Random Flashcards
(573 cards)
1
Q
Reduced (10-30% of normal) UGT activity; indirect hyperbilirubinemia, usually asx/transient jaundice
A
Gilbert’s syndrome
2
Q
Autosomal recessive; none (Type I) or little (Type II) UGT activity; indirect hyperbilirubinemia
A
Crigler Najjar Syndrome
3
Q
MRP2 gene mutation; mild conjugated hyperbilirubinemia; grossly black liver; asx except with illness/pregnancy
A
Dubin Johnson Syndrome
4
Q
Similar to Dubin Johnson syndromes but milder + no black liver
A
Rotor’s Syndrome
5
Q
Gastrin secreting tumor —> HCL hypersecretion
A
Zollinger-Ellison syndrome
6
Q
Screening for HCC
A
Alpha-FP, US
7
Q
Rupture of distal esophagus after repeated, forceful vomiting
A
Boerhaave’s Syndrome
8
Q
Mucosa lower esophageal constrictions at squamocolumnar junction; associated with hiatal hernia
A
Schatzki Ring
9
Q
Pharyngoesophageal pouch/false diverticulum
A
Zenker’s Diverticulum
10
Q
AST>ALT
A
Alcoholic hepatitis
11
Q
ALT>AST
A
Viral hepatitis
12
Q
Post MI pericarditis
A
Dressler’s syndrome
13
Q
Meds that decrease mortality in HF
A
ACEi, ARB, BB, nitrates, hydralazine, spironolactone
14
Q
Electrolyte abnormalities in ACEi, loop diuretics, K-sparing diuretics, and thiazides
A
ACEi - hyperkalemia
Loop - hypOkalemia, hypOcalcemia, hypOnatremia, hyperglycemia, hyperuricemia
K-sparing - hyperkalemia
Thiazide - hypOnatremia, hypOkalemia, hyperglycemia, hyperuricemia
15
Q
Distant muffled sounds, increased JVP, hypotension
A
Beck’s triad, pericardial tamponade
16
Q
Heart swinging in fluid; ECG sign (pericardial effusion)
A
Electric alternans
17
Q
Signs of constrictive pericarditis
A
Pericardial knock
Kussmaul’s sign
Pulses paradoxus
18
Q
Signs of cardiac tamponade
A
Kussmaul’s sign
Pulses paradoxus
Beck’s triad
19
Q
Nonatherosclerotic inflammatory dx of small + medium arteries/veins; strongly associated with tobacco
A
Buerger Disease
20
Q
ECG: RBB pattern, ST elevation V1-V3, T wave inversion V1+V2; may cause syncope, v-fib, sudden cardiac death
A
Brugada syndrome
21
Q
Usually seen with lung SCC
A
Pancoast Syndrome
Hypercalcemia
Cavitary lesions
22
Q
Dilated neck veins, facial plethora, prominent chest veins, common in small cell lung cancer
A
SVC syndrome
23
Q
Shoulder pain, Horner’s syndrome, atrophy of hand/muscles; often seen in NSCLC (esp squamous cell)
A
Pancoast Syndrome
24
Q
Diarrhea due to increased serotonin; flushing, tachycardia, bronchoconstriction, hemodynamic instability
A
Carcinoid syndrome/tumor
25
Palpable edema and swelling of costal cartilages with costochondritis
Tietze syndrome
26
Criteria for exudates (Light’s criteria)
Pleural fluid protein >0.5
LDH for pleural fluid:serum >0.6 OR Pleural fluid LDH > 2/3 upper limit of normal LDH
27
Pneumonia, increased LFTs, GI sxs, hyponatremia
Legionella
28
PNA with cavitary lesions
S. Pneumonia
S. Aureus
Klebsiella
29
Gram + cocci in pairs
S. Pneumo
30
Gram + cocci in clusters
S. Aureus
31
Gram - rods
H. Flu
Klebsiella
Pseudomonas
32
Mississippi + Ohio Valley; bird/bat poop; PNA
Histoplasmosis capsulatum
33
PNA; southwest US soil
Coccidioides
34
PNA w abscess
S. Aureus
Klebsiella
Anaerobes
35
PNA w bullous myringitis
S. Pneumo
| Mycoplasma
36
PNA w/ rusty blood-tinged sputum
S. Pneumo
37
PNA with currant jelly sputum
Klebsiella
38
PNA with green sputum
H. Flu
| Pseudomonas
39
PNA w/ foul smelling sputum
Anaerobes
40
Causes of anion gap metabolic acidosis
```
Methanol
Uremia
DKA
Propylene Glycol
Izoniazid, infection
Lactic Acidosis
Ethylene Glycol
Rhabdo/
Renal failure
Salicylates
```
41
Causes of non-gap metabolic acidosis
```
Hyperalimentation
Acetazolamide
Renal Tubular Acidosis
Diarrhea
Ureto-pelvic shunt
Post-hypocapnia
Spironolactone
```
42
Causes of metabolic alkalosis
Vomiting
Diuretics
Post-hypercapnia
43
Causes of respiratory alkalosis
```
CNS disease
Hypoxia
Anxiety
Mech ventilators
Progesterone
Salicylates/Sepsis
```
44
Determining an acid base disorder
Look at pH
Look at PCO2: if going in opposite direction from pH —> respiratory
Look at HCO3: if going in SAME direction as pH —> metabolic
45
Age for Lung CA screen for smokers
55-80
46
Treatment for primary biliary cirrhosis
Ursodeoxycholic acid
| Cholestyramine
47
Copper acculturation in brain, kidney, cornea;
Wilson’s Disease
48
Periumbical ecchymosis; sign of pancreatic hemorrhage
Cullen’s sign
49
Flank ecchymosis; sign of hemorrhagic pancreatitis
Turner’s sign
50
Palpable, non-tender, distended gallbladder it’s associated jaundice (CBD obstruction); associated with pancreatic cancer
Courvoisier’s sign
51
Pancreatic tumor markers
CEA, CA-19-9
52
Painless rectal bleeding; may cause intussesception, volvulus, or obstruction
Meckel’s diverticulum
53
Current jelly stools, vomiting, colicky abdominal pain, sausage-shaped mass
Intussesception
54
Asthma, nasal polyps, allergy to aspirin
Samter’s triad
55
Hyperkeratosis, hemorrhage, hematologic (anemia)
Vitamin C deficiency
56
Peripheral neuropathy, symmetric impairment of sensory, motor, and reflexes, anorexia, muscle cramps, wasting
“Dry” beriberi (thiamine deficiency)
57
High output failure, dilated cardiomyopathy, edema (deficiency)
“Wet” beriberi (B1 deficiency)
58
Ophthalmoplegia, ataxia, global confusion
Wernicke’s encephalopathy
59
Memory loss and confabulation; thiamine deficiency
Korsakoff’s dementia
60
Lesions of mouth, magenta-colored tongue, angular cheilitis, pharyngitis, photophobia/corneal lesions, scrotal dermatitis
Oral-ocular-genital syndrome (B2/riboflavin deficiency)
61
Diarrhea, dementia, dermatitis
Pellagra (B3/niacin deficiency)
62
Autoimmune destruction of parietal cells that secrete intrinsic factor
Pernicious anemia (B12 deficiency)
63
Autosomal recessive; urine with musty/mousy odor; vomiting; mental retardation
PKU
64
Traveler’s diarrhea; drinking unsanitary water; watery diarrhea, abdominal cramping, vomiting
Enterotoxogenic E. Coli
65
RLQ pain with LLQ palpation; appendicitis
Rovsing sign
66
RLQ pain with internal and external hip rotation with bent knee; appendicitis
Obturator sign
67
RLQ pain with right hip flexion/extension; appendicitis
Psoas Sign
68
Tenderness at the point 1/3 the distance from the anterior superior iliac spine and navel; appendicitis
McBurney's point tenderness
69
Abdominal pain out of proportion to exam
Acute Mesenteric Ischemia
70
Chronic, dull abdominal pain that is worse after meals
Chronic Mesenteric Ischemia
71
Characteristics specific to ulcerative colitis (7)
```
Tenesmus
Bloody diarrhea
Primary sclerosing cholangitis
Toxic megacolon
Sandpaper appearance on endoscopy
“Stovepipe sign” - loss of haustra on barium study
+PANCA
```
72
Characteristics specific to Crohn’s disease (8)
```
Transmural
Weight loss
No visible blood usually
Perianal dx (fistulas, strictures, abscesses, granuloma)
B12 + Fe deficiency
Skip lesions w/ cobblestone appearance on endoscopy
“String sign” on barium
+ASCA
```
73
20y; autosomal dominant; polyposis; mucocutaneous hyperpigmentation; increased risk of CRC/ovarian CA
Peutz-Jehgers Syndrome
74
CRC biomarkers
CEA
75
Age for colonoscopy screening
Start at age 50, q10
Start at age 40 if relative >60y with CRC, q10
Start at age 40 if relative <60y with CRC, q5
76
Contaminated fried rice; incubation period 1-6h; vomiting, cramps, diarrhea
bacillus cereus
77
fecal/oral contamination; cramps lower abdominal pain, high fever, tenesmus, explosive mucoid/blood/watery diarrhea, leukocytosis (>50k);
shigella
78
contaminated milk, tofu, or pork; mimics appendicitis; invasive infectious diarrhea
yersinia enterocolitica
