Clinical Lectures Flashcards
Pathophysiology of SIADH. What agent causes this?
1) Retain free H2O and dilutes serum –> mental status change
2) Antidiuretic Hormone/Arginine Vasopressin (AVP)
____ is a velvety or warty surface with stuck on appearance. Typically occurs in older adults
Seborrheic Keratosis
Typical ___ rash begins on the face and then becomes confluent.
Measles
Ovarian Carcinoma can lead to Malignant ___
Ascites
___ i facial redness in central part of the face and can be characterized via swollen red bumps and enlarged nose/eye problems.
Rosacea
What are some of the clinical consequences of HIV therapy
1) Cardiovascular Risk (MI and Stroke)
2) Cervical Cancer Risk
scarlet fever is associated with what microbe
Group A B-hemolytic Strep
Sister Mary Joseph Nodule is indicative of ___ metz normally via ___ carcinoma
1) Umbilical
2) Ovarian
List the 3 recognizable groups of congenital malformations that increase risk of Wilms Tumor
1) Beckwith-Wedemann Syndrome
2) WAGR syndrome
3) Denys-Drash Syndrome
Virchow Node is associated with ____ esp. in older adults.
Carcinoma - any thoracic or abdominal carcinoma may be responsible
If a physician was stuck with a used needle from a pt with unknown status what is the next step?
PEP
Proximal muscle weakness that improves with repetitive motion/stimulation is indicative of ____
Lambert Eaton Myasthenia Syndrome
Common Etiologies for Humoral Hypercalcemia of Malignancy
1) Squamous Carcinoma
2) Lung
3) Breast
4) GI/GU
Actinic Keratosis is ___malignant for ___
Pre
SCC
Tumors can be irritate the ___ and ___ space leading to fluid accumulation and inflammation.
1) Peritoneum
2) Pleural
If breast lump has skin invasion you should be afraid of ___
Metz until proven otherwise
It is important to check the ___ reflex in sus. pts of retinoblastoma
red
___ tingling pain, eruption of vesicles in a dermatomal distribution
- Pustules –> crusting
Zoster Rash
Any child presenting with LAD and shorness of breath need to have a ____. because Lymphoma loves teh ___.
CXR
Mediastinum
Fibrosarcoma is a ____ neoplasm
malignant
Laboratory Testing can detect:
1) Hemorrhage
2) Effusion
___ is a concern in a pt who has Zoster Rash
Post-herpetic Neuralgia
___: High protein, High cellular count
Exudative
A pt with a positive Kernig and Brudizinskis sign is at risk for what disorder caused by DIC
1) Purpura Fulminans
Before the Cushing Syndrome is diagnosed, the pt may present with ____, __, ___.
New onset hypertension, buffalo hump, or moon facies depending on the cause.
Endobronchial Lung Cancer Tumor can lead to what clinical manifestations that may be present in the physical exam?
1) Stridor
2) Downstream Lung Tissue collapse - SOB
____: Lesions appear at all stages at once; “Dew drop on a rose petal”; Pruritic
Varicella Rash
Why are African Americans the demographic that made up the most HIV diagnoses
Social Determinants of Health
Radiography can detect: CT = gold standard
1) Mass
2) Indications of invasion
3) Obstructive sings/symtptoms
4) Compression
5) Hemorrhage
6) Effusions
What is Pemberton’s Sign?
What is it used for>
1) Exaggeration of findings when arms are raised above the head
2) SVC Syndrome
Cushing Syndrome is the 2nd most common paraneoplastic syndrome in ___
Small Cell Neuroendocrine Carcinoma
Post-menopausal female menstruates again. What type of cancer do you suspect. This is an example of ____ in tumors.
Uterine
Hemorrhage
Irritation of the pleura by tumor can lead to the formation of a ____
Malignant pleural effusion
1) How do you diagnose Lambert Eaton Myasthenia Syndrome
1) Antibody analysis
2) Nerve Stimulation Testing
Cat-scratch disease is caused by ____
Bartonella Heselae
___ are an erythematous rash consisting of macules and papules that is symmetrical and diffuse in terms of distribution
Measles
Tumor obstructs ureters may lead to
Hydronephrosis
Lung Cancer Tumor growing ___ can cause Stridor and lung tissue collapse
Endobronchially
Centor Clinical Criteria is for ____
Strep. Pharyngitis
What is the prevalence of HIV in the US?
