Fall + Summer Comp Flashcards
(375 cards)
1
Q
Storage form of iron
A
ferritin, in liver (Fe2+)
2
Q
what type of iron is absorbed best?*
A
heme-iron (animal sources)
3
Q
nutrients required for proper iron absorption*
A
B12, Folic Acid, Copper, Vit C
4
Q
EPO is produced by
A
kidneys
5
Q
Thrombopoietin is produced by
A
liver and kidneys
6
Q
where are platelets stored?
A
20-40% in spleen
7
Q
Pelger-Huet anomaly - cell in peripheral blood smear
A
inherited blood condition where WBC have dumb-bell shaped nucleus
8
Q
poikilocytosis
A
variation in RBC shape
9
Q
Schistocyte
A
RBC fragment, characteristic of mechanical trauma
10
Q
anisocytosis
A
variation in RBC size
11
Q
Burr cells
A
aka echinocytes
associated with uremia, chronic renal disease
irregular short projections
12
Q
basophilic staining of rbc*
A
aggregates of ribosomes
13
Q
Inclusions in RBC*
A
basophilic staining: aggregates of ribosomes, many small dots
Howell-Jolly bodies: nuclear fragm after splenectomy, one dot*
14
Q
Peyer’s patches*
A
B cells in ileum (sm. intestines)
15
Q
NK cells
A
recognize non-self proteins, non-specific immunity
16
Q
Left shift/”Bandemia” *
A
higher number of immature WBC
serious infection
CBC: inc segments and bands
17
Q
aplastic anemia
A
bone marrow suppressed, no production
18
Q
segmented neutrophils, common in…?
A
bacterial infection
19
Q
most common anemia cause
A
iron deficiency
20
Q
haptoglobin
A
binds free HGB (after RBC taken apart) and recycles heme
21
Q
signs of anemia (later Sx, asymp initially)
A
fatigue, SOB, weakness
pallor: conjunctiva, mucosa, palmar creases
tachycardia
22
Q
Sickle Cell*
A
DNA point mutation in HGB Beta chain
smear: target + sickled cell
23
Q
what can uremic metabolite from renal failure cause?
A
decrease lifespan of RBC
24
Q
G6PD function
A
protects RBC from oxidative stress, genetic deficiency can cause anemia (episodic from triggers)
25
G6PD deficiency on smear
```
Heinz bodies: see early in acute phase, denatured Hgb
Bite cells (pac man): macrophage removing Heinz bodies
```
26
megaloblastic anemia
impaired DNA synthesis, cell grow w/o division
| folace, B12 deficiency
27
Schilling test
evaluates B12 deficiency (in meat/dairy)
28
B12 deficiency
permanent neuro damage if left untreated! (dementia Sx, numbness, glossitis)
affects posterior column first (vibra/propriocep)
can be immune problem
29
Folic acid deficiency
Sx rapid bc low body stores
leafy greens, animal products
NO NEURO SX
30
acute chest syndrome
LEADING CAUSE OF DEATH IN SC
new infiltrate w/pulm Sx
vaso-occlusion of sickle cell crisis, painful, episodic, from triggers
31
How does aspirin interfere w/clotting
irreversibly inhibits COX (cyclooxygenase I)
32
How does NSAIDs interfere w/clotting
reversibly inhibits COX (cyclooxygenase I)
33
clotting common pathway converts...
fibrinogen to fibrin
34
Where are clotting factors produced from?
all from liver
| EXCEPT VWF produced by megakaryocytes/endothelial cells - binds F8
35
Vitamin K dependent pro-coagulants*
Factors 2, 7, 9, 10 (production blocked by warfarin)
36
Vitamin K dependent anti-coagulant*
Warfarin
37
Factor V Leiden
overactive FVa, resistant to protein C
| Spontaneous DVT!
38
Number 1 cause of inherited thrombophilia***
Factor V Leiden mutation
39
most common hereditary bleeding disorder***
von willebrand's disease
40
Most significant effect of polycythemia vera
75% splenomegaly
41
intense itching after bathing
polycythemia vera, increased histamine release
42
Tx for polycythemia and hemochromatosis
phlebotomy
43
hemochromatosis
excessive iron destroys pancreatic islet cells--> insulin dependent diabetes
most serious effect: cirrhosis of liver
Sx occurs when Fe >10g
Dx w/serum transferrin
44
HEMOCHROMATOSIS TRIAD
Cirrhosis, DM, skin pigmentation
45
which immunoglobulin crosses placenta?
