Final Flashcards
T/F “all that wheezes is not asthma, and all asthma does not wheeze”
true
asthma incidence has been increasing for 30 years
two theories why
air pollution
increased sensitivity to allergens due to hygiene hypothesis
describe the effect of H pylori on cancer
increaesd risk of gastric cancer, decreased risk of esophageal cancer
five chronic complications of DM
CAD
PVD
nephropathy
neuropathy
retinopathy
three Ps of diabetes
polyuria
polydipsia
polyphagia
resistant TB treatment
up to 20 months of 2nd or 3rd line agents
US findings of ectopic pregnancy
No IUP “empty uterus”
adnexal mass
free fluid in the cul de sac
what is necessary for the evaluation of first trimester pain and bleeding
ultrasound is mandatory to catch ectopic pregnancy brefore rupture
diagnosis of melaoma
biopsy
ABCDE
ugly duckling
fatal complication of diabetes
diabetic ketoacidosis
four non-joint manifestations of RA
is there an effect on lifespan
anemia, pleura, eye, skin
life span is shortened, mechanism unknown
T/F multiple myeloma bones are prone to fracture
true
OA symptoms
pain on use that is worse with activity and improved with rest
<15 of stiffness each morning
what is the presentation of ectopic pregnancy
vaginal bleeding
pelvic pain
usually starts in the firs ttrimester
what percent of people have asthma
how many office visits are asthmas related
7-10%
1-3%
define diabete mellitus
a disorder characterized by chronic hyperglycemia due to relative or absolute deficiency of insulin, or resistance to insulin
signs of appendicitis
abdominal pain
nauseaa
low fever, leukocytosis
treatment for gastric cancer
gastrectomy (only possible for 30% of patients)
chemo
what is the most common type of hyperthyroidism (60-80%)
graves disease
how do H2 inbitors block acid production
block the binding f histamine in to receptors, stopping the production of cMAP from adenylate cyclase and reducting proton pump action
what medication is used to treat gout by reducing inflammation
colchicine
two photo treatments of psoriaisis
UVB, PUVA
which thyroid hormone is most readily available
why is this effect in treatment
T4
because T4 is converted to T3 in tissues
when will most diabetic have complications
after 20 years
psoriasis
chronic, relapsing skin disorder that causes itching, joint inflammation, and depression
what is the function of beta-2 agonists in asthma treatment
side effects are caused by beta 1 cross reactivity
what are the side efects
bronchodilation
tachycardia, hyperglycemia, HTN
describe multiple myeloma in three bullets
most common form of bone cancer
comes from a single plasma cell
produces large amounts of antibodies
four pathologies of appedicitis
obstruction form feces, foreign body, inflammation, neoplasm
tests and exams to confirm cushings
elevated cortisol
cortisol suppression test
Low ACTH levels
imaging
what is the process of a bone marrow transplant
destroy bone marrow with radiation and chem
transplant hematogenous stem cells
What is responsible for GERD
a disorder of the lower esophageal sphincter that allow acid to come up
risk factors for GERD
obesity
hiatal hernia
increased acid production
5 general categories of hormones
amino acid
neuropeptides
proteins/glycoproteins
Steroids
Vitamin deriviatives
what is required to pass TB onto someone else
what is the efficiency of transition
fair close prolonged contact
23%
what is the preferred method of treatment to definatively cure hyperthyroid
what makes it good
ablation wth radioactive iodine
because it spares the parathyroid
symptomatic treatment of cirrhosis
paracentesis of ascities
shunts to reduce portal hypertension
correction of coagulopathy and hypoalbumemia
treatment for fibromyalgia
antidepressants
lifestyle adjustment (stress reduction, exercise, normal sleep)
how does the IBD increase the risk of colon cancer based on duration
after 10 yrs 2%
after 20 8%
after 30 18%
what is the treatment for a cure in esophageal cancer
surgery, radiation, chemo
5 protein/glycoprotein hormones
FSH
LH
TSH
HCG
Insulin
PTH
target cell
the end-target of a hormone that produces a response within the cell
what is the hallmark of type II DM
insulin resistance
what is the most common cause of cholecystitis
distal occulsion of the bile duct by a gallstone
gram negative sources of HAP
klebsiella, pseudomonas
why can radioactive iodine be used to ablate the thyroid
because the thyroid is the only place where iodine is stored in the bdoy
psoriasis is associated with increased risk for what diseases
inflammatory bowel disease
skin cancer
upper GI cancer
lung cancer
which is more relevant, long or short feedback loops?
why?
