

abdominal pain

With

Rebound Tenderness,

suddenly worsens

Xray shows ==

Xray will show free air under the diaphragm==>

just below the edge of the base of the lung

 

=Perforated peptic ulcer

Gastric secretions==>> released into the peritoneum

==peritonitis==> rebound tenderness

 

453

Persistent

Severe Epigastric Pain

Xray shows ileus of small intestines

Q image thumb

Gallstone Pancreatitis

comes with nausea and  vomiting

454

Episodic 

RUQ pain

fatty meal

BiLiary COLIC(pain)

Gallstones pressing against the opening of the cystic duct

455

Minimal Change disease

what tool to employ

Electron Microscopy

 

biopsy and Immunofluorescence will yield nothing

456

Q image thumb

Cerebellar hemorrhage 

an occipital headache

vermis=> unstable trunk

hemisphere==> Limbs unstable

repeated vomiting by patient and unstability to stand with no loss of consciuousness should raise suspicion 

Horizontal gaze palsy

 

457

Hemineglect

Q image thumb

hemineglect ==> parietal lobe stroke

458

Acute Coronary Syndromes

A spectrum of Clinical signs or syndromes

Caused by

Plaque disruption or Vasospasm

that Leads to

The Acute Myocardial Infarction

 

ST segments/ Ecg/ S4 heard

Unstable Angina or ST-elevated MI

459

Pleuritic chest pain With FEVER

Right Atrial Strain--> minor JVD

O2 saturation less than 96%

Irregular heartbeat

tachycardic

tachypneic

narrow QR

Pulmonary EMbolism

strains and obstructs flow out of the Right heart

==> Fibrillation

 

460

Q image thumb

Discoid Plaque

461

Q image thumb

Erythematous Papules

A image thumb
462

Ciprofloxacin

TMP-SMX

Tetracyclines

Penicillin

Not good for Oral anaerobic

 

 

463

Pain began in Lower Abdomen

but progressed to upper

vomit

fever

chills

sexually active

Irregular menses 

intermenstrual spotting

negative pregnancy test

PID

starts in lower quadrant

may involve liver capsule--> upper abdomen pain and vomit

464

Patient comes with

Hypercalcemia

and pancytopenia

The typical presentation of Multiple Myeloma

Volume depleted due to polyuria

465

Patient in a trauma unit

stuporous & reacts only to noxious

BP is 6o systolic

Asystole & Pulseless -->post mechanical ventilation

Hypovolemic patient

pre-ventilation==> he is, either way, getting a lesser venous return to the right atrium

 

1) Positive pressure Mechanical Ventillation==>>Intrathoracic Pressure increases==>>>>> collapses Venous capacitance vessels ( IVC) ==>>cuts off venous return

 

2) Pre-Intubation==>> Sedatives used==>>Relaxes Venous Capacitance Vessels==>> Also decreases Venous return

466

spares palms and soles

Rubeola Measles 

pityriasis Rosea

Ricketsia Typhus

467

Rash on Palms And Soles

Secondary Syphilis

Coxsackie Virus

Rocky Mountain Spotted fever

Acral Lentiguous

Toxic shock desquamation

Kawasaki desquamation

468

Patient younger than 1 year old

Took a International trip

What infection can the baby spread

Rubeola Measles

the vaccine is given at age 1 and 4

469

Vesicles on outer ear and facial droop

Ramsay Hunt Syndrome

Herpes===>> Bell's palsy

470

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Tophaceous Gout

471

Q image thumb

Osteoarthritis

A image thumb
472

Q image thumb

A image thumb
473

Rotavirus

risk of Intussusception 

474

paradoxical agitation

Agitated after an hour of taking benzodiazepine

475

altered state of consciousness 

Postical 

post seizure

476

severe trauma

burns

parentral nutrition long time

Severly ILL patients in ICU

chole stasis ==> Acalculous cholecystitis

Seconday gall bladder infection-->Pericholecystic fluid

 

477

Examination finding==>> but pain is out of propoprtion and doesnt make sense

 

segmental bowel thickening

 

 

Mesenteric Ischemia

478

herniated disk

pain will radiate

479

Q image thumb

MACROLIDES

FLUOROQUINOLONES

ANTIFUNGAL

===>>> QT PROLONGATION==>>TORSADES

IV MAGNESIUM

 

{{ one antiArrhythmic drug causes QT prolongation too==>> Sotalol}}

A image thumb
480

Q image thumb

Hidden P waves

 

Adenosine==>>PSVT

A image thumb
481

Chlamydia vs gonococcal conjuctivits

Chlam-->> watery and after 5 days of birth

 

Gonococcal-->> copious and Purulent and same day

482

Neonatal conjunctivitis with Copious and Purulent discharge 

Gonococcal Conjuctivits

483

No palpable fetal presenting part at the station

but presentable abdominal fetal parts

Uterine rupture

484

Q image thumb

Multilayered onion texture

Ewing sarcoma

485

Q image thumb

Osteoid Osteoma

486

pulmonary embolism on ECG

A image thumb
487

GBS screening

32-35 weeks

488

Deleted vs reduced Dystrophin gene

Deleted in Duchenne

reduced in Becker

489

Myotonic discharges

Delayed muscle relaxation

cataracts and heart conduction problem

mostly facial and intrinsic hand muscles dysfunction

Myotonic dystrophy

490

essential tremor

worsons at end of activity

(wehn approaching to pick up a remote)

versus

basal ganglia tremor

==> that worsens when body is at rest and improves when trying to pick up a remote

491

patient severe abdominal pain and vomiting

history of previous abdominal surgery 

hasnt passed any flatulus

peristaltic pain

distanded and tympanic abdomen

SBO or mesenteric ischemia

But SBO has an air-fluid level in distended loops of small bowel

SBO-->if severe==>do emergent abdominal explorations urgery( due to risk of impending ischemia, strangulation)

 

for mesenteric ischemia==>> do CT 

492

Anxiety

panic 

treatment

Acute==> benzodiazepine

 

chronic maintenance = ssri

keep in mind CBT and SSRI will ta ake month to kick in

493

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jejunal atresia

cocaine

494

Q image thumb

nerves are missing

 

enterocolitis, megacolon, bowel obstruction and intestinal perforation

495

the holosystolic murmur that increases with squatting 

at

3rd to 4th left intercostal space

VSD

496

Short systolic murmur

disappears with squatting

non ejection type click

MVP

squatting--> increased preload--> delays prolapsed valve--> late click and shorter murmur

497

Infective endocarditis murmur

Systolic--> MR

498

PEEP

Positive

end

expiratory 

pressure

Given in ARDS to keep alveoli from collapsing

more positive than atmospheric pressure

Ards( inflamed and damaged lung)

peep damages already fragile lung tissue

PEEP--> Tension pneumothorax

499

Q image thumb

Tension Pneumothorax

Air leaks out of lungs

gets trapped in pleura

==>> pushes back the the collapsed lung

==> compresses the mediastinum

 

==>> hypotensive patient

 

500

Refractory hypokalemia in alcoholic

Hypomagnesemia

 

Magnesium stops potassium secretion by Renal 

outer medullary potassium channels

501

uterus larger than gestation age

patient is hypertensive

hyperthyroid

and vomiting that increases RUQ pain

Abnormally elevated hCG

Hyaditiform mole

 

compare with fitz hurg curtis ==>> fever hypotension and sepsis

502

What kind of fibroids don't cause miscarriage

Subserosal Fibroid and pedunculated

A image thumb
503

Exudative pharyngitis vs non exudative

Exudative==>> EBV

non Exudative ==>>>>>Gonococcal

504

High fevers

vomiting and diarrhea

headache and confusion

Pulmonary manifestations==>>comes after systemic

Legionella Pneumophilia

505

Medroxyprogesterone depot

Every 3 months

inhibits the release of GnRH

Suppresses ovulation

weight gain breast tenderness 

spotting and menstrual irregularities

506

Premenopausal // Young one

adnexal fullness

hyperechoic nodules

cyst has calcifications

Mature teratoma -- Cystic

507

Multiseptated bilateral cystic masses

Do not have calcifications or hyperechoic nodules

Theca lutein cysts

happens in pregnancy due to ovarian stimulation by hCG

508

neutropenia

recurrent sinusitis

splenomegaly

stomatitis /gingivatitis

Felty syndrome(severe rheumatoid arthritis with vaculitis and skin ulcers)

gaucher

sarcoidosis

509

Corticospinal tract in brain

Q image thumb

A image thumb
510

First gen antipsychotic given to a patient

After a while he develops a sustained contraction/ spasm

what medication to treat this

Acute dystonia--> spasmed--> torticollis or eyes looking up constantly or facial grimacing or tongue twisting or protuding

==> develops in hours to days

==>> Treat with Anticholinergics

or 

Antihistamines

Antipsychotic originated Spasm is treated with Anticholinergics

511

Post chemo

patient is febrile

and 

Neutropenic

what drug==?