79
invasive; fecal-oral transmission from poultry products and exotic pets; abdominal pain, fever, cramping, "pea soup stools"; self-limited
salmonella gastroenteritis
80
invasive; fecal-oral transmission from poultry products and exotic pets; abdominal pain, fever, cramping, "pea soup stools", intractable fever, bradycardia, "rose spots"
typhoid fever (salmonella)
81
invasive infectious diarrhea; undercooked beef, unpasteurized milk, day care centers, contaminated water; bloody diarrhea, crampy abd pain, vomiting; cytotoxins
enterohemorrhagic E Coli
82
invasive infectious diarrhea; contaminated poultry, raw milk, water, dairy cattle; watery-->bloody diarrhea, fever, HA, abd pain; Guillan-barre syndrome
campylobacter jejuni enteritis
83
contaminated water from streams/wells; frothy, greasy, foul non-bloody diarrhea
giardia lamblia
84
GI colitis; liver abscess
amebiasis
85
farmers/contaminated soil; malabsorption, weight loss, steatorrhea, nutritional deficiency, arthritis, neurologic sxs
Whipple's disease
86
lesion seen in anterior shoulder dislocation; groove on humeral head
Hill-Sachs lesion
87
lesion seen in anterior shoulder dislocation; glenoid inferior rim fracture
Bankart lesion
88
common nerve injury in anterior shoulder dislocations
axillary nerve
89
rotator cuff tears are more common above what age? Whats more common in younger patients?
40
| tendonitis/subacromial bursitis/impingement
90
tests for impingement
supraspinatus strenght test ("empty can")
Hawkins (elbow/shoulder flexed @ 90)
Drop arm test (unable to lift past shoulder)
Neer test (thumbs down, forward flex)
91
What sensation should you check with FOOSH injuries?
deltoid to r/o brachial plexus injury
92
Management for humeral shaft fracture
sugar tong splint
93
What nerve should you check with humeral shaft fracture?
radial nerve; wrist drop
94
common signs of thoracic outlet syndrome
brachial plexus: pain/paresthesia, esp ulnar side
| subclavian vein/artery: swelling/discoloration/cyanosis
95
“Tram tracks” on CXR
| Or “signet-ring” sing on CT
Bronchiectasis
96
Side effects of HIV drugs
Rifampin - orange body fluids
Isoniazid - hepatitis and peripheral neuropathy
Pyrazinamide - hepatotoxicity and polyarthralgias
Ethambutol - optic neuritis
97
Most common electrolyte disturbance of sarcoidosis
Hypercalcemia
98
Treatment for pulm HTN
Sildenafil
99
Carcinoid tumor rx
Octreotide
100
anterior fat pad on xr
```
radial head fracture (adults)
suprachondylar fracture (peds)
```
101
complications of suprachondylar fractures
median/radial nerve + brachial artery injury
102
what nerve injury should you look out for in an olecranon fracture?
ulnar nerve
103
"goose egg" swelling near elbow with limited flexion
olecranon bursitis
104
proximal ulnar shaft fracture with anterior radial head dislocation
Monteggia fracture
105
mid-distal radial shaft fracture with dislocation of the distal radio-ulnar joint
Galeazzi fracture
106
"ivory white" calcified pleural plaques on CXR
asbestosis
107
lateral epicondylitis (inflammation of the extensor carpi radialis brevis muscle tendon)
tennis elbow
108
medial epicondylitis (inflammation of the pronator teres/flexor carpi radialis tendon)
golfer's elbow
109
what nerve/vessel injuries must be ruled out with a elbow dislocation?
brachial artery
| median/ulnar/radial nerve
110
lightly tapping (percussing) over the nerve to elicit a sensation of tingling or "pins and needles" in the distribution of the nerve; carpal/cubital/tarsal tunnel
Tinel's sign
111
make a strong pinch between the thumb and index finger and grip a flat object such as a piece of paper between the thumb and index finger; attempts to pull the object out of the subject's hands to test for CUBITAL tunnel
Froment's sign
112
cast for scaphoid fracture
thumb spica
113
distal radial fracture with dorsal/posterior ("dinner fork") angulation
Colles fracture
114
complication of Colles fracture
extensor pollicus longus tendon rupture
115
cast for Colles/smith fracture
sugar tong splint
116
distal radial fracture with ventral/anterior ("garden spade") angulation
smith's fracture
117
carpal bone injury with a "piece of pie" sign on AP XR or "spilled teacup" on lateral
lunate dislocation
118
avascular necrosis of lunate bone d/t lunate fracture
Kienbock's disease
119
cast for lunate fracture
thumb spica
120
autonomic dysfunction following bone/soft tissue injury; pain out of proportion, swelling, extremity color changes, increases nail and hair growth
complex regional pain syndrome
121
what prophylaxis is recommend for complex regional pain syndrome?
vitamin C for fractures
122
avulsion of extensor tendon; unable to straighten distal finger
mallet (baseball) finger
123
disruption of extensor tendon at base of middle phalanx --> hyper flexion of middle joint
Boutonniere deformity
124
ulnar collateral ligamental injury of the thumb; unstable MCP joint; thumb far away from digits
Skier's(acute)/Gamekeeper's(chronic) thumb
125
cast for gamekeeper's/skier's thumb
thumb spica
126
cast for boxer's fracture
ulnar gutter splint
127
intraairticular fracture through the base of the first metacarpal (MCP) bone
Bennet/Rolando Fracture
128
SALTER classification
```
S (I) - same
A (II) - above
L (III) - lower
T (IV) - through
R (V) - rammed/compression
```
129
tenosynovitis of abductor pollicus longus and extensor pollicus brevis; pain along radial aspect of wrist--> forearm
DeQuervain's tensynovitis
130
flex both wrists for 30-60 sec to reproduce carpal tunnel symptoms
Phalen's test
131
signs of carpal tunnel
Tinel's sign
Phalen's test
thenar muscle wasting
132
contracture of palmar fascia due to nodules/cords; fixed flexion at MCP joints
Dupuytren Contracture
133
treatment for Dupuytren contracture
steroid/collagenase injections, PT, surgery
134
main complications of hip dislocation
avascular necrosis
| sciatic nerve injury
135
difference in presentation between hip dislocation and hip fracture
dislocation: leg shortened and internally rotated
fracture: leg shortened and externally rotated
136
idiopathic avascular necrosis of femoral head in children 4-10 yrs old; painless limp, pain in hip/knee/groin, internal rotation of leg
Legg-Calve-Perthes Disease
137
hip disorder common in 7-16y old obese, male children; hip/thigh/knee pain with external rotation of leg
Slipped Capital Femoral Epiphysis
138
inward bowing of knees
vaLgus
139
outward bowing of knees
vaRus
140
sign of PCL injury
pivot shift test, posterior drawer test
141
sign of ACL injury
lachman's test, anterior drawer test
142
knee popping, locking, giving away, +McMurray's sign
meniscal tear
143
best xray view for patellar fracture
sunrise view
144
palpable defect above knee d/t quadriceps tendon rupture
patella baja
145
palpable defect below the knee d/t patellar tendon rupture
patella alta
146
important complication to look out for in tib-fib dislocation (which often reduces itself
popliteal artery rupture
147
sign of peroneal nerve injury
foot drop
148
pseudothrombophlebitis syndrome that mimics DVT
Baker's cyst rupture
149
common in runners; knee pain behind or around patella; worse with climbing or sitting; apprehension sign with patella pressure
patellofemoral syndrome
150
most common knee pain in runners; lateral knee pain
IT band syndrome
151
pain or resistant to adduction of leg parallel to table; IT band syndrome
Ober test
152
most common ligament damaged in ankle sprain
anterior talofibular collateral ligament
153
what are the Ottawa ankle rules?
