Classic Presentations Flashcards
Clinical Presentation on the Question side, and Diagnosis / Disease on the other side (335 cards)
1
Q
Abdominal pain
Ascites
Hepatomegaly
A
Budd Chiari Syndrome (aka Post-Hepatic Venous Thrombosis)
2
Q
Achilles Tendone Xanthoma
A
Familial Hypercholesterolemia (Decrease LDL Signaling)
3
Q
Adrenal Hemorrhage
Hypotension
DIC
What is the pathogen that leads to this presentation?
A
Waterhouse - Friedrichson Syndrome (Meningococcemia)
4
Q
Arachnodactlyly
Lens Dislocation
Aortic Dissection
Hyperfelxible joints
A
Marfan’s Syndrome
5
Q
A mutation in which gene leads to Marfan’s Syndrome?
A
Fibrillin gene
6
Q
Athlete with polycythemia
A
Secondary to EPO injection
7
Q
Back pain
Fever
Night sweats
Weight Loss
A
Pott’s Disease
8
Q
Pott’s Disease is caused by_____?
A
Vertebral TB
9
Q
Bilarteral Hilar Adenopathy
Uveitis
A
Sarcoidosis
non-caseating granulomas
10
Q
Blue Sclera
A
Osteogenesis Imperfecta
11
Q
Bluish linie on gingiva
A
Burton’s line
12
Q
Burton’s line is caused by____?
A
Lead Poisoning
13
Q
Bone Pain
Bone Enlargement
Arthritis
A
Paget’s Disease of Bone
increase of osteoblastic and osteoclastic activity
14
Q
Bounding Pulses
Diastolic Heart Murmur
Head Bobbing
A
Aortic Regurgitation
15
Q
“Butterfly” facial rash
Raynaud’s phenomenon in a young female
A
SLE
16
Q
Cafe-au-lait spots
Lish Nodules
Iris Hamartoma
(+pheochromocytoma, Optic Gliomas)
A
Neurofibomatosis Type I
17
Q
Cafe-au-lait spots
Polyostotic fibrous dysplasia
Precocious Puberty
Multiple Endocrine Abnormalities
A
McCune Albright Syndrome
18
Q
Which Mutation causes McCune Albright Syndrome?
A
Mosaic G-Protein Signaling mutation
19
Q
Calf pseudohypertrophy
A
Muscular dystrophy
20
Q
What movement is characteristic of Muscular Dystrophy?
A
Gower’s Maneuver
21
Q
What mutation causes Muscular dystrophy?
A
X-linked Recessive mutation of dystrophin gene
22
Q
“Cherry - Red Spot” on Macula
Individual causes
A
Tay-Sachs: Ganglioside accumulation
Neimann-Pick Disease: Sphingomyelin accumulation
Central Retinal Artery Occlusion
23
Q
chest pain on exertion
A
Angina:
Stable - with moderate exercise
Unstable - with minimal exercise
24
Q
Chest pain
pericardial effusion/ friction rub
Persistent fever following MI
A
Dressler’s Syndrome
25
What is the cause of Dressler's Syndrome?
Auto-immune mediated Post-MI fibrinous pericarditis
26
When is it common to see Dressler's syndrome post an MI?
1-12 weeks
27
Child uses arms to stand up from squat
Gower's Maneuver
28
Child with fever later develops red rash on face that spreads to body
"slapped cheeks"
| Erythema infectious/ 5th Disease: parvovirus B19)
29
Chorea
Dementia
caudate degeneration
What causes this?
Huntington's Disease
ADDx: CAG repeat expansion
MC: 30-40 years
shows anticipation
insidious onset of personality and then physical changes:
personality: Aggressiveness, Flat affect, depression, or anxiety, dec. memory, concentration, psychosis.
Movement:
purposeless movement, choreiform movements, bradykinesia
30
Chronic exercise intolerance with myalgia
Fatigue
Painful cramps
myoglobinuria
McArdle's Disease
31
What causes McArdle's Disease?
Muscle Glycogen Phosphorylase Deficiency
32
Cold Intolerance
Hypothyroidism
33
Heat Intolerance
Hyperthyroidism
34
Conjugate lateral gaze palsy
| Horizontal diplopia
Internuclear ophthalmoplegia (damage to MLF)
35
Bilateral INO
Multiple Sclerosis
36
Unilateral INO
Stroke
37
Continuous "machinery" heart murmur
PDA
38
How do you close a PDA? Keep it open/maintain?
Close: Indomethicin
Open: Misoprostol
39
Cutaneous/ Dermal edema due to connective tissue deposition
Myxedema
40
Cause of Pre-tibial Myxedema?
Hypothyroidism
| Grave's Disease
41
Dark Purple skin
| Mouth Nodules
Kaposi's Sarcoma
Usually seen in AIDS patients
Associated with HHV-8
42
Deep, Labored Breathing
| Hyperventilation
Kussmaul breathing
| associated with DKA
43
Dermatitis
Dementia
Diarrhea
Pellagra
| B3-Df
44
Dilated Cardiomyopathy
Edema
Alcoholism or malnutrition
Wet Beri-Beri (Vitamin B1 Df.)
45
Dog or cat bite resulting in infection
How does this present?
Pasteurella multocida
Presents as cellulitis at inoculation site
46
Dry eyes
Dry Mouth
Arthritis
Sjogren's syndrome
47
What causes Sjogren's Syndrome
Autoimmune destruction of exocrine glands
48
Dysphagia (esophageal webs)
Glossitis
Iron Deficiency Anemia
Plummer-Vinson Syndrome (may progress to esophageal squamous cell carcinoma)
49
Elastic Skin, hyper mobility of joints
Ehlers-Danlos Syndrome
50
Erythroderma
Lympadenopathy
Hepatosplenomegaly
Atypical T Cells
Sezary Syndrome (Cutaneous T-Cell Lymphoma)
OR
Mycosis fungoides
51
Facial muscle spasm when tapped
Chvostek's Sign
| Indicative of Hypocalcemia
52
Fat
Female
Forty
Fertile
Cholelithiasis
53
Fever
Chills
headache
myalgia following ABx treatment for syphilis
Jarisch-Herxheimer Rxn
| rapid lysis of spirochetes results in toxin release
54
```
Fever
Cough
Conjunctivitis
Coryza
Diffuse Rash
```
Measles
55
Fever
Night sweats
Weight Loss
B-symptoms
56
Fibrous Plaques in soft tissue of penis
Peyronie's Disease (CT Ds)
57
Gout
Mental Retardation
Self-mutilating Behavior in a boy
Lesch-Nyhan Syndrome
58
What causes Lesch-Nyhan Syndrome?
