Week1 Lectures Flashcards
(112 cards)
1
Q
___ (3) are reabsorbed in the kidney
A
Na+, Cl-, water
2
Q
___ (1) are excreted in the kidney
A
H+
3
Q
___ (2) are reabsorbed and secreted in the kidney
A
K+ and Uric Acid
hint: creatinine + inulin are unchanged
4
Q
- porous nephron segment -
- trancellular transport (K+, H20) -
- 85% HCO3- abs -
- site of CAi -
- site for SGLT2 drugs (diabetes)
A
Proxtimal Tubule
hint: abs carbonate, excretes acid
5
Q
- Passive water movement based on conc gradient -
- tx site of osmotic diuretic aquaresis after entry (eg mannitol)
segment?
A
Descending limb LOH
6
Q
- impermeable segment to water -
- dilutes tubular fluid permb to small solutes (25% Na)
segment?
A
Thin Ascending Limb LOH
hint: diluting segment
7
Q
___(enz) restores nephron’s chemical electroneutrality
___(enz) is inh by loop diuretics –> Mg and Ca loss w/ Na, K, Cl
A
ROMK (electroneutrality);
NKCC2 (loops diuretics)
8
Q
Renal Autocoids (3)
A
- Adenosine
- Prostaglandins
- peptides (ANP/BNP vasoD’s)
9
Q
Renal Hormones (5)
A
- Renin-Ang sys
- EPO
- Aldosterone (MR rcp Na reabs)
- 1,25 OH Vitamin D3 (via I-𝛂-OHase)
- ADH (V2 rcp water abs)
10
Q
autocoid responsible for:
- afferent arteriole vasoD
- glomerular blood flow autoregn
- ↓Na reabs in LOH;
- ↓H2O transport in CTs
A
Prostaglandins
11
Q
Nephron segment: -
- active NCC co trnsporter -
- impermb to water -
- Apical Mg channel -
- baso Na/Mg transporter
A
DCT I
hint: 25% NaCL reabs
12
Q
Nephron segment: -
- active NCC co transporter -
- apical ENaC channel for Na+ -
- baso Cl channel -
- baso Ca/Na + Ca active transporters (PTH reg’d)
A
DCT II hint: 25% NaCL reabs
13
Q
____(celltype) in the collecting duct (CD) transports Na, K, H2O; while ____ (celltype) have acid base function in CD (𝛂 for H+ and β for HCO3-)
A
principle cells;
intercalated cells (𝛂 and β)
14
Q
Name presentation and causative fungus? -
- hypersensitivity rxn to inftn
- complicates asthma or CF -
- dx on exam -
- treat with itraconazole, sinus surgery , xolar
A
ABPA from Aspergillosis
15
Q
Name presentation and causative fungus? -
- colonizing fungus ball after cavitary lung disease -
- air crescent/grape cluster on scan (dx) -
- tw itraconazole vel surgery
A
Aspergilloma from Aspergillosis
16
Q
Name presentation and causative fungus? -
- mimics TB air crescent on scan -
- needle-aspirate lung fluid for histo -
- ↑risk for alocoholism , COPD, CGD -
- tw voriconazole + AmphoB
A
CNPA from Aspergillosis hint: unresponsive to antibiotics
17
Q
Name presentation and causative fungus? -
- resp distress after prfound PMH of IMNS -
- halo sign on scan (dx) -
- needle/biopsy for histo (Acute Angles*)
A
Invasive from Aspergillosis
18
Q
Whats the dx and Tx? -
- Caused by rhizopus -
- deadly invasive vasculitis from env mold -
- non septate right angle* on histo -
- sinus entry –> brain invasion –> infarction -
- Risk: unctrl’d T2DM, Fe overload , IMNS
A
Mucormycosis (Rhinocerebral, wound, cutanous, lung/GI) tw amphoB + surgery
19
Q
Whats the dx and Tx? -
- ubiq env mold + rare.fatal inftn -
- seen in HSCT pts -
- eye, lung, and skin sx -
- blood culture + histo dx
A
Fusarium (mycotoxicosis, local, disseminated) tw amphoB + voriconazole
20
Q
Whats the dx and Tx? -
- ↓host imm resp -
- late ppt: meningitis; skin; nodules; pulm sx -
- dx: biopsy, CSF, crag
A
Cryptococcosis tw Fluctyosine –> AmphoB –> fluconazole
21
Q
how does arteriolar tone affect vascular function curves (esp venous return)
A
- arterioles hold min vol thf MSFP is not changed -
- blood trapped upstream via vasoC –> ↓venous blood –> ↓venous P + reutrn at any CVP -
- vice versa w/vasoD
22
Q
vasc pressure when blood flow ceases?
