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Comprehensive Exam > Comprehensive Pearls > Flashcards

Comprehensive Pearls Flashcards

0
Q

Cullen sign

A

In acute pancreatitis:

Periumbilical bruising

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1
Q

Charcot Triad

A

Cholangitis

Jaundice, fever >38c, RUQ pain

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2
Q

Turner sign

A

In acute pancreatitis:

Flank bruising

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3
Q

Anion gap calculation

A

Anion gap=Na+ - (HCO3- + Cl-)

Normal 12 +- 4

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4
Q

Pulsus paradox

A

> 10mm drop in systolic BP during inspiration

Seen in cardiac tamponade, COPD, hypovolemic shock, patients using unusually strong inspiratory effort (asthma)

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5
Q

MUDPILERS

A

Anion gap metabolic acidosis

Methanol
Uremia
DKA/Alcoholic KA
Paraldehyde
Isoniazid
Lactic Acidosis
Etoh/Ethylene Glycol
Rhabdo/Renal Failure
Salicylates
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6
Q

4Fs

A

Risk factors for cholelithiasis:

Fat
Female
Fourties
Fertile

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7
Q

Mallory-Weiss tear

A

Esophageal tear from retching, vomiting, straining

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8
Q

Trousseau and Chvostek signs

A

In hypocalcemia

Trousseau: hand curling with BP cuff inflation

Chvostek: facial twitching with tap

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9
Q

Murphy’s Sign

A

In acute cholecystitis:

Patient halts inspiration with subcostal palpation

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10
Q

Collin’s Sign

A

In cholelithiasis:

Pain radiating to right scapular tip

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11
Q

Alport’s Syndrome

A

Nephritis with high frequency hearing loss and visual changes

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12
Q

Goodpasture’s Syndrome

A

Glomerulonephritis with hemoptysis

Dx: anti-GBM abs

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13
Q

Wilm’s Tumor

A

Renal tumor

Non-tender abdominal mass in a 2-5 year old

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14
Q

Reynold’s Pentad

A

In acute cholangitis:

Charcot’s triad (RUQ tenderness, jaundice, fever) plus altered mental status and hypotension; indicates sepsis

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15
Q

Courvoisier’s Sign

A

In pancreatic cancer:

Jaundice and a palpable gallbladder

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16
Q

ALT/AST in alcoholism

A

AST will be >2x ALT

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17
Q

Alkaline phosphatase

A

Elevated in biliary obstruction

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18
Q

ALT/AST

A

Released into bloodstream upon liver damage, not useful for advanced cirrhosis/fibrosis

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19
Q

Wilson’s Disease

A

Genetic abnormality in copper metabolism

Diagnostic tetrad: evidence of liver disease, neuro symptoms, low ceruloplasmin levels, Kayseri Fleischer rings on iris

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20
Q

Rovsing’s sign

A

In acute appendicitis:

Increased pain in RLQ with palpation of LLQ

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21
Q

Dressler’s Syndrome

A

1-2 weeks post-MI

Low grade fever, pleuritic chest pain, pericardial effusion

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22
Q

Metabolic syndrome

A 
3 or more of:
Abdominal obesity
Triglycerides >150
HDL 110
Hypertension
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23
Q

Pulsus parodoxus

A

> 10mm fall in BP with inspiration

Occurs in cardiac tamponade

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24
Q

Ankle brachial index

A

<0.9 is peripheral arterial disease

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25
Q

Thumbprint sign

A

In acute epiglottitis

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26
Q

Steeple sign

A

In croup, also seal-like barky cough

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27
Q

S1Q3T3

A

Classic ECG finding in PE (seen in <20%)

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28
Q

Hypertension Dx (JNC 7)

A

Systolic >140 or diastolic >90 on 3 separate occasions

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29
Q

Desirable lipid levels (ATP III)

A

Total cholesterol 60

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30
Q

Janeway Lesions

A

Painless erythematous lesions of palms and soles

Seen in infective endocarditis

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31
Q

Osler’s Nodes

A

Painful violaceous lesions of lesions of fingers, toes, or feet

In infective endocarditis

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32
Q

Pyramidal system damage sx

A

Weakness
Hyperactive tendon reflexes
Spasticity
Babinski positive (up going)