HGPRT Df. X-Linked Recessive
59
Green-yellow rings around peripheral cornea
Kayser-Fleiscer rings from Copper Accumulation in Wilson's Syndrome
60
Hamartomatous GI Polyps
| Hyperpigmentation of Mouth, Feet and Hands
Peutz-Jergers Syndrome
Inherited, benign polyposis can cause bowel obstruction
carries an increased cancer risk - Mainly GI
61
Hepatosplenomegaly
Osteoporosis
Neurologic Symptoms
Gaucher's Disease
62
What causes Gaucher's Disease
Glucocerebrosidase Df.
63
Hereditary nephritis
Sensorineural Hearing loss
Cataracts
Alports Syndrome (mutation in the Type IV collagen in GBM)
64
Hyperphagia
Hypersexuality
Hyperorality
Hyperdocility
Kluver Bucy Syndrome
65
What causes Kluver-Bucy Syndrome
Bilateral Amygdala lesion
66
Hyperrefelxia
Hypertonia
Babinki signt present
UMN lesion
67
Hyporeflexia
hypotonia
Atrophy
Fasciculations
LMN lesion
68
Hypoxemia
Polycythemia
Hypercapnia
"Blue Bloater" COPD = Chronic Bronchitis due to hyperplasia of the mucous cells
69
Indurated, ulcerated genital lesion
Non-painful: chancre (Primary Syphilis, Preponema pallidum
Painful, with exudate: chancroid (Haemophilus ducreiyi)
70
```
Infant with cleft lip/palate
microcephaly
holoprosencephaly
polydacyly
cutis aplasia
```
Patau's Syndrome
Trisomy 13
71
Infant with failure to thrive
Hepatosplenomegaly
Neurodegeneration
Niemann - Pick Disease
72
What causes Niemann-Pick Disease?
genetic sphingomyelinase deficiency
73
Infant with hypoglycemia
Failure to thrive
Hepatomegaly
Cori's Dx
74
What causes Cori's Disease?
Debranching Enzyme Df.
75
Infant with microcephaly
Rocker-bottm feet
Clenched hands
Structural heart defect
Edward's Syndrome (Trisomy 18)
76
Jaundice
| Palpable distended non-tneder gallbladder
Couvoisier's sign - distal obstruction of biliary tree
77
Large rash with bull's eye appearance
Erythema chronic migraines from Ixodes tick bite
Lyme Dx: Borrelia
78
Lucid interval after TBI
Epidural hematoma
79
Most common artery that breaks in a Epidural Hematoma?
Middle Meningeal artery
80
Male child
Recurrent infections
No Mature B-Cells
Burton's disease
81
What causes Burton's disease?
X-Linked agammaglobulinemia
82
Mucosal bleeding and prolonged bleeding time
Glanzmann's thrombasthenia (defect in PLT aggregation due to lack of GpIIb/IIIa)
83
Cause of Glanzmann's thrombasthenia
defect in PLT aggregation due to lack of GpIIb/IIIa
84
Muffled heart sounds
distended neck veins
Hypotension
Beck's triad of cardiac tamponade
85
Multiple colon polyps
Osteomas/ soft tissue tumors
impacted/supernumarary teeth
Gardner's syndrome (subtype of FAP)
86
"Thyroidization" of the Kidneys: with which Disorder is it associated?
Chronic Pyelonephritis
87
recently hospitalized patient displays spastic quadriplegic...what could have happened and why?
Central Pontine Myelinolysis: Destroys the corticospinal tracts creating a "locked in Syndrome"
Note: Locked in Syndrome can also be caused by an occlusion of the basilar artery
88
Triad: dysarthria, dysphagia, and head/neck muscle weakness that presents in addition to quadriplegia
```
The other half of Central Pontine Myelinolysis: Pseudobulbar palsy.
Demyelination of:
CN IX: can't talk
CN X: can't swallow
CN XI: head and neck muscle weakness
```
This is called pseudo bulbar because it is a DEMYELINATING disorder, which by definition means that you are affecting the axons. Bulbar palsy however, is caused by degeneration of the associated nuclei of the CN listed above.
89
Rapid correction of Hypernatremia leads to
Cerebral edema
90
Rapid correction of Hyponatremia
Central pontine myelinolysis
91
Capropedal spasm
Spasmodic movement of the hands +/- feet
| Caused by Hypocalcemia
92
Chvostek's sign
twitching if the jaw by tapping the mandibular nerve.
93
Early onset ataxia with repeated sinopulmonary infections, and then abnormal dilatations of the capillary vessels of the eye.
ARDx: Faulty DNA Repair after Ionizing radiation
Ataxia-Telangiectasia
94
Chromosomal Instability Ds
1. Ataxia-Telangiectasia: Unable to repaire non-homologous end-joining caused by Ionizing radiation
2. Xeroderma Pigmentosa: NER: UV Light (premature skin aging and increased risk of skin cancer = malignant melanoma and SCC)
3. Fanconi syndrome: HS of DNA to cross-linking agents
4. Bloom Syndrome: Generalized chromosomal instability - increased susceptibility to neoplasms
5. HNPCC: defect in MMR
95
Neurofibrillary tangles
Alzheimer's Dx
96
Loss of neurons in the substantial nigra pars compacta
PDx
Presents with memory impairment, cogwheel rigidity, bradykinesia, masked facies. The dementia is gradual
97
Bilateral Atrophy of the Caudate and putamen
Huntington's
In addition: Caudate atrophy shows
dilation of the frontal horns of the lateral ventricles, and microscopy of the atrophic areas reveals gliosis and neuronal loss
98
Posterior DCML demyelination
B12 or syphilis
99
Lewy bodies
PDx OR
| Lewy Body dementia
100
VMN
Nml: satiety
AB: hyperphagia
(+) letpin
101
LMN
Nml: hunger
AB: Anorexia
(-) leptin
102
AMN
N: heat dissipation via PSNS
A: hypothermia
103
PMN
N: Heat conservation via the SNS
A: hypothermia
104
Arcuate
Secretes DA to (-) PRL, GHRH, GnRH
105
PVNM
ADH, CRH, Oxytocin, TRH secretion
106
Supraoptic Nucleus
ADH and Oxytocin secretion
107
Suprachiasmatic Nucleus
Circadian rhythm and pineal gland function (melatonin)
108
Jet Lag represents disorder in what hypothalamic nucleus?
Suprachiasmatic nucleus
Dyssynchrony between the body's circadian rhythms and the environment (i.e. light): insomnia, daytime sleepinesss, dec. work performance, GI issues, and malaise.