1.2 million
When will a acute HIV infection normally present
2-4wks
___ is the most common primary renal tumor of childhood
Wilms Tumor
Labs that indicate Humoral Hypercalcemia of Malignancy
1) Elevated Ca2+
2) Low PTH
3) Elevated PTH-rP
____ syndrome is when a tumor secretes substances or tumor cytokines cause other factors to be released by the body like autoantibodies or cytokines
1) Paraneoplastic
List two diseases that cause vesicular rashes.
1) Herpes Simplex
2) Herpes Zosters
Pts with multiple SCC have an increase rate of ____ and nodal ___
1) Local recurrence
2) Nodal Metz
Sx of Measles
1) Fever
2) Conjunctivitis
3) Koplik Spots
4) Maculopapular rash (blanching)
___, ___, ___ cavities provide an abundant room for tumors to grow with out detection. What is the clinical key to sus. these types of tumors?
1) Thoracic
2) Abdominal
3) Pelvic
4) Obstruction
What is the incidence of HIV in the uS
37,968
Population that is consistent with Seborrheic Dermatitis
1) Parkinson Dz
2) HIV + pts
3) Acute Ill
____ is tender to palpation with sand paper like feel; sun exposed parts of body
Actinic Keratosis
____: Painful loose bullae, oral mucosa is common
Pumphigus Vulgaris
List LN to check for in Lung Carcinoma. This is done by the means of _____
1) Hilar
2) Mediastinal
3) Radiographic Evaluation
___ is the peak incidence of wilms tumor
2-5yrs
What is key for the differential of pleural effusion and ascites?
HISTORY
Cutaneous Sx in SLE are diffuse and ___
nonswelling
Pathogenomic findings in Dermatomytosis
1) Periorbital Erythema (Heliotrope)
2) Violaceous Papules over joints of dorsal hands (Gottons Papules)
Pts with meningitiswill have neck stiff ness, fever, back stiffness, and a ___ rash on skin and mucous membranes.
Petechial
Male child pt presents with gonadal dysgenesis and nephropathy. Dx
Denys Drash Syndrome
_____ is indicated by a nonhealing ulcer or warty nodule
SCC
Tumor obstructs GI tract –>
SBO
Koplik Spots occur ___ hrs before characteristic measles exanthem
48
Advance ____ can manifest through Hematogenous metz as well via the ____ –> ___.
1) Carcinomas
2) Thoracic Duct
3) Left Subclavian
___: blueberry muffin baby appearance
Neuroblastoma - Cutaneous dissemination
List LN to check for Breast Cancer
1) Internal and External Mammary Group
2) Axillary Vein Group
Which HIV test may be negative during acute phase?
HIV antibody
Syndrome of inappropriate ADH secretion (SIADH) is the most common paraneoplastic syndrome in ____
1) Small cell neuroendocrine carcinoma
Social Determiants of health for African Americans –> Lack of Access to Care –> Lack of Access to HIV PrEP
Social Determiants of Health for African Americans –> Lack of Access to Care –> Lack of Access to HIV PrEP
What is the first HIV to be positive?
HIV RNA PCR ( HIV NAAT) (Viral Load)
____ are dry scales (dandruff) or oily yellowish scruff
Seborrheic Dermatitis
Mass Effect can lead to …. (4x)
1) Airway Obstruction
2) Invasion and rupture of vessels –> hemorrhage
3) SVC syndrome
4) Spinal cord compression
Pathophysiology of Lambert Eaton Myasthenic Syndrome
Anti-VGCC antibodies (voltage gated Ca2+ channels) at neuromuscular junction
List all of the HIV tests
1) HIV RNA PCR/NAAT/Viral Load
2) HIV p24 antigen
3) HIV Antibody
Pt presents with severe pharyngitis, cervical LAD, spleen enlargement, and fatigue. Dx
Mononucleosis caused by EBV
___ is a pink waxy plaque on lower leg that is associated with Graves and Hyperthroidism
Pretibial Myxedema
List the Centor Clinical Criteria for Strep Pharyngitis (4X)
1) Fever >38
2) Tender anterior cervical adenopathy
3) Lack of cough
4) Pharyngotonsillar Exudate
Clinical symptoms of Hemorrhage tumors (3X)
1) Blood in body fluid
2) Rapid enlargement of tumor or compartment –> PAIN
3) Iron Deficiency Anemia
After detecting a Lymph node that has sus. cancer, the next the to do is a ___. NOTE this is more helpful for specific cancers like ___ and ___. Want to weigh the benefit and risk.