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33
Q

Extrapyramidal system damage sx

A

Bradykinesia
Rigidity
Tremor
Athetosis/chorea

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34
Q

Cerebellar damage sx

A 
Errors of:
Rate
Range
Force
Direction
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35
Q

“Lucid interval”

A

Epidural hemorrhage

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36
Q

“Worst headache of my life”

A

Subarachnoid hemorrhage

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37
Q

Cushing’s Triad

A

For increased ICP:
Increasing BP
Falling pulse + widening pulse pressure
Abnormal respiratory patterns

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38
Q

Status epilepticus duration

A

At least 5 minutes

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39
Q

Guillain-Barre

A

Symmetrical extremity weakness that begins distally and ascends

Associated with preceding infection of the lungs or GI tract, esp. Campylobacter jejuni

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40
Q

Myasthenia gravis

A

Antibodies against Ach receptors

Weakness and fatigability of skeletal muscles

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41
Q

Multiple sclerosis

A

Autoimmune
Multiple foci of demyelination of CNS white matter

Initially episodes of reversible neurological deficits

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42
Q

ALS

A

Amyotrophic Lateral Sclerosis
“Lou Gehrig’s Disease”

Degeneration of upper and lower motor neurons in the CNS

Progressive weakness of speech, swallowing, extremities
No sensory loss

43
Q

RBC lifespan

A

120 days

44
Q

Platelet lifespan

A

7-10 days

45
Q

Hemophilia A

A

Factor VIII deficiency

X-linked recessive, males only

47
Q

Von Willebrand Disease

A

Deficient or defective vWF

Tx desmopressin (ADH)

48
Q

HIT

A

Heparin-induced thrombocytopenia
5-14 days after starting heparin
Mild to moderate thrombocytopenia and thrombosis

49
Q

ITP

A

Immune thrombocytopenic purpura
Common in children (2-4) following infectious process, not very sick
Isolated thrombocytopenia
Tx: prednisone, gamma globulin

50
Q

TTP

A

Thrombotic thrombocytopenic purpura
Deficiency of vWF-cleaving ADAMTS13
Thrombocytopenia, progressive renal failure, CNS sx
Tx: plasmapharesis

51
Q

HUS

A

Hemolytic uremic syndrome
In children, follows bloody diarrhea
Microthrombi are confined to kidneys

52
Q

Reed Sternberg Cells

A

Hodgkins Lymphoma

53
Q

Philadelphia chromosome

A

CML

Treated with Gleevec

54
Q

Auer rods

A

AML

55
Q

Can’t see can’t pee can’t climb a tree

A

Reactive arthritis
Acute asymmetric arthritis 3-4 weeks after GI or STI infection
Especially shigella and chlamydia

56
Q

Sausage fingers

A

Psoriatic arthritis

57
Q

Bamboo spine

A

Ankylosing spondylitis

58
Q

Inflammatory arthritis in patients with IBD

A

Enteropathic arthritis

59
Q

HLA-B27+ RF- ANA-

A

Seronegative spondyloarthropies

60
Q

Scottie dog fracture

A

Spondylolysis

61
Q

Bugs that cause reactive arthritis

A

Shigella and chlamydia

62
Q

Gottron’s papules, heliotrope rash, shawl sign

A

Dermatomyositis

Dx: inc. CK and aldolase, muscle bx

63
Q

+ANA

A

Lupus (in 99%)

64
Q

Legg-Calve-Perthes Disease

A

Aseptic necrosis of hip in 4-8 year olds

65
Q

Osgood-Schlatter

A

Osteochondritis of tibial tubercle

Mostly 11-13 year olds

66
Q

Heberden and Bouchard nodes

A

In osteoarthritis:
Heberden DIP
Bouchard PIP

67
Q

+RF and +CCP

DIPs spared

A

Rheumatoid arthritis

68
Q

Tophus

A

Urate crystal

Seen in gout

Usually attacks metatarsal phalangeal joint of great toe first

69
Q

Herald patch and Christmas tree pattern

A

Pityriasis rosea

Tx: self-limiting

70
Q

Auspitz’s Sign

A

Peeling a scale produces specks of bleeding

Seen in psoriasis

71
Q

“Stuck on look”