109
Input into the Suprachiasmatic nucleus comes from ___
Photosenstative ganglion in the retina = retina hypothalamic tract.
110
the suprachiasmatic regulates the circadian rhythm by modulating ___
```
modulates body temperature (inc. in morning)
cortisol levels (why its higher with no sleep)
melatonin levels (induction of sleep). should be highest at night, lowest in the middle of the night
```
111
Traveling which direction takes a longer time to resynchronize the suprachiastmatic nucleus?
Eastward travel > Westward
its easier to lengthen the sleep/wake cycle than it is to shorten it.
112
sudden spike in prolactin that is drug induced
typically antipsychotics that have more D2>5HTx. these would be typical anti-psychotics
113
galactorrhea
regulated by increased prolactin. normal post-delivery, abnormal any other time
114
tuberoinfundibulnar dopaminergic pathway
connects the hypothalamus and the pituitary gland. DA (-) PRL release.
115
Sx of high prolactin (with no tumor)
galactorrhea
changes in menstrual cycle
Sexual dysfunction
116
Mesolimbic - mesocortical pathway
regulates behavior and is the most disrupted in Schizophrenia, where the tonic control of the Mesolimbic pathway over the mesocortical is missing
117
Nigrostriatal pathway
Substantia nigra to the caudate nucleus and the putamen (in this sentence both PDx and HDx is covered).
This pathway has DA (-) ACh release
118
Why can the Tx with high dose anti-psychotics present with parkinsonian features?
because they disrupt the DA (-) over ACh in the nigrostriatal pathway that controls movement (via basal ganglia)
119
What are the 3 important DA pathways?
1. Tuberoinfundibular (DA (-) PRL release)
2. Nigrostriatal (DA (-) ACh)
3. Mesolimbic-Mesocortical (DA (-) 5HTx)
120
Necrosis due to ischemic injury presents with what two features? Which organ is the one exception to the rule?
Ischemia will almost always lead to Coagulative Necrosis. the one organ that is exempt is the brain, which presents with liquifactive necrosis.
1. Presents with initial preservation of cytoarchictecture
2. a nucleated eosinophillic cytoplasm
3. eventual Leukocytes clean up the mess
121
Liquifactive necrosis is due to _____, and presents with what features?
Causes: focal bacterial infections that (+) WBC reaction
Predominant form of necrosis in the brain
1. Necrotic cells are digested, no cytoarchitecture preserved
2. viscous liquid mass made
3. necrotic fluid becomes filled with pus, and is assoc. with abscess formation in the peripheral tissues. In the brain it will be CSF-filled spaces.
122
Fat Necrosis
Seen with acute pancreatitis - enzymatic activation will self-digest.
Seen with saponification (chalky -white deposits that form with FFA)
Note: this is also seen in the gut. it is not recommended to take calcium with fatty foods - will not absorb.
123
Caseous necrosis
```
TB infection (MC)
Histoplasma
Cryptococcus
Coccidioses
Cheesy tan-white gross appearance
Consits of fragmented cells
surrounded by M0 = granuloma
```
124
Left MCA stroke
R. hemiparesis
| Dysphagia
125
the brain will present with full on liquifactive necrosis in __ Days
10
126
Fibrinoid necrosis
Histologic pattern of injury seen in the vessel walls that are affected by:
Vasculits (i.e. PAN)
Malignant HTN
DM
127
Non-enzymatic Fat necrosis occurs due to
trauma
MC is the female breast
often mistaken for a tumor
128
Broca's Aphasia
```
"Broca = Broken Speech"
Broadman Area 44/45
Communication motor planning
Patient will be able to talk but they have to think about how to make every word. Comprehension is intact, and they have a hard time repeating anything.
Associated with r. hemiparesis
MCA stroke
typically a frustrated patient
```
129
Wernicke's aphasia
Word Salad
Poor comprehension
rep. impaired
Associated with R. Superior visual Field defect
130
Damage to frontal eye field?
Located directly anterior to the pre-central gyrus
Damage = Ipsilateral deviation
131
Pre- central gyrus
Primary motor cortex
- dysarthria
- paresis/ paralysis
- trouble moving mouth, tongue, and larynx.
- hemiparesis
- apraxia
- NO language involved.
132
MCC aseptic meningtitis
Viral
Enteroviruses
coxsackievirus, echovirus, poliovirus, and enterovirus = 90% of cases
133
HA
Fever
Neck stiffness
Viral Meningitis
Spinal tap will differentiate the types.
+/- photophobia, lethargy
134
Focal Neurologic Signs
Stupor
Photophobia
Fever
Bacterial Meningitis
| in only 40% of cases do you see nuchal rigidity
135
MCC Bacterial Meningitis
S. pneumonia
N. meningitidis
(in neonates = Listeria and GBS)
136
meningitis + parotitis
seen in 50% of mumps cases
137
MCC common cold
Coronavirus
Rhinovirus
Adenovirus (Also the MCC of monocular conjunctivitis)
138
MCC of meningitis in AIDS patients
Cryptococcal Meningitis
| DDx: India ink stain
139
Acute onset difficulty walking with bilateral extremity weakness
Seen with absent DTRs
PMH reveals GI infection
c. jejuni - MCC of infectious diarrhea and it is the
| MCC of GBS
140
Demyelinating syndromes of the peripheral nerves
GBS
Ascending paralysis that can lead to respiratory failure
141
diplopia
dysphagia
dysphonia
The 3 D's of Botulinum Toxin
Occurs within 12-46 hrs of exposure
142
types of botulism
Food-borne
Wound
infant (honey)
143
confusion
HA
Inflammatory CSF
Meningitis
144
C. neoformans
- Narrow based buds with thick capsule
- soil/pigeon droppings
- Primary: Lung
- MC: meningoencephalitis
- Can disseminate
DDx: India Ink + Latex agglutination (poly.capsule) of CSF
Growth: Sabouraud's agar
145
Methenamine
Mucicarmine stains fo tissue = C. neoformans
146
Tx of c. neoformans
Amphotericint B + Flucytosine (Acute)
| Fluconazole (prophylaxis)
147
Non-septate hyphae
Wide angle: Mucor/Rhizopus
- love DM/leukemia patients
Narrow angle: Aspergillus
148
Germ tubes
C. albicans
| to see germ tubes you have to incubate at 37 degrees for 3 hours
149
spherules
Coccidiodes immitis
Lung Dx
Disseminated mycosis
150
How many Ub indicate destruction tag?