Tazobactam - piperacillin

covers both gram-negative and positive

Antipseudomonal beta-lactams

cefepime

meropenem

piperacillin-tazobactam

512

Vericella vaccines

Chickenpox

at what age

At

Age 1 and 4

513

Bacterial Pharyngitis criteria

Centor

Fever by history

Tender Anterior Cervical lymphadenopathy

exudate on tonsil

An absent cough

==> if all 4 present==>> give antibioitcs

==> if 2or 3 present==>> do Rapid strep test

Bacterial Pharyngitis==>> Mostly Group A strep===>>>>>>Oral Penicillin or Amoxicllin

514

Viral Symptoms

Cough Rhinorrhea Conjunctivitis Oral Ulcers

 

Viral Pharyngitis==>> symptomatic treatment only

515

Atrial fibrillation

or ST-elevated MI 

and what?

Chances of atrial originated thrombus==>>Left Ventricular thrombus

Do transthoracic Echocardiogram

and 

Echocardiogram

516

Aortic Regurgitation

Diastolic murmur

Blood comes back to LV==>>

Large volume in LV==>>LV stretches out to hold==>> bigger water hammer stroke volume to be pumped out==>>LV hypertrophies 

 

Hypertrophic heart==>>insufficiency takes birth==>> blood starts backing up into lungs==>> pulmonary cracksles heard==>> mostly bilateral

517

Placenta previa vs Placenta Abruptio

Abruptio has constant pain

although both bleed in mostly third trimester as the baby grows and put more stress on attachment of placenta to the endometrium

518

cocaine vs paranoid personality disorder

see paranoia with sympathetic activation signs ( diaphoresis, tremor, vigilant)

519

When you see various healed scars on the abdomen

or history gunshot wounds

or history of trauma

or the history of an car accident

Think==>> Splenectomy==>Impaired antibody faciliated Phagocytosis==>> Gram positive cocci==>> that are Encapsulated

520

splenic opsonization

A image thumb
521

hyperkalemia and hypocalcemia

Hyperkalemia==> PR prolongation

Wide QRS

loss of P-wave

 

Hypocalcemia==>>QT prolongation

522

B12 forms what two biochemistry products

B12 produces

Succinyl co A

&

Methionine

 

Methylmalonyl Acid----b12 and folic---->>>>$uccinyl coA

 

Homocysteine -----B12----->>>>Meth

523

Hepatosplenomegaly

diffuse cervical or posterior lymphadenopathy

develops a Rash after amoxicillin

EBV

test is positively hetero

524

PPSV 23

Under 65

with

Heart conditions

Diabetic

Smoking

Lung Disease

525

Td vs Tdap

Tdap should be given atleast once in place of Every 10 yr booster of Td

or Adults that are going to closer contact with kids

526

Broad based gait

Difficuty with heel to shin testing

Cerebellar lesion

posterior circulation

527

Psychodynamic therapy

Traces problems to their roots in childhood 

and

An Unconscious conflict

528

CBT plus Dialectical

For borderline personalities==>>mindfulness and proper emotion regulation

529

Fishy and yellow

FY=T

Fishy yellow=Trichomonas

530

Prematurity 

Maternal Alcohol, tobacco

 

 

Risk of fetal Cerebral palsy

==>>epilepsy, Intellectual disability, strabismus, Scoliosis

 

Cp==>>non progressive motor dysfunction

three kinds

Spasitc Diplegia->m/c in preterm infant==>>hypertonic and hyper reflexia of mostly lower limbs--> both feet pointing down and inward-->>equinovorous deformity

Dyskinetic Diplegia

Ataxic Diplegia

531

Shy-Drager Syndrome

Patient with parkinsonian symptoms

(cerebellar and pyramidal dysfxn)

comes with 

Impotence

orthostatic hypertension

abnormal sweating

disturbance of bowel or bladder control

impotence gastroparesis

532

Ashkenazi jew

gross dysfunction of ANS

with severe hypotension

Riley Day syndrome==>> Familial Dysautonomia

533

Crohns and Stone

Oxalate Stone

increased fat in intestines steals calcium away from oxalate

Alone oxalate gets reabsorbed more==>>stone

 

Calcium prevents oxalate stone formation

Fat malabsorption disorders promote oxalate stones

534

seminoma germ cell tumor

produces only hCG

535

AFP and B hCG

produced by 

only Nonseminoma germ cell tumor

536

Copper

Depression

hepatic dysfunction

copper from liver spills==>> goes to basal ganglia==>parkinsonian tremor

537

atopic

scaly or papular rash

538

contact dermatitis

vesicles and papules

539

Duodenal ulcer

pain gets better with food

food-D

540

Young woman

alternating diarrhea and constipation

pain gets better after stooling

mucus, loose stool

IBS

541

bullous impetigo

Honey color crusted lesions

staph aureus 

common in children

542

rash thats limited to exposed skin

makes linear streaks where skin has brushed against the plant leaves

vesicle and small bullae at site of exposure

plants nickle dye leather rubber

poison ivy

atopic contact dermatitis

eroded erythematous plaques with vesicles

type 4

543

upper abdominal systolic-diastolic bruit

Also see, unexplained rise in serum

creatinine after staring ACE inhibitors

Renal Artery Stenosis

 

544

Eye

redness of Medial Canthal

Purulent discharge

Infection of lacrimal sac==>Dacrocystitis

545

Q image thumb

Abscess over the eyelid

==>> could be upper or lower eye lid

546

Q image thumb

Orbital cellulitis

happens behind the orbital septum

==> comes with fever and restriction of Extraocular muscles movement

red eye lids

547

Gums growing ==>gingival hyperplasia

Phenytoin

I cell disease

Cyclosporine

Calcium channel blockers

548

Eosiniphilia

wbc cast

hematuria

sterile pyuria

interstitial nephritis

penicillin, sulfonamides, cephalosporin

549

15 -20 weeks

definitive karyotypic

Amniocentesis

invasive--> risk of membranes rupture, fetal injury and pregnancy

550

woman > 35

first trimester--10th week

cell free fetal DNA

551

reticular, peri hilar opacities--> linear

surfactant deficiency

552

hyperphagia

almond eyes

microphallus --->hypogonadism

 

dysmorphic facies of prader willi

paternal deletion

of 15q11

553

11p15

Beckwith-Wiedemann

rapid growth

macroglossia

HEMIHYPERPLASIA

Umbilical hernia

554

15q11-q13

Angelman Syndrome

short stature

ever smiling

hand flapping

ataxia and seizure

555

Ketoralac

Meloxicam

Peroxicam

NSAID

556

Paget disease of the breast

Adenocarcinoma

557

Exudative pleural effusion 

==>

Pleural protein / serum protein = .5

 

==>> Pleural LDH / Serum LDH = .6

 

==> Pleural LDH==> more than 2/3rd the upper limit of serum LDh

 

 

558

if bacteria gets into effusion (pleural)

makes it acidic with low glucose seen and more WBC are seen

 

Empyema==>> have additional, frank pus

559

Hypoalbunemia

HF

Transudative effusion

Bilateral

560

Dopamine precursors

leva/carba for elderlies

Adverse effects==> somnolence, hallucination, confusion

561

prevents breaking down of dopamine

COMT

Entacapone and tolcapone

adverse effects -->choreiform dyskinesia

562

Absent thelarche--> absent breast

short height

what hormones are increased

FSH

and Lh

increased in turner due

to absent estrogen and progesterone

 

563

Edema

=Angioedema==> facial/periorbital/circumfurol

ACE inhibitors

564

Sun-exposed body area

non-healing ulcer

rough and thickened

patient is on chronic immunosuppressive agent

Squamous Cell Carcinoma

 

565

Carotid pulse 

with

dual upstroke

 

Hypertrophic Cardiomyopathy

dual CAROTID stroke due to obstruction by ASSYMETRICAL HYPERTROPHIED HEARD 

566

Aminoglycosides

gentamycin tobramycin

neomycin

Severe Gram Negative Infections

567

Clindamycin

Anaerobic bacteria above diaphragm

Metronidiazole => below diaphragm

568

trauma patients

Cervical immobilization

spine stability

Cardio-Respiratory stability

Peripheral IV access

Pelvic injury ( if not visible==> insert a urinary catheter to assess urinary retention

and prevent possible bladder injury from distension

569

IV cefazolin

60 minutes before surgery ( prophylaxis)

570

CHF creates what kind of murmur

MR==>>Holosystolic 

 

LV dilated or remodeled==> dilation causes mitral annulus enlargement and remodeling causes papillary muscle displacement==>> MR

571

Rotator cuff tear visualizing?