IgG (anti-AB, anti-D)
46
erythroblastosis fetalis
mom's AB attacks infant's RBC
| hemolytic dz of infants
47
hypersegmented neutrophils on smear*
megaloblastic anemia (B12 Pernicious)
48
idiopathic thrombocytopenia (ITP)
Almost immediate thrombolysis
49
what do basophils release?
heparin
50
hematologic cause of post-surgery numbness/tingling
normocytic anemia
51
presence of holly jowell bodies on smear
splenectomy
52
lead poisoning on smear
basophilic stippling
53
examples of type III hypersensitivity rxn
SLE, Arthus Rxn, farmer's lung, serum sickness
| cardinal finding: 90% rash
54
transfusion reaction is what type of hypersensitivity rxn
type II, hemolytic
55
How to prevent the spread of impetigo
wash hands
56
Dowling Degos Dz
reticulated macules, brownish black on flexures (axilla, groin, neck)
57
presentation of acute cutaneous rheumatoid arthritis
DIP spared
58
erysipelas
sharply demarcated red, superficial fiery red infection
59
scabies is characterized by
nocturnal pruritus
60
"spaghetti and meatballs" on KOH
tinea versicolor
61
"Blueberry muffin" lesion
Rubella: triad of cardiac, hearing, ocular
| from cutaneous hematopoiesis
62
Wart subtypes associated w/malignancy
6, 11, 16, 18, 31, 35
63
Most common subtypes assoc w/common warts
2, 4
64
rare CON of cryotherapy treatment of warts
"doughnut wart": recurrence around treated spot annually
65
most common subtypes of genital warts (condylomata acuminata)
>90% 6, 11
66
Molluscum Contagiosum on adult face
think HIV
67
Herpes Gladuatorum
on face, arm, neck, and upper trunk
| spread from contact sports
68
Gold standard for Dx of HSV
Tissue culture
69
tzanck smear
fast Dx of HSV but can't distinguish HSV1 or 2
70
Herpes Zoster
Shingles
| reactivation of varicella virus
71
"dew drops on roses"
varicella: vesicles, papules, ulcers, blisters
72
herpes zoster ophthalmicus affects which nerve
trigeminal
73
herpes zoster oticus (Ramsay Hunt) affects which nerve
facial nerve
74
Hand foot mouth disease
Coxsackievirus A16
Enterovirus 71
fecal oral
75
pitting of nails (looks like sandpaper scratched on nail)
Psoriasis
| could also be alopecia areata
76
Nail atrophy, "angle wings"
lichen planus
77
"Boggey", well-circumcised plaque on scalp
Kerion, caused by trichophyton tonsurans most common
| Tx: PO anti-fungal: griseofulvin
78
looks like ringworm on head
tinea capitis
Tx w/griseofulvin
children, living in crowded conditions
79
Actinic Keratosis
```
"Solar Keratosis"
precancerous, confined to epidermis
can become squamous cell carcinoma if extend to dermis
REMOVAL OF SCALE CAUSES BLEEDING!
tx: cryo, surgery, Tretinoin, 5FU
```
80
Basal cell carcinoma
80% of skin cancers
don't usually metastasize, locally destructive
most commonly NODULAR: sun-exposed area, umbilicated center, SHINY (Pearly), telangiectasis
81
Squamous Cell Carcinoma
```
strong risk of metastasis
precursor = AK (60%)
20% of skin cancers
hyperkeratotic lesion w/crusting and ulceration, necrotic center
Tx: <4mm deep ED&C, >4mm Mohs
```
82
Bowen's disease
squamous cell carcinoma in situ***
slow growing, red scaly plaques, grows horizontally
Tx: electrodessication and curettage, cryo, excision, 5FU
83
erythroplasia of queyrat*
almost exclusively in uncircumcised men**
| SCC in situ
84
Melanoma
rare but highest risk of metastasis and mortality
always obtain full thickness biopsy
Tx: wide excision to confirm margins and ree-excision to get full depth
85
Mucocutaneous rash of Lupus Erythematous
Malar rash: butterfly rash
discoid rash: "coin shaped"
subacute cutaneous
Acute cutaneous spares knuckles!
86
Dermatomyositis
```
rare but severe, affects muscle and skin
INVOLVES KNUCKLES
heliotrope erythema of eyelids
gottron's papules: on knuckles, joints, side of fingers
20-70% coincide w/internal malignancy!
Definitive Dx: muscle biopsy
Tx: 1st line high dose steroid taper
```
87
Scleroderma
CREST syndrome: calcinosis, raynaud's, esophageal dysfunction, sclerodactyly, telangiectasias; limited type, TIGHT skin
Systemic type can be fatal
88
Bullous Pemphigoid
thicker bulla, on flexor surfaces
| Tx: oral prednisone
89
Dermatitis Herpetiformis
Extensor surface
| ALMOST ALL W/GLUTEN SENSITIVITY ENTEROPATHY
90
Psoriasis
Extensor surface
immune mediated rapidly growing skin cells
Stress induced
Auspitz's sign: bleed when pick silver-white dry scales
Koebner's phenomenon: psoriasis at/shape of trauma
can get psoriatic arthritis: "pencil in a cup" collapsed joint space
91
Acute drug induced photoallergy can cause
stevens johnson syndrome
92
Melasma
area of dark pigmentation on women's face, darker skin types
93
Seborrheic Keratosis
looks like "stuck on mud"
benign, superficial
sudden increase can suggest malignancy
"stucco keratosis": small white-gray SK, pepper on dorsal foot of older fair skins
94
What are skin tags (acrochordons) a marker for?