long, because they work on the hypothalamus and the pitutiary
what medications can be used to reduce inflammation of asthma
glucocorticoids or other anti-inflammatories
trigger of RA
unknow, suspected infectious agent or smoking
what diagnoses for cushings have a good prognosis?
poor?
good: cushings disease and iatrogenic cushings
bad: adrenal carcinoma and small cell lung cancer
how is COPD related to asthma
smoking damages epithelium, leading to infection, inflammtion and asthma like reactive airways
typical cause of lobar pneumonia
strep
dermatological manifestation of insufficient oxygenation
clubbing and cyanosis
T/F its common to have severe symptoms in the early stages of pancreatic cancer
false, it is commonly asymptomatic
what changed in peptic ulcer treatment after 1981
helicobacter pyloria was linked to PUD
what is common when ovarian cancer starts to spread in the abdomen
obstruction, malabsorption
special hazard of PR
connection with giant cell arteritis in 1/3 of patients what can cause sudden blindness due to occluding the opthalmic arteries
what is the main method of TB spread
where else can it come from
airborne in aerosol mucus
infected cow milk
what is the effect of Hep D and B infection
a significantly more severe disease than Hep B alone
what is the age and gender bias for esophageal cancer
50-70
3x more common in men to women
explain why endocrine systems are homeostatic
they respond to outside challenges to maintain homeostasis
what is the result of build up of nodular and fibrotic tissue from cirrhosis
obstruction of the biliary channels and portal hypertension
two types of auto immunte arthritis
rheumatoid arthritis
lupus
when does obstetrical dating start
the first day of the LMP
what is the hallmark symptom of RA
early morning stiffness lasting more than one hour
renal involvement of gout
urate crystals can deposit in the glomeruli and cause renal failure
risk factors for esophageal cancer
tobacco (specifically for squamous cell)
obesity
GERD/Barrett’s esophagus
two types of myalgia for our test
fibromyalgia
polymyalgia rheumatica
three orgin sites for ovarian cancer
which is the most common
epithelial
germ cell
stromal/sex cord
epithelial
differentiating factor between RA and OA
OA effects the hips and spine, RA doesn’t, though it can effect many joints
three types of peptic acid disorders
benign peptic ulcers
GERD
zollinger-ellison syndrome (gastrinoma)
what treatment that works on gout won’t be very helpful in other cases of arthritis
colchicine will reduce pain only in gout, not OA and RA
where are other ACTH secreting cells located beside the pituitary
small cell lung cancers
methods to stimulate cartiliage repair in OA
glucosamine/chondroitin, chondroctye transplantation
diagnostic process of lung cancer
direct visualization with biopsy
diagnostic imaging
what happens histologically with smoking
the loss of respiratory cilia
what is the gender bias of cholelithaisis
women over men, 8.6% to 5.5%
how common is Hep A
how is it spread
what is the mortality rate
30% of americans are serologically positive for Hep A
fecal oral transmission from sanitation, shellfish
usualyl low, the disease does not lead to chronic infection or liver damage
what was the mean survival of a diabetic patient before 1922
after
what changed?
5 year <5%
increaed to 30-40 years
insulin was discovered
PE findings for appedicitis
RLQ, pain, guarding, rebound, positive psoas or obturator
treatment for melanoma
excision
chemo
immunotherapy
prognosis of active TB
100% cure rate with compliance and non-drug resistance
withotut treatment 35% will die in 1 year, another 35% in five years
is Hep C commonly spread to babies through breast feeding
not commonly
what is the process of Hep A
incubation for 30 days
prodrome for several days
icteric phase for 2-3 weeks with worsening symptoms
convalescence
why is it imporant to know the amount of a hormone that is bound vs free
a bound hormone can’t do anything
how long does an acute gout flare last
do they recur?
when wil gout cause joint deformity
several days to weeks
yes, in months or years later
only in early onset or untreated goiut
paracrine
chemical signalling to nearby cells
5 adverse effects of cortisol
weight gain
striae
moon facies
HTN
peptic ulcers
three facts about steroid hormones
insoluble
requires transport molecules
causes DNA transcription and translation
four less common symptoms of pneumonia
pleurisy, chest pain, hemoptysis, anorexia
what is the fucntion of C peptide after it is removed from proinsulin
what would high levels of c peptide indicate?
low?