Xray or MRI

MRI 

MRI scan==> visualizes soft tissue around the bone==> shows the tear in muscle

 

Xray can show only calcification

572

CD4 22

Diarrhea

3mm induration

AVIUM

Azithromycin

573

HIV diarrhea

180--->>50

180--> crypto--> Watery

100------>Isosporodium---->watery

50------>Avium---->watery

50=====>>>>CMV==>> Bloody

574

Pregnant patient

hyperandrogenic symptoms

Ultrasound--->> bilateral cysts on ovaries

Observe and expectant management

hyperandrogenic states mostly seen in african americans 

cysts form==>> luteoma 30% are asymptomatic

575

Hypotension

==>> Decreased RBF-->>

Decreased RBF==>> Renal saves Na+ and Urea

 

FeNa+ decreased

Uxe decreased

 

Hypotension==>>>Prerenal

576

Ischemia ( nephritis)

or toxins 

to the tubules==>>

Intrinsic Renal Failure

patchy necrosis-->>debris

 

debris obstruct--> builds a backflow--> GFR decreases-->> impaired rabsorption too--> excretion increases of Na and urea

577

Urine gets darker after starting a drug regimen

Drug-induced Interstitial nephritis

penicillin

cephalo

sulfonamides

578

Peripheral eosinophilia

eosinophiluria

pyuria

hematuria

Interstitial Nephritis

Drug-induced

579

ADh on sodium

Just deals with water

580

Q image thumb

Pain will be Bilateral that will radiate and get better on rest

and get worst with ambulation

 

OsteoArthritis of Spine

581

Q image thumb

Ground glass

and bronchograms ( fluid)

RDS in infant

=> prematurity

Maternal diabetes= High glucose==> Insulin==> antagonizes cortisol==> delays production of sufractant

MAle gender and cesareon without labor is a risk too

582

undercooked fish

clonorchis , diphyllobothrium latum

 

Biliary problemo

 

B12 problemo

583

Q image thumb

Bulging==>> hydrocephalus

 

sunken==> dehydration

584

Vomiting

hco3 = high or low

Vomiting==> loses stomach acid

==>alkalosis

 

but

volume also lost==> contraction

contraction==> RAAS=> K+ and H+ secreted into urine==> contraction alkalosis

585

Q image thumb

Lichen planus

pruritic flat topped plaques

586

AFP and hCG elevated 

Non seminoma germ cell tumors

 

Seminoma= only hCG, not even some AFP elecated

587

Augmenting Antidepressant medication to make the patient hit baseline function

Add antidepressant of different mechanism

or

add second generation antipsychotic

or 

psychotherapy

588

SiADH 

If you give normal saline

water stay but kidneys will throw out the sodium

 

Hyponatremic Hypovolemia

589

Asymmetric oligoarthritis

with conjunctivitis and mouth ulcers

urethral discharge

Reactive arthritis

initial therapy==> NSAIDs

590

reactive Arthritis

Vs

gonococcal septic arthritis

reactive will have 

conjunctivitis

asymmetrical arthritis

mouth ulcers

enthesitis (Tendon pain, mostly Achilles)

591

Osler nodes

painful fingertip nodules

592

drugs that increase Potassium 

in the body

Beta blockers--> block K+ uptake

ace inhibitos

cyclosporine

heparin

nsaids

succinylcholine

trimethoprim ( like amiloride, K+sparing)

593

headaches

Mig -->Pulsates and throbs-> unilateral

 

Cluster--> sharp and behind one eye

 

Tension--> Band like, dull tight and persistent

594

Duodenal ulcer

Worst at empty stomach

acid drives into duodenum unopposed and drives it crazy

595

Warty skin lesion

Violaceous nodule

peripheral ulcer

midwest states

Blastomycosis

bone pain and also genitourinary

A image thumb
596

597

ALF 

most common cause of death

Cerebral edema

598

gerd adenocarcinoma

Gerd for 20 years

 

Gerd==>> most probably barrets==>> strectures

 

strictures==>>symmetric==>circumferential narrowing==> distal esophagus

 

strictures==>> progressive dysphagia to solids==>may even block acid reflux due to narrowing

 

599

achalasia

peristalsis issue

==> shows dilated proximal esophagus

 

both liquids and solids

600

Fanconi Anemia

vs

Fanconi Syndrome

Fanconi Anemia==> Bone marrow failed and cafe au lait spots, short stature, hypogonadism, skeletal anomalies

 

Fanconi Syndrome==> Proximal Convoluted Tubule doesn't reabsorbs shitt

601

Macrocytic

but

Non-MegaloBlastic

Liver failure

Diamond beclo

Alcoholism

602

Ectopic Pregnancy

hCG==>>Transvaginal Ultrasound

603

Q image thumb

Congenital Melanocytic Nevus

604

Q image thumb

Nevus Flameus

605

HIIT

confirmatory test

Serotonin release essay

606

Disseminated Histoplasmosis

IV

Liposomal Amphotericin B

607

Cytokines from stored blood

Leukocytes-->> cytokines

 

Non-Hemolytic

Febrile

Reaction

==>> Fever, Chills, And Malaise

608

Diabetic-->see bicarbonate-->if low

&

hyperkalemia

(with mild renal dysfunction)

 

H+ and K+ don't get secreted out 

by the collecting duct ==> Type 4 RTA

 

Diabetic +Elderly==>> JG apparatus damaged==> Hypreninemic ==> Hypoaldosteronism==> H+ and K+ stay in body==> metabolic acidosis

H+ does not get secreted==> Hco3 does not get generated

609

Lithium

toxicity increases

in 

dehydration

thiazides

ace

whatever gets the reabsorption increased

610

profound lymphopenia

SCiD

611

Brutons and lymph

Absent Lymphoid Tissue

612

A cough with laughing, night, exercise, steam

Resembles common cold

paroxysms of cough

Whoops

pertusis

Forceful coughing==> vomit==>weight loss

Lymphocytosis may be seen

Macrolides=> decreases severity and contagion

613

ectopic tachicardia and av block

digitalis toxicity

614

Pendular reflex

Less brisk==> cerebellar dysfunction

615

Medial Cerebellar lesion

Truncal Ataxia

Nystagmus

dysmetria ( tremor when reaching for a target )

Impaired and rapid alternating movements

( Dysdiadochokinesia )

Muscle hypotonia--> pendular knee

616

Acute Pelvic pain

A ROPE

Appendicitis--> RLQ pain-->>fever and vomiting

Ruptured Ovarian cyst===>> recent strenuous activity

Ovarian Torsion 

Pid==Gradual

Ectopic pregnancy

617

myopathy

if with palpitations--> thyroid

with tenderness--> Polymyositis

facial or ocular weakness---> MG

CNS disorders plus lactic acids= MELAS mitochondrial-->red ragged

Daptomycin

statins, fibrates, 

618

Newborn

 

Scaphoid /concave abdomen in newborn

Breathing emergency= (breath sounds not heard on left side)

70/40 BP

Nasal flaring, grunting, barrel shaped chest

 