insulin resistance and atherosclerosis
95
Tx of keloid
refer or intralesional steroid (topicals dont work), don't remove bc worst scarring
96
Wood's lamp
blue/green: fungus
| bright coral: bacterial
97
"one hand, two feet" syndrome
Tinea Pedis! (fine scaling w/creases)
98
Satellite lesions
yeast infection (Candida) - opportunistic
99
Koplik spots
Measles
100
Scarlet fever
Sandpaper quality on arms
Pastia's lines
desquamation
101
Fifth's Dz
erythema infectiosum, Parvovirus B19
| Slapped cheeks, reticular rash
102
Roseola Infantum
very high fever** (102, 104F) then rash (fine almond shaped)
| Febrile seizures common
103
Kawasaki Dz
Febrile >5days
cardiovascular main cause of mortality
Tx: ASA high dose
104
Eccrine (merocrine) gland
sweat, not w/hair follicle
105
Apocrine gland
thick milky fluid, w/hair
106
Lanugo hair
only on fetus
107
Macula Densa cells
sense low Na+, Cl-
signal to Juxtaglomerular cells
in distant convoluted tubules
NOT stimulated by high GFR***
108
Juxtaglomerular cells
IN WALL OF AFFERENT ARTERIOLE
SENSE LOW BP
Secrete Renin to inc Na+ absorption to inc BP
109
Angiotensin II
Vasoconstrict arterioles
| dec GFR. inc BP
110
ADH
Inc H2O reabsorption in DCT, inc BP
| during dehydration to decrease urine
111
Aldosterone
inc Na reabsorption, inc K secretion; inc BP
112
RAA System
dec BP/dec Na/sympathetic --> JG --> Renin splits angiotensinogen (liver) --> Angiotensin I --> Angiotensin II by ACE from lungs --> aldosterone
113
hemolytic uremic syndrome
hemolysis
thrombocytopenia
acute renal failure
114
gold standard test in DM/HTN to assess early glomerular dz
microalbumin test
115
red blood cell cast
glomerulonephritis
116
WBC cast
pyelonephritis
117
WBC in urine microscopy
bladder in fection
118
RBC in urine microscopy
bleed from ureter and down
119
Muddy brown cast
Acute tubular necrosis
120
LHU graduate GPA to be good standing
3.0
121
90% cause renal artery stenosis
atherosclerosis
122
"beads" on renal angiography
aneurysms of fibromuscular dysplasia, more prevalent in women
123
Hypertensive emergency
BP >180/120
124
Anasara
MASSIVE and generalized edema
125
nephrotic syndrome
extreme proteinuria (>3.5g/day) from glomerular damage that causes EDEMA
126
edema worst in the morning
Renal cause/hypoalbumin
127
Myxedema
thyroid
| causes facial edema
128
Edema that increases at end of day and better throughout night
Cardiac/dependent/cyclic causes
129
Signs of nephrotic syndrome*
Proteinuria: >3.5g.day
Hyperlipidemia: see fatty casts, inc hepatic synthesis
edema of legs/feet/ankle
Hypoalbuminemia
130
Gold standard test to Dx nephrotic syndrome
24hr Urine
131
Primary causes of nephrotic syndrome
Minimal changes Dz: 80% of childhood NS; good prognosis
Focal Segmental Glomerulosclerosis: poor prognosis
Membranous Glomerulopathy: 80% of NS in ADULTS
132
2nd causes of nephrotic syndrome
```
DM!!!
SLEO
Cancer
Amyloidosis
Malaria
Infections
```
133
Most common systemic Dz causing nephrotic syndrome
Diabetic glomerulosclerosis (DM I OR II)
134
Fatty casts and Oval fat bodies
Nephrotic Syndrome
135
Consequences of proteinuria*
```
immunocompromised
Hypercoagulable
Anemic
Hypothyroid
Dec Ca+/Vi D
HTN, Atherosclerosis
```
136
Features of Nephritic Syndrome*
```
Inflammation of glomeruli
HTN
Oliguria
Coca-Cola urine (hematuria)
Berger's disease (IgA nephropathy) --> most common cause of primary glomerulonephritis
```
137
#1 cause of acute kidney injury
chronic kidney dz
138
Dx for Acute kidney injury
inc creatinine, Dec urine output
139
Berger's Dz
IgA nephropathy --> IgA deposits in glomeruli
140
What Tx do you avoid in Acute Kidney Injury?
