Day4 - derm, nephrology, pulm, ambulatory, rheum Flashcards
1
Q
Pearly nodule = think?
A
Basal cell Cancer
2
Q
Multiple Purple lesions = think?
A
Karposi Sarcoma (HHV-8)
3
Q
Yellow skin lesion = think?
A
SOMETHING W/ FAT! (ie necrobiosis lipoidica)
4
Q
Bullous pemphigoid location (in skin layers and body)
A
- junction of dermis epidermis
- ## not in mouth
5
Q
Pemphigus vulgaris location (in skin layers and body)
A
- dermis
- found in the mouth
- serious
6
Q
Blisters that rupture easily, can be painful, in mouth think?
A
Pemphigus vulgaris
7
Q
Blisters that rupture easily, can be painful, NONE in mouth think?
A
Bullous pemphigoid
8
Q
Keloid vs hypertrophic scar?
A
Differentiate by growth pattern
- Keloids grow beyond wound border (irregular)
- Hypertrophic scar does NOT grow beyond wound border
9
Q
Treat Keloids?
A
Inject w/ steroids
- NEVER cut off – will just grow back, potentially worse
10
Q
Treat hypertrophic scar?
A
Inject w/ steroids
11
Q
Pruritic coin-shaped lesions = think?
A
Nummular Dermatitis
- Nummular = coin in latin
12
Q
Classic location of stasis dermatitis?
A
Around Medial Malleoli
13
Q
What goes over Medial Malleoli?
A
Great Saphenous vein
14
Q
Venous insufficiency –> rash where?
A
Back up to great saphenous vein –> rash on Medial Malleoli (stasis dermatitis)
15
Q
Brown rash and edema @ medial malleoli = think?
A
Stasis dermatitis (due to venous insufficiency)
16
Q
Arterial insufficiency –> skin changes where?
A
Distal!!
17
Q
Upper lip nodule (above crease) –> think?
A
Basal cell CA
18
Q
Lower lip nodule (below crease) –> think?
A
Squamous cell CA
19
Q
One patch –> multiple patches in “christmas tree like distribution” (or at least diffusely) = think?
A
Pityriasis rosacea
20
Q
Facial rashes where cheeks look red diff dx (4)?
A
- Lupus (doesn’t effect nasolabial folds + has systemic issues)
- Parvo Virus B19 (viral illness)
- Rosacea (facial flushing rash DOES effect nasolabial folds, “shy” or “embarrased” all the time, NO systemic issues)
- Dermatomyositis (Purple rash around eyes, papules on knuckles)
21
Q
Most common melanoma?
A
Superficial spreading melanoma
22
Q
Worst melanoma?
A
Nodular melanoma
23
Q
Nodular melanoma clinically presents?
A
ONE nodule, lesion is RAISED (never flat)
24
Q
Subungual = ?
A
Under the nail
25
Acral lentiginous melanoma found?
Palms and soles of the feet on darker skinned individuals
26
Genetic generalized fine scaly skin over the whole body = think?
Icthyosis vulgaris
27
Icthyosis described as?
"lizard skin" or "Scaling skin"
28
Lizard or scaling skin over entire body = think?
Icthyosis
29
Most common icthyosis?
Icthyosis vulgaris
30
Metal allergy is what type of hypersensitivity?
Delayed hypersensitivity (type 4)
31
Poison ivy is what type of hypersensitivity?
Delayed hypersensitivity (type 4)
32
waxy/greasy nodule that looks pasted on face = think?
Seborrhic keratosis
33
Tetracyclines predispose to what?
Rash w/ sunexposure that looks like sunburn
34
anti-U1-ribonucleoprotein Ab = think?
Mixed connective tissue disease
35
Anti-centromere = think?
CREST
36
SCL70 = think?
Scleroderma
37
Anti-histone Ab = think?
Drug induced lupus
38
Anti-smooth muscle Ab = think?
Autoimmune Hep
39
Anti-mitochondrial Ab = think?
PBC
40
Anti-peroxidase Ab, anti-microsomal Ab = think?
Hashimoto
41
Anti-transglutamidase, antigliadin, antiendomisial = think?
Celiac
42
What meds cause drug induced lupus (2)?
Hydralazine
| Isoniazid
43
What antibodies found in celiac that are specific (3)?
Anti-transglutamidase
Antigliadin
Antiendomisial
44
Hashimoto Ab's are (2)?
Anti-peroxidase Ab
| Anti-microsomal Ab
45
Bilateral hilar fullness = think?
Sarcoid
46
What does Sarcoid release?
1,25 dihydroxycholecalciferol --> more Vit D
47
Squamous cell releases what?
PTHrp or PTH
48
Lytic bone lesions and Interlukin release
Multiple myeloma
49
Familial HyperCalciurea is?
Altered calcium sensing and blunted PTH feedback loop
50
Bowed legs, high alk phos, and hearing issues = think?