CdH

Deviation of Abdominal Viscera into the thorax

results in a concave/ scaphoid abdomen & barrel-shaped chest

Emergent Intubation

619

number of times woman has been pregnant regardless of outcome

Gravida

620

Preeclampsia Diagnosis

Urine Protein/Creatinine ratio

or

24 Hour collection for Total protein --> Gold Standard

621

patchy areas of demyelination

AIDS patient

JC virus

622

PTSD less than a month

Acute Stress Disorder

 

If they persist more than a " Month" ==>> PTSD

623

3 mm pupil size

NORMAL

624

sternum angle

Below clavicle==>> CVP

 

Above Clavicle ==>> Jvp

 

CVP= 5 cm 

Jvp= 3 cm

6-8 cm = Normal

 

 

625

Mitral classic finding

Loud S1

mid DIASTOLIC rumbling at apex

626

a patient comes and tells 

that vaginal pain 

gets better with urination

 

Exam-> palpation of anterior vaginal wall elicits tenderness

relieved by voiding==> Interstitial Cystitis

Painful bladder syndrome

painful in filling

627

a middle age woman is waiting in room

and tells you she is having painful intercourse

hx-> dental caries only

 

Sicca

increase lubrication

628

cyclophosphamide 

Adverse effect

Bladder Cancer

629

150-500 Triglycerides

Decrease alcohol

exercise

weight loss

 

fibrates ==>> if above 1000, and abstinence from alcohol

630

patient tells you about recurring

vertigo

unilateral tinnitus and fullness

and sensorineural hearing loss

Maniere

631

Elderly patient comes

tells you he cant tolerate loud sound in the room that others can!

bilateral tinnitus

Presbycusis-> sensorineural

632

patient tells you

that he gets dizzy

with changing positions or when looking at upper shelf

BPPV

dix-hallpike maneuver diagnoses it

Epley maneuver fixes it

633

dialysis related 7 causes of cardiovascular incidents

NO= inhibited

accelerated atherogenesis= due to enhanced oxidant stress

increased homocystein== not cleared out by the kidneys

Hyperphosphatemia

hypercacemia- given to fix excess phosphate

Anemia- > tachycardia

ESRd

634

Thiazides 

and calcium

A milder form of Hypercalcemia

 

<12 mg

 

Severe form of hypercalcemia doesnt happen

 

635

A patient comes to you

with a history of smoking

and now has Hypercalcemia,

severe=> more than 13mg

Malignancy related Hypercalcemia

636

Alzheimers

Q image thumb

Temporal and parietal lobes shrunken

637

Young patient comes 

and tells he cant play basketball

he has tenderness on proximal tibia, at the site of patellar tendon insertion

 

Q image thumb

Traction Apophysitis  ==>>  Osgood-Schlatter

RUnning, kneeling, playing --> Quadriceps tendon puts traction on Apophysis of Tibial Tubercle

 

Firm mass can be felt there due to the heterotropic bone formation 

A image thumb
638

Patellar Tendonitis

Point tenderness

on

Inferior pole of the patella

 

(overused)

639

Patient is a long time runner

now feels pain

while walking down hill or down the stairs

Patellofemoral Stress syndrome

640

large

thick

multiloculated cystic mass

on one of the adnexal area

if fever and high leukocytes==> Tubo-ovarian abscess

if not, or with weight loss => serous cystadenocarcinoma 

641

3 wk old Neonatal not pooping after initially pooping fine

also bile vomits

premature born

nasogastric formula

what will be seen on radiography

Necrotizing entrocolitis==>>Air in bowel wall and portal veins

 

Premature--> decreased bowel motility--> bugs can born in stasis

increased permability-->inflammation---> Leukocutosis

intestinal ischemia--> Metabolic acidosis

Gas--> from gas producing bacteria-->>gas in bowel wall and also the gas migrates to mesenteric and portal veins

642

dilated abdoment and duodenum

double bubble sign in duodenal atresia==>> bilious vomiting

643

failure to pass meconium within 48 hrs of birth

hirschsprung disease

644

contrast and renal

Nephro-pathy

Brownish casts ( Mud)

granular texture

CIN - resolves with in 3-5 days

645

patient had coronoary stent placement --> last week

now has mottled skin of legs

and

increased BUN

and Increased Eosinophils

cholestrol emboli

646

paroxysmal Norcturnal Hemoglobuneria 

and coombs

negative Coombs

because

its complement-mediated hemolysis

647

idiosynchratic hepatitis

inflammatory cells attack toxins from some drugs

eosinophilia present but absent in==>

==>>isoniazid induced hepatitis

648

Autoimmune hepatitis

first rule out

viral

drugs

toxins

after that --> do ANA  test or anti smooth muscle antibody test

649

Vaccination to yellow fever

contraindicated in 

live attenuated vaccine

low immunity cases or where patient is taking methotrexate or biologicals

650

meningococcal booster 

at age 16-21

 

primary is at 11

651

Menopause 

Genitourinary symptoms

urinary incontinence = due to less estrogenic firmness of vagina==>> weak closure pressure of urethra--> recurrent UTI & incontinence

Vulvovaginal dryness--> irritation and pruritus

652

IBS and colonoscopy indications

Post diagnosis= 8 years

 

if rleft side of colon diagnosed= 12-15 years

653

a patient comes into the trauma unit

with

loss of pain and temperature and also loss or weakness of motor function

in lower limbs

bilaterally

Anterior Cord Syndrome

Anterior Spinal Artery==> anterior portion of spinal cord is damaged but back one is ok

back of spinal cord==vibration and touch will be ok

A image thumb
654

Q image thumb

Intussesption

telescoped

air enema==>> goes in from rectum==> uses air or contrast==>> un-telescopes with the use of pressure

A image thumb
655

Action tremor

Essential

beta blockers

mild alcohol

Anticonvulsant= Primidone

656

Trochlear groove

if you compress the patella into the trochlear groove==>> Patellofemoral pain syndrome

 

Over use

young adults

dancers or athletes

A image thumb
657

Hyperpigment and Velvety skin 

on flexures like axilla and groin

If patient lost weight==>> Undelrying malignancy==>> Acanthosis Migricans

 

If patient gained weight==>>insuline resistant diseases==>> DIabetes mellitus, Polycystic ovary

658

Lymphoma

MaLT

Marginal Zone-B cel Lymphoma

Bacterial--> H Pylori

659

nitro on stomach

smoking

High salt

Adeno carcinoma of stomach

660

drugs that are not recommended for first line antihypertensives

Loop inhibitors

Doxazosin

661

Normal Liver span

 

@Midclavicular level   =   it spans   8   --> 12 cm

 

@Midsternum level   =    it spans    4  ---> 8 cm

A image thumb
662

ProPtosis

A image thumb
663

Ptosis?

Drooping

 

A image thumb
664

Anti Mitochondrial Antibody

Bile duct

if blocked- - - - >>> Cholangitis

 

Sclerosing --> P Anca

 

Mitochondrial antibody- --> PBC --> autoimmune and granulomatous

 

Direct 

665

Young patient

More than 5 days of fever

with

Non exudative conjuctivits

non exudative tonsill

lips are fissured

strawberry tongue

lymph node in " Cervical Area " more than 1.2 cm in size

Kawasaki

also 

hands- -- > swelled

feet-----> swelled

aneurysms----> on Coronary artery

666

667

rupture after a heart attack in

3 to 5 days

Pulmonary Edema ===>>>

Papillary muscle rupture --- Right Coronary Artery

 

Shock And Biventricular Failure===>>

Interventricular septum

Apex--- Left anterior descending artery

Basal--->  RIght Coronary Artery

 

Left to Right ventricular flow==>> Blood causes harsh holosystolic murmur and a palpable thrill

 

 

668

5 Second Generation Antipsychotics

Riseperidone

Ziprasidone

Queitapine

Olanzapine

Aripiprazole

669

lochia rubra

blood looking fluid present after delivery= few days

after 3-4 days==>>thin pinkish brown==>lochia serosa

after 2-3 weeks==>> yellow white discharge

670

Muffled voice and drooling

Epiglottis

H.Influenzae

671

Casts or eosinophils

Interstitial

Acute interstitial nephritis

 

672

 

Antibiotic given

FeNa increased

no casts

no eosinophils

Aminiglycosides

Amikacin

gentamicin

neomicin

tobramycin

streptomycin

673

Fever, Chills

Bleeding from intravenous sites

bleeding started after blood transfusion

Just after an hour

Acute hemolytic Transfusion Reaction

--->> Renal Failure

--->> DIC

674

Celiac tests

 

Initial and gold standard

Initial =>

IgA Anti-tissue Transglutaminase

IgA Anti-Endomysial

DQ = 2 & 8

Gold standard= Biopsy=>

Villous Atrophy or blunted and Hyperplasia of crypts

Check for T-cell Lymphoma

 

675

Crescendo--->>>>>Decrescendo

Aortic Stenosis

Hypertrophic heart    --->>  Hypertrophied Interventricular Septum

676

young patient

Palpable rash on legs and buttocks

bones hurt

blood in the urine

 

Henoch

vasculitis

colicky abdominal pain--->> Intussusception cases

Renal behaves like IgA nephropathy 

Arthritic

arthralgic

677

SiADH ==> What saline?