IV/PO K+ bc already hyperkalemia --> arrhythmias
| Tx w/IV Ca++ bc cardiac protective
141
Calcitriol
increases Ca absorption in small intestines
| secreted by kidneys
142
Primary causes of chronic kidney failure
Diabetes
| HTN
143
Sx of chronic kidney failure
fatigue, nausea, anorexia
| late: confusion, pruritus (from hyperphosphatemia), dry skin
144
Urinary calculi can cause
flank pain, infection, hematuria, N/V
| CVA tenderness
145
Presentation of stone within ureter
severe colicky pain, radiates to groin
146
Choice imaging study for renal stones*
Non-contrast CT abdomen/pelvis
147
Struvite stones are more common in...
women
see Staghorn Calculi*
UNDERLYING UTI
148
1st stone after 50yo
RARE, consider other causes
| consider abdominal aortic aneurysm if pt >60yo
149
Most common calculi
calcium oxalate
150
Crohn's Dz
Inflammatory Bowel Disease
151
Tx of stones
<5mm: pass on its own; Hydration, pain, alpha blocker in expulsive therapy
>5mm: urology consult OR struvite! (underlying UTI)
eswl (shockwave therapy): <2cm
152
Post-Strep glomerulonephritis
self-limiting
Sx: hematuria, upper body EDEMA, HTN, Hypo C3
Dx w/ C3/C4 test*
153
Most common glomerular hematuria
IgA nephropathy (Berger's dz):
HEMATURIA ATTACKS after non specific viral illness, exercise, or immunization
RECURRENT*
benight; supportive Tx
154
What diseases are most commonly associated w/glomerular dz?
DM, SLE
155
most common polycystic kidney disease
```
Autosomal dominant
in both kidneys and other organs
PKD1 mutation
Pain, HTN, hematuria
assoc risks: cerebral aneurysm, CAD, Cardiac hypertrophy
```
156
Most common infectious agent in pyelonephritis
E coli
157
Acute pyelonephritis in men
ALL CONSIDERED COMPLICATED bc high probability of tract anomalies, enlarged prostate
ALL NEED IMAGING
158
Tests for UTI
Leukocyte esterase test
| nitrite test
159
Painless, Gross hematuria is what until proven otherwise
CANCER
| also worry about cancer if pt >40yo
160
microscopic hematuria criteria
>/= 3 RBC
161
Highest risk factors for renal cancer
tobacco use
| occupational exposure
162
Imaging study for renal cancer
CT urography ub adults
| U/S in kids
163
Most common renal malignancy
90% renal cell carcinoma --> clear cell carcinoma most common type
164
Gold standard type of access for hemodialysis
AV fistula
165
complication of replacing sodium too fast
central pontine myelinolysis
166
Normal BUN:CREAT
20:1 or less
167
BUN 60's: Creat 1.8
prerenal azotemia
168
pseudo/isotonic hyponatremia
displaced by protein and lipids, inc osmotic force
| erroneous low sodium
169
Na <120
seizures and comas
170
ARPKD
liver fibrosis
171
lesion in lyme disease
Erythema chronicum migrans
172
BIG 5 TO RULE OUT W/CHEST PAIN**
```
acute coronary syndrome
aortic dissection
PE
Tension pneumothorax
Esophageal rupture
```
173
Chest Pain DDx*
```
Acute coronary syndrome
acute aortic dissection
mediastinitis
pericardial tamponade
pulmonary embolism
tension pneumothorax
```
174
Quick Estimate for rate in EKG
300, 150, 100, 75, 60, 50, 43, 38
175
Wolf-Parkinson-White Syndrome*
LAD, right-sided accessory pathway
SEE DELTA WAVE*
Shrt PR, Wide QRS
176
aortic ejection kick*
early systolic, just after S1
| aortic stenosis
177
opening snap*
```
early diastolic sound, just after S2
mitral stenosis (or tricuspid)
```
178
Anterior leads on EKG
V3,4
179
QRS UP in 1 and DOWN in AVF*
LAD
180
QRS down in 1 and DOWN in AVF*
Extreme RAD
181
"Party streamer" on EKG
Torsades de Pointes
182
"bag of worms" on EKG
V Fib; high freq, disorganized
| need immediate defibrillation, fatal 3-5min; ischemic heart disease
183
"coved" T wave on EKG
Brugada Syndrome type I
| Types II, III is "saddleback "
184
Commotio cordis
```
blunt blow ("precordial thump") to T wave cause V Fib and sudden death
avg age 15yo
```
185
LDL >190*
REQUIRE HIGH INTENSITY STATIN THERAPY
186
TRIGLYCERIDE LEVEL >1000MG/L*
RISK FOR PANCREATITIS
187
Paradoxical splitting
opposite of physiological splitting
| A2 FOLLOWS P2 during expiration
188
S4 Gallop
atrial contraction hitting a stiff noncompliant wall
"tennessee"
Hypertrophic Cardiomyopathy (HCM), LVH
189
Aortic ejection click
Early SYSTOLIC sound – Heard just after S1
abnormally shaped or stenotic aortic valve*
aortic stenosis
190
Opening Snap*
Opening of abnormal tricuspid or mitral valve
Early DIASTOLIC*** sound — Heard just after S2
mitral stenosis
191
what keeps HR lower than true intrinsic SA rate?
vagal tone dominant at rest
192
What grade of murmurs do thrills start?