A
mean systemic filling pressure (MSFP) hint: ∝ blood vol
23
Q
determinants of systolic fx? (3)
A
- preload
- afterload
- contractility
24
Q
COPD, effusion, congestion, or obesity would cause voltage signal to (increase/decrease)
A
decrease (more distant)
25
Myocardial hypertrophy would cause EKG voltage to (increase/decrease)
increase (large muscle)
26
\_\_\_\_ (chemical class) ↑ intracell cAMP, Ca+, and contractility
catecholamines
27
Normal ejection fraction (EF)
55-65%
28
* - ∆ perfusion to body -
* ↑ fluid in lungs (congestion) -
* SOB + pulm edema
characterizes...
Left heart failure
29
* - ∆ perfusion to lung -
* ↑ fluid in periphery -
* ascites + periph edema
characterizes...
right heart failure
30
whats the dx? -
* ∆ NCC in distale tubule (SLC12A3) -
* hypoMg\* + hypoK + alkalosis + ↑plasma renin + aldo
* ± low BP -
* caused by _LOOP_ diuretics
Gitelman's syndrome (low serum Ca+)
hint:
* Bartter's + hypoMg
* dump bicarb --\> ↑water into lumen
31
whats the dx? -
* ∆ NKCC2 symporter in Thick Asc LOH (SLC12A1) -
* hypoK + alkalosis + ↑plasma renin + aldo -
* ± low BP
* caused by THIAZIDE diuretics
Bartter's Syndrome (high urine Ca+)
hint: water (vol) drops --\> renin/aldo↑
32
what Rx combo is used for nephron paralysis? (3)
CAHi + loop + distal diuretics
33
what's this rare AD dz? and how do you tx? -
* gain of fx: EnAC channels -
* clinica; ppt: htn, ↑Na+ reabs, K wasting
Liddle's Syndrome
tw
* K-sparing diuretics:
* amiloride (or triamtereneif allergic )
34
2 yrs dapsone + rifampin is tx for \_\_\_
Tuberculoid Hansen's (M. Leprae)
35
Hansen's disease form chr by:
* Paucibacillary,
* vigorous, but ineffective CMI (CD4+, Th1) --\> PPD⊕
* nerve damage (clawed hands + toes, foot drop)
Tuberculoid
36
Hansen's disease form chr by:
* multibacillary ,
* weak CMI (useless Th2 w/ Abs) --\> PPD⊖
* extensive cutaneous sx
lepromatous
hint: lionine facies
37
\_\_\_\_ has no in vitro culture system, slowest growing human pathogen, only affects 5-10% of humans\*, prefers 30-37C
M. Leprae
common ppt: asymptomatic seroconversion\*
38
Scrofula in kids indicates ___ inftn; while in adults indicates \_\_\_\_
Atypical Mycobacterial inftn; TB
39
key histo features for M. Leprae inftn? (2)
1. foam cell mø's
2. granulomatous epiths + lymphos
hint: skin smear/punch biopsy
40
Labs for M. Leprae in the US and Abroad
PPD (abroad):
Serology (US):
* LMIT for tuberculoid
* phenolic glycolipid-1 for lepromatous
41
* health care worker exposed to Mleprae
* pt with tuberculoid form
* previous lepromatous form responding to tx
these are indicative of (neg/pos) lepromatin PPD?
POSTIVE PPD
42
* naive pt
* lepromatous leprosy
these are indicative of (neg/pos) lepromatin PPD?
NEGATIVE PPD
43
Name that drug:
* Unknwon MOA
* SEs: N/V; hepatotox; HS rxns
Pyrazinamide
44
Large proteins, cells, and complexes that can be **centrifuged**\* out is a job for ____ (procedure)
Apharesis
hint: **exchange** (replace) vs true **pheresis** (substract)
45
Separating **plasma** contents small enough for a semipermb membrane through diffusion/convection would be a job for ___ (procedure)
Dialysis
hint: AEIOU = **A**cid/base, **E**lectrolytes, **I**ntoxication, **O**verload of fluid, **U**remic Sx
46
types of Dialysis (2) and their subtypes (2 each)
1. Hemodialysis
* cont CRRT vs intermittent IHD
2. Peritoneal Dialysis
* manual vs auto
47
Why is sodium citrate used for dialysis?