ankle films: pain along lateral or medial malleolus
foot films: mid foot or 5th metatarsal/navicular pain
both: unable to walk >4 steps
154
spiral proximal fibular fracture d/t rupture of distal talofibular syndesmosis
Maisonneuve fracture
155
fracture of distal tibia from impact with talus
Pilon (tibial plafond) fracture
156
post tibial nerve compression from overuse or restrictive footwear; pain numbness @ medial malleolus, heel, and sole
tarsal tunnel syndrome
157
diabetic foot
Charcot's joint
158
painful mass near tarsal heads; reproducible pain on palpation + mass
Morton's neuroma
159
transverse fracture through diaphysis of 5th metatarsal
Jones fracture
160
triggers for G6PD
infections, stress, fava beans, aspirin, and other drugs.
161
A condition causing red blood cells to break down in response to certain triggers leading to fever, dark urine, abdominal and back pain, fatigue, and pale skin
G6PD
162
disruption of the articulation between the medial cuneiform and the base of the 2nd metatarsal +/- metatarsal fractures
Lisfranc injury
163
most common site for herniated disc
L5-S1
164
tests for herniated disk
straight leg raise
165
signs of a herniated disk at L4
anterior thigh pain
weakness with ankle dorsiflexion/knee extension
loss of knee jerk
166
signs of a herniated disk at L5
lateral thigh/leg, hip, and groin pain/parasthesia
| weakness with big toe extension
167
signs of a herniated disk at S1
posterior leg/calf and plantar foot pain/parasthesia
weakness with plantarflexion
loss of ankle jerk
168
new onset bowel retention/incontinence, saddle anesthesia, bilateral leg pain, decreased anal sphincter tone
cauda equina syndrome
169
what alleviates/worsens spinal stenosis?
worsens: extension, prolonged standing
alleviates: flexion, sitting/walking uphill
170
scoliosis, cafe au lait spots, skin tags, axillary freckles
neurofibromatosis
171
measurement of the severity of scoliosis
Cobb's angle (>10=scoliosis)
172
defect in pars interarticularis of spine from repetitive hyperextension
spondylolysis
173
forward slipping of vertebrae on another
spondylolithesis
174
most common organism seen in acute osteomyelitis in newborns (<4mos)
GBS
175
most common organism seen in acute osteomyelitis in children (>4mos) as well as general acute/chronic osteomyelitis
S. Aureus
176
most common organism seen in acute osteomyelitis in those with sickle cell disease
salmonella
177
most common organism seen in acute osteomyelitis in those with puncture wound or IVDU
pseudomonas
178
most common organism(s) in septic arthritis
S. Aureus
N. Gonorrhea (sexually active young adults)
Strep
179
what amount of WBCs from an arthrocentesis would be considered a septic joint?
>50K
180
what pressure is diagnostic of compartment syndrome?
>30-45mmHg
181
bimodal distribution; bone pain/swelling; "sun ray burst" on XR; mixed sclerotic/lytic lesions
osteosarcoma
182
which is the malignant tumor: osteosarcoma or osteochondroma?
osteosarcoma
183
most common in children/males; bone pain/joint swelling; "onion peel" appearance on XR
Ewing's sarcoma
184
pedunculate benign bone tumor that often grows away from bone
osteochondroma
185
autosomal dominent; abnormal bone remodeling; high ALP (normal Ca + phos), bone pain, stress fracture or warmth, DEAFNESS, headache; COTTON WOOL appearance of skull on xray
Paget's disease
186
treatment for Paget's
bisphosphanates and calcitonin
187
diagnostic tests fo SLE
ANA (non-specific)
| Anti-dsDNA + anti-smith (specific but not sensitive)
188
associated with SLE; may cause frequent miscarriages, livedo reticularis (discoloration of skin); increased risk of arterial and venous thrombosis
antiphospholipid ab syndrome (APLS)
189
calcinosis cutis, Raynaud's, esophageal motility d/o, sclerodactyly, telangectasia
CREST syndrome (limited cutaneous systemic sclerosis)
190
treatment for Raynaud's
CCB (amlodipine)
191
diagnostic tests for scleroderma
anti-centromere ab (CREST/limited cutaneous)
anti-scl-70 ab (diffuse cutaneous/multi-organ involvement)
ANA (non-specific)
192
treatment for scleroderma
DMARD (methotrexate)
| CCB (for Raynaud's)
193
diagnostic tests for Sjogren's
```
ANA
antiSS-A (Ro)
antiSS-B (La)
RF
Schirmer test (decreased tear production)
```
194
treatment for Sjogren's
artificial tears, pilocarpine (cholinergic)
195
treatment for fibromyalgia
TCA
SSRI
Cymbalta
Exercise
196
progressive symmetrical proximal muscle weakness, dysphagia, skin rash, polyarthralgias, muscle wasting
polymyositis
197
diagnostic tests for polymyositis and dermatomyositis
aldolase, CK (muscle enzymes)
anti-Jo 1 Ab (specific)
anti-SRP Ab (polymyositis)
Anti-Mi-2 Ab (dermatomyositis)
198
HELIOTROPE (blue/purple) eyelid discoloration, GOTTRON's papule (knuckles), malar rash (INCLUDING nasolabial folds), "SHAWL or V sign"
dermatomyositis
199
fever, joint pain, malaria rash SPARING nasolabial folds
SLE
200
triggers for gout attack
purine-rich foods (alcohol, oily fish, yeasts), diuretics, ACEi/ARBs, HIV meds, aspirin
201
arthrocentesis finding indicative of gout
negatively birefringent NEEDLE-shaped urate crystals
202
acute management of gout
NSAIDS (indomethacin), colchicine, steroids (if severe)
203
chronic management of gout
allopurinol (inhibits xanthine oxidase), colchicine
204
calcium phosphate deposition in joints; most commonly in knee
pseudogout
205
arthrocentesis finding indicative of pseudogout
positively birefringent RHOMBOID-shaped crystals
206
treatment for pseudogout
steroids, NSAIDS, colchicine (prophylaxis)
207
symmetric MCP/PIP/wrist/knee/MTP/shoulder/ankle joint pain, worse with REST, morning joint stiffness, boutonniere/swan neck deformities
RA
208
diagnostic tests for RA
RF (initial)
anti-cetrullinated peptide ab (specific)
ESR,CRP
209
triad of RA + splenomegaly + low WBC
Felty's syndrome
210
pneumoconiosis + RA
Caplan syndrome
211
treatment for RA
DMARDs, NSAIDs, steroids
212
DIP/thumb/knee/hip/spine pain, worse with ACTIVITY, evening joint stiffness
osteoarthritis
213
XR RA vs osteoarthritis
osteo: osteophytes, ASYMMETRIC joint space loss
RA: osteopenia, SYMMETRIC joint space loss
214
daily arthritis, high fevers, SALMON-colored migratory rash, hepatosplenomegaly, lymphadenopathy, pericardial/pleural effusions, hepatitis
systemic juvenile idiopathic arthritis
215
important part of managing juvenile idiopathic arthritis
frequent eye exams to check for iridocyclitis
216
labs notable for rhabdomyolysis
increased CPK >20k
increased LDH, ALT
hyperkalemia
hypocalcemia
217
main complication of rhabdo
acute tubular necrosis
218
list the large, medium, and small vessel vasculitis syndromes
large: GCA, takayasu
medium: kawasaki, polyarteritis nodosa
small: eosinophilic GPA, wegeners GPA, microscopic polyangitis, HSP
219
large vessel vasculitis that affects aorta, aortic arch, and palm arteries; usually follows illness; can cause MI, TIA, CVA, HTN crisis, lower extremity claudication, aneurysms; diminished pulses, bruits, asymmetric BPs, cool extremities
Takayasu arteritis "pulseless disease"
220
treatment for Takayasu arteritis and GCA
high dose corticosteroids
221
most common in children; conjunctivitis, polymorphous rash, arthritis, cervical lymphadenopathy, strawberry tongue
Kawasaki disease
222
complications of Kawasaki
coronary artery aneurysms, MI
223
treatment for Kawasaki
IV IgG + high dose aspirin
224
systemic vasculitis of medium/small arteries; microaneurysms ; associated with HBC/HCV; HTN, renal failure, fevers, myalgias, neuropathy, livedo reticularis
polyarteritis nodosa
225
small vessel vasculitis with asthma, hypereosinophilia, chronic rhinosinusitis
eosinophilic granulomatosis with polyangiitis (EGPA or Churg Strauss)
226
which syndromes are P-ANCA positive?