4
151
Parkin
PINK-1
DJ-1
mutations
ARDx form of PDx (<50y/o)
| leads to a breakdown in the Ub-Proteosome system
152
Histone acetylation promotes_____
euchromatin
153
Histone deacetylation promotes
Heterochromatin
154
Df. of bilirubin glucuronidase
Crigler-Najjar Syndrome
| Complete Df is fatal
155
Ophthalmoplegia
Ataxia
confusion
```
"Eyes, Lies, Capsize"
Wernicke Syndrome
lethal in 10-20%
due to B1 Df.
commonly seen in the malnourished (classic patient is an alcoholic)
```
Will show foci of hemorrhage and necrosis in the MAMILLARY BODIES and PAG
Tx: B1 + Glc
156
vitamin B1: Rxns
Pyruvate dehydrogenase
alpha-ketoglutarate dehydrogenase
Transketolase (PPP - pensose to G3P)
157
Wernicke Syndrome: DDx
increase in RBC transketolase levels after B1 infusion
158
G6PD Df
RLS in PPP: hemolytic anemia
159
Methylmalonic acid
product of FFA oxidation
| converted to succiyl-CoA by methylmalonyl-CoA mutase with the help of B12
160
B12
Methylmalonyl-CoA mutase
DDx: increased methylmalonic acid, which will not be present in Folic acid df.
161
why does a df. in B1 lead to Wernicke Syndrome?
the brain can't utilize glucose as well because it is so critical to the Kreb's Cycle and the FFA beta-Oxidation
162
pale catecholaminergic nuclei
pale hair, skin
light eyes
```
PKU
can't use phenylalanine = no DA, NE, E
No melatonin (Tyrosinase can't convert nothing)
```
163
abdominal pain
neuropsychiatric changes
darkening of urine
acute intermittent porphyria
164
Valproate in a pregnant woman
Teratogenic
Neural tube defect - meningocele
Why?
Valproate (-) intestinal Folic Acid uptake
165
coarctation of aorta + bicuspid aortic valve = Most Likely Ds
Turner Syndrome
166
Duodenal Atresia = associated congenital disorder
Downs
- bilious vomiting w/o abominal distension
Typically seen on 1st day of life
Peristaltic wave may be appreciated
Commonly (+) History of polyhydramnios
167
Potter Sequence results in
Renal agenesis and Lung hypoplasia
| typically spontaneously abort
168
Lithium in pregnancy
Ebstein's anomaly
"atrialized RV"
Downward displacement of tricuspid and thin IV septum
169
Mature defenses
Suppression: intentional withholding of distressing unconscious material
Humor: making light of ___
Altruism: ameliorated feeling of guilt by giving to others without solicitation
170
Immature defenses
Repression: trigger releases a stored memory
Isolating: distance yourself from a bad memory
171
```
emotional lability
disruptive behavior
dec. need for sleep
sexual inappropriateness
auditory hallucinations
Record of previous episodes
```
psychotic feature: auditory hallucination
the record of the previous episode will shift this from a DDx of "bipolar Ds, manic episode with psychotic features"
TO
"Schizoaffective Ds"
172
Schizoaffective Ds
mood symptoms
concurrent symptoms of schizophrenia
at least a 2 eek period in the absence of prominent mood symptoms
173
paranoid schizophrenics
no mood swings, only paranoia +/-hallucinations
174
Schizophreniform Ds vs. Schizophrenia
Both have:
- 2+ of delusions, hallucinations, disorganized speech/behavior +/- (-) Sx
Schizophreniform: Sx longer than 1 month but less than 6
Schizoaffective Ds: 2 weeks of schizophrenic Sx with mood symptoms
175
Tooth crowding
arched palate
long thin face with prominent forehead/jaw
Mental retardation
Fragil X Syndrome
CGG Trinucleotide repeat Ds
> 200 = full blown Ds
176
Neurologic deficits that cannot be explained by 1 lesion
| motor and sensory
```
suspect MS
Patient is MC a female between 20-30 y/o
- Optic Neuritis
- INO
- Cerebellar DysFx
- Sensory and Motor symptoms: includes bladder and bowel dysfx
```
177
optic neuritis
visual disturbances
Central scotoma
painful eye movements
178
INO
```
Internuclear Ophthalmoplegia (INO)
impaired eye adduction during the lateral gaze during the lateral gaze due to demyelination of the MLF
```
179
Tremor
Ataxia
Nystagmus
Cerebellar DysFx triad
180
MC Non-Specific Symptom of MS
When is this most pronounced and why?
Fatigue
- after taking a hot shower or after strenuous activity unheated environments
Due to decreased axonal transmission associated with increased heat.
heat may also lead to worsening of neuro deficits (heat sensitivity)
181
Depression
Apathy
Dementia
Choreiform movements
HDx
Progressive
CAG repeat gene
182
Choreiform Movements
```
Facial grimacing
Ataxia
dystonia
tongue protrusion
writhing movements of the extremities
```
183
transient focal neuro Sx that last less than 24 hrs
TIA
184
amaurosis fugax
Transient monocular blindeness
In TIA = does not progress to optic neuritis
185
Development of Pruritis when exposed to a hot shower
polycythemia
Caused by HIS release from Basophils
186
```
Neuromuscular excitability
Irregular course tremors
fascicular twitching
agitation
ataxia
delirium
```
DDx? Tx? Contraindicated Rx?
Chronic Li Toxicity
Gradually develops and will present with neurologic symptoms
Tx: Hemodialysis
```
contraindicated drugs for Li:
Thiazide diuretics
ACE-I: impairs CL
NSAIDs: impairs CL
Non-DHPs
```
187
Lithium
Very narrow therapeutic index
Toxicity develops at Cp>=2.0
almost exclusively handled by the kidneys, PCT >60% handling.
Li will impair Na handling, and therefore drop s[Na]. To compensate the kidney tries to take up more Na, but only more Li can come in - this is how you develop Lithium Toxicity
188
What will worsen Lithium toxicity?
anything that changes the GFR
- Renal Injury
- Toxins
- Drugs
- volume depletion
- decompensated CHF
- cirrhosis
all will lead to an inc. reabsorption of Li and Na
189
If you have a schizophrenic with HTN and CHF, which drug class should you choose?
Furosemide
| DHPs (only!)
190
ADDx
| Hemangioblastomas
VHL
Capillary hemangioblastomas in the Retina/ cerebellum
congenital cysts and/or neoplasms in the:
- Kidney
- Liver
_ Pancreas
Patients are also at risk for bilateral RCC
191
VHL as a TSG
VHL controls HIF-alpha phosphorylation. When de-phosphorylated, it can combine with HIF-beta = upreg. of GF: VEGF, PDGF, EDGF, FGF...