Grade IV
193
Prinzmetal's Variant Angina*
occurs at rest, morning
coronary artery spasm WITHOUT plaques
can cause ventricular arrhythmias
194
Friction rub*
pericardial inflammation
195
Leaning forward and inspiration*
increase pericardial friction rub
196
Posterior wall leads EKG*
V1-2
197
Beck's triad for acute cardiac tamponade
JVD
low Arterial pressure
Muffled heart sounds
198
5 P's of acute limb ischemia*
```
Pain
Pulseless
Pallor
Paresthesias
Paralysis
```
199
What do you grow on Sabouraud's agar
Fungus
200
NEGATIVE Beta lactamase testing on culture plate
GOOD --> means not resistant
201
What fungal infection shows hilar adenopathy on CXR?
Histoplasmosis
202
What organism causes rheumatic fever, tonsil abscess?
S. pyogenes
203
Most virulent form of Hepatitis?
Hep B
204
What can high altitudes cause?
HAPE: pulmonary edema
HACE: cerebral edema
205
Absent cremaster reflex
testicular torsion
206
Follistatin mechanism
binds to activin to inhibit FSH
207
What is not a risk factor for testicular cancer?
Varicocele (reversible)
208
"Saxophone penis"
LGV
209
G6PD Triggers
Fava beans, Sulfa drugs
210
Trichinella can be found in...
Pork
211
itchy anus, scotch tape test
Enterobius vermicularis
212
What is present with 1/3 of patients w/Paget's disease of vulva?***
second neoplasm (cervical or vaginal)
213
What is cervical cancer strongly associated with?***
HPV***
214
Most common gynecologic malignancy***
endometrial cancer***
215
Endometrial cancer TRIAD***
Obesity
HTN
DM
216
What increases risk of endometrial cancer
increased estrogen
| nulliparity
217
Endometrial cancer Sx***
>60% abnormal uterine bleeding***
| uterus can be enlarged, hard, fixed
218
Ovarian cancer presentation***
ASYMPTOMATIC UNTIL WELL ADVANCED***
| symptoms don't become apparent until tumor compress/invade adjacent structures, ascites develop, or evident metastasis
219
What lab result is elevated in ovarian cancer?***
Ca-125 (postmenopausal women, advanced stage)
| ^serum tumor marker
220
Activin and Inhibin
produced by gonads
growth factor beta family
Inhibin: decreases FSH, +conversion: progesterone
Activin: increases FSH, + conversion: estradiol
221
Follistatin
inhibit FSH synth and release
inhibit FSH response to GnRH
binds to activin to inhibit
222
Metabolic Syndrome
cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels
223
Mesonephric duct
Wolffian, Male
224
Paramesonephric duct
Mullerian, Female
225
What are three developmental defects?*** (identify them)
agenesis: MRKH Syndrome
ex: mullerian duct doesnt develop --> no cervix, uterus, vagina, tubes
lateral fusion defects
vertical fusion defects: vagina and cervix abnormalities
226
Lateral fusion defects***
Mullerian ducts dont fuse --> various effects
227
unicornuate uterus***
destruction of one mullerian duct
almost aways MISSING KIDNEY AND URETER ON SAME SIDE***
pregnancy loss
228
Most common type of developmental defect***
septate uterus***
indented fundus
failure of reabsorption of septum
229
What should you check w/mullerian abnormalities?***
50% renal anomalies
| 12% skeletal
230
CAH
ambiguous genitalia
too little cortisol so ACTH increased --> too much androgens
also little aldosterone
231
What is PCOS at increased risk for?***
Endometrial cancer (3x)
232
What is NOT typical of PCOs?***
true virilization!
233
acanthosis nigricans*
discoloration of skin folds from hyperinsulinemia
| areas of dark, velvety discoloration in body folds and creases.
234
Detrusor instability/urge incontinence
losing all urine
| overstimulation of detrusor
235
Overflow incontinence
reduced sensation of full bladder, leaking
| cant stimulate detrusor
236
Genuine stress incontinence
leak urine
| trauma, pelvic prolapse, drugs relax sphincter
237
Triad of ectopic pregnancy***
amenorrhea
irregular vaginal bleeding
pelvic pain
238
Endometriosis
endometrial tissue outside of uterus
estrogen dependent, benign
in reproductive popu.
Ex: pelvis endometriosis, ovarian endometrioma, deeply infiltrating endometriosis
Sx: dysmenorrhea, dyspareunia, chronic pelvic pain
239
Adenomyosis
ectopic endometrial tissue grow down into myometrium
| perimenopausal women
240
Tx for both endometriosis and adenomyosis
hysterectomy 1st line
241
What age group is affected by vulvar cancer?
postmenopausal
242
Leukoplakia
white lesions
hyperkeratosis
avascularity
243
Vaginal pH of bacterial vaginosis or Trich?
>5.0
| fungal/physiological discharge <4.5
244
Do postmenopausal women get yeast infections?
No but can get atrophic vaginitis (vaginal inflammation from thinning of tissue, decreased lubrication
from low estrogen)
245
Lichen planus (psoriasis)*
inflammatory, autoimmune
| mucous mem.
