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Step 2CK > DDx > Flashcards

DDx Flashcards

How to dx a dz

1
Q

Jaundice in pregnancy

A

-HELLP
Hemolysis, Elevated Liver enzymes, Low Platelet
Preeclampsia, RUQ pain, N/V

-Intrahepatic cholestasis of pregnancy
Very elevated AST/ALT, direct bilirubinemia
Pruritus and jaundice

-AFLP
Liver failure, DIC, mod elevated AST/ALT
RUQ pain, malaise, N/V

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2
Q

Erythema nodosum

A 
Sarcodosis
Group A strep
TB
Histoplasmosis
IBD
(always do a CXR)
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3
Q

Hemorrhagic vs ischemic stroke

A

If hemorrhagic rapidly worsening sx
N/V, headache, AMS
Risk factors: smoking, HTN
Dx with CT scan w/o contrast

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4
Q

Anemia of chronic dz

A

Low MCV
Low iron (if high and microcytic think thalassemia)
Low TIBC
High ferritin

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5
Q

Lumbar spinal stenosis

A

Worse with extension
Pain when standing and walking downhill
Neurological deficits
Dx with MRI

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6
Q

Spondylolisthesis/spondylolysis

A

Fracture of pars interarticularis
Stiffness that radiates to buttocks and back of thighs
Worsen with standing/walking
Improves with rest

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7
Q

Solitary lung nodule

A 
Concerning if on CXR:
>2cm size
spiculated, scalloped
then biopsy
causes: primary cancer, metastasis, granuloma, benign neoplasm (lipoma, granuloma, hamartoma), vascular malformation
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8
Q

Laryngomalacia

A

chronic stridor
Peaks at 4-8 months
dx with laryngoscopy
worse when supine, better when prone

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9
Q

CVID

A

Low Ig in all classes
Recurrent resp infxn, sinusitis, GI infxn
Tx with immunoglobulin replacement

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10
Q

Lung cancer

A 
Adenocarcinoma
Squamous
Small cell
Large cell
Carcinoid
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11
Q

Spherocytosis

A

Extravascular hemolysis, jaundice, splenomegaly
Hgb concentration elevated, ankyrin mutation
Spherocytes on smear
negative Coombs
Glycerol lysis test positive for fragility
eosin 5 maleimide binding test
B19 parvovirus -> aplastic crisis

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12
Q

Hypoparathyroidism

A 
Post surgical or autoimmune
High phos, low Ca
Tetany spasms (Chvostek sign)
Prolonged QT from hypocalcemia
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13
Q

Hyperparathyroidism

A

Low Phos, high Ca, due to adenoma, hyperplasia, carcinoma
Secondary from CKD -> high Phos, low Ca
Vit D def -> high Ca, low Phos
Bones, stones, groans, psych overtones

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14
Q

HUS

A

follows Shiga like E coli infection
MAHA (Coombs neg), thrombocytopenia, AKI
bruising, petechiae, edema
schistocytes on smear

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15
Q

Pernicious anemia

A

Abs against parietal cells producing intrinsic factor
Low B12 serum levels with glossitis, neuropathy, macrocytic anemia
Atrophic gastritis increases risk of gastric cancer, carcinoid

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16
Q

Primary sclerosing vs biliary cholangitis

A 
Fatigue, pruritus, cholestasis
mutlifocal narrowing with onion skin fibrosis
PBC = middle aged women
anti mt abs +
PSC = young men with IBD
pANCA abs + (nonspecific)
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17
Q

Epidural vs subdural

A

Epidural:
Does not cross suture lines
biconvex shape, fast growing, mass effect
Subdural:
Crosses suture lines
lentiform shape, slow growing, no mass effect

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18
Q

NPH

A 
onset in 60 to 70s, M=F
Early gait impairment with broad based shuffling
Incontinence
Late memory and cognitive impairment
normal CSF opening pressure
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19
Q

PE

A

Elevated JVP, loud P2
Tachycardia, hypoxia, chest pain, syncope
Reduced EF, hypotension
on echo, R free wall hypokinesis with apical sparing
Bowing of septum into LV due to PHTN
Tx with LMWH then switch to warfarin

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20
Q

Thyroiditis

A

Hashimoto’s = chronic autoimmune, hypothyroid
nontender diffuse goitier, + TPO, variable iodine uptake
Painless = mild, transient, hyperthyroid
nontender small goitier, + TPO, low iodine uptake
De Quervain = subacute postviral, hyperthyroid
tender goitier, low iodine uptake

distinguish Graves from painless t. with uptake test

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21
Q

Muscular dystrophy

A 
Becker = no dystrophin, early onset, XLR
Duchenne = reduced dystrophin, early onset, XLR
Myotonic = DMPK triplet expansion, late onset, dominant
22
Q