EGPA, microscopic polyangitis, UC/PSC
227
which syndromes are C-ANCA positive?
Wegener's
228
small vessel vasculitis; necrosis of nose, lungs, kidney; URI and LRI sxs, SADDLE-NOSE deformity, glomerulonephritis (hematuria, proteinuria)
Wegener's (GPA; granulomatosis with polyangiitis)
229
treatment for Wegener's and microscopic polaynagiitis
steroids + cyclophosphamide
230
small vessel vasculitis that affects arterioles, venules, and capillaries; purpura, cough, dyspnea, hemoptysis, acute glomeronephritis
microscopic polyangiitis
231
IgA vasculitis; IgA deposition into skin + kidney most common in children; palpable purpura, abdominal pain, arthritis, hematuria; SELF-LIMITING
Henoch-Schonlen purpura
232
IgG Ab against type IV collagen in glomerular basement membrane + alveoli; often post URI; HEMOPTYSIS + glomerulonephropathy
Goodpasture's syndrome
233
treatment for Goodpasture's syndrome
steroids + cyclophosphamide
234
asymmetric inflammatory arthritis, conjunctivitis/uveitis, urethritis; seen with chlamydia
Reiter's syndrome (reactive arthritis)
235
back stiffness (esp morning), better with activity, peripheral arthritis, sacroiliitis; "BAMBOO spine" on XR
ankylosing spondylitis
236
marker for ankylosing spondylitis, reactive arthritis, and psoriatic arthritis
HLA-B27
237
asymmetric "sausage digits"; sacroiliitis, pitting of nails, chronic uveitis; "pencil in cup" deformity on XR
psoriatic arthritis
238
bitemporal hemianopsia
optic chiasm lesion
239
total blindness of ipsilateral eye
optic nerve or retina lesion
240
homonymous hemianopsia
contralateral optic tract lesion
241
nasal hemianopsia
ipsilateral LATERAL optic chiasm lesion
242
2 common conditions associated with blepharitis
Down's syndrome
| eczema
243
non-tender eyelid swelling; larger, firmer and less painful than stye/hordeolum
chalazoin
244
redness to nasal side of lower lid; lacrimal gland infection
dacrocystitis
245
signs of an orbital floor (maxillary, zygomatic, palatine) fracture
decreased visual acuity
diplopia (esp w/ upward gaze)
orbital emphysema
246
treatment for orbital floor fractures
nasal decongestants
prednisone
clinda/unasyn
ophtho referral
247
gradual bilateral/blurred loss of central vision + color vision; DRUSEN (diffuse, small, round, yellow-white spots on outer retina)
macular degeneration
248
central vision loss/blindness, COTTON WOOL spots, neovascularization
diabetic neuropathy
249
floaters, flashing lights, progressive unilateral vision loss, shadow "CURTAIN" vision loss in peripheral-->central pattern
retinal detachement
250
decreased vision, pain with ocular movements, proptosis; most common in children; associated with URI
orbital cellulitis
251
most common organisms in orbital cellulitis
S. pneumo, GABHS, H. Flu, S. Aureus
252
acute UNILATERAL peripheral vision loss; unilateral ocular pain; halos around lights; "steamy cornea"; "cupping" of optic nerve; increased IOP (>21)
acute narrow-angle glaucoma
253
treatment for acute narrow-angle glaucoma
acetazolamide (decreases aqueous humor production)
BB (timolol)
cholinergic (pilocarpine)
iridotomy
254
gradual BILATERAL peripheral vision loss; tunnel vision
chronic open angle glaucoma
255
treatment for chronic open angle glaucoma
```
prostaglandin analog (latanoprost)
BB (timolol)
```
256
treatment for allergic conjunctivitis
olopatadine (topical antihistamine)
257
common organisms in NEONATAL infectious conjunctivitis
day 2-5: gonorrhea
day 5-7: chlamydia
day 7-11: HSV
258
pain, photophobia, reduced vision, hazy cornea; rapidly progressing; sight-threatening
keratitis
259
what is optic neuritis most commonly associated with?
multiple sclerosis; autoimmune
| ethambutol (HIV med)
260
unilateral color vision loss; visual field defects; ocular PAIN worse with eye movement; papillitis
optic neurtitis
261
treatment for optic neuritis
IV methyprednisone
262
unilateral ocular pain/redness/photophobia; blurred/decreased vision; associated with systemic inflammatory diseases
uveitis
263
acute, sudden, monocular vision loss; pale retina with cherry-red macula
central retinal artery occlusion
264
treatment for central retinal artery occlusion
```
no good treatment options
acetazolamide (decrease IOP)
ocular massage
thrombolysis
anterior chamber paracentesis (drop pressure to dislodge clot)
```
265
acute, sudden, monocular vision loss; extensive retinal hemorrhages ("blood & thunder" appearance)
central retinal vein occlusion
266
most common pathogen in otitis EXTERNA
pseudomonas
267
most common pathogens in otitis INTERNA (as well as acute sinusitis)
S. pneumo
H. flu
Moraxella
S. pyogenes (GAS)
268
which two conditions are associated with malignant otitis externa?
DM
| immunocompromised
269
unilateral hearing loss, tinnitus, HA, facial numbness, disequilibrium
acoustic/vestibular neuroma (CN VIII)
270
episodic vertigo, NO hearing loss; worse with head position changes; horizontal nystagmus
Benign Paroxysmal Positional Vertigo
271
continuous vertigo, N/V, ear pain, +/- fever; vestibular (CN VIII) neuritis + hearing loss/tinnitus
Labyrinthitis
272
treatment for labyrinthitis
steroids
| meclizine (antihistamine, antiemetics)
273
hearing loss, tinnitus, ear fullness, episodic vertigo (lasting min/hrs), horizontal nystagmus
Meniere's Disease
274
treatment for Meniere's disease
meclizine (antihistamine, antiemetic)
HCTZ
avoid salt, caffeine, chocolate, EToH
275
graduation tissue that over time erodes ossicles, painless otorrhea, vertigo, brown/yellow discharge with strong odor from ear
cholesteatoma
276
salivary stones
sialolithiasis
277
salivary gland infection
sialadenitis
278
treatment for sialadentitis/sialithisasis
sialogogues
279
ducts involved in sialolithiasis
Wharton's duct
| Stenson's duct
280
LACY white lesions of oral mucosa; associated with HCV
oral lichen planus
281
white patchy oral lesions that canNOT be rubber off; painless; precancerous
oral leukoplakia
282
non-painful, "feathery" white plaque in oral/buccal mucosa that canNOT be scraped off; associated with EBV and immunocompromised
oral hairy leukoplakia
283
white, curd-like plaques that bleed when scraped off; associated with immunocompromised
oral candidiasis (thrush)
284
diagnostic method for Candida albicans infection
KOH smear
285
treatment for thrush
nystatin
286
most common pathogens in peritonsillar abscesses
GAS
S. Aureus
polymicrobial
287
cellulitis of the sublingual and submaxillary spaces in the neck; most commonly from dental infections; swelling/erythema of upper neck/chin + pus on floor of mouth
Ludwig's Angina
288
can be used for abortion up to 9 weeks of GA
mifeprostone + misoprostol
289
can be used for abortion up to 7 weeks of GA
methotrexate + misoprostol
290
can be used for abortion at 4-12 weeks of GA
D&C
291
can be used for abortion at 13-24 weeks of GA
D&E (dilation and evacuation)
292
amenorrhea d/t increased prostaglandins
primary dysmenorrhea
293
amenorrhea d/t pelvic pathology
secondary dysmenorrhea
294
management for premenstural dysphoric disorder
fluoxetine/sertraline/SSRI
| OCP
295
absence of spontaneous mentruation before age 15
primary amenorrhea
296
absence of menses for 3 (previously regular) or 6 (previously irregular) menses
secondary amenorrhea
297
What is the cause of premature ovarian failure and what disorder is it related to?