192
Von-Recklinghausen's Dx
Chr. 17: NF-1 ADDx
Almost complete penetrance, but variable expressivity
Inherited PERIPHERAL NS tumor syndrome
- neurofibromas
- optic nerve gliomas
- lisch nodules (copper flecks)
- cafe au lait spots
193
NF-2
Neurofibromatosis - 2
ADDx
CNS Tumor syndrome
Bilateral cranial nerve VIII schwannomas and multiple meningiomas
194
Encephalotrigeminal angiomatosis
aka Sturge-Weber Syndrome
Rare
Congenital nerucutaneous Ds
195
```
Facial angiomas
leptomeningioal angiomas
Typically involves V1 and V2 distributions
Mental retardation
Seizures
hemiplegia
Skull radiopacities
Skull = "tram-track" appearance
```
Sturge-weber Syndrome
196
cyts in the kidney
| cortial and sub-ependymal hamartomas
```
Tuberous Sclerosis
ADDx
Causes cysts in:
- kidney
- liver
- pancreas
Also:
CNS manifestation:
- Hamartomas
Skin:
- cutaneous angiofibromas
- Visceral cysts
Tuberous Sclerosis is the MCC:
- Renal Angiomyolipomas
- Cardiac rhabdomyomas
```
197
Biggest complication in TS
Seizures
198
- epistaxis
- GI bleeding
- hematuria
Osler-Weber-Rendu Syndomre (HHT)
ADDx of congential telangiectasias
Rupture of the telangiectasias = Sx
199
Waddling Gait
Hip instability:
| -DMD/ BMD (less)
200
kyphoscoliosis in a young person
DMD
| Marfan's
201
lipid accumulation in muscle
Carnitine palmitoyltransferase Df
202
Proximal muscle weakness W/O proximal muscle weakness
Polymyositis
| will show PMN in the myofibers, not near the periphery
203
Ragged Red fibers
MESLA
| MERA
204
area postrema
On dorsal medulla, near the 4th ventricle
Chemoreceptor trigger zone
area that receives blood from fenestrated capillaries, allowing sampling
Thought to be involved in vomiting reflex to toxins/changes in electrolytes
205
ASA (anterior spinal artery)
```
Lateral Corticospinal tract:
Medial Lemniscus
Caudal Medulla (CN XII)
Sx: Contralateral hemiparesis - LE
decreased contralateral proprioception
Ipsilatral hypoglossal dysfunction (tonge deviates ipsilaterally)
Common to present bilatrally
```
206
MCA stroke
Contralateral motor and sensory deficit in face + UE>LE + homonymous hemianopia WITH macular involvement (unlike the PCA which does not have macular involvement)
If Temporal lobe: Wernicke's Aphasia if in the dominant lobe, hemineglect if in the non-dominant lobe
If Frontal Lobe: Broca's Aphasia
207
ACA stroke
Motor Cortex: Contralateral paralysis of lower limb
| Sensory cortex: Contralateral loss of sensation in LE
208
Lateral Striate artery stroke
Striatum and internal capsule are affected:
| Contralateral hemiparesis/ hemiplegia
209
Common cause of lateral striate artery stroke
lacunar infarct (Charcot-Buchard) secondary to HTN
210
which stroke is common bilaterally
ASA stroke
211
Medial medullary syndrome
infarct of paramedian branches of ASA and vertebral
arteries
Sx:
Contralateral LE hemiparesis with Decreased proprioception ("slapping foot gait")
Ipsilateral paralysis of the tongue to the ipsilateral side of the lesion (so opposite the LE)
212
Lateral meduallay (Wallenberg's ) Syndrome
Caused by a PICA stroke
"Vomiting, Vertigo, Nystagmus" +
Contralateral Loss of pain and temp sensation
Ipsilateral deficits of:
CN V, VIII, IX, X, XI; and horner's Syndrome
213
AICA Stroke
Classic Sx: Vomiting, Vertigo, Nystagmus and PARALYSIS of the face with preserved touch sensation
Lateral pons: CN nuclei affected
Vestibular nuclei: Vertigo, Vomiting, Nystagmus
Facial Nucleus: decreased taste from anterior 2/3 of the tongue (CN VII),
Spinal Trigeminal nucleus: decreased pain and temp sensation
cochlear nucleus: decreased hearing ipsilaterally
Sympathetic fibers: decreased corneal reflex
Ipsilateral Horner's Syndrome: decreased lacrimation, salivation (PSNS)
Middle and inferior cerebellar peduncles:
ataxia
dysmetria
214
Lateral Pontine Syndrome
Facial nucleus effects are specific to AICA
| "If the face droops, then the AICA's Pooped"
215
sudden onset HA
Partial loss of vision
Contralateral Homonymous hemianopia with macular sparing
PCA stroke
occipital cortex, visual cortex
Contralateral hemianopia with macular sparing
216
A. Comm Stroke
Common site of saccular (berry) aneurysm = impingement on cranial nerves
leads to visual field defects
Lesions are typically aneurysms, not strokes
217
P.Comm Stroke
Common site of saccular aneurysm
| CN III palsy
218
"Down and Out"
Ptosis
Pupil dilation
CN III palsy
219
"worst HA of your life"
Sub-arachnoid hemorrhage
| Classically: rupture of a berry aneurysm
220
Berry Aneurysm
MCC of Sub A hemorrhage:
At the circle of willis
rupture = SAH: there will be NO focal neuro deficits if it is a SAH
Can see bi-temporal hemianopia with compression of the optic chasm = if still an aneurysm
ADPKD, EDS, Marfans are Genetic disorders classically associated with Berry Aneurysms
221
cuneus vs. lingual gyrus
cuneus: upper 1/2 of retina
lingual: lower 1/2 of retina
222
Acute onset
painless
complete loss of vision in one eye
Occlusion of the central retinal artery
223
_____ can block tolerance to morphine
Ketamine: (-) NMDA (R)
Dextromethorphan: (-) NMDA, reverses tolerance
up-reg glutamate in NMDA (R) which will lead to inc. (P) or inc NO levels, which mediate morphine tolerance
224
NE
- as a hormone
- as a NT
Hormone: attention and impassivity
NT: post-ganglionic neurons to (+) SNS
225
Innervation to the tongue
Motor: CN XII, except the palatoglossus (CN X)
General Sensory:
Anterior 2/3: CN V3
Posterior 1/3: CN IX
Posteror area of the tongue root and taste buds of the larynx and esophagus: CN X
Gustatory:
ant. 2/3: chorda tympani of the CN VII
same for post 1/3 and larynx/esophagus as it is for sensory
226
terminal sulcus and foramen cecum of the tongue
Think of an Arrow:
terminal sulcus is the front full edge (triangle), the foramen cecum is the tip.
the wood stick and back is going to be the anterior 2/3 of the tongue and is innervated by CN XII, V3, and the chorda tympani of the VII for motor, sensory, and taste, respectively
227
+/- history of aneurysm
AMS (+)
neurological deficits
DDx? Tx?