Hepatorenal syndrome

A

precipitated by infxn, GI bleed, vomiting, diuresis, NSAID
Renal hypoperfusion with low FeNa, no tubular injury
no sediment, no improvement with IV fluids
Tx: splanchnic vasoconstriction with octeotride, midodrine, NE, address precipitating factors

23
Q

Beckwith-Wiedemann syndrome

A 
Hemihyperplasia
macroglossia
omphalocele
abd U/S for Wilms tumour
Monitor alpha fetoprotein
24
Q

Wilms tumor

A 
Hypertension, hematuria, abd mass
associated with:
Beckwith-Wiedemann
neurofibromatosis
WAGR syndrome
25
Q

Pediatric hip disorders

A

SCFE - obese adolescent boys, cartilage, Sx
LCP dz - younger boys, avascular necrosis, orthoses
CHD - from birth, harness

26
Q

Post op fever

A

water, wind, walk, wawa, weird drugs
Immediate - trauma, infxn, blood products, drugs
Acute - Infxn group a strep, C perfringens, MI, PE, DVT
Subacute - catheter, drug fever, PE, DVT, C diff
Delayed - viral or surgical site infxn
PE, DVT, atelectasis have similar timing

27
Q

Dementias

A 
FTD = cortical atrophy frontal and temporal lobes
early onset (50-60s), personality changes, Pick bodies
AD = cortical atropy of parietal and temporal lobes
late onset (60-70s), memory loss, senile plaques
LBD = generalized atrophy, parkinsonism, late dementia
insidious onset, hallucinations, Lewy bodies
28
Q

Cervicits

A

Chlamydia (most common)
dysuria, + cx, doxy or azythro
Gonorrhea
mucopurulent d/c, + cx, ceftriaxone
Trichomonas (least common, strawberry cervix)
green, frothy d/c, motile orgs, metronidazole

29
Q

Adnexal mass

A

Endometrioma - homogeneous mass, infertility
Epithelial carcinoma - septations, solid components, high serum CA-125
Mature teratoma - echogenic material, calcifications
Malignant signs: fixed, firm, b/l, multilocular, ascites
Benign signs: mobile, soft/cystic, unilocular, < 8cm

30
Q

Ovarian tumor markers

A 
Epithelial - CA 125
Endodermal or embryonal - AFP
Choriocarcinoma - hCG
Dysgerminoma - LDH
Granulosa cell - Inhibin
31
Q

Precocious puberty

A

True if advanced bone age, <8 for girls, <9 for boys
Administer GnRH agonist (leuprolide)
Central - positive GnRH stimulation test (high LH)
Constitutional, CNS lesion, or dysgerminoma
Peripheral - negative GnRH stimulation test (low LH)
CAH, McCune Albright, gonadal tumor

32
Q

Lyme disease

A

ELISA first, then confirmatory Western blot
early dz with doxycycline (amoxicillin or cefuroxime if peds)
late disseminated dz (arthritis, CNS) with IV ceftriaxone

33
Q

Placenta previa vs vasa previa

A

Placenta previa - maternal painless bleed, FHT unaffected, associated with smoking, previous c section
Vasa previa - umbilical vessel damage, fetal distress
Avoid intercourse, digital exam w/o prior US if either is suspected

34
Q

Pseudotumor cerebri

A

Young obese women with daily headaches, worse in AM
Impaired CSF resorption leads to high ICP
Papilledema, oculomotor abnormalities, N/V
May lead to blindness
Weight loss, acetazolamide, surgical fenestration of CNII

35
Q

Herpangina vs herpetic gingivostomatitis

A

Herpangina - Coxsackie A virus
3-10 years old
Fever, pharyngitis, gray vesicles/ulcers in post mouth
Herpetic gingivostomatitis - HSV type I
1-5 years old
Fever, pharyngitis, clusters of small vesicles in ant mouth

36
Q

Leukemoid vs lymphomas vs leukemias

A

Leukemoid reaction - infection, serum LAP high
ALL (3-5 yrs old) - Down syndrome, lymphoblasts in bone marrow
AML (13-40 yrs old) - Auer rods, myeloblasts in bone marrow, high LDH, tx for PML subtype with ATRA
CML (40-60 years old) - BCR-ABL fusion/Philadelphia chromosome, serum LAP low
CLL (males > 50) - smudge cells, splenomegaly