3% saline for hypotonic patient

678

High plantar arch

decreased vibration

position problem

reflexes slow or absent

unsteady gait

cvs problems

Freidrich ataxia

679

680

general anxiety 

vs panic

vs

social

general = multiple reasons and chronic

social== while performing or being judged

panic= sudden , without any reason

681

 

Endocarditis

and 

abdominal tenderness

( Had bowel movements )

 

 

Acute Mesenteric Ischemia

bacterial emboli from heart went to Bowel blood supply

 

682

Vitiligo vs versicolor

Vitiligo is without scaling

683

Extra articular---->> TOPHI

Urate

684

Increased MCHC

Spherocytosis

Autosomal DOminant

685

Seizure

less than 20sec

doesnt respond vocals or name being called

Presence of automatism

Absence seizure

686

Exudative formula

 

A)  Protein in Pleural fluid /  Protein in serum = more than .5

 

B) Pleural Fluid Lactate Dehydrogenase/serum Lactate Dehydrogenase = more than.6

687

 

Wells Criteria

To Diagnose Pulmonary Embolism

 

Clinical Signs of DVT = +3 points

Alternate diagnosis not likely 

 

previous DVT or PE = 1.5

Tachycardic >100

Recent surgery or immobilization

 

Hemoptysis = +1

Cancer

>4 points --->> PE

 

688

Alkalotic body

and its influence of Calcium

Alkalosis--->> hydrogen gets redistributed from bound albumin-calcium complex and makes it Unionized---> calcium gets deposited more and more on albumin--> hypocalcemic body--> spasmatic

689

papillary thyroid cancer

solitary nodule

enlarges slowly

690

Elevated direct bilirubin

the patient is febrile and hypotensive

Increased Alkaline Phosphatase

Acute Cholangitis 

and ascending

(infection)

691

 

The patient was treated for tremors recently

 

Now--> comes with a dilated pupil and eye pain.

and

blood shot conjuctiva

 

Patient was probaly treated for parkinsons 

and treated

with 

anticholinergic drug

Anticholinergic drugs--> block drainage of humor

sudden eye plain--> close angle glaucoma 

692

Q image thumb

scaly

Actinic Keratosis

gets importance due to its progression to Squamous Cell Carninoma

693

capsule vaccine

T-cell independent B-Cell response

694

Psychosis

Depression

Personality changes

Liver Enzymes high

gait disturbance

Wilsons

copper damages hepatocytes and basal ganglia

695

Intramuscular Penicillin G

Syphilis - Treponema Pallidum

Strep

Actinomyces

696

Pain upon removal of pressure on abdomen

Rebound Tenderness

Peritonitis

SBO

Peritoneal Irritation

Appendicitis

697

698

pertussis

lymphocytosis

Hospitalize if less than 6 months old

699

Lymphocytosis

Pertussis 

EBV

CLL

700

Glasgow 

below 3 is problems

701

Nephrotic cases

Amyloidosis--> Mostly with multiple myeloma or rheumatoid arthritis

Membranous nephro--> SLE, GOLD, NSAIDSSolid tumors, HBV, MAlaria

FSsG- African->HIV HEroine or w/ Uncontrolled HTN

Minimal CHange DIsease

702

Patient has a history of AFib & Nonischemic

cardiomyopathy

now feels constipated, and gained weight

difficulty concentrating and forgetful

Amiodarone-induced hypothyroidism

703

Hematuria

and

Scrotal Vericocele

That fails to empty when patient is recumbent

Renal cell Carcinoma

Asymptomatic mostly and gets diagmosed really late

tumor obstructs gonadal vein--> Vericocele

704

Normocytic Anemia

Membrane defects

enzyme defects

sickle cell

extrinsic microangiopathic/macroangio

infections

Hbc

705

706

scleroderma and lungs

Interstitial lung disease

Anti Scl 70

anti RnA Pol 3 antibody

707

if you oxidize hemoglobin

Heinz body

gets removed by a bite

708

FEV1/FVC in Restrictive

Normal

709

Pain on

hip abduction & Internal Rotation

Osteonecrosis

( Aseptic necrosis )

sickle cell case--> adults have ( no more foveal artery like kids)

710

Pulsatile groin mass in elderly

pain in anterior thigh

Femoral Artery Aneurysm

 

pain due to femoral nerve entrapment ( runs lateral to artery

711

alcoholic patient in room care

what to expect in his stay?

 

Seizures or Hallucinations = 12 to 48 Hrs

 

Delerium Tremens = 48 to 96 hrs

712

Cocaine vs Heroin withdrawal

Cocaine = Hypersomnia and hyper-eating

 

Heroin = Diarrhea , cramps dilated pupils and yawning

713

patient tells cant sleep

kids left and make her sad

she drinks wine two sleep

but wakes up at 3

tremor is noted

labs show high liver transimnases

Alcohol use disorder

714

tick case 

in 

southern America

patient has high fevers as well

not lyme

lyme is not available south

monocytic ehrilichiosis

Leukopenia

715

septation mass on ovary

thick and solid

epithelial carcinoma

of Ovary

and fallopian tube

and

peritoneum

716

breastfeeding delayed or failure

neonatal jaundice

delayed breastfeeding--> delayed feeding-->> delayed stooling---->> delayed bile removal

 

Increased enterohepatic circulation--> Indirect increased

717

marfan and heart

Aortic dissection 

Aortic root dilation-->> Aortic regurgitation

718

decrescendo

aortic regurgitation

719

sudden and severe chest pain

radiates to the back

Aortic Dissection

 

if renal deficit--> do TES

if renal ok --> give contrast--> do CT Angiography

720

Normal Bicarbonate

Age of Boy to Becoming man

22-----28

721

Tension Pneumothorax

Immediate needle decompression 

in second intercostal space

722

Digitalis Overdose

what kind of tachycardia

Atrial tachycardia

with

AV block ( due to increased vagal tone)

723

Hypertension case

what is the test list

Electrocardiogram

lipid panel ( coronary)

urine analysis (any occult hematuria and protein /creatinine)

 

 

724

Impaired tandem walking/heel-shin test

with

preserved finger nose testing

wide based gait

alcoholic for more than 10 years

Alcoholic cerebellar degeneration

Vermis

 

725

Wolff and AV node

AF disguised as Wolf bypasses Av block and creates an accessory pathway

rapidly depolarizing ventricle

professionally Cane the wolf by procainamide

or cane its BUTt by Ibutilide

726

check ups for elderly time period

 

every two years = mammography

 

every three years = pap smear

 

every ten years = colonoscopy

727

panic disorder treatment

 

short term = benzodiazepine

 

long term = ssri / cbt

728

primidone

barb

essential tremor

729

 

Acholic stools

 

Jaundice

 

Hepatomegaly

 

Biliary atresia

 

Pipe that connects liver to the intestine is missing (Atresia)

Liver won't even be able to send " a tracer " to the Small bowel aka Scintiography

Do Kasai Procedure

A image thumb
730

731

sturge weber vs tuberous sclerosis

Seizures with retinal/ocular/ and cutaneous hypopigmented patches

==>>>> Tuberous sclerosis

 

Seizures with port wine stain only and no hypopigmented patches==> Sturge Weber

732

Ischemic Stroke

what can happen after two days

Hemorrhagic Transformaton

repeat CT scan

733

alcohol & tobacco-->> Leukoplacia and SCC

DIfference?