nothing
high levels = type 2 DM
low = type 1 DM
what is the most common type of osteoporosis
involutional
what is the gender ratio of patients with graves disease
female 8:1
three bacteria agents that will cause septic arthritis
gonorrhea, staph, strep, TB
three subtypes of osteosarcoma
osteoblastic
fibroblastic
chondroblastic
polymyalgia rheumatica
also has…
pain and stiffness of the shoulder and pelvic muscles causing difficulty combing hair or rising from a chair due to pain, not weakness
also has a low grade fever, weight loss, and malaise
two types of COPD
what is the difference
chronic bronchitis and emphysema
chronic bronchitis is has more obstruction from sputum and inflammation
emphysema has more destruction of alveoli
what percent of people will develop episodic biliary pain related to gallstones
what are the symptoms
10-25%
RUQ pain, often at night
pain related to a high fat meal
lasts from 30 minute to hours
screening procedures for colorectal cancer
fecal occult blood testing
fecal immunochemistry screening
colonoscopy
three ways to limt joint trauma in OA
reduce joint loading, change types of exercise, strengthen muscles
risks of osteoporosis treatment
estrogens: heart disease and breast cancer
bisphosphonates: jaw osteonecrosis
SERMs: hot flashes
Ca supps: renal caliculi
two variants of endometriosis
benign and aggressive
what is the effect of glucocorticoids on asthma treatment
typical oral treatment
one example of inhaled glucocorticoids
strong anti inflammatory effect
prednisone for 5-10 days
flunisolide
what joint is most commonly effected by gout
the big toe
T/F tuberculosis only effects the lungs
false, late stages can effect every organ
describe pelvic pain associated with ectopic pregnancy
usually mild, starts at 6-8 weeks in
what are the physical exam findings present with cholecystitis
murphy’s sign
diagnossis of esophageal cancer
endoscopy, biopsy, Ct for stagin
T/F gallstones are usually symptomatic
false
three mediations that cause cause asthma
beta blockers
anaphylaxis to medication
aspirin
why would you check for hyperthyroidism in new onset a fib
because hyperthyroid can trigger arrhytmias
symptoms of lung cancer
weight loss (50-90%)
cough (60%)
hemoptysis (10-30%)
some have cest pain (20-40%)
tophus
a nodular deposit of urate monohydrate crystals that cuases a foreign body reaction
what is the risk of breast cancer in females without estrogen
what about men with estrogen
male level risk
increased risk because of estrogen
what joints are most commonly affected by RA
MP, PIP, knees
thyroid storm
acute high levels of T3 and T4 that can cause hypotension and fever
two stratgies to reduce insulin resistance
weight loss
medication (biguanides and thiaxolidinediones)
what are the protective effects of gastric prostaglandins
suppression of acid production
stimulates mucin production
increase HCO3
increase muscosal blood flow
four types of arthritis
auto immune
osteo
gout
septic/infectious
PUD treatment
eradicate H pylori
reduced acid secretion
neutralize acid
enhance mucosal defense
what is the pathophysiology of asthma
reduction in airway diameter brough about by a contraction of smooth muscle, vascular congestion, edema, and tenacious sputum
diagnostic process for asthma
improvement of symptoms with bronchodilators
sensitivity to stimuli
sputum elevated IgE
high blood eosinophil counts
what are three less common presentations of breast cancer
nipple erosion or discharge
skin dimpling
inflammatory breast carcinoma
describe pelvic pain associatd with ectopic pregnancy
usually starts at weeks 7-9
can vary from cramping to sharp pain
how has PUD disease changed
H pylori
nsaid and sterioids effect
increase acid production (smoking and stress)
inadequate mucosal effect (smoking)
autocrine
chemical signaling of cells among the same type
what two effects of cortisol are considerd to improve resistance to stress
increased glucose availibility
increased blood pressure
three signs of clotting abnormalities in the skin
petechiae
purpura
easy bruising
prognosis of osteosarcoma
good with treatment, greater than 10 years at 60-80%
without, death in months
where are T3 receptors found
in alll most all human tissue
what percent of patients with lung cancer are symptomatic on diagnosis
75-90%
who should be screened for colorectal cancer
low risk patients every 10 years at 50
high risk earlier and more often
what is the goal of psoriasis treatment
slow the turnover rate of the epidermis
what makes Hep C more problematic
chronic infection is a comon complication and is the leading cause of cirrhosis
how is IBD diagnosed
diagnostic imaging
endoscopy
what has changed recently in RA treatment
DMARDs have allowed for early intervention with aggressive treatment, if patients can afford them
what causes tuberculosis
describe the pathogens
infection by mycobaterium tuberculosis
slow growing acid fast aerobe
five symptoms of acute cholecystitis
biliary pain
nausea/vomiting
fever
leukocytosis
jaudice
dermatological manifestation of heart failure
pitting edema
cushing syndrome
a cluster of symptoms caused by excess cortisol
OA treatment types
anti-inflammatory/analgesia
cartilage repair
surgical
reduce joint loading
what is the presentation of ruptured ectopic pregnancy
massive intrabdominal blood loss
severe pain
syncope
what cells in the pancreatic islets that secrete insulin
glucagon
beta cells
alpha cells
what are the main risks for chronic pancreatitis
alcoholism, smoking, biliary tract disease
three areas of cancer of the reproductive system
breast cancer
ovarian
uterine
two ways to improve COPD symptoms
stop smoking and control infections
improve airways with asthma medicaiton (bronchodilators, glucocorticoids, reduction in airway mucus
what triggers beta cell loss in type I DM
can be a virus or toxin such as mumps or coxsackie, as well as a genetic predispostion
what is the second most common primary bone cancer
is it common overall?