37
Q

Felty syndrome

A

RA with neutropenia and splenomegaly
Rheumatoid nodules, mononeuritis multiplex, vasculitis
ESR, anti CCP and RF elevated,

38
Q

Mallory Weiss tear vs Boerhaave syndrome

A 
MW = mucosal tear, hematemesis
BS = transmural tear, esophageal air/fluid leakage
39
Q

Anemia due to iron def vs thalassemias

A

Thalassemia (alpha, beta, Hgb H)
extramedullary hematopoiesis with bone changes
target cells, high or normal iron and ferritin
Iron deficiency
hypochromia, low iron and ferritin, elevated TIBC

40
Q

Cyanide vs CO vs methemoglobinemia

A

Cyanide - burning polymers
tx with hydroxycobalamin, thiosulfate or nitrites
CO - burning of carbons
tx with pure O2
Methemoglobin - nitrites and oxidants, dapsone
tx with O2, methylene blue

41
Q

Hemorrhagic stroke

A

Cerebrum - contralateral hemiparesis and sensory loss, eye deviation away from lesion, seizures, homonymous hemianopsia
Cerebellum - ataxia, nystagmus, n/v, neck stiffness
Thalamus - contralateral hemiparesis and sensory loss, eye deviation towards lesion, upgaze palsy
Pons - coma, paralysis, locked in syndrome with pinpoint reactive pupils
Basal ganglia - contralateral hemiparesis and sensory loss

42
Q

Breast feeding vs breast milk jaundice

A

Breastfeeding - inadequate feeding in first week of life

Breast milk - adequate feeding, peaks at 2 weeks due to excess deconjugation from milk in intestine

43
Q

Herniation

A

1 - ipsilateral hemiparesis (crus cerebri)
2 - Mydriasis (CNIII parasympathetics)
3 - ptosis, down and out gaze (CN III motor)
4 - homonymous hemianopsia (PCA compression)
5 - LOC, coma (reticular formation)

44
Q

Rashes of childhood

A

Pytiriasis rosea - herald patch, xmas tree sign, self resolving
Erythema marginatum - faint borders, evanescent, ARF
Erythema multiforme - dusky center, red borders, due to infection or medication
Tinea corporis - contact sports, scaly rash, central clearing, raised borders
Eczema - scaly or papular patches in flexural areas
Urticaria - raised plaques resolve over 24 hrs

45
Q

central vs peripheral Bell’s palsy

A

Central - contralateral, spares forehead
Peripheral - ipsilateral, affects forehead
may cause decreased tearing, hyperacusis, decreased taste in anterior 2/3 tongue

46
Q

Skin infection

A

Erysipelas - (S pyo), raised sharp edges, fever, superficial dermis and lymphatics, rapid onset
Non purulent cellulitis - (MSSA, S pyo), flat, blurred edges, deeper layers of dermis, indolent
Cellulitis - (MSSA, MRSA), folliculitis, abscess formation

47
Q

Immunodeficiencies

A

Affect B cells:
Bruton’s agammaglobulinemia, CVID, IgA deficiency
Affect T cells:
Di george syndrome, SCID, Wiskott Aldritch
Affects phagocytes:
Chronic granulomatous disorder, Leukocyte adhesion defects, Chediak Higashi
Affects complement:
C1 esterase def, terminal complement def

48
Q

Vaginal bleeding in pregnancy

A

Vasa previa - fetal distress and painless bleeding
Placenta accreta - retained placenta
Uterine rupture - tender uterus, palpable parts
Abruptio placentae - fetal distress, distended uterus

49
Q

Amniotic fluid embolus vs pulm edema in pregnancy

A

embolus - hypotension, shock, resp failure peri partum

edema - hypertension, low albumin, low renal function in pre-eclampsia

50
Q

RTA

A

hyperchloremic metabolic acidosis with normal AG
Type 1 - meds, autoimmune dz, genetic dz
reduced H excretion (low K, high urine pH)
Type 2 - Fanconi syndrome
poor bicarb reabsorption (low K, low urine pH)
Type 4 - obstruction, adrenal hyperplasia
aldosterone resistance (high K, low urine pH)

51
Q

Multiple myeloma

A

CRAB - calcium is elevated, renal failure, anemia, bone lesions
Protein-albumin gap
SPEP with M-spike, Rouleux formation
Dx with bone marrow biopsy showing clonal plasma cell

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