Leukoplakia -->> Granular

 

SCC--->> Ulcerated and Nodular and regional lymphadenopathy present probably

734

 

Peritonitis

how to check

 

Upright X-Ray of Chest & Abdomen

--->> Free Intraperitoneal Air

735

Prednisone

Decreases CRH from hypothalamus

736

Colicky pain

Unable to pass gas

Hyperactive sounds and sometimes no sounds

Pain in "WAVES"

Air/FLuid in bowels

 

Change in "Character" of pain

Fever

Hemodynamic Instability

 

Short Bowel Syndrome

 

Mild--> bowel rest, suction and electrolyte fix

Peristaltic rush in the beginning--> hyperactive sounds

as it gets severe--> no sound

 

Severe--> urgent exploratory exploration

737

 

Large amounts of purulent sputum

numerous episodes of bronhitis

Gets improved with antibiotics but returns again

 

now see some blood

Atelctactic lung due to

impaired clearing or blockage

=

Bronchiectasis

 

High-resolution CT scan for Bronchiectasis

738

Q image thumb

Bronchial wall thickening

first bronchitis episodes

second atelactic lobe

third chronic bronchitis 

739

 

Intraductal Papilloma 

 

Versus

 

Infiltrating Intraductal carcinoma

Both bleed

but

IIC has a mass

740

Depot Medroxyprogesterone 

for

Contraception

Every 3 months

741

patient comes with Stroke-like 

symptoms

hemiplegic pain

headache

Figure out if its

Ischemic or hemorrhagic stroke

 

742

tearing eye pain

pupil size changed

stabbing pain in eye

unilateral

Cluster 

743

TCA effect on heart

QRS widening

Treated with Sodium Bicarbonate

Inhibits Fast Sodium channels

of -->> His-Purnkinje

& myocardium

Decreases Conduction-->

Prolongs Absolute refractory period 

744

745

Methanol vs Ethanol Poisoning

Methanol-->> damages eyes

 

Ethenal ( glycol) ---->> damages kidneys

746

Edwards

 

Rocker bottom feet

overlapping fingers

clenched fist

VSD

MicroGnathia (nose area)

Limited Abduction of hips

Renal defects

 

 

 

747

Vulvar PLAQUE

intense itch

post menopausal woman

loss of labia minora

clitoral hood shrunken

very painful intercourse--> penetration not possible

Lichen Sclerosus

paper thin vulvar skin

very high chances of SCC

 

748

 

Watery conjunctivitis

Allergic and viral

 

allergic------>> mandatory bilateral

 

Viral----->> prodrome

749

Intraparenchymal hemorrhage

Sudden neurologic deficits--> worsen--> minutes

Amyloid or Hypertension

Amyloid---> lobar--> elderly

 

hypertensive-->

750

When 

Uncle 

herniates after

Epidural

Oculomotor compressed--> mydriasis and ptosis

 

crus cerebri compressed--> hemiperesis--> Ipsilateral

 

Posterior Cerebral Artery compressed--> Homonymous Hemianopsia--> Contralateral

 

Reticular formation compressed--> lost consciousness--> coma

 

751

Pain and temperature impaired

 

Upper extremity motor function impaired

Syringomyelia

 

 

752

External Auditory meatus is edematous with purulent discharge

 

granulation tissue is seen on the floor

Tympanic Membrane is clear

 

Externa case

Anti pseudomonals

AMino= TAG

Cipro levo

ceftiaz-cefepime

Ticar-Piperacillin

753

NMS

malignant hyperthermia

Acute Dystonia

Antipsychotic --->>Rigid muscle + HIGH Fever --> NMS--> Dantrolene

 

Inhaled Anesthetic--> fever+ muscle contracted-->>Dantrolene

 

Antipsychotic--> rigid muscle without fever--> Diphenhydramine , Benztropine

754

Placenta Previa

vs

Abruptio 

Abruptio--> uterus is very tender and in pain + fetal Heart rate abnormalities

 

Previa --> painless bleeding, normal FHR 

755

False Labor

Irregular contractions without pain

weak in strenght

reassure patient and discharge

756

Panic disorder 7s

Recurring

Derealization/Detachment

sweating chilling or trembling

Dizziness

fear of losing control

Worry about additional attacks

Palpitations and shortness of breath

757

Liver CT scan

mass is seen

 

If weight loss--> cancer

 

Hx of bloody diarrhea--> Amebic cyst--->Entamoeba

 

Hx of Animal Contact---> Echinoccous

 

Old man/ hx of peritonitis--> Bacterial abscess

758

Infant Respiratory distress

causes?

Prematurity

maternal diabetes

cesarean without labor

male sex

 

See Air Bronchogram on radiograph--> air filled alveoli is standing out, from surround alveoli that are opacified

A image thumb
759

Ground glass ( reticlular) radiograph

and

bronchoghram

Respiratory distess (Infant)

760

Viral prodrome

slowly grown and scaled

within a week --> cluster develops in xmas tree pattern

pruritic

wrestler

Q image thumb

pityriasis rosea

761

wrestler

Q image thumb

TInea corporis

 

central clearing

762

Callus

A image thumb
763

Primary lung cancer and clubbing

Activating mutations of

KRas, EGFR, ALK-->> growth--> Adenocarcinoma on Periphery of Lung

764

Focal Glomerulosclerosis

NephrOtic

"He"

hIv

HEroin

hEmoglobinopathy--> Sickle RBc

765

Nephrotic 

BCSS

membranous-->

Hep B

Hep C

SLE

Syphilis

766

Painless Genital ulcers

Granuoma Inguinale--> klebsiella--> extensive ulceration--> granulation in base

 

single --> clean based ulcer--> corkshaped Syphillis

 

Shallow-->>small ulcers--> venereum Chlam -->lymphogranulama --> Chlam is Coalesced

767

768

Y descent

Relaxing descent

Right atrium

ORGASMs into

RIght Ventricle

769

X descent

tricuspid pushed back due to increased pressure generated from RV contraction

770

toxoplasmosis --> multiple or single

<100 cells

Multiple

Tox--Multiplies-->below 100 cells

771

Solitary Ring

C

CNS Lymphoma

772

Spasm of The Coronary

Diltiazem

 

AmloDipine FeloDipine

 

Sublingual NitroGlycerin --Aborts the ongoing Episode

773

Peridontal Group

HACEk

 

Eikonella CorroDens

kingella

CArdiobacterium HOminiS

 

Haemophilus Aphrophilus

AggreGatiBacter

774

swollen eye

with

conjuctival injection

but no discharge

If pain with ocular movement--> orbital cellulitis

 

if no pain--> preseptal cellulitis

 

Orbital--> IV antibiotic +- SUrgery

 

Preseptal--> Oral Antibiotic

775

776

MCA stroke

Anosognosia--> Lack of awarens of ones illness

 

Hemi neglect

Eye deviates--> towards the lesion

 

Upper limb affected

Face

777

Diabetic kidney timeline

H-T-E-N

 

Hyperfiltration-->BM thickening-->Mesangium expansion-->Nodular

778

for depression

and insomnia and to stimulate hunger ?

Mirtazapine

779

6 year old

consistent hip pain but normal xrays 

Leg--calve-Perthes disease

 

Idiopathic Avascular necrosis of "A Child"

780

IgE mediated 

histamine and inflammation

No vesicles

781

Linear allergic reaction

vesicular

some are crusted and some are still wet

Delayed

takes time to linear formation

varied presentation due to time elapsed 

T cell mediated type 4 attack

782

Optic neuritis causing drugs

Ethambutol

Hydroxychloroquine

783

Most effective intervention to prevent post operative pneumonia 

Incentive Spirometry

Aim to promote lung expansion

( also,deep breathing and CPAP)

784

Anti thrombotic tx criteria

CHA2D

S2

VASc

CHF-->Htn-->AGe75-->Diabetes

Stoke

Vascular disease-->Age65-74-->Sex category

785

Prostatitis

vs

BPH

similar

but 

Prostatitis --> comes with back pain and pain with ejaculation

 

BPH--> only stream problem

786

tender

and immobile uterus

and adhesive 

Endometriosis

787

Tardive dyskinesia

after how many months and what drug?

6 months

Valbenazine

788

Hemorrhagic bladder

and 

bladder cancer

after starting a drug

Which drug?