* sodium citrate binds Ca+
* Ca+ is vital for coagn via **intrinsic pathway** (F9,10,V and thrombin)
* ↓ Ca+ --\> bleeding risk
48
\_\_\_ moves solute; ____ moves water; is also known as solvent drag or the movement of water with stuff in it
* diffusion;
* hydrostatic F (osmosis)
* convection = solvent drag
49
Why does hereditary hemochromatosis and transfusion lead to iron overload myocardial dz?
ventriclular iron deposition --\> ∆ metal dep enz systems + **O2\* injury** --\> systolic dsfx (∆ pumping)
50
dilated heart and ↑hemosiderin laden mø's (on Prussian blue stain) is chr histopathology for \_\_\_
Iron Overload (myocardial dz)
51
these are signs of what tupe of thryoid disfx?
* nonspecific ischemic hypertrophy
* tachycardia, palpitations, and _cardiomegaly_
HypERthyroidism
52
these are signs of what type of thryoid disfx?
* ↓stroke vol --\> ↓CO
* myofibers swelling w/↓ striations + basophilic staining
* flabby, _dilated_ heart
hypOthyroidism
53
what the dx?
* AD inheritance
* ∆ desmosomes --\> thinned R ventr wall (fatty + fibrotic change)
* leads to heart failure, vtach, and vfib
Arrhythmogenic R Ventricular Cardiomyopathy/Dysplasia
54
Whats the Dx?
* AD congenital dz
* spongy ventricular myocardium --\> arrythmias + heart failure
* tx sx + heart tranplasnt
Non-compaction cardiomyopathy
55
1. On histology _____ (dx) shows intersitital **lymphocytic infiltrate** + **focal necrosis** --\> focal or patchy inflamm/**progressive** fibrosis. Clinical sx incl _dyspnea_, palps, _precordial discomfort_ + _fever_ w/± normal/dilated heart
2. WHat is the most common cause for this dx in US?
1. myocarditis;
2. viral inftn = most common cause in US
hint: ppt = precordial discomfort + fever
56
_on clinical exam,_ pt complains of dyspnea and excerise intolerance, and appears to have right sided heart signs. _On echo_ myocardium appears thick, w/↑ atrial size and normal ventr size. _On EKG,_ voltage is low with condduction abnormalities (afib + arrhtymia). Biopsy is seen below. Dx?
bonus? what contributes to dyspnea and exercise intolerance?
Amyloidosis leading to _Restritive Cardiomyopathy_ (**Diastolic dysfx)**
bonus: ↑ filling pressure (which --\> ↓CO)
57
**Least common** type of cardiomyopathy. Chr by myoc infiltr --\> ↓ ventr compliance --\> ↓diastolic ventr filling
Restrictive Cardiomyopathy
58
What's your dx?
* 100% genetic (sarcomeric prots)
* ↑ IVS thickness (obstruction) w/ banana shaped LV
* Myocyte disaaray + replacement fibrosis on histo
_bonus_: why does sarcomeric change lead to gross heart changes?
Hypertrophic cardiomyopathy **(diastolic dysfx)**
Bonus: sarcomeric dyfx/change --\> defective E transfer from mt to sarcomere
59
What does the pt have? how would you dx (2)
* Sx:
* Dyspnea on exertion (↑HR and contractility)\*
* chest pain
* syncope\*
* signs:
* loud S4
* systolic ejection murmur ± mitral regurg
* 2 upstrokes --\> ↑↑↑carotid pulse rate
Hypertrophic cardiomyopathy
dx by echo + family hx
hint: dyspnea + syncope dt outflow obstruction
60
Explain how systolic ejection murmur changes with:
1. squatting/lying/hand grip/straight leg raise
2. standing/Valsalva
3. where is its best heard?