246
Candida vaginitis
thick, curd-like vaginal discharge
| itching
247
Organism that common causes BV
Gardnerella vaginalis
248
"strawberry cervix"
trichomonas (women more symptomatic)
| 5%
249
Trichomonas SSx
copious discharge, can be frothy
| 50% irritation, dysuria
250
Leiomyoma v. adnexal masses
Leiomyoma: central/uterine
Adnexal: more lateral
251
Leiomyoma are dependent on what hormone?
estrogen
252
Rash of palms/feet: what do you think of?
Mono (EBV), rocky mountain spotted fever, Lyme, syphilis
253
puerpera
just gave birth
254
Climacteric
perimenopause
255
gravidity
pregnancy
256
What to rule out w/Chancroid by Haemophilus ducreyi
must rule out Syphilis and HSV
NOT chancre
chancroid: purulent base, bleeds easily
257
HSV SSx
painful blisters on genitals (butts, thighs)
more likely recurrent than zoster
Raw burning "cut"
258
LGV = lymphogranuloma venereum
elephantiasis, enlarged inguinal lymph nodes
259
Congenital syphilis presents with?
```
hutchinson teeth
saddle nose
frontal bossing
(eat away bones)
chancre
```
260
disseminated gonococcal infection has pain where?
joints and tendon
261
condyloma lata v condyloma accuminata
lata: flat, syphilis
accuminata: HPV
262
Reiter's disease
reactive arthritis
263
Gold standard Tx for BPH
trans urethral resection of prostate (TURP)
264
Low testosterone with low or low normal LH/FSH =***
secondary hypogonadism
265
withdrawal from what can be fatal?***
alcohol and benzodiazepines
| NOT opioids
266
what is the risk of too rapid rehydration and refeeding in eating disorders?*
risk of CHF* and edema
| significant risk of hypophophatemia (life threatening arrythmias)
267
stages of grief by Elisabeth Kubler Ross**
```
Denial
Anger
Bargaining
Depression
Acceptance
```
268
Takotsubo Cardiomyopathy*
stressed induced non-ischemic cardiomyopathy
usu. normal cardiac function within 2 months
"broken heart syndrome"
269
best values spirometry measures
Forced expiratory volume in one second (FEV1)
Forced vital capacity (FVC)
FEV1/FVC%
270
Obstructive pattern on PFT
DECREASED FEV1,
DECREASED FEF 25-75
Decreased FEV1/FVC - <70% predicted
271
DDx for obstructive lung dz
asthma
| COPD (chronic bronchitis, emphysema)
272
Restrictive pattern on PFT
Decreased TLC, FVC
| Normal or increased: FEV1/FVC ratio
273
significant bronchodilator response value
FEV1 increase by 12% AND >200ml
| asthma: >20%
274
what does spirogram measure
forced inspiratory and expiratory flow rate
gold standard
evaluate upper respiratory obstruction
275
lung volume patterns in obstructive dz*
TLC >120% PREDICTED
| RV >120% PREDICTED
276
lung volume patterns in restrictive dz*
TLC <80% PREDICTED
| RV <80% PREDICTED
277
What value is used to follow disease severity in COPD patients?*
FEV1
| marker for obstructive lung dz
278
Causes of COPD
Asthma; 10-30 fold increase risk
childhood respiratory infection
alpha 1-trypsin deficiency
279
Biggest risk for COPD
80-90% TOBACCO SMOKE
| VERY HIGH RISK if >40ppy
280
Pathophysiology of COPD
```
chronic irritation
airflow limitation/air trapping
gas exchange abnormalities
mucus hypersecretion
pulm vascular scarring from chronic inflammation --> pulm HTN --> R HF
PERMANENT
```
281
2 types of COPD
emphysema
chronic bronchitis
(often coexist)
282
Biggest symptoms of Chronic Bronchitis
excessive mucus --> cough
283
Acute Bronchitis
affects LARGE bronchi
| from virus/bacteria
284
Chronic Bronchitis
increase mucus and inflammation from hyperplasia/hypertrophy of goblet cells/mucus glands
affecting terminal bronchioles
285
Emphysema
permanent destruction of alveolar sac --> enlarged air spaces
286
Classic COPD Symptoms
chronic cough
sputum (purulent w/exacerbation)
breathlessness + fatigue, DOE
(and wheezing, chest tightness)
287
Late dz presentation of COPD
```
muscle wasting, weakness
pursed lip breathing**
R HF Sx: JVC, Peripheral edema, hepatomegaly
depression, anxiety
osteoporosis
polycythemia (inc epo from hypoxia)
```
288
Spirometry findings for COPD
FEV1/FVC <0.7 --> Dx
(reduced expiratory flow)
FEV1: stages/determines tx for COPD
289
how to distinguish asthma from COPD?
Do Pre/Post bronchodilator spirometry
| asthma will have post bronchodilator change, but NOT COPD
290
What do ALL COPD patients need?
flu and pneumococcal vaccine!