Cyclophosphamide

789

Sudden epigastric pain--> Intense

Free Air under the diaphragm

 

A image thumb
790

Hemodialysis Hypertensive crisis

Acute Hypertensive Crisis--> Bilateral Retinal Hemorrhages, Headache and Severe Hypertension

Anemia of CHronic Kidney diseases---> patients are given Erythropoietin

Erythropoietin increases RBc--> HYpertension

791

Compression of heart by Air inspired in Lung

systolic pressure drops --> Pulsus paradoxus --> equalized diastolic pressure in all four chambers

Tamponade, Severe croup--> Pulsus paradoxus

 

 

792

Cardiogenic shock

Heart doesn't pump out blood

 

Low urine 

cold extremities

Hypotension

793

Schizophrenic patient

cannot sit and keeps wandering here and there

Akathisia--> Restless

Beta blocker

Lorazepam

Benztropine

794

Amenorrhea test

Hx-->PE--> Pregnancy test-->If negative

--> Prolactin TSH FSH

795

Feltys

Advanced Rheumatid Arthritis

W/

Splenomegaly

Neutropenia

796

Behcet

Recurring & painful 

oral and genital ulcers

w/ Uveitis

797

cruise trip

hotel stay

high fever

crackles

Interstitial Infiltrates

Legionella

 Low sodium on lab

Macrolides or FLUOROQUINOLONES

798

Atypical pneumonia

azithromycin

fluoroquinolone

799

Patient

hx of immobilization

cocaine use

and

lab is shown for creatine Phosphokinase (Kinase)

Rhabdomyolysis

Intrinsic Renal Failure

800

Cirrhosis and Portal htn

management?

They frequently have Abdominal ascites due to low albumin---> Transdutive effusion--> leaks through small defects in right side ,less muscular side of Diaphragm

-->Hepatic Hydrothorax

801

Tet spell

Agitation ,exertion--> increases pulmonary resistance--> RVOT exaggerated--> RV drains into Aorta--> cyanotic spell

Pulmonary stenosis--> blood makes noise at upper left sternal border

Management--> make aorta busy for rv blood--> knee chest positioning

802

Venous valve

vs 

lymphatic obstruction

Lymphatic obstruction is severe than

venous valve incompetence

803

Enemies of patient with  Cystic Fibrosis

age one to twenty = Staph Aureus

 

beyond--strep straps you 

Staph comes and let streps come

804

bubbles in urine

Check for colo-vesical fistula due

to diverticulitis

805

806

 

Depression after breakup

gets angry--> acts suicidal

BPD

DIalect behavior therapy is best

807

Outstreched hand

Scaphoid--> snuff box resident--> Avascular necrosis

 

hook of hamate--> Ulnar

 

essential tremor--> with movement

Nigra--> give movement--> and tremor is gone-->tremor when (Park)inson

808

Sulfonylurea

class 1 and class2

class 1 -> ChlorProp & TOLbut

 

Class 2 --> 

Glim

Glyb

Glip

1= Dislufiram

2= Hypoglycemia

NOT at all a initiation therapy

809

Mumps vs E coli

Mumps--> prodrome viral--> high fever--> partitis --> orchitis

Ecoli--> above 35--> bladder obstruction-->unilateral testicular pain-->erythematous--> Epididymitis

 

Chlamydia & Gonorrhea--> under 35--> urthrtitis--> discharge plus testes pain

810

hyper-resonance to percussion

Hyperinflated lung or pneumothorax

 

if fluid in the lung--> pneumonia--> sound travels better in liquid--> increased breath sounds and increased tactile fremitus

If fluid on the lung--> malignacy or effusion from trauma--> liquid will insulate the sound

811

Disconjugate gaze

absent ciliary reflex

Isopropyl alcohol ingestion

812

Within 7 days of neonatal delivery--> 

fuller anterior fontanelle

Meningitis

Group B

813

814

less the 3 months old infant

What causes the meningitis

Strep

Listeria

Group B

E coli

Herpes

815

Esophageal aperistalsis differential

Eosinophilic--> Gerd-->hx of heart burn and exam->hypercontractility

 

Increased LES pressure--> Achalasia

 

Decreased LES pressure-->systemic sclerosis-->Smooth muscle atrophies and fibrosed

816

parvus and tardus are seen in what heart condition

seen in 

aortic stenosis

parvus-->weak

tardus--> delayed

817

Hot temperature migration

eye disk swollen/blurry/hyperemic

pain and light touch decreased mildly

fatigue

MS

818

Acute Abdominal Pain imaging

RUQ-->Ultrasonography

LLQ/RLQ--> CT scan

819

Non Exudated Ulcer on vulva

indurated edges

Syphilis

820

Blood at urethral meatus

perineal injury

high riding prostate

Posterir urethral Inury

 

Do urethrogram and "aVoid Foley"

821

Infant

Intestinal perforation 

microcolon

inissipated mucus in ileum

 

 

meconium ileus

intestinal perforation -->free air

822

 

SLE Anemia

 

 

A) Immune-mediated destruction

B) nephritis -- > ineffective erythropoiesis

 

823

824

Capillary refill time

Press the thumbnail--> time it will take to re-fill the empty capillaries--> normal is less than 2 seconds

 

825

Hypertrophic Cardiomyopathy

Treatment

BB--> symptomatic relief--> prevent syncope and load on heavy heart

CCb

partial excision or Alcohol Ablation of septum

826

Increases with inspiration 

TriCuspid Regurgitation

 

lungs fill in with air--> compresses the vessels--> blood goes back to right ventricle

827

young guy

inspires and murmur is heard

plus 

if they show you a arm with needle marks ( in a track)

IV 

Tricuspid Regurgitation

828

septic emboli

MOSTLY middle carotid artery --> stroke

Give IV antibiotics

no need of typical anticoagulants

829

INR >1.3

Synthetic Liver Dysfunction

 

 

830

Q image thumb

Palmar Erythema

Due to excess estrogen 

 

Excess estrogen also causes Spider angiomas

831

Turner like craniofacial defects

like webbed neck

but with very low Hemoglobin

Diamon becklowith Anemia

also see

triphalangeal thumb

short strature

cleft palate

Defect --> erythroid progenitor cells--> leads to apoptosis of Red blood cells

832

Young patient

age less than 5 

comes with tender and swollen single lymph node

Patient is non-toxic appearing

Lymphadenitis

Bacterial --> non toxic appearing

833

Accidental case

xray is shown

one lobe looks clouded and loss of diaphragmatic border--> left side

look for

1) naso gastric tubes--> if the tubes are in lungs--> abdominal contents have hernited through diaphram tear--> mostly left side

 

2) if patient is hypotensive

if distended neck veins--> globular arthitecture of heart--> tamponade

 

if not than just tension pneumothorax

834

lack of muscle atonia in 

REM sleep

Beta

Dream enactement

 

Rem is dreaming phase

penile clitoral 

Memory process

 

835

SLeep phases

BATS DB

Bats drink blook

836

Central venous catheter

places in 

either of

subclavian vein

jugular

azygos

Keep checking now

with portable chest radiograph

because, most apporpirate place for the catheter is in lower superior vena cava

 

all others are smaller veins--> chances of perforation

837

Fever

+

Thick and Multiloculated mass on adenexa

abscess

=tubulo-Ovarian

COmplication of PID

polymicrobial infection--> Inflammatory exudate-->purulent fluid-->Wall thickening

838

bugs crawling

withdrawal from what

alcohol

839

Hyperechoic nodule

+

calcification

+

and found incidentally

 

cystic teratoma

840

High B-hCG stimulates what?