1. decreases dt ↓outflow obstruction
2. increases dt ↓ventr filling
3. best heard @ **L lower sternal border (tricuspid posn)**
61
* Most common type of cardiomyopathy
* 50% cases are idiopathic
* both ventricles are affected
* death w/i 5 years
Dilated Cardiomyopathy (systolic dysfx)
hint: Toktsubocardiomyopathy (broken heart syndrome)
62
Treatment for Dilated CMP (4) + anticoagn
1. Digoxine (improves contractility)
2. diuretics (ACE inh)
3. VasoDs (βBs)
4. Cardiac Transplant
hint; remove offending agent if possible
63
Clinical features point to what dx?
* L and R sided CHF sx
* S3, S4 + murmurs\*
* Cardiomegaly (balloon~ on CXR)
* sudden death\*
bonus: Explain the reasons behind the \*
Dilated Cardiomyopathy
bonus:
* mitral/tricuspid insuffc --\> murmurs
* cardiomegaly --\> ↑thrmobotic risk
64
These are etiologies for what cardiomyopathy?
* **Al**cohol abuse,
* wet **B**eriberi,
* **C**oxsackie B viral myocarditis,
* chronic **C**ocaine use,
* **C**hagas disease,
* **D**oxorubicin
Dilated Cardiomyopathy
hint: ABCCCD
65
what leads to sudden death in young athletes?
ventricular arrythmia --\> syncope --\> suddetn death dt Hypertrophic Obstructive Cardiomyopathy
66
These are etiologies for what cardiomyopathy?
* **P**ostradiation fibrosis,
* **L**öffler endocarditis (hypereosinophicic syndrome)
* **E**ndocardial fibroelastosis in kids (thick fibroelastic tissue in endocardium)
* **A**myloidosis
* **S**arcoidosis
* **H**emochromatosis (although dilated cardiomyopathy is more common)
Puppy LEASH\*
Restrictive Cardiomyopthaty
hint: Puppy LEASH\* is restrictive
67
6 stages of plaque formation
1. endoth cell damage
2. monocyte/lø adhesion (ox LDL + leukotriene chemotaxis)
3. mø maturation
4. lipid uptake by mø (foam cells)
5. Sm mucle cell migration (media --\> intima)
6. advance lesion
68
Whats your dx?
* mostly asympto but AD
* mitral valve ballooning during systole --\> mitral insuffc --\> incidental **mid systolic click + murmur**
* emboli
* mixoid change --\> ∆ conductionsystem --\> sudden death
Mitral Valve Prolapse (MVP)
hint: floppy valves in 3-5% of Americans; Marfan + Ehlers Danlos syndrome assc
69
Whats your dx?
* degenerative change in the elderly
* stenotic leaflets + valve ring regurgitation
Mitral Valve annular calification
70
Whats your dx?
* Cardiac sx of seratonin sydnrome
* R heart lesions (subendo gray yellow plaques)
Carcinoid Valve Dz
71
Click and murmur become ___ (softer/louder) w/ squatting in **mitral valve prolapse** bc?
**softer** bc ↑ systemic resistance --\> ↓ventr emptying
72
Complications of MVP include (3)
1. infectious endocarditis
2. arrythmia
3. severe mitral regurg
hint: valve replacement
73
The difference bwn acute and subacute endocarditis (virulence, valve, predispn, eg bug)
Subacute
Acute
* Low virulence + small vegetations
* Mitral valve involvmt
* Previously dmg valves infted
* E.g. **strep viridans**
* High virulence
* Tricuspid valve (why?)
* Normal valves infted
* E.g. **staph aureus**
triscupid valve involvement dt to R heart drainage
74
Name the assc etiology:
1. strep viridans (subacute)
2. staph aureus
3. staph epidermidis
4. strep bovis
1. chronic RHD, mitral valve prolapse
2. IV drug abuse
3. prosthetic valves
4. colorectal carcinoma --\> endocarditis
75
Name the HACEK organisms and key assc with endocarditis
1. Haemophilus
2. Actinobacillus
3. Cardiobacterium
4. EIkenella
5. Kingella
assc with NEGATIVE blood cultures
76
Clinical features of bact endocarditis (4)?
1. Fever (bactermia)
2. Murmur (∆flow)
3. veg emboli --\> _skin involvemnt_: Janeway lession (palms and soles); Osler nodes (ouch); splinter hemorrhages; roth spots (retina)
4. _Anemia of chronic dz_ (microcytic + inflamm)
77
what's the dx?