Vasospasm post sub-A hemorrhage
Treat with Nimodipine
228
generalized muscle stiffness
shaking of one hand
3 weeks ago he had a psychotic episode
```
Drug-induced parkinsonism
- D2 (R) (-)
Anti-Psychotics: T>A
(Haloperidol is the most)
Anti-emetics/ GI motility agents:
Prochorperazine, metoclopramide
```
Sx: Prominent rigidity & bradykinesia
Tremor at rest and postural
Masked facies
Tx: dec. / stop Rx, Anti-cholinergics (Trihexyphenidyl, benztropine), Amanatadine (anti-viral with (+) DA)
229
Trihexylphenidyl
| Benztropine
used to reverse Drug induced parkinsonism
these are CNS acting anti-Mx(R)
230
In what time period would it make sense to suspect Drug induced parkinsonism
first 3 mod of Tx
231
Person comes in with Drug induced Parkinsonism - give him Levodopa right?
Bromocriptine?
No - it can precipitate psychosis
232
In what patient population are trihexyphenidyl and benztropine contraindicated?
- elderly
- closed - angle glaucoma
- BPH
can also cause dry mouth and suppurative parotitis
233
Used to Tx:
Seizures
Anxiety Disorders
Muscles Spasms
```
Benzodiazepine:
Diazepam
modulates GABA-A (R)
CNS depressant with significant abuse potential
Drug abuse Sx:
Mild euphoria
relaxation
mild amnesia
sedation
slurred speech
dec. RR, BP, HR
```
234
Indications:
| Akathisis
Propanolol - beta blocker
235
Hemiballismus
contralateral sub-thalmic nucleus
| damage MC due to lacunar stroke
236
classic patient that has lacunar stroke
long-standing poorly controlled HTN
237
Subthalamic nucleus is located:
ventral to the thalamus, superior to the internal capsule
238
Wing-beating tremor
Psychosis
Cirrhosis
Kayser-Fleischer rings in cornea
```
Wilson Disease:
Lentiform nucleus (globus pallidus + putamen)
```
239
a pure motor or pure sensory deficit would be expected to be localized at _____
the internal capsule= when perf. A are obstructed
240
Thalamic syndrome
burning on one half of the body post thalamic stroke
241
"Red Neuron"
Transient severe ischemia, hypoxia, toxicity damage that leads to neuronal cell death
Not seen with normal aging - that would be apoptosis
242
MCC of metabolic encephalopathy
hypoglycemia
hyperglycemia
hepatic encephalopathy (ammonia toxicity)
243
Lisch nodules
Hamartomas of the iris: NF-1
| Hamartomas of the cornea: Wilson Disease
244
Nml division of the prosencephalon
5th week of development
245
Holoprosencephaly is associated with what three conditions:
```
Trisomy 13 (Patau's syndrome)
Trisomy 18 (Edward's Syndrome)
FAS
```
246
loss of GABA in the brain
HDx
247
NO in the brain has a unique job - what is it?
formation of new memories - communication between FC, hippocampus, hypothal, cerebellum, olfactory bulb
248
HDx gene - chr.?
4
249
Indications:
Absence Sz
Tonic-clonic Sz
In children
Valproate
250
Indications:
| Absence Sz in children
Ethosuximide
| VSCC - T- Type (-)
251
Indications:
Tonic-Clonic Sz
Status Epilepticus
Phenytoin
| VSSC (-)
252
Indications
| tonic-clonic Sz
Phenobarbitol
253
Indications:
Complex Partial Sz
Tonic-Clonic
Adverse Effect?
Carbamazepine
AE: Agranulocytosis, Aplastic Anemia
254
Drugs that cause agranulocytosis
Clozipine
| Carbamazepine
255
Drugs that cause Aplastic anemia
Carbamazepine
256
Ischemic-Hypoxic encephalopathy (aka global cerebral ischemia)
You are going to hit your watershed zones and those will go ischemic first.
Borders between the ACA, MCA, and PCA.
ACA-MCA watershed: Frontal lobe about 15 degrees from midline
MCA - PCA watershed: posterior temporal lobe between the occipital/ temporal lobes
these will display wedge shaped infarcts
257
Loss of O2 to the brain for:
```
A. 5-10 sec.
B. 1+ min.
C. 4-5 min.
D. Areas hit first
E. Areas hit second
```
```
A. LOC (syncope)
B. stop neuron activity
C. permanent damage
D. Most sensitive cell groups: Purkinje cell layer of the cortex (5,6), purkinje layer of the cerebellum, and the pyramidal cells of the hippocampus.
E. Watershed zones
```
258
mu (R) traits
- physical dependence
- Euphoria
- Respiratory and cardiac depression
- Sedation
259
Kappa (R) traits
Miosis
dysphoria
sedation
260
delta (R) traits
Anti-depressant effects
261
Nociception/ orphanin (N/OFQ)
Anxiolysis
| Increased appetite
262
Naloxone
pure -opioid receptor antagonist with the greatest affect at mu (R)
used to pull people off of opioid overdose
Reversal seen in min.
duration is dose-dependent (keep them on a drip - you don't need them to go back under because the drug hasn't cleared yet)
It must be given IV because it is inactivated in the liver
263
Hexamethonium
potent nicotinic receptor antagonist
264
Phencyclidine (PCP)
```
Hallucinogen: NMDA (R) (-) = excess relase of (+) NT
Sx:
Agitation
DISSOCIATION: Medium dose
VIOLENT BEHAVIOR: High dose
```
PE:
NYSTAGMUS
ataxia
memory loss
265
Cocaine
```
Stimulant: (-) catecholamine reuptake
Sx:
Euphoria
Increased arousal
agitation
CHEST PAIN
HA
SEIZURES
```
```
PE:
Tachycardia
HTN
MYDRIASIS
the word is longer, so its a blown pupil
```
MI/Stroke: Serious complications due to severe vasoconstriction
Acute intoxication lasts for less than 1 hour.