291
Characteristics of Asthma*
airflow obstruction
bronchial hyper-responsiveness
underlying inflammation
(attacks of impaired breathing)
292
Asthma cough characteristics
non-productive (dry)
episodic
worst at night*
293
Hyperkalemia*
increased amplitude and peaking in T wave
| hypokalemia: T flattening or inversion
294
How to objectively diagnose asthma?*
FEV1 increase 12% from baseline after SABA (reversibility)
| atleast 20% decrease in FEV1 after methacholine (bronchoprovocation test)
295
Transudative pleural effusion*
due to increased hydrostatic pressure or low plasma oncotic pressure
***causes: 90% CHF, cirrhosis, nephrotic syndrome, PE
296
Exudative pleural effusion*
due to inflammation and increased capillary permeability
| ***causes: pneumonia, cancer, TB, viral infection, PE
297
Lab differences between transudative and exudative fluid*
Transudative fluid: low in protein and LDH
| Exudative: high in protein and LDH
298
Causes of exudative pleural effusion***
malignancy: lung, breast, ovarian
infection: TB, bacterial pneumonia
PE
Chylothorax: lymph fluid accumulation
Hemothorax
GI dz
Collagen dz
299
Light's Criteria for exudative pleural effusion
1. pleural fluid protein/serum protein >0.5
2. or pleural fluid LDH/serum LDH >0.6
3. or pleural fluid LDH >2/3 normal upper limit of serum LDH
300
Biggest PE finding in Pleural Effusion*
dullness w/percussion
301
Lab results of pleural effusion w/malignancy*
pos cytology, need 3 diff samples
glu <60mg/dl
frank red fluid
302
Lab results of pleural effusion w/chylothorax*
milky fluid
| triglyceride >110 mg/dl*
303
Low glucose levels of pleural fluid
infections
autoimmune
malignancy
304
What is low pH of pleural fluid and malignancy associated with?
poorer prognosis
305
What can you get if you remove too much pleural fluid at once?
pulmonary edema
306
Interstitial lung disease
damage to alveolar walls and lung parenchyma from inflammation and resulting fibrosis
307
Hallmarks of interstitial lung disease
restrictive pattern on PFT
| decrease diffusing capacity for carbon monoxide
308
Most common type of interstitial lung dz*
idiopathic interstitial fibrosis - DLCO (diffusing capacity) reduced
309
"ground glass" on CXR
amiodarone
| Inflammation --> potentially reversible
310
"honey comb" on CXR
Fibrosis
| VERY POOR PROGNOSIS - IRREVERSIBLE
311
Pathology of idiopathic pulm fibrosis
triggering event --> inflammation --> damage alveolar-cap basement membrane --> inc perm --> FIBROSIS
312
characteristic of sarcoidosis
multiple uniform non-caseating granulomas (lungs and lymph nodes) - north american blacks*
large, "fluffy" nodules on CXR
most don't req treatment
313
What can you get with sarcoidosis*
iritis and uveitis*
314
Sarcoidosis staging*
Stage 0: normal
Stage I: Hilar adenopathy only
Stage II: Hilar adenopathy and parenchymal involvement
Stage III: parenchymal involvement alone
315
pneumoconiosis
hypersensitivity pneumonitis from inhaled dusts/chemicals (occupational)
316
what cancer can you get with asbestos
mesothelioma
317
Cotton pneumoconiosis****
Byssinosis***
318
mineral/stone pneumoconiosis****
silica - most toxic
319
shiparyward/contractors pneumoconiosis****
asbestos
320
Where do you relieve tension pneumothorax?***
2nd intercostal space
321
What is ineffective in ARDs?***
FiO2 ineffective
322
What is a cause of spontaneous pneumothorax?***
emphysema
323
Tracheal deviation of tension pneumothorax*
AWAY from side w/decreased breath sounds
324
most common risk factor of lung abscess?
alcoholism
| lung abscess 75% right side*
325
which side is more common in bronchiectasis?*
left*
326
what's the mean arterial pressure in pulmonary HTN*
>20mmHg at rest
327
Group 1 pulmonary HTN
pulmonary arterial HTN - RIGHT heart dz
328
Group 2 pulmonary HTN
pulmonary venous HTN - LEFT heart dz
329
What should you think w/dyspnea at rest AND pleuritic chest pain
PE
330
Which PE is more likely to cause pulmonary infarct and pleuritis*
segmental and subsegmental (branches)*
331
Clot in transit PE*
TRAVELS THROUGH HEART
| HIGH MORTALITY!!
332
RV thrombus has**
double mortality!!
333
cor pulmonale
right sided heart failure from pulmonary HTN (from chronic lung disease like COPD, OSA)
334
Massive PEs sign
systolic BP <90mmHg or drop in atleast 40mmHg from baseline
JVD
only 4% of PEs byt 20-60% mortality
335
Pathophysiology of cystic fibrosis
defect in CFTR gene --> abnormal Cl transport --> mucus more viscous/sticky to bacteria --> promote infection/inflammation
336
Dx of CF*
Dz in one or more organs
| >/= 60mmol/L sweat chloride**
337
Presentations of CF
Respiratory tract involvement
sinus dz: chronic nasal congestion
pancreatic dz: pancreatic insufficiency - fat malabsorption
meconium ileus: meconium obstruction, distal intest obstrunction syndrom (DIOS)
hepatobiliary dz: focal biliary cirrhosis
musculoskeletal dz: dec bone mineral desnity
reduced/infertility: >95% males infertile bc defect in sperm transport*** (absent vas deferens most common)
338
What do most patients eventually get w/CF*
Pseudomonas respiratory infection
339
How to differentiate between asthma and emphysema w/DLCO?
asthma: inc DLCO
emphysema: dec DLCO
(DLCO unaffected in Chronic bronchitis)
340
Ghon lesion
fibrotic, calcified lesion
contain: T cell, macrophage, central necrosis
Latent TB
341
Where do you first see calcifications in TB?