follicular failure to produce E/P or resistant to LH/FSH
| Turner's syndrome
298
What is the progesterone challenge?
tests estradiol levels
10mg medroxyprogesterone x10days
+bleeding = enough estrogen
299
scarring of uterine cavity secondary to postpartum or D&C or infection
Asherman's syndrome
300
treatment for Asherman's syndrome
estrogen
301
endometrial tissue within myometrium; SYMMETRIC, SOFT, TENDER, "boggy" uterus; menorrhagia, dysmenorrhea
adenomyosis
302
45X0, short webbed neck, no breast development, premature ovarian failure (high FSH/low estrogen)
Turner Syndrome
303
46XX, no breast development, amenorrhea, low FSH/low LH
HPA insufficiency
304
46XY, normal breast development, high T, amenorrhea
androgen insensitivity
305
most common pathogens in endometritis/chorioamnioitis
GAS
| S. Aureus
306
"chocolate cyst" on laparoscopy
endometriosis
307
GnRH analog
Leuprolide
308
What TVUS finding is indicative of endometrial cancer/hyperplasia?
endometrial stripe >4mm
309
risk factors for endometrial cancer
nulliparity, chronic anovulation/PCOS, obesity, estrogen replacement therapy, tamoxifen
310
thin, yellow vaginal discharge, pH >5.5, pruritis
atrophic vaginitis
311
estrogen modulator; used for infertility
clomiphene
312
urine leakage due to increased intrabdominal pressure
stress incontinence
313
treatment for stress incontinence
kegal exercises, biofeedback
| midodrine (increases urethral sphincter tone)
314
urine leakage accompanied by preceding urge; urgency/frequency, nocturia; OVERACTIVE detrusor muscle
urge incontinence
315
treatment for urge incontinence
bladder training
tolterodine (bladder relaxant)
oxybutynin (antispasmodic/anticholinergic)
316
urinary retention/incomplete emptying; UNDERACTIVE detrusor muscle or bladder outlet obstruction
overflow incontinence
317
treatment for overflow incontinence
catherterization
| bethanacol (cholinergic, increases detrusor activity)
318
alpha blocker used for BPH; decreases urethral resistant
tamsulosin
319
risk factors for ovarian cancer
```
family hx
infertiliy
nulliparity
>50y
BRCA1/BRCA2
PROTECTIVE: OCPs, high party
```
320
ovarian cancer mets to umbilical lymph nodes
Sister Mary Joseph's node
321
serum marker for ovarian cancer
CA-125
322
Diagnostic labs for PCOS
increased testosterone
increased DHEA-S
increased LH:FSH 3:1
323
treatment for PCOS
```
OCP
spironolactone
leuprolide
clomiphene (for fertility)
metformin
```
324
which cancer/condition is linked to DES exposure?
clear cell cervical cancer and vulvular cancer
| cervical insufficiency
325
thin, grey vaginal discharge, fishy odor, pH >5
bacterial vaginosis
326
diagnostic lab for bacterial vaginosis
clue cells on KOH prep
327
frothy, yellow/green vaginal discharge, strawberry cervix, pH >5
trichomoniasis
328
thick, curd-like/cottage cheese vaginal discharge
candida vulvovaginitis
329
diagnostic lab for candida vulvovaginitis
hyphae, yeast on KOH prep
330
PAINFUL genital ulcer caused by H. Ducreyi
chancroid
331
"CAULIFLOWER LIKE" lesions (condyloma acuminata), genital warts
HPV
332
PID + hepatic fibrosis/scarring (perihepatitis; RUQ pain)
Fitz-Hugh Curtis Syndrome
333
what is the most common pathogen in toxic shock syndrome
S. Aureus (enterotoxins)
334
most common pathogens in cystitis/pyelo
E. coli
| Staph Saprophyticus
335
What levels of WBC in UCx is needed to diagnose a UTI?
>100k
336
hypoestrogenic/hyperandrogenic medication for endometriosis
danazol
337
estrogen antagonist in breast, agonist in bone/endometrium
tamoxifen
338
what is a beta-HCG >100k indicative of?
molar pregnancy
339
At what week are pregnancy women screened for gestational diabetes? With which test?
24-28
50g oral glucose challenge; >130 --> 3hr test
100g GTT (3hrs); 2/3 hours must be high
340
when is Rhogam given?
at 28 weeks + within 72 hours of delivery
341
meds to delay preterm delivery
terbutaline (b2 agonist)
| magnesium sulfate
342
med for morning sickness/hyperemesis gravidarum
pyroxidine (B6)+doxylamine
343
BP meds safe in pregnancy
hydralazine*
methyldopa (weak BP med)
labetalol
nifedipine
344
hemolytic anemia, elevated liver enzymes, low platelets ; often associated with severe preeclampsia
HELLP syndrome
345
what are the delivery windows for gestational diabetes? preeclampsia? chronic HTN?
GD: 38 weeks
Preeclampsia: 34-36 weeks
Chronic HTN: 39-40 weeks
346
When is a pregnancy woman screened for GBS?
32-37 weeks
347
What does APGAR stand for?
```
Appearance/color
Pulse
Grimace
Activity
Respiration
*scores 0-2
```
348
medications to give during postpartum hemorrhage
oxytocin
| misoprotsol
349
what common conditions/tumors are seen in MEN I/II?
I: hyperparathyroidism, pituitary tumors, pancreatic tumors
II: hyperparathyroidism, pheochromocytoma, medullary thyroid cancer
350
What is the main cause of secondary hyperparathyroidism?
chronic kidney failure (can't convert vitamin D --> stimulates PTH)
351
clinical signs of hyperparathyroidism (hypercalcemia)
strones, bones, abdominal groans, psychic moans
DECREASED deep tendon reflexes
shortened QT interval
352
clinical signs of hypocalcemia
Trousseau + Chvostek sign
increased deep tendon reflexes
prolonged QT interval
353
treatment for hypercalcemia
furosemide
| calcitonin
354
treatment for osteoporosis
vitamin D
high impact exercise
bisphosphonates
Raloxifene (selective estrogen receptor modulator)
355
sever osteoporosis, blue sclerae, presenile deafness
osteogenesis imperfecta
356
bone pain, muscle weakness, bowing of legs, "looser lines" on XR
osteomalacia + ricketts
357
bone pain, muscle weakness, bowing of legs, but high phos and "salt and pepper" skull on XR
renal osteodystrophy
358
treatment for Addison's disease (1ry) and 2ry adrenal insufficiency
1ry: glucocorticoids (hydrocortisone) + mineralocorticoids (fludrocortisone
2ry: glucocorticoids
359
common lab abnormalities in adrenal crisis
hyponatremia, hyperkalemia, hypoglycemia
360
adrenal aldosteronoma
Conn syndrome
361
most common cause of secondary hyperalosteronism (d/t increased renin)
renal artery stenosis
362
signs of hyperaldoseronism-induced hypertension
hypokalemia
| diastolic more elevated than systolic
363
proteinuria, hypoalbuminemia, hyperlipidemia, edema, +/- periorbital edema (children), anemia, DVT, FROTHY URINE
nephrotic syndrome
| *hyplipidemia/anemia/DVT is a result of low protein --> liver compensates by creating lipoproteins
364
associated with viral infections; mostly children; nephrotic syndrome with NO cellular changes but + podocyte damage on electron microscope
minimal change disease
365
treatment for minimal change disease
prednisone
366
nephrotic syndrome associated with sclerosis/fibrosis of the glomerulus; associated with HTN (esp AA)
focal segmental glomerulosclerosis
367
nephrotic syndrome associated with thickened glomerular basement membrane due to immune complex deposition (SLE, viral hepatitis, etc); most common in white male >40
membranous nephropathy
368
diagnostic test for nephrotic syndrome
24h urine collection with >3.5g/d of protein
| OVAL FAT BODY on miscropscopic examination of urine
369
HTN*, hematuria (RBC CASTS, "coco-cola colored" urine), proteinuria, AZOTEMIA (elevated BUN)
acute glomerulonephritis
370
usually 1-days post-URI or GI infection; IgA deposits in kidney --> glomerulonephritis
IgA nephropathy (Berger Disease)
371
cola-colored dark urine, puffy eyes, facial edema; post-pharyngeal/impetigo infection
post-infectious glomerulonephritis
372
diagnostic labs for post-infectious glomerulonephritis
anti-streptolysin titers
| low complement
373
treatment for IgA nephropathy/Berger disease/rapidly progressive GN/SLE GN
ACEi
| corticosteroids
374
diagnostic test for acute glomerulonephritis
UA (RBC casts, proteinuria)
BUN/Cr (elevated)
renal biopsy
375
clinical differences between nephrOtic and nephritic/glomerulonephritis
nephrotic: glomerular damage; hyperlipidemia, pleural effusion/DVTs, frothy urine, FATTY CASTS/oval fat bodies
nephritic: immune-mediated; azotemia, hematuria, HTN, oliguria, AZOTEMIA, RBC CASTS
376
usually from prerenal AKI or aminoglycosides; epithelial and MUDDY BROWN casts on UA; hyperkalemia, hyperphosphatemia
acute tubular necrosis
377
treatment for ATN
IV fluids, remove offending agents
378
Intrinsic AKI; inflammatory/allergic; most commonly caused by PCN, NSAIDS, sulfa drugs; fever, eosinophilia, urine esosinophiles, rash, WBC casts
acute tubulointerstitial nephritis
379
what do WAXY casts on UA indicate?