Paget's Disease
51
How do you treat Paget's Disease?
Bisphosphonates
52
blanching of hands in cold = think?
Raynaud's
53
Anti-Ro (aka Anti SS-A) Ab = think?
Sjogren Syndrome
54
CREST syndrome is?
```
"Limited Scleroderma"
Calcinosis
Raynaud phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasia
```
55
Resistance to thumb abduction and extension w/ ttp of the radial styloid = think?
DeQuarvains Tenosynovitis
56
DeQuarvains Tenosynovitis has what 2 tendons effected?
- Extensor pollicis BREVIS
- Abductor Pollicis
(two tendons rub up on each other --> irritate)
57
DeQuarvains Tenosynovitis happens in what population?
Post-pregnancy
58
Osteoarthritis what can be found on radiograph of joint (3)?
- Osteophyte formation
- Subchondral sclerosis (bc bones rubbing)
- Subchondral cysts
59
Bone erosions found in RA or OA?
RHEUMATOID Arthritis
60
Reactive arthritis can come from what types of infx?
- GI (campylobacter)
| - STD (chlamydia)
61
Treat chlamydia?
Doxycycline
62
Lupus w multiple miscarraiges = think?
Anti-phospholipid Antibody Syndrome
63
Anti-phospholipids Syndrome Abs (2)?
Lupus anti-coagulant Ab
| Anti-cardiolipin Ab
64
Anti-phospholipid syndrome effect on coagulation?
Prolonged aPTT
65
Cryglobulinemia associated w/?
Hep C
66
Cold agglutinins = think?
Cryglobulinemia
67
Lupus anti-coagulant Ab + Anticardiolipin Ab = think?
Anti-phospholipid Antibody Syndrome
68
Septic Arthritis treat?
1) Arthrocentesis --> analysis + cx
| 2) Abx
69
fever + swollen knee = think?
septic arthritis (esp w/ high WBC)
70
fever + swollen knee + high WBC, but no organisms found on analysis (cx pending) --> most appropriate initial management step?
Ceftriaxone and Vancomycin
| to cover gonnorhea and staph, respectively
71
Heberden node located?
HeberdEN's node at the END --> DIP
72
Bouchard node located?
MIP
73
Heberden and Bouchard nodes found in what type of arthritis?
OA
74
STD + discharge - think?
Chlamydia or Gonorrhea
75
Syphilis has how many ulcers?
ONE! (not multiple) -- painless
76
Treatment of ankylosing spondylitis?
Anti-TNF-a agent
77
Anti-histidyl-tRNA synthetase (jo-1) Ab = ?
Myositis
78
Anti-Jo 1 Ab = ?
Myositis
79
Myositis Ab?
Anti-histidyl-tRNA synthetase (Jo-1) Ab
80
Polymyalgia rheumatica main muscle complaint?
PAIN
81
Polymositis main muscle complaint?
WEAKNESS
82
Fibromyalgia medication treatment?
"FMAM radio"
FM - fibromyalgia
AM - Amitriptyline
83
Firbomyalgia treatment?
1) Aerobic exercise
| 2) Amitriptyline
84
Back pain relieved by sitting and leaning forward = think?
Lumbar spinal stenosis (diff position relieves compression on nerves from bony osteophytes)
85
Bowed femur + dec hearing + bone scan w/ intense uptake --> think?
Paget's Disease
86
Uptake in bone scan indicates?
osteoBlasts are working
87
Muscle weakness + CK elevated = think?
Polymyositis
88
Interstitial lung disease aka?
Restrictive lung disease
89
Definitive dx test for polymyositis?
Muscle Biopsy
90
What is initial dx test for polymyositis?
Check Anti-Jo Ab levels
91
rhomboid-shaped crystals w/ weak positive birefringence = think?
Pseudogout
92
Negative needle shaped birefringent crystals = think?
gout
93
Pseudogout caused by?
Calcium Pyrophosphate dihydrate
94
Most specific for lupus?
Anti-ds DNA
95
Most sensitive for lupus?
Antinuclear Ab
96
ptosis w/ constricted pupil = think?
Horner's syndrome (ptosis, miosis, and anhydrosis)
97
lung stuff + horner's syndrome = think?
Pancoast tumor
98
Asthma looks like what on xray?
NORMAL
99
What is normal tidal volume?
500mL/breath
100
Cirrhosis + pleural effusion is?
Hepatic Hydro Thorax
101
Treat hepatic hydro thorax w/?
Thoracentesis
102
Need to be careful how you treat COPD pts w/ what?
DON'T GIVE TOO MUCH OXYGEN (so not 100%) --> may cause to be decreased respiratory drive
103
Chest xray + solid nodule --> dx steps?
1) compare to previous
| 2) CT (if no previous to compare)
104
Popcorn calcifications in a nodule is malignant or benign?