1) Biopsy/dissection
2) Breast Carcinoma
3) Melanoma
____: psoriasis on the scalp, palms, feet
Palmoplantar Psoriasis
Breast Cancer may present with ____
Breast Lump and LN involvement if metz
Common presentation for Lambert Eaton Myasthenia Syndrome
1) Weak Legs/muscles that improves with repetitive motion/stimulation
2) Mouth DRY
____ is lateral pressure on skin causes sloughing of epidermis
Nikolsky Sign
What causes the labs of SIADH
1) Antidiuretic Hormone/Arginine Vasopressin (AVP)
Physical Examination can detect:
1) Palpable and/or visible mass
2) Indications of invasion
3) Compression
4) Effusions
Tumor that obstructs biliary system –>
Jaundice
Carcinomas normally will metz through the___
Lymph System
Sarcomas will normally mez through ___
Hematogenous
____ is a bright red tounge with enlarged papillae and white patches. This is indicative of ___
Strawberry tongue
Scarlet Fever
When can mother transmitt HIV to child
1) During Birth
2) During Pregnancy
3) During Breastfeeding
Seborrheic Keratosis can either be ___ or ___.
Papules or Plaques
Which demographic made up the most HIV diagnoses
African American
___ is the most common malignancy in kids < 10yrs old
Leukemia
Symptoms of Herpes Simplex 1 and 2
1) Stomatitis
2) Urogenital Lesions
3) Bells Palsy
4) Encephalitis
Pt has trouble climbing stairs or raising arms above head and presents with violaceous papules over joints of dorsal hands.
Dermatomytosis
child pt presents with wasting and diffuse LAD. Dx
HIV
Sister Mary Joseph Nodule can be a ____ exam finding
Physical
Cushing Disease and Primary Adrenal Dz present with
1) Centripetal Obesity
2) Mood Facies
3) Buffalo Hump
You can perform a ____ for Ascites to provide therapeutic and diagnostic advantages
Paracentesis
Pt with strep throat, cervical LAD w/ headache, stomach ache, and sore throat. Dx
Strep Pyogenes
A Blanching rash is adequate enough to make a tentative diagnosis of
Measles
You can perform a ___ for pleural effusion to provide therapeutic and diagnostic advantages.
Thoracentesis
Pt. presents with facial port wine stain, leptomeningeal angiomas, and developmental delay. Dx
Sturge Weber Syndrome
What is incidence
New Diagnoses
Pt comes in with severe back pain and diminished strength. You suspect Spinal Cord compression. This is a true oncologic emergency because this may cause permanent ____
Paralysis
What is the window period?
Early HIV infection before HIV antibody test becomes +
Pt presents with fever, malaise, conjunctivitis, coryza, and cough. He also has a maculopapular Rash that blanches under pressure. what is the Dx
Measles
Pathophysiology of Rosacea
Small BVs that swell often and become visible
When do Koplik Spots appear?
Prodrome Phase
Dermatomytosis is associated with ___ dz and increased risk of maliganancy
Celiac
____ is a chronic inflammatory papulosqumous and immune-mediated disorder
Psoriasis
Port wine stain is a Hemangioma that is fairly ___
Permanent
____ is a congenital malformation that presents with Wilms tumor, aniridia, genital anomalies, and mental retardation
WAGR Syndrome
In carcinomas on physical examination you will want to check ___. NOTE not all lymph nodes can be checked via physical exam but will have to use ___ evaluation
1) Lymph Nodes
2) Radiographic
___: Low protein, Low cellular count
Transudative
Clinical Manifestations of Humoral Hypercalcemia of Malignancy
1) Drowsy and Confused (Mental Status Changes)
Triggers for Psoriasis (5x)
1) Koebner Phenomenon
2) cold
3) sun or hot
4) Infection
5) Meds
Lambert Eaton Myasthenic Syndrome is often associated with malignancy esp ___
Small Cell
Psoriasis of the nails and flexural areas are known as ____
Inverse Psoriasis
____ evolves from exudative pharyngitis
Scarlet Fever
What are some of the social challenges in HIV treatment (3x)
1) Late Diagnosis
2) Difficulty Engaging in care
3) Stigma/Discrimination
What is the halmark of Sturge Weber Syndrome
Facial Port wine stain
What is prevalence
Total amount of people (new + old) living with dz
Pt presents with axillary LAD on the ipsilateral side of a cat scratch. Dx
Cat-Scratch Dz caused by Bartonella Henselae
Polyarteritis Nodosa is not associated with _____.
ANCA autoantibodies
Any growth or deep dimple over a babys lumbar/sacral area, do a __ or __ to check for spinal cord or vertebral abnormality
1) MRI
2) US
What you sense a mass does this tell you if it is benign or malignant?