266
Methamphetamine
```
Stimulant:
intoxication lasts 20 minutes (longer than PCP)
Sx:
agitation
PSYCHOSIS
diaphoresis
violent behavior
```
```
PE:
Tooth decay
HTN
Tachycardia
Choreiform movement
```
267
LSD
```
Hallucinogen
Very unpredictable drug
Sx:
VISUAL HALLUCINATIONS
depersonalization
Euphoria
occasional dysphoria
panic
```
PE:
Mild tachycardia
mild HTN
ALERT AND ORIENTED
268
Marijuana
```
Psychoactive Drug
Sx:
increased appetite
euphoria
slowed reflexes
impaired time perception
```
PE:
Dry mouth
conjunctival injection
mild tachycardia
269
Heroin
```
Opioid Analgesic:
Sx:
Mild euphoria
lethargy
coma
```
PE:
MIOSIS
DECREASED RR - life threatening
DECREASED BOWEL SOUNDS
Don't be fooled - the BP/HR can be NML to low
270
Somatozation Dx
```
Somatoform Ds
Pts. with numerous physical complaints over the course of years with no physical cause.
Must have started prior to 30yo
significant impact on social/occupational Fx
Must have at least:
- 4 pain symptoms
- 2 GI symptoms
- 1 sexual problem
- 1 pseudoneurologic Sx
```
271
Ptosis, Miosis, Anhydrosis, Enophthalmos
Horner's Syndrome
Ipsilateral interruption of SNS due to impingement (i.e. tumors in the apex of the lung (adenocarcinoma), Pancoast tumors):
1. Partial Ptosis due to denervation of the SNS controlled Muller muscle of the upper eyelid
2. Miosis: SNS fibers are interrupted on their way to the dilator pupillage muscle, = unopposed PSNS
3. anhydrosis: impaired sweating due to no SNS innervation to face
4. enophthalmos - opposite of exophthalmos
With further invasion/ compression, there will be impingement of the brachial plexus = ipsilateral shoulder and arm pain
Compression of the SCA = UE edema
272
```
Ipsilateral paralysis of:
soft palate
pharynx
larynx
hoarseness
dysarthria
dysphagia
loss of gag reflex
```
CN X compression
273
synaptophysin
protein on pre-synaptic vesicles of neurons, neuroendocrine, and neuroectodermal cells.
274
CNS tumors will frequently stain (+) for:
Synaptophysin
275
Glial CNS tumors will always stain (+) for:
GFAP (+)
astrocytomas
ependymomas
oligodendrogliomas
276
sudden onset left eye pain that has lasted for 30 minutes then resolved spontaneously.
+
Jaw pain that starts in the middle of a meal
Giant Cell Temporal Arteritis
will cut off circulation to the working muscles of mastication (and tongue claudication is actually a thing)
presents in the elderly
MC Sx: HA
scalp tenderness, especially during hair combing
inflamed temporal artery can sometimes be palpated as firm painful subcutaneous cord in the temporal region
50%: polymyalgia rheumatica that is worse in the mornings
When the suspicion is high - check ESR, if elevated - DO NOT WAIT FOR BIOPSY - START ON PREDNISONE LEST THEY LOSE AN EYE.
The ESR will always be high
277
Jaw claudication +
| ESR > 1000mm/hr
giant cell temporal arteritis
278
delirium
acute onset mental status change in the setting of a medical condition
- causes global memory impairment with fluctuations of consciousness.
When considering delirium as a DDx look for things that would either (a) change the electrolyte balance (i.e. dialysis) or (b) infection
279
ADx
irreversible and progressive memory loss that leads to compromise in all facets of life.
this will develop over the course of years
Remote memory is initially spared, and there is never a loss of consciousness
280
breif psychotic disorder
pschyotic symptoms that last for a few hours - month
| the patient will return to the same pre-morbid state that he was once the episode concludes
281
Vascular dementia
(aka Multi-infarct dementia)
```
Additive effects
will have (+) focal neurologic deficits
```
282
Delirium vs. Dementia
Onset: Acute Vs. Gradual
Consciousness: Impaired vs. intact
Course: Waxing and Waning vs. additive and progressive
Prognosis: reversible vs. irreversible
Memory impairment: global vs. remote memory is spared
283
On Histology:
1. cell body rounding
2. displacement of nuclei
3. dispersion of the Nissl Substance
what happened?
axonal section and reaction
when an axon is severed there is "Wallerian degeneration": degeneration of axon and myelin distal and proximal to the site of injury
284
Wallerian degeneration
- occurs where a segment of axon is separated from the soma
- 1- swelling and irregularity in the distal axon
- 2- w/in 1 week the axon is destroyed
- 3- fragments are digested by schwann cells and M0
this degeneration is bidirectional
285
What changes occur in the neuronal cell body seen after an axonal section?
AXONAL REACTION
1. cellular edema
2. swollen, rounded, with the nucleus displaced to the periphery
2. Nissl substance becomes fine, granular, and is dispersed throughout the cytoplasm (aka central chromatolysis)
286
When does "axonal reaction" become visible
24-48 hrs post injury
Maximal changes in the neuronal body occur ~ 12 days post-injury.
this increased change represents a high turn over of protein in order to regenerate the axon.
287
irreversible cell injury will be seen as__?
Hypoxia/ ischemia/ toxic injury will show:
1. shrunken cell
2. pyknotic nucleus
3. deeply eosinophilic cytoplasm
4. LOSS of Nissl substance
288
in terms of nissl substance, how can you differentiate an axonal reaction vs. apoptosis due to ischemic cell injury?
the nissl substance is lost in ischemic injury. it is just disbanded in axonal injury
289
loss of size and number of neurons would indicate that there was___?
compression atrophy
mass affect, ICP
290
infarcts of the anterior pons will affect what tracts?
corticospinal (pyramidal) tracts
corticobulbar tracts
pontine nuclei and pontocerebellar fibers
291
damage to the corticospinal tracts at the level of the pons =
CL hemiparesis and (+) babinski sign
292
damage to the corticobulbar tract
CL facial palsy and dysarthria
293
damage to the pontine and pontocerebellar fibers during damage to the pons
Ataxic hemiparesis:
- CL dysmetria
- CL dysdiadochokinesisa
part of cerebellar processes
294
difference between a lesion in the cerebellum and the pons?
in the cerebellum = ipsilateral deficit
in the pons = contralateral deficit at the basis pontis because at this level the fibers enter the cerebellum enter via the CL peduncle
295
what is the only CN that will present with a contralateral deficit?
the trochlear nerve - the only once to decussate before innervating its target.