chronic ATN or ESRD
380
what do WBC casts on UA indicate?
AIN (acute interstitial nephritis)
| Pyelonephritis
381
what do MUDDY BROWN casts on UA indicate?
ATN
382
what do RBC casts on UA indicate?
vasculitis or acute glomerulonephritis
383
What other complications are associated with polycystic kidney disease?
cerebral "berry" aneurysms
| mitral valve prolapse
384
most common cause of HYPOphosphatemia
primary hyperparathyroidism
385
most common cause of HYPERphosphatemia
renal failure (then primary hypOparathyroidism)
386
diagnostic test for CKD
GFR and spot UAblumin/UCreatinine Ratio (ACR)
387
diagnostic test for diabetes insipidus
fluid deprivation test
| desmopressin stimulation test
388
equation for serum osm; what is a normal serum osm?
2Na [+ (Glu/18) + (BUN/2.8)]
| normal: 285-295
389
diagnostic labs for testicular cancer
alpha-fetoprotein
| beta-hcg
390
most common organisms for UTI/pyelo
E. Coli
staph saprophyticus
enterococci (if indwelling catheter)
391
most common organisms for prostatitis
E. Coli
Pseudomonas
G/C in men <35y
392
treatment for BPH
finasteride (5-alpha reductase inhibitor)
| tamsulosin (alpha blocker; increases urinary outflow)
393
clinical signs of renal cell carcinoma
```
hematuria
flank/abdominal pain
palpable mass
L-sided varicocele
HTN
Hypercalcemia
```
394
most common renal tumor in children; painless, palpable abdominal mass, hematuria, HTN, anemia
Wilm's tumor (nephroblastoma)
395
treatment for nephrolithiasis
<5mm: IV fluids, analgesics, tamsulosin
>7mm: shock wave lithotripsy, uretoscopy/stent
>10mm/struvite: percutaneous nephrolithotomy
Uric stones: alkalize urine >6.5
396
treatment for priapism
terbutaline (vasoconstriction)
phenylephrine (vasoconstriction)
needle aspiration
397
dopamine agonists used in Parkinson's (younger patients to delay levodopa use)
bromocriptine
| pramiprexole
398
treatment for Tourett's
dopamine-blocking agents (haloperidol, risperdone)
399
post-infection immune response (usually campylobacter, CMV, EBV, GI/URI) leading to demyelination; lower --> upper parasthesias/weakness
GBS
400
diagnostic test for GBS
CSF with high protein and normal WBC
401
treatment for GBS
plasmaphoresis
| IVIG
402
autoimmune antibody against ACh receptors; progressive weakness with muscle use, ptosis, weakness with chewing; can progress to respiratory failure
myasthenia gravis
403
diagnostic tests for myasthenia gravis
ice pack test
| +ACh-receptor antibodies
404
treatment for myasthenia gravis
pyridostigmine/neostigmine (ACh-esterase inhibitor)
| plasmapheresis/IVIG for MG crisis
405
what are some clinical signs of MS?
weakness, paresthesias, fatigue, **TRIGEMINAL NEURALIA**, OPTIC NEURITIS
Uhthoff's phenomenon (worsening of sxs with heat/exercise)
Lhermitte's sign (neck flexion --> lightening-shock pain down spine)
406
diagnostics tests for MS
MRI w/ contrast: white matter plaques
| CSF: increased IgG
407
nystagmus, staccato speech, intentional tremor
Charcot's triad (associated with MS)
408
treatment for MS
acute: steroids, plasma exchange
| relapse/progressive: beta-interferon
409
treatment for cluster HAs
acute: 100% O2
prophylaxis: verapamil
410
treatment for migraine HAs
triptans, metoclopramide (for nausea), propanolol
411
diagnostic test for pseudotumor cerebri
CT scan FIRST to r/o mass
| LP
412
treatment for pseudotumor cerebri
acetazolamide (diuretic)
413
treatment for trigeminal neuralgia
carbamazepine (tegretol), gabapentin
414
what are the main pathogens associated with Bell's palsy?
HSV, VZV, lyme
415
treatment for Bell's palsy
prednisone, artificial tears, acyclovir
416
Bell's palsy caused by VZV
Ramsey-Hunt Syndrome
417
CN responsible for inferior rectus (moving eye down)
CN III
418
CN responsible for superior oblique rectus (moving eye to look down+in)
CN IV
419
CN responsible for lateral rectus (lateral gaze)
CN VI
420
most common pathogens in bacterial meningitis (based on age)
<1mos: GBS
1mos-18y: N. Meningitidis (assc with petechial rash); S. Pneumo
18y-50y: S. Pneumo, N Meningitidis
>50y: S. Pneumo, Listeria
421
inability to straighten knee with hip flexion; sign of meningitis
Kernig's sign
422
neck flexion produces knee/hip flexion; sign of meningitis
Brudzinski's sign
423
CSF findings in viral vs. bacterial meningitis
bacterial: high protein, high WBC (neutrophils), low glucose
viral: high protein, high WBC (leukocytes), normal glucose
424
most common causes of VIRAL meningitis
echovirus, coxsackie
425
most common causes of VIRAL enchephalitis
HSV-1
426
mild form of depression that lasts for >2 yrs
dysthymic disorder
427
What is buspirone used to treat?
GAD (1st line SSRI)
428
What is a major contraindication for bupropion/Wellbutrin?
seizure d/o
429
What is are some important complications of MAOIs?
MAOI + tyramine: HTN crisis
MAOI + SSRI: serotonin syndrome
MAOI + TCA: delirium + HTN
430
what are the various clusters of personality disorders?