A

Seborrheic keratosis

72
Q

Ototoxic med

A

Gentamicin and other aminoglycosides

73
Q

Otitis media organisms

A

Strep pneumo, H. influenzae, M. catarhhalis

Tx: amoxicillin, augmentin as 2nd line

74
Q

Central vs peripheral vertigo

A

Central: nystagmus vertical

Peripheral: nystagmus horizontal

75
Q

Centor Criteria

A

Tonsillar exudates, tender cervical nodes, hx of fever, absence of cough

76
Q

Blood and thunder retina

A

Central retinal vein occlusion

77
Q

Intertrigo

A

Rash in body folds

Seen in Type II diabetes

78
Q

Curtain-like loss of vision

A

Retinal detachment

79
Q

BP Target in Diabetics

A

<130/80

80
Q

Metabolic syndrome

A

3 or more of:

BP >130/85
Fasting glucose >100
Large waist
Low HDL
High triglycerides >150
81
Q

“Bones, stones, moans, and psychiatric overtones”

A

Hypercalcemia

82
Q

24hr Urine VMA

A

Used to diagnose pheochromocytoma

Excess catecholamine production

83
Q

Goiter with a bruit

A

Grave’s disease

Hyperthyroidism

84
Q

Prolactin regulation

A

Release inhibited by dopamine
Stimulated by TRH
Inhibits GnRH

85
Q

Sheehan’s Syndrome

A

Post-partum infarction of pituitary

Posterior pituitary usually spared

86
Q

Grayish membrane

A

Diphtheria

Tx: horse serum antitoxin from CDC

87
Q

Rash with azithromycin for suspected strep pharyngitis

A

EBV infectious mononucleosis

Dx: monospot or heterophile Ab test

88
Q

Sandpaper rash with strep throat

A

Scarlet fever

89
Q

Jones Criteria

A

For acute rheumatic fever:

J-joints, arthritis
O-heart, carditis
N-nodules, subcutaneous
E-erythema marginatum
S-Syndenhan's chorea

Occurs 15-20 days after strep pharyngitis

90
Q

Koplik spots

A

In measles

Bluish-white lesions

91
Q

Slapped cheek

A

Erythema infectiosum (Fifth disease)

Caused by parvovirus

92
Q

Skin infection antibiotic of choice

A

Cephalexin

93
Q

RPR or VDRL

A

Test for syphillis

Tx: pen G

94
Q

SIRS

A

Systemic inflammatory response syndrome

Fever, tachycardia, tachypnea, high leuks

Most commonly in sepsis

95
Q

ASO titer

A

Increased in rheumatic fever

96
Q

Roth spots

A

Retinal hemorrhages

Seen in infective endocarditis

97
Q

Rice water diarrhea

A

Cholera

98
Q

“Owl eye” inclusions

A

Cytomegalovirus

99
Q

Lewy body dementia

A

Visual hallucinations or paranoia/delusions

100
Q

Prehn’s Sign

A

For evaluating testicular pain:

Positive-pain relieved when lifting testicles, likely epididymitis

Negative-pain not relieved, likely testicular torsion

101
Q

Ballard score

A

Estimates gestational age

102
Q

Blueberry muffin spots

A

Congenital rubella in 1st trimester

103
Q

Basophilic stippling

A

Lead toxicity

104
Q

Lisch nodules

A

Neurofibromatosis-1

105
Q

Fixed split S2

A

Atrial septal defect

106
Q

Stills Disease

A

In children

Spiking fevers at least 2 weeks in addition to arthritis
Salmon colored rash

107
Q

Legg-Calve-Perthes Disease

A

Avascular necrosis of femoral head in peds

Comprehensive Exam (2 decks)

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