NO - local mass doesn’t tell you this information but need to look at adjacent structures for invasion
History taking can determine __, __, ___ when wanting to detect a tumor
1) Palpable and/or visible mass
2) Obstructive signs/symptoms
3) Hemorrhage
Actinic Keratosis can either be ___ or ___
Macules or Papules
_____ is a chronic inflammatory papulosquamous dz that is associated with ___ and ___ comorbidities
1) Psoriasis
2) Joint
3) Cardiovascular
Even benign tumors can be fatal when they hemorrhage. An example is ____ adenoma. This can cause __ bleeding and formation of a ____ hematoma.
1) Hepatic
2) Extensive
3) Subscapular
True or False: In a varicella rash you will see papules, vesicles, pustular and crusted lesions all at the same time.
True - lesions appear at all stages at once
Rosacea pts may develop a enlarged nose called ___
Rhinophyma
Pt. presents with bacterial lymphadenitis caused by a lesion that drains to near by lymph node. Dx
Staph/Strep
Breast Cancers and Soft Tissue Sarcomas can be detected by ____ of a Mass. What are some direct ways you can detect the masses in primary care clinic or at home?
1) Physical Examination
2) pt self examination
Pt with acute HIV symptoms (flu like symptoms) comes in to the office. If the pt was HIV positive what would be the test to use to receive dx
HIV RNA PCR (HIV NAAT) (Viral Load)
Labs of SIADH
1) Decreased Na+
2) Decreased serum osmolality
3) Increased urine osmolality
Nikolsky sign will be positive for ____ and negative for ____
1) Pempphigus Vulgaris
2) Bullous Pemphigoid
What is the chance of developing a Wilms Tumor in Denys Drash Syndrome
90%
Carcinomas will need ____ staging
Lymph Node
How do you decrease the likelihood of transmitting HIV from mother to child
1) ART therapy
Types of manifestations of Herpes Zoster
1) Varicella Rash
2) Zoster Rash
Which HIV test may be positive during acute phase
1) HIV p24 antigen
2) HIV RNA PCR/NAAT/Viral Load
___ is a congenital malformation that presents with gonadal dygenesis in males, early onset of nephropathy and a 90% chance of developing wilms tumor
Denys-Drash syndrome
Psoriasis normally presents on ___ surfaces like on the ___ or ___.
1) Extensor
2) Knees
3) Elbows
Classical Symptoms of Ectopic ACTH secretion
1) HTN
2) Hypokalemia
3) Metabolic Alkalosis
4) Muscle Wasting
Pt. recieves illness from rabbit and has LAD. Dx
Tularemia
What is the most common tumor-like lesion of infancy
Hemangioma
____ is the most common malignancy in adolescent 15-19yo
Hodgkin Lymphoma
Pts with scarlet fever with have a strawberry tongue but describe the rash
1) Diffuse erythematous rash with sand paper consistency in the groin and axillae
2) Also flushed face
In terms of sensation how is Varicella different than Zoster rash?
1) Itchy v. Painful
Gottons Papules are characteristic of ____
Dermatomyositis
Etiology of Bullous Pemphigoid(3x)
1) UV light
2) Radiation
3) Drugs: Furosernide, Ibuprofen, and Captopril
Lab abnormalities of Cushing Syndrome caused by Ectopic ACTH secretion (3x)
1) Hypokalemia
3) Elevated Cortisol
4) Increased ACTH
Pt has painless Hematuria. what are some causes of this interms of cancer
1) Urinary Bladder
2) Kidney
What does WAGR stand for in WAGR syndrome
1) W: Wilms Tumor
2) A: Aniridia
3) G: Genital Anomalies
4) R: Mental Retardation
___: Type 2 hypersensitivity and is intensly puritic bullous and not in oral mucosa
Bullous Pemphigoid
Sx of Strep Pharyngitis: (2x)
1) Red pharynx, soft palate, and tonsils
2) Possible Exudate
Ewing Sarcoma causes _____
Chronic bone pain in area of tumor
Pretibial Myxedema is associated with what diseases
1) Graves
2) Hyperthyroidism
____ are pearly papules, Erythematous or nonhealing ulcer in sun exposed areas. They also have a history of bleeding.
Basal Cell Carcinoma
Invasion of the Mediastinal LN can cause ______ Syndrome. List the Characteristics of this syndrome.
Superior Vena Cava Syndrome
1) Venous distension of neck
2) Venous distension of chest wall
3) Facial Edema and Plethora
4) Upper arm edema
___ is a congenital malformation that presents with: Macroglossia, organ enlargement, hemi-hypertrophy, omphalocele
Beckwith-Wiedemann Syndrome