Apices
342
Mesial Temporal Sclerosis*
complex partial seizure pattern
| most common adult epilepsy
343
Lennox-Gastaut Syndrome*
Juvenile atonic seizures associated with severe developmental delay
344
Best imaging study for ischemia localization*
MRI
345
Cauda equina Sx*
urinary retention
346
What vascular system supports spinal cord?*
anterior and posterior vertebral artery
347
MoA of phenytoin*
decrease sodium in neurons by blocking na channels
348
What does kyphoplasty treat?*
vertebral compression
349
Tx for cluster HA*
O2, subQ sumatriptan
| prevention with: verapamil* (CCB)
350
idiopathic intracranial HTN (pseudotumor cerebri)
young obese women in childbearing years get
351
Polymyalgia rheumatica*
50% of those w/temporal arteritis
| pain/stiffness in neck that radiates to hip; steroid tx years; self resolves
352
Cluster HA characteristics
severe orbital, supraorbital/temporal pain
UNILATERAL
***Autonomic Sx: ptosis, miosis, lacrimation, conjunctival injection, rhinorrhea, nasal congestion
15-180 MINUTES
occur in clusters then remission
353
Cluster HA characteristics
severe orbital, supraorbital/temporal pain
UNILATERAL
***Autonomic Sx: ptosis, miosis, lacrimation, conjunctival injection, rhinorrhea, nasal congestion; horner's syndrome
15-180 MINUTES
occur in clusters then remission
354
Most common aneurysm*
Saccular aneurysm ("Berry")
355
How is Parkinson's Dz characterized clinically from other parkinsonisms
Asymmetric parkinsonism
| Clear/Dramatic benefit from dopaminergic therapy
356
essential tremor
worst w/action
| not parkinson's
357
how to confirm normal pressure hydrocephalus
beneficial response to Large volume CSF tap
improves gait, not cognition
"feet glued to floor"
358
tremor in Parkinson's
"pill rolling"
improves w/intention
presents unilaterally, can progress to bilateral
359
Cardinal symptom of PD*
Bradykinesia or Akinesia
progresses distal to proximal
classic shuffling gait w/unsteadiness
festination: quick short steps, "unwilling running pace"
360
primary neurochemical change in AD
Reduced amount of acetylcholine
| cholinesterase inhibitor used in treatment - Donepezil, galantamine and rivastigmine
361
cauda equina syndrome
compromised canal below L1
most commonly from herniated nucleus pulposus
urinary retention*, dec sphincter tone, Perineal/Saddle paresthesia
EMERGENCY*
362
radiculopathy
dysfunction of nerve root
Pain, sensory impairment, weakness, decreased DTR in a nerve root distribution
non-emergent, eg sciatica
363
how does pain decreased in spinal stenosis*
sitting or spinal flexion*
| (increase w/spine extension)*
364
ankylosing spondylitis
Inflammatory arthritis of the spine (Seronegative spondyloarthropathy)
squaring of vertebral bodies and syndesmophytes
can have fusion
365
what is ankylosing spondylitis characterized by?*
Morning stiffness, improved with exercises/activity**
pain wakes you up at night
can have extraskeletal manifestation: uveitis. psoriasis, IBD
366
steroid effect on lower back pain
NO EFFECT
367
Spondylosis
```
Osteoarthritis of the spine
“wear and tear” of the spine
Bone spurs
Disc space narrowing
morning stiffness
```
368
Spondylolysis
Defect or stress fracture in pars interarticularis
Most common at L5-S1
worry w/young HS athletes
"Scotty dog" on XRAY**
369
Spondylolisthesis
Defect or fractures of bilateral pars interarticularis resulting in slippage
370
Which posturing is commonly seen in pontine strokes*
decerebrate posturing
371
What is present w/true vertigo?*
nystagmus
372
Vestibular Neuritis*
Inflammation of vestibulocochlear nerve
usu. VIRAL AND SELF LIMITING
Occurs in healthy young people
PE: vestibular imbalance (veer toward affected side), horizontal nystagmus, positive head thrust test (eye moves)
373
labyrinthitis*
vestibular neuritis AND unilateral hearing loss
374
Paraphimosis*
Inability to return the retracted foreskin to its natural position covering the glans. --> EDEMA AND CONGESTION OF GLANS* --> PENILE NECROSIS
urologic emergency!!!
375
What severe pathology can Enterohemorrhagic E. coli cause?
hemorrhagic colitis and hemolytic uremia syndrome