Theca-Luetin cysts

like 

in Molar pregnancy

( Present only during pregnancy)

841

Patient has a history of some benign mass in adnexa

Now comes with sudden pain and guarding to deep palpation

suspect ovarian torsion, no matter what to anyone with a mass until proven otherwise

842

hyperkalemic patient with stroke and ecg shows bradycardia

what to give

IV calcium gluconate

or 

IV Insulin

843

Lung

squamous cell carcinoma

small cell cancer

Sentrally located

844

Scaphoid Fracture

Thumb Spica Splint

repeat radiography in 2 weeks

845

vericella vaccine at what ages?

what if a kid has missed one vaccine and exposed to other kid going through vericella at age of 5

varicella at age of 1 and 4

give vaccine if exposed

846

Pleuritic chest pain

with

pregnancy like mass

with fever & sepsis--> ectopic due fitz-hugh

 

without fever or sepsis like --> Hyaditiform mole

847

echinococcus

vs 

ameobic cyst

drugs

Echinococcus--> Eggshell calcification -->Albendazole

 

Entamoeba histolytica-->Pasty exudate abscess on liver-->plus bloody diarrhea and flask ulcers--> Metronidazole plus

paromomycin to clear up the intestine

848

MEN 2A

Medullary thyroid 

PheochromocytomA

Parathyroid HyperplasiA

849

Anti Smooth muscle antibody

OR

Anti Nuclear Antibody

Autoimmune Hepatitis

 

850

gritty sandy irritation in eye

plus

proptosis

propotisis = scary protuding eyes

 

ptosis= eye lid drops

 

gritty/ sandy kind of irritation= Graves proptosis

MG==> Ptosis== not PROPTOSIS

LEMS==> less frequently ocular

851

Idiopathic Juvenile Arthritis

not migratory

852

No mucoid discharge

 

no purulent discharge

no morning mattering of eye lids

but blood shot eyes

and diarrhe with apthous ulcer in mouth

Anterior Uveitis

No mucoid--> not viral

no purulent --> not bacterial

 

DIarrhea and ulcers--> associated with IBS--> Uveitis

853

more than 25% lymphoblasts

ALL

854

BAck pain

Focal exquisite tenderness on palpation

paraspinal muscle spasm

leg raise test is negative

febrile

vertebral osteomyelitis

855

bone pain

cytopenia

G.Cbro--> GAU-CH-ERrrrr

856

Von Gierke

Type VON 1

Glycogen stays in one form only and does not gets broken down to glucose

kids with chubby cheeks--> doll like face

857

Chronic Fluctuating 

mood disorders

( when cant dignose depression or bipolar)

Cyclothymic

858

Inspiration and venous return

Venous return increases and gets into right heart

---->> pushes the interventricular septum into the left heart

---> decreases LEDV

859

 

 

 

Progesterone

vs

hCG

 

 

progesterone maintains implantation

 

 

hCG maintains corpus luteum

860

Lyme

Babesiosis

Ehrilichiosis

RMSF

Lyme-->early-->see migrans

Babesios---->splenectomy-->anemia, reticulocytosis, Leukocytosis

Ehrilichiosis-->>lichi and amb -->amblyoma-->leukopenia & thrombocytopenia

RMSF-->wrist and ankles to--> rash on hand and rash on soles

861

mesenteric Ischemia

fresh bllod through anus--> Hematochezia

Plus

out of poportion kind of pain 

on Periumbilical area

862

Rebound Tenderness

anything that irritates

Peritoneum

Appendicitis

Peptic Ulcer Disease

Small bowel Obstruction

863

vaginal bacterial color code

Greybound--> Grey bacterieal

GTA-->> trichomonas is green

864

Coliform bacteria

Floss after cowliflower

Ecoli--> levofloxacin

865

smooth tapering of distal esophagus with dilated proximal esophagus

Achalasia or pseduoachalsis

aperistalsis vs malignancy

 

Achalasia-->sphincter wont relax

Esophageal cancer--> changes the tissue or compresses it

Endoscopic evaluation

866

pseudotumor cerebri

treatment kya hai bhai

acetazolamide

weight loss

stop offending drugs

867

cyst here

Q image thumb

bakers popliteal cyst

see a crescent shaped ecchymosis

A image thumb
868

Crescent

shaped hematoma--> sub-dura bleed

Kidneys-->Light microscopy-->crescent shapes-->antibodies -->RPGN

Crescent shaped Ecchymosis on gastronemius area--> bakers cyst--> can rupture and spill below and cause swelling of calf

869

viral video paramixed Group of dogs

barking and striding

in flames and 

larynxing the turkey

 

Croup

inflammation of turkey and larynx

paramyxovirus

dexamethasone-->worse case give Nebulized racemic Epinephrine

870

collison

trauma case

do first what

FAST

focussed-assesment-sonograph for Trauma

871

Chronic HCV

treatment revolves around prevent further liver damage

--> vaccinate patient

give antioxidants

and give some anti virals

872

Acromegaly

COarse face

enlargement of fingers and carpal tunnel--> shooting pain upon tapping

 

873

BArtholin cyst vs gartner

Bartholin--> bahar than gartner

gartner is deeper than bartholin

874

previa = vaginal or cesarean

cesarean

vagina if placent is less than 2 cm on os

875

dementia & parkinson 

if muscular/tremors are present before the hallucinations begin--> parkinson disease dementia

 

if hallucinations or dementia is present and then later on you get rigid gait--> lewy body dementia

876

 

 

Heart Rupturing after M.I

(Right Coronary--> Papillary)

 

Left Anterior Descending--> Interventricular septum

Papillary muscle & Interventricular septum= Within 5 days----> New Holosystolic Murmur

After 5th day---> LAD-->Wall rupture--> Shock

 

Aneurysm Formation--> Months

 

Weeks-->months==remodelling= thin walls of the heart and dilated chamber--> CHF = prevent with ACEi

 

 

877

no central pallor rbc 

round and small

membrane tights it up and constrains the rbc

membrane defect--> tight rbc

round as round abdomen of lifeless married man to a boring wife

chittrocytosis

spherocytosis

878

PVR cystica

parathyroid related von recklinghausen increased osteoclastic activity and replacement of bone with brown tumors

879

excess T3

or constant thyroid upregulation

osteoclastic

880

Actinic Keratosis 

vs 

Melanoma

white flaky like a deas skin -->AK squamous

 

brown irregular margin --> Basal

881

Fever 

dry cough

CD4 less then 200

PCP

Punjab control police--> Rs 200cd4

tmp-smx with glucocorticoids 

882

(Stroke kind of presentation)

Neurologic deficits lasted less than 24 hrs

 

Non contrast CT shows no abnormalities

Transient Ischemic Stroke

 

Aspirin and statin

883

Catatonia

vs 

akathisia

vs 

NMS and malignant hyperthermia

Catatonia--> is a part of syndrome versus others are side effect of drugs

 

EIther patient would stay immobile and wont move or make purposeless movements

884

rash

face to trunk

and neck to trunk

 

Head/neck with buccal mucosa

face to trunk -3 day german toga rubella

 

neck to trunk scarlet

 

head/neck with buccle--> ola -> cough coryza conjuctiva

885

how to diagnose SLE

start with

Anti nuclear antibody

if present

then confirm with

Anti double strand dna

anti smith

886

septated mass on ovary

vs

ectodermal calcified mass

sepateted mass-->with fluid-->epithelial of ovary/fallopian tube carcinoma

 

calcified mass-->without fluid-->with nodule-->dermoid ectodermal cystic teratoma

887

Tuning fork web

Normally there is a background noise all the time

if you hear the the tuning fork better on one side--> conductive hearing loss on that side--> tuning fork not masked by backgroud noise

if its not heard at all by left ear--> and heard only by the right ear = sensoryneuronal loss of left ear.

 

RInne--> bone vs air--> air needs to work 

 

888

Factitious

vs

Malingering

Factitious= false facts and no gains

Malingering==Money, motivation for multitude gains

 

Conversion= Emotional Con, no gains

889

Hx =prostate cancer

now has 

hyperreflexia

urinary  incontinence

Spinal nerves are compressed

Epidural Spinal Cord Compression

 

Intavenous Glucocorticoids-->Decrease vasogenic Edema-->

then MRI to see the theca compression

890

Delerium management

establish sleep-wake cycle

frequently reorient the patient

avoid multiple drugs or physocal restraints

891

Pulmonary capillary

measures Left Atrial Pressure

892

take two arms blood pressure

Takayasu

893

Norepinephrine and Dopamine increaser

BuProPion

894

diverticulosis 

vs

angiodysplasia

Diverticulosis-->arterial bleeding--> bright red blood

 

angiodysplasia--> anywhere in colon--> m/c in Vwf acquired coz of misbehaving valvcongenitalntial disease--> maroon colored stool

895

bulky & tender uterus

globular shape