* small, sterile vegetations dt SLE
* undersurface of **mitral \> tricuspid** valves
* ANA changes (eosinophilic necrotic debris) + mitral regurgitation
Libman-Sacks/Lupus Endocarditis
78
What's the dx?
* _sterile thrombotic_ vegs on mitral valve --\> regurg
* hypercoagb state/_underlying adenocarcinoma_/marantic endocarditis
Non bact thrombotic endocarditis (NBTE)
79
Triad for chronic RHD
1. Leaflet thickening (**mitral** fish mouth)
2. Commissural fusion (aortic valve involement)
3. thickened cordae tendinae
80
What's the dx?
* Dyspnea on exertion, slowly ↑ with age
* Fainting spell + vision loss in one eye (aortic valve sx)
* Blood tinged sputum (pulm edema + hemosiderin cells)
* history of acute rheumatic illnesses (firbotic changes)
Chronic RHD
81
WHats the Dx with this type of pancarditis? assign each sx to a layer :
1. - mitral verrucae + regurg
2. - Ashoff bodiess + Anitschkow cells
3. - friction rub and chest pain
ACUTE rheumatic Fever
1. endocarditis - mitral verrucae + regurg
2. myocarditis (sudden death) - Ashoff bodiess + Anitschkow cells
3. pericarditis - friction rub and chest pain
82
what does this dx point to?
* ↑ASO/Anti-DNase B titers
* minor criteria: fever and ↑ESR
* major criteria: J❤NES (what does this stand for?)
ACUTE rheumatic fever
hint: J❤NES
* Joints (polyarth)
* ❤ heart (pancarditis)
* Nodules on skin
* Erythema **marginatum** (trunk + limbs)
* Syndenham Chorea
83
why does strept throat (Pharyngitis) cause ARF?
bact M protein in Aβ-hemolytic strep mimics human tissue (Ab cross reactivity)
hint: S. pyogenes + anti streptolysin O titer
84
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Check Valve
85
Whats your dx?
* _Chronic wear + tear (age \> 60)_
* Hx of Healed RHD or congential biscupid valve --\> fibrosis
* A fib and LV hypertrophy on ECG
* Cardiomegaly + _calcification @ aortic valve_ on CXR
Calcified aortic stenosis
86
the ∆F508 mutation is class ___ (2). Describe the problems in each class.
* Class II - no traffic --\> need to correct prot folding
* Class VI - less stable --\> need to promote statbility
87
5 steps in CF pathophys:
1. CFTR gene defect
2. ∆ ion tranpsort
3. ↓airway surface liq
4. ∆ mucciliary clearance
5. inftn + inflamm + mucus obstruction
88
explain why dosage reqs are much higher with short interval/cont admin (3)?
how would you dose tobramycin or Ceftazidime?
high/short dosage rationale:
1. ↑metabs
2. ↑excretion
3. ↑vol of distribution
IV Tobramycine: 14 mg/kg/day
Ceftazidime: cont infusion of 200 mg/kg/day (10-14 g)
89
THe most common pathogen in CF pts is \_\_\_\_. Why are outcomes so bad?
Pseudomonas
1. Polymicrobial Biofilms
2. Co-dependancy
3. ∆ virulence
90
2 non TB atypical mycobacterials that affect IMNS CF pts
1. M. Avium (MAC)
2. M. abscessus/M. chelonae
91
what is the dx? explain the asterisks
1. ↓NaCl alkalosis
2. infertility\*
3. manutrition + vit defc
4. pancreatitis + diabetes\*
5. steatorrhea and billiary cirrhosis\*
6. neonatal jaundice + meconium plug
Cystic Fibrosis
\* hint: ø vas deferens in males; pancreatic burnout of islet cells --\> diabetes; mucus obstruction in biliary tree --\> fat mal-abs
92
Whats the dx?
* onset of dyspnea/difficulty breathing hours within exposure to welding (self limited)
* fever, chills, cough, wheezing,chest pain (normal CXR)
* metallic taste in mouth
Metal Fume Fever
hint: zinc/cadmium oxide + teflon
93
Large Vessel Vasculitis Dzs (2)
1. Takayasu Arteritis
2. Giant Cell Artertitis
94
Medium Vessel Vasculitis Dzs (2)
1. POlyarteritis Nodosa
2. Kawasaki Dz
95
ANCA-assc Small Vessel Vasculitis Dzs (3)
1. MIcroscopic Poyangiitis
2. GPA (Wegener's)
3. Churg Strauss (Eosionophil GPA)
96
IMmune COmplex Small Vessel Vasculitis
1. Cryoglobulemic Vasc
2. Henoch-Schōnlein (IgA Vasc)
3. AntiC1q Vasc (hypocomplementemic Urticarial Vasc)
4. Anti-GBM Dz
97
Immune complex mediated Vasc is assc with what 2 dz?