Benign
105
Workup for PE?
1) Sprial CT, if can't have --> V/Q scan
2) Unstable --> TPA (thrombolysis), unless can't give then embolectomy (ie pregnancy, hemorrhagic stroke in past)
2) Stable --> LMWH
106
Definitive test/gold standard for PE
Pulmonary angiogram
107
COPD pts should all receive what vax?
Pneumococcal vax
108
When do you give COPD home oxygen therapy?
Think of speed limits (road + back to the future)
PO2 of
109
lung cancer + low Na = think?
Small Cell CA
110
Small Cell CA can release (2)?
- ACTH
| - ADH --> SIADH
111
Small Cell CA can lead --> ?
Lambert Eaton
112
Squamous Cell CA can release (2)?
PTH
| PTHrp
113
Serious complication of silicosis is?
TB
114
Upper lobe environmental disease (ie rock miner...)
Silicosis
115
Needle should go above or below rib?
ABOVE to avoid vessels
116
NSAIDs --> what happens to leukotriene or prostaglandins
Increased leukotriene production and dec prostaglandins
117
Kid w/ nasal polyps think?
Cystic fibrosis
118
hilar mass w/ sheets of small round cells = think?
Small cell CA
119
Central lung CA (3)?
- Squamous CA
- Small cell CA
- Carcinoid
120
Peripheral lung CA?
Adenocarcinoma
121
long bones broken + dyspnea + petichae = think?
FAT embolism
122
COPD findings on chest x-ray?
Too much air in lungs!
- Flattening of the diaphragm
- Increased retrosternal air space
- Long narrow heart shadow
123
Multiple small nodules in the upper lungs?
Silicosis or TB
124
Diaphragmatic calcifications =?
asbestos
125
Severe allergic rhinitis not helped by antihistamine + intranasal steroids, what is next step?
Oral steroids
126
COPD two types?
- Emphysema (pink puffer)
| - Chronic bronchitis (blue bloater)
127
COPD
Decreased diffusion capacity
128
Bronchodilator response = think?
Asthma
129
COPD w/ cyanosis?
Chronic bronchitis
130
amiodarone induced lung disease main finding?
"foamy" macrophages
131
Most common cancer in women (1-3)?
1) Breast
2) Lung
3) Colon
132
Most common cancer to kill in men (1-3)?
1) Lung
2) Prostate
3) Colon
133
Most common cancer to kill in women (1-3)?
1) Lung
2) Breast
3) Colon
134
Most common cancer in men (1-3)?
1) Prostate
2) Lung
3) Colon
135
DM fasting glucose?
>126
136
impaired fasting glucose #?
slightly below 126
137
Impaired glucose tolerance #?
slightly below 200
138
When do you give tetanus immunoglobulin?
Wound Status - dirty
| Vaccinated? - no or unknown
139
What causes endometrial hyperplasia?
Tamoxifin
140
Does Raloxifene cause endometrial hyperplasia?
NO, just tamoxifin
141
Raloxifene can be used for CA and for what?
Osteoporosis prevention and treatment
142
Diffuse mesangial proliferation = think?
IgA nephropathy (Berger's Disease)
143
HTN + kidney disease - preferred treat of HTN?
ACE inhibitor
144
Glomerular nephropathies that steroids are helpful for (4)?
- Minimal Change
- Lupus
- Membranous
- Post-Strep
145
HyperKalemia causes what ECG change?
Peaked T waves
146
stethoscope in abdomen =?
- AAA (midline)
- Renal artery stenosis (on side)
- Hyperperistalsis of small bowel obstruction
147
Confirmatory test for renal artery stenosis is?
Duplex Doppler U/S
- Can't do angiography b/c in renal failure can't give contrast
148
Renal tubular acidosis type 1 is? Causes?
Poor hydrogen ion secretion into urine (DISTAL)
- genetic disorders
- med toxicity
- Autoimmune diseases (ie sjogren, RA)
149
Renal tubular acidosis type 2 is? Causes?
Poor bicarbonate resorption (PROXIMAL)
| - Fanconi syndrome (glucosuria, aminoaciduria, phophaturia) --> loose stuff in the urine
150
Renal tubular acidosis type 4 is? Causes?
Aldosterone Resistence
- Obstructive uropathy
- CAH
151
When deciding b/t Renal tubular acidosis types steps?
1) Determine Anion Gap (Na - [Cl + HOCO3] -- should be normal
2) Look at K ( high = type 4, low - either 1 or 2)
3) Type 1 (stones, pH >5.5) v Type 2 (pH
152
Distinguish b/t RTA types 1 and 2?
Type 1 - distal, gets stones in kidney
| Type 2 - proximal, losing a lot of stuff in urine (glucose, amino acids, phosphates), loose Ca from bones
153
Td booster timing depends on what?
Dirty wound - 5 yrs
| Clean wound - 10 yrs