A: weird, odd eccentric
B: dramatic, emotional, impulsive
C: anxious, fearful, dependent
431
personality disorder: social withdrawal, hermit-like behavior, prefers to be alone, flat affect, "cold"
schizoid personality disorder
432
personality disorder: odd, eccentric, peculiar thought patterns WITHOUT psychosis, "magical thinking", discomfort with close relationships
schizotypal personality disorder
433
personality disorder: distrustful, suspicious, easily insulted, preoccupation with loyalty
paranoid personality disorder
434
personality disorder: deviates sharply from norm, harmful, volatile, **violates the rights of others**, sets fires, harms animals, may begin as conduct disorder in child
anti-social personality disorder
435
personality disorder: unstable, unpredictable, **mood swings, moments of intense anger; unable relationships, cannot tolerate "being alone"
borderline personality disorder
436
personality disorder: overly emotional, dramatic, seductive, attention-seeking
histrionic personality disorder
437
personality disorder: grandiose often excessive sense of self-importance, needs praise and admiration, entitled, lacks empathy, Trump
narcissistic personality disorder
438
personality disorder: desires relationships but avoids them; "inferiority complex", timid, shy, lacks confidence
avoidant personality disorder
439
personality disorder: submissive behavior, constantly needs to be reassured, relies on others, will not initiate things
dependent personality disorder
440
personality disorder: perfectionist, requires a great deal of order and control, preoccupied with minute details
obsessive-compulsive personality disorder
441
meets criteria for schizophrenia but <6mos duration
schizophreniform disorder
442
schizophrenia + mood disorder
schizoaffective disorder
443
paranoid delisions about things that could happen in real life
delusional disorder
444
>6 mos duration, functional decline + 2 of the following: hallucinations, delusions, disorganized speech, disorganized/catatonic sxs, negative sxs
schozophrenia
445
negative vs positive sxs of schizophrenia
negative: flat emotional affect, social withdrawal, lack of emotional expression/communication (insufficient dopamine)
positive: hallucinations, delusions, disorganized speech, movement disorders (excess dopamine)
446
treatment for schizophrenia
clozapine, risperidone, olanzapine
447
physical symptoms but no physical cause found; preoccupation with medical/surgical therapy
somatization disorder
448
neurologic loss of sensory or motor function; caused by psychological factors
conversion disorder
449
preoccupation with the fear or belief that one has a serious, undiagnosed disease
illness anxiety disorder (hypochondiasis)
450
persistent pattern of negative, hostile, defiant behavior, hyperactivity, blames others
oppositional defiant disorder
451
social and academic difficulty, lack of remorse, sets fires, harms animals, sexually uninhibited; <18y
conduct disorder
452
purple, polygonal, planar, pruritic papule with fine scales; or lacy lesion of oral mucosa; immune response
lichen planus
453
herald patch, salmon-colored macule/papule, Christmas tree pattern
pityriasis rosea
454
treatment for pityriasis rosea
none
455
treatment for lichen planus
topical steroids
456
silver/white scales, raised, dark red plaques, nail pitting, **punctuate bleeding with removal of plaque; SAUSAGE DIGITS, PENCIL-IN-A-CUP DEFORMITY
psoriasis
457
treatment for psoriasis
high dose steroids, UVB light therapy
458
overgrowth of Malassezia yeast; fine scaling with hypo/hyper pigmentation; "spaghetti and meatball" appearance on KOH
pityriasis versicolor
459
usually over sebaceous glands (scalp, face, eyebrows, body folds); erythematous plaques with fine white scales; "cradle cap" in infants; usually due to a fungus
seborrheic dermatitis
460
treatment for seborrheic dermatitis
selenium sulfide or ketoconazole
461
most common drugs to cause hypersensitivity reactions
abx, NSAIDS, allopurinol, thiazide diuretics
462
acute/self limiting rash, often due to infections (HSV) or drugs (sulfa, beta-lactams); dusty-violet target lesions
erythema multiforme
463
sloughing of skin, often a reaction to drugs (sulfa) or infection (mycoplasma); <10% of body
Steven-johnson syndrome
464
sloughing of skin, often a reaction to drugs (sulfa) or infection (mycoplasma); >30% of body
toxic epidermal necrolysis
465
sign of a blistering skin condition; skin will slough off with touch
Nikolsky sign
466
treatment for rosacea
metronidazole, clonidine (for flushing)
467
most common with prolonged sun exposure; may be pre-cancerous; dry, rough, "sandpaper" skin, hyperkeratotic plaques
actinic keratosis
468
small papule/plaque, velvety warty lesion "grease/stuck on appearance"
seborrheic keratosis
469
treatment for seborrheic keratosis
none
470
common cause of plantar and genital warts (chondyloma acuminata)
HPV
471
diagnosis of HPV (wart)
whitening of lesion with acetic acid
472
PAINFUL, self-limited, inflammatory nodule on anterior shins; usually due to estrogen exposures (OCPs, pregnancy), sarcoid, infections/inflammatory disease
erythema nodosum
473
most common skin cancer type; slow growing, translucent, PEARLY, WXY papule with central ulceration and raised rolled borders
basal cell carcinoma
474
skin cancer often preceded by actinic keratosis, HPV infection; most common in lips, hands, neck, and head; red, elevated nodule, white scaly or crusted bloody margins
squamous cell carcinoma
475
aggressive skin cancer, ABCDE; most common skin cancer death
malignant melanoma
476
self-limiting; single or multiple DOME_SHAPED, flesh-colored/pearly white, waxy papule with central umbilication, *POX VIRUS*
molluscum contagiosum
477
treatment for lice
permethrin shampoo
478
treatment for scabies
permethrin topical
479
treatment for tinea captitus, tinea barbae, tinea pedis, tinea corporis
griseofulvin or topical antifungal
480
urticarial plaques, tense bullae that don't rupture easily; no Nikolsky sign; treated with steroids
bullous pemphigoid
481
classification for minor and major burns
minor: <10% TBSA adult, <5% children, does not involve face hands/feet, perineum, joints, circumferential
major: >25% adult, >20%children
482
treatment for keloids
corticosteroid injections
483
high fever 3-5 --> rose pink maculopapular blanch able rash trunk/back --> face; caused by HHV6/7
Rosealo (sixth's disease)
484
fecal oral spread esp late summer/early fall; vesicular lesions on reddened base on hand/foot/mouth, mild fever, URI sx
coxsackie
485
two complications of coxsackie
pericarditis/myocarditis
| pleurodynia (severe CP with swelling over diaphragm)
486
strongly associated with celiac disease; IgA complex deposition into dermal papillae; pruritic, papulovesicular rash on extensor surfaces and scalp
dematitis herpetiformis
487
low grade fevers, myalgia, HA, painful parotid gland swelling; sometimes associated with orchitis and acute pancreatitis in children; paramyxovirus
mumps
488
high fever, cough, coryza, conjunctivitis, Koplik spots, brick-red maculopapular rash on face beginning at hairline-->extremeties/palms/soles; paramyxovirus; main complication is otitis media
rubeola (measles)
489
fever, cough, anorexia, lymphadenopathy, pink/light-red spotted maculopapular rash face --> extremities, joint pain, photosensitivity; togavirus
rubella (German measles)
490
"blueberry muffin rash", sensorineural deafness, cataract, mental retardation, heart defects
rubella during 1st trimester
491
pathogens of TORCH syndrome
```
Toxoplasmosis
Other (syphilis, VZV, HIV, fifths disease)
Rubella
CMV
HSV
```
492
coryza, fever, "slapped cheek", lacy rash on extremities, spares palms and soles; sometimes associated with arthropathy; parvovirus B19
erythema infectiosum (fifth's disease)
493
most common side effect of vancomycin
"red man's syndrome"/flushing
494
most common side effect of macrolides (azithromycin)
prolonged QT
495
most common side effect(s) of fluoroquilolones
tendon rupture, QT prolongation
496
most common side effect of clindamycin
c.diff colitis
497
most common side effect of tetracyclines (doxy)
teeth discoloration (do not give to pt <8), photosensitivity
498
most common side effect of PCN/cephalosporins
allergic reaction, nephrotoxicity
499
painless black eschar on exposed skin areas, rapidly progresses to dyspnea/shock, medistinum widening on CXR
anthrax
500
transmitted by cat/cat litter; mono-like illness that can lead to encephalitis and chorioretinitis; RING-ENHANCING LESIONS ON HEAD CT
toxoplasmosis
501
diagnostic test for HSV
PCR, Tzanck smear
502
diagnostic test for CMV
antigen tests, "owl's eye" appearance on bx
503
Which virus is associated with Hodgkin's lymphoma?
EBV
504
What is a complication of fifth's disease/eryhtema infectiosum in patients with sickle cell?
aplastic crisis
505
skin eruptions at the SAME STAGE simultaneously; flu-like sxs
small pox/variola
506
prophylaxis for HIV patients with CD4 200-500
INH (tuberculosis)
507
prophylaxis for HIV patients with CD4 <200
Bactrim (PCP)
| Itraconazole (histoplasmosis)
508
prophylaxis for HIV patients with CD4 <100
Bactrim (toxoplasmosis)
| Cryptococcus (Fluconazole)
509
prophylaxis for HIV patients with CD4 <50
azithromycin (MAC)
| valganciclovir (CMV retinitis)
510
At what CD4 count is HAART initiated?