1. Rheumatoid vasc
2. Lupus Vasc
98
Whats the dx?
1. early, self limited childhood dz
2. risk of renal involvement ↑with age
3. purpura on buttocks and LE + abdominal pain (GI bleeds) + hematuria+ arthritis
HSP
Henoch-Schōnlein (IgA Vasc)
hint: small vessel; _tx with steroids **if severe**_; abdominal pain (GI bleeds); IgA nepropathy → hematuria (glomerular/mesangium bleeding)
99
ANCA assc small vessl vasculitis dz with extravasc granulomas (2)?
1. Wegener's Granulomatosis (cANCA; PR3)
2. Churg Strauss (pANCA; MPO)
100
ANCA ass small vessl vasculitis dz withasthma and eosionophia (1)?
Churg Strauss
hint: pANCA + MPO; also has extravasc granulomas
101
Small vessel ANCA vasculitiis with neither extravasc granulomas/eosinophilia
Micro Polyangiitis
hint: pANCA or cANCA
102
Whats the dx?
1. eosino-med necrotizing granulomas (lung, heart, GI\*)
2. pANCA ∝ severity
3. progressive, steroid dep asthma + peripheral eoinophilia
Churg Strauss
103
Whats the Dx? How would you treat?
* necrotizing vasulities **w/o granulomas** (lung + kidney)
* ø nasopharyngeal involvment
* ⊕ pANCA (perinucear)
1. Microscopic **P**olyangiitis
2. tw: cyclophosphamide + steroids
hint: relapse is common
104
105
what's the Dx? How would you tx?
* Necrotizing granulomas + vasculitis (nasopharynx, lungs, kidneys)
* sinusitis, hemoptysis, hematuria
* ⊕cANCA (**cytoplasmic**)
* 82% mortality @ 1 yr
GPA (granulomatous Polyangiitis; Wegener's Granulomatosis)
tw:
1. Cycophosph/Rituximab
2. steroids (prednisone)
3. bactrim prophx (for S.aureus)
106
subglottic stenosis is usually assc with what dx?
GPA
107
what's the dx? How do you tx?
* Gran vasc in women \> 50
* signs + sx: as ∆vision, headache w/jaw claudn, flu like sx , arthr-/my-algia + ↑ESR
* vasc biopsy: segnantal lesions w/ giant cells + intimal fibrosis
1. Giant Cell/Temporal Vasculitis
2. tw: steroids **otw blindness!**
hint: segmental lesions → **false⊖ biopsy**; major branches of **carotid artery** → blindness (opthalmic), HA/jaw (temporal); **polymalgia rheumatica** --\> arthr-/my-algia + ↑ESR
108
(2) what's the dx? How do you tx?
* Gran vasc in **A****sian** women \< 50 (classically)
* signs + sx: ∆vision + neuro, **weak/absent pulses in UEs** + ↑ESR
1. **Takayasu** Arteritis
2. tw CCSs
hint: branches of the **aorta** → **"****pulseless" dz**
109
(2) whats the dx? how would you treat?
* fibrinoid necr vasculities that spares the lung
* HbsAg⊕ w/ pears on string renal arterial
* young adults with htn, mesenteric melena, CNS + sx
1. Polyarteritis Nodosum
2. tw with CCSs + cyclophosph
110
what's the dx? how would you tx?
* Asian kids \< 4
* erythema on palms and soles
* nonspecf fever + conjunctivitis
* coronary arteries at risk for 1)thrombosis + MI and 2)aneurysm
1. Kawasaki Dz
2. tw ASA + IVIG; otw self-limited
hint: the only case that you'd give ASA to a child with fever (usually causes Rye Syndrome)
111
(2) What's the Dx? How would you tx?
* necro vasulitis in digits
* sx: ulcerative, gangrenous → autoamputation of fingers + toes
* Raynaud's
* smokers\*
1. Buerger Dz
2. tw smoking cessation
hint: vasospasm → Raynaud's
112