296
Causes of Conductive hearing loss
- Cerumen impaction
- Cholesteatoma
- Otosclerosis
- External or middle ear tumors
- Tympanic membrane rupture
- severe otitis media
297
Causes of senorineural hearing loss
- congenital
- Meniere's Dx
- ototoxic drugs
(i. e. aminoglycosides)
298
ototoxic drugs
Aminoglycosides
299
Abnormal rinne test means that:
bone > air
conductive hearing loss
300
Abnormal Weber Test
the sound will localize to the affected ears, instead of being even in both ears:
conductive
301
Conductive hearing loss
a problem in the sound transduction mechanism, but not reception.
causes lateralization to the affected are as the conduction deficit masks the ambient noise in the room
302
sensorineural hearing loss
will cause laterlization to the unaffected ear as the unimpaired inner ear can better sense the vibration
303
Low Potency Typical Antipsychotic medication:
Sedation (H1 block)
Anti-ACh effects (ACh block)
Orthostatic Hypo-TN (alpha-1 block)
Ex:
Chlorpromazine
Thiroidazine
304
High Potency Typical Antipsychotic drugs:
```
EPSx: Due to D2 block
Acute Dystonia
Akathisia
Akinesia
Parkinsonism
```
Ex:
Haloperidol
Fluphenazine
305
Hyperglycemia as an anti-psychotic Rx - Most likely what class?
Atypical
| it is the most with Olanzapine
306
tabes dorsalis
due to tertiary neurosyphilis
occurs in < 10%
longest latency period, occurring 20-30 years post primary infection
spirochetes target the sensory dorsal roots, and eventually demyelinate and cause axonal damage in the DCML
307
```
Lancinating pains
paresthesias
loss of vibratory and position sense
arreflexia
Argyll Robertson pupils
(+) romberg sign
```
Loss of proprioception is compensated by visual cues - however with loss of night time vision - there will be stumbling
308
argyll robertson pupils
HIGHLY SPECIFIC SIGN FOR NEUROSYPHILIS
| pupils that are non-reactive to light but will constrict during accommodation
309
Meckel's diverticulum: Cause
how many GI layers
Failure to obliterate the omphalomesteric duct.
Has all three layers:
Mucosa, Submucosa, and Muscularis
310
Meckel's diverticulum: MC presentation
Painless Melena or with intestinal obstruction that causes RLQ pain
Bloody stools that are dark are due to the gastric acid that is being secreted into the lower GI tract (where it doesn't belong)
311
An inflamed Meckel's diverticulum can mimic___
Appendicitis
312
colicky Abd. pain
| "Red Current Jelly Stools"
Intussusception
313
Imperforate anus
Failure of Hindgut formation/ malformation
314
Neonate
failure to pass meconium
Bilious vomiting
Abd. distention
Hirschprung's Disease
315
MC Rx that cause ED
```
SSRIs
SNS blockers (clonidine, methyldopa, BB)
```
316
MC traumatic causes that lead to ED
Recent pelvic trauma
Prostate surgery
Priapism
317
MC met to the ovary
Gastric CA
| "Krukenburg Tumor"
318
Krukenburg tumor
Sister-Mary-Joseph Nodule
Virchow's node
Metastasis of Gastric CA
319
Periodic, Non-peristaltic contractions of the esophagus
Diffuse Esophageal Spasm (DES)
Several segments will contract at the same time, preventing peristalsis
Often painful (can mimic angina pectoris). Differentiated because the chest pain is not associated with exertion, and is not resolved by rest.
320
Pleuritic Chest pain
coughing
dyspnea
hemoptysis
PE
321
RUQ pain
Radiation to back/neck
worse with meals
cholecystitis
may also see:
fever
nausea
vomiting
322
Hydrocele
Collection of peritoneal fluid within the tunica vaginalis
the peritoneal tissue = processus vaginalis - if this fails to obliterate = increased risk for hydrocele that can even move up into the abdomen
323
HNPCC I vs. II
HNPCC I: Adenocarcinoma of the colon < 50 yo
HNPCC II: HNPCC I that can co-present (in same person or in family tree) with endometrial and ovarian CA, Stomach CA, Pancreatic CA, or urothelial tract + others
324
Cirrhosis
Kayser-Fleisher Rings
CNS involvement
Wilson's disease
325
```
cirrhosis
pancreatic fibrosis
DM
cardiomyopathy
secondary hypogonadism
```
Hemochromatosis
326
```
Urinary Retention
Prolonged QRS/QT interval
SZs
Orthostatic Hypotension
Tyramine Reaction
Sedation
Depression Rx
```
TCADs
327
clomipramine has a high side effect of:
SZs
it is a TCAD
328
```
patient is admitted for ____ badness___.
next day presents with:
- disorientation
- abdominal distention
- flapping tremor (asterixis)
- gynecomastia
- decreased liver span
```
Hepatic encephalopathy
329
What mediates all the symptoms of Hep. B infection, EXCEPT the hepatic s/sx
Immune complex deposition
330
```
sterility
thick mucous in lungs
pancreatic insufficiency
Mucous plugging of biliary ducts (leads to obstructive biliary cirrhosis), and salivary ducts
Frequent URIs
Bilateral sinusitis
Nasal polyps
```
CF
331
```
Calcinosis
Raynaud's (can lead to fingertip ulceration)
Esophageal dymotility
Sclerodactyly
Telangeictasia
```
CREST Syndrome
(+) anti-mitochondrial Ab.
Systemic sclerosis that involves the skin of the face and fingers
CD4 cells are induced to produce tons of collagen = excessive tissue fibrosis
Esophageal dysmotility is a resutlt of atrophy and fibrous replacement of esophageal muscles, and the LES will become atonic and dilated = severe reflux
332
Hepatomegaly
Abdominal pain
Ascites
Liver is grossly swollen, reddish purple with a TENSE capsule
Budd-Chiari Syndrome
Severe centrilobular congestion and necrosis are present
we are really worried about these patients getting in any hard contact in the liver = can break the capsule = hemorrhage
333
Normal liver with signs of portal HTN
pre-cirrhotic pathology
clot in the portal vein before the liver.
Ascites is uncommon, but esophageal ruptured varices are common
334
Fibrates inhibit what enzyme
7-alha-hydroxylase
| inhibits the production of cholesterol to bile salts, which has the potential to lead to cholesterol stones
335
epigastric pain
vomiting
EtOH in PSH
DDx: Pancreatic pseudocyst
MCL:
MCL: lesser peritoneal sac - bordered by the stomach, duodenum and transverse colon.
it will be posterior to the stomach