<350 (or viral load >55k)
511
"dew drops on a rose petal"; rash in different stages simultaneously
chicken pox
512
strawberry tongue, sandpaper rash, facial flushing, Forchheimer spots
Scarlet fever
513
Blood smear: RBCs stick together like a "stack of coins: (Rouleaux formation)
multiple myeloma
514
macrocytosis on blood smear
B12/folate deficiency
Liver dx
aplastic anemia
515
microcytosis on blood smear
iron deficiency anemia
thalassemia
lead poisoning
516
Howell-Jolly bodies on blood smear (small, dense RBC inclusions)
patient with splenectomy
517
Blood smear: bite cells (bite like mark on cells from phagocytes)
thalassemia
| G6PD
518
Blood smear: schistocytes
```
mechanical RBC damage
hemolytic anemia (TTP, HUS, DIC)
```
519
Blood smear: target cells (hypo chromic RBC with round area of central pigment)
sickle cell, thalassemia, Hgb SC
520
Blood smear: tear-shaped cells/dacrocytes
thalassemia, hemolytic anemia
521
Blood smear: ringed sideroblasts, basophilic stippling (blue granules in RBC)
lead poisoning
522
electrolyte abnormalities in reseeding syndrome
hypokalemia, hypophosphatemia, hypomagnesium
523
Blood smear: burr cells
uremia
524
Blood smear: Auer Pod
AML
525
Blood smear: smudge cell
CLL
526
Blood smear: reed-sternberg cell
Hodgkin lymphoma
527
Main causes of vitamin B12 deficiency
pernicious anemia, EToH, Crohn's, veganism, PPI
528
MACROCYTIC ANEMIA; pallor, glossitis, stomatitis, GI sxs, peripheral neuropathy
B12 deficiency anemia/pernicious anemia
529
diagnostic test to look for B12 deficiency
Schilling test
530
ileocecitis, pseudoappendacitis, common in Scandinavia and Europe
Yersinia enterocolitica
531
```
microcytic
decreased serum Fe
decreased ferritin
increased TIBC
decreased transferrin saturation
```
iron deficiency anemia
532
what should you consider in a patient that has microcytic anemia with normal Fe and no response to iron supplementation?
alpha or beta thalassemia
533
treatment for moderate/severe alpha thalassemia
moderate: folate, avoid oxidative stress
severe: blood transfusions, deferoxamine, BMT
534
when do patients become symptomatic with B-thalassemia and why?
at 6 months, the fetal hgbF wears off
535
treatment for severe beta-thalassemia
weekly transfusions, deferoxamine, BMT
536
microcytic hypo chromic anemia with basophilic stippling, ringed sideroblasts in bone marrow, abdominal pain, constipation, neuro sxs, fatigue, learning disabilities
lead poisoning
537
normocytic anemia
decreased serum Fe
increased ferritin
decreased TIBC
anemia of chronic disease
538
```
normocytic, hemolytic anemia
schistocytes
increased reticulocytes
increased indirect bili
decreased haptoglobin
```
G6PDD
539
defect in RBC membrane --> sphere-shaped cells, anemia, jaundice, splenomegaly, Coombs negative
hereditary spherocytosis
540
what can cause a prolonged PTT?
heparin, DIC, vWD, hemophilia A+B
541
what can cause a prolonged PT?
warfarin overdose, vitamin k deficiency, DIC
542
immune-mediated; thrombocytopenia, microangiopathic hemolytic anemia, kidney failure/uremia, neurologic sxs, fever; NORMAL COAGS
Thrombotic Thrombocytopenic Purpura
543
treatment for Thrombotic Thrombocytopenic Purpura
plasmapheresis (to remove ab), steroids
544
usually preceded by enterohemorrhagic E. coli, shigella, or salmonella GASTROENTERITIS*; thrombocytopenia, microangioapthic hemolytic anemia, kidney failure
hemolytic uremic syndrome
545
treatment for hemolytic uremic syndrome
usually self limiting but plasmapheresis if severe
546
triggered by infections, malignancies, or obstetric conditions; elevated PTT/PT/INR, decreased fibrinogen, severe thrombocytopenia, elevated D-dimer
DIC
547
when to transfuse platelets
<20k
548
isolated thrombocytopenia (normal coags); most common post viral infection in children; immune-mediated; mucocutaneous bleeding, purpura, bruises, petechiae, bullae
idiopathic/autoimmune Thrombocytopenic Purpura
549
treatment for idiopathic/autoimmune Thrombocytopenic Purpura
children: observation, IVIG
adults: corticosteroids, IVIG
550
most in males, prolonged PTT, normal PT/platelets -- corrects with mixing study; excessive hemorrhage in response to trauma, hemarthrosis, epistaxis, bruising
Hemophilia A (factor 8) or Hemophilia B (factor 9)
551
treatment for Hemophilia A+B
factor 8/9 infusion
| desmopressin for HEMOPHILIA A ONLY* (transiently increases factor 8)
552
bleeding with minor cuts, mucocutaneous bleeding, easy bruising, epistaxis, petechiae, prolonged PTT
von willebrand disease
553
treatment for moderate/severe von willebrand disease
desmopressin, cryoprecipitate
vWF + Factor VIII prior to procedures
avoid aspirin
554
what causes a prolonged PT? PTT? Bleeding time?
PT: vit k deficiency, DIC
PTT: hemophilias, vWF def, DIC
Bleeding time: thrombocytopenia, vWF def, DIC
555
lymphocyte neoplasm; bimodal (peaks at 20y + 50y); assoc with EBV; painless lymphadenopathy, hepatosplenomegaly, CYCLIC FEVERS, night sweats, weight loss; Reed-Sternberg cell
Hodgkin's lymphoma
556
lymphocyte neoplasm; mostly peripheral, in old pt and immunocompromised; painless lympadenopathy, splenomegaly, B symptoms rarer
Non-Hodgkin's lymphoma
557
neoplasm associated with monoclonal Ab proliferation; BREAK = bone pain/bone lytic lesions, recurrent infections, elevated calcium, anemia, kidney failure
multiple myeloma
558
diagnostic labs for multiple myeloma
SPEP (IgG/IgA spike), UPEP (Bence-Jones proteins: kappa or lambda), skull xray with "punched out lesions"
559
treatment for multiple myeloma
stem cell transplant, chemotherapy
560
childhood leukemia; pancytopenia, fatigue, petechiae, bruising, lethargy, bone pain, CNS sxs, hepatosplenomegaly, LAD; HYPERCELLULAR BM w/ >20% BLASTS
acute lymphocytic leukemia
561
treatment for ALL
chemo (highly responsive)
562
B clonal malignancy, >50y adults; often asx and diagnosed on blood tests; peripheral smear with well-differentiated lymphocytes and scattered "SMUDGE CELLS"
chronic lymphocytic leukemia
563
treatment for CLL
observant if indolent or PO chemo
564
most common in adults >50y; anemia, thrombocytopenia, neutropenia, splenomegaly, gingival hyperplasia; AUER RODS >20% BLASTS IN BONE MARROW
acute myeloid leukemia
565
treatment for AML
chemotherapy, BMT
566
treatment for tumor lysis syndrome
allopurinol
567
signs of tumor lysis syndrome
hyperkalemia, hyperuricemia, hyperphosphatemia, hypOcalcemia, acute renal failure
568
most asx until they develop BLAST CRISIS (acute leukemia); strikingly elevated WBC and LDH, splenomegaly; associated with PHILADELPHIA CHROMOSOME
chronic myeloid leukemia
569
translocation between chromosome 9 + 22; CML
Philadelphia chromosome
570
overproduction of all 3 cell lines; JAK2 mutation; hyperviscosity, pruritis (ESP IN HOT BATH*), splenomegaly, flushed face
polycythemia vera
571
treatment for polycythemia vera
phlebotomy, hydroxyurea
572
autosomal recessive; increased iron absorption and storage; cirrhosis, cardiomyopathy, bronze skin
hereditary hemochromatosis
573
which hemophilic conditions cause hypercoagulability (increased DVTs and PEs)?
factor V leiden mutation
protein C deficiency
antithrombin III deficiency