when does it most commonly strike
osteosarcoma
no
60% in the first two decades
two types of vitamin derived hormones
retinoids (vitamin A)
vitamin D
three types of steroid hormones
estrogens
androgens
progestins
should patients with hep C us protection
its not necessary
three disease that can be triggered by hyperthyroid
acute chest pain (MI)
CHF
Arrhythmia
two considerations to account for with surgical excision of melanoma
wide surgical margins with lymph node sampling
what is the 5 year survivable prognosis for esophageal cancer
less than 20%
secondary hyperthyroid
failure of the pituitary to release TSH
two actions of insulin
inhibit catabolism
promotes anabolism
what is the etiology of PR
autoimmune disorder with elevated ESR
in what countries are breast cancers most commonly found
why
developed countries
related to fat content
what is the main cause of cervical cancer
what are two synergistic factors
HPV
smoking, immunosuppression
common treatment of PR
predinsone should produce recovery in 72 hrs or its something else
conitinue low does steroids for 6-12 montsh
two main types of hyperthyroidism
graves disease
toxic nodular goiter
gout treatment strategies
reduce acid production through diet
reduce inflammation
enhaance excretion
what is the common cause of squamous cell carcinoma
when would it be considered deadly
UV light
when it is in the oral cavities or mucus membranes
what is insulin
what compound is it derived from
how does this happen
a small protein
conversion of proinsulin into insulin
removal of connecting C peptide
downsides of glucocorticoid treatment of asthma
can cause calcium deficiency, HTN, hyperglycemia
where do lung mets spread
liver, spine, and brain
2/3 of RA patients will present with what
fatigue, malise, generalized weakness, vague joint complaints
define pneumonia
inflammation of the lungs caused by bacteria, viruses, fungus
what is the radiographic hallmark of multiple myeloma
punch out lesions
what is the treatment for multiple myeloma
aggressive chemo, possibly bone marrow transplant
in what hyperthyroid condition does exopthalmos not occur
goiter
what is the cause of goiters
is there a gender bias
what may be a contributing factor
unknown
no, 1:1
low iodine may contribute
what differentiates allergic from idiosyncratic asthma
idiosyncratic has no Hx, negative allergy skin tests, normal serum IgE
what are the three primary surgical treatments of breast cancer
lumpectomy
mastectomy
axillary node dissection
three imaging studies for lung cancer and their utlitiy
CXR
CT (for CT biopsy)
PET (useful in looking for distant mets)
how to prevent Hep A
sanitation
hep A vaccine
antiobodies for post exposure treatment
what is the method of imaging a gall stone
ultrasound
two methods to reduce acid production related to PUD
H2 receptor antagonist
PPI
what is the first line treatment for hypothyroid
daily thyroxine
what is the purpose of screening procedures for colorectal cancer
the identification and removal of adenimoatous polyps
four types of primary bone cancer
multiple myeloma
osteosarcoma
chondrosarcoma
ewing sarcoma
three pathophysiology hallmarks of COPD
airflow obstruction
alveolar dialtion and destruction
chronic and acute airway infection
what is the connection between ethanol and breast cancer
slight increase in ris
long feedback look
a feedback loop where the end hormone produce by trophic stimulation will inhibit production at the hypothalamus and pituitary
what causes DKA
hyperglycemia >300mg/dl causes keto acids to accumulate
what is the treatment of an ectopic pregnancy
removal of affected tube
blood transfusion
treatment for HAP
ABx for resistant pathogens
supportive care
how common are peptic ulcers
how has the epidemiiology changed
very common (500,000 new cases yearly)
increasing numbers of gastric ulcers vs duodenal
what typpe of diabetics are most likely to have DKA
type one
treatment of unruptured ectopics
methotrexate with follow up
laproscopy with preservation (little) or removal (big) of the tube
what is the effect of smoking cessation on CVD
decreased risk to normal within 3-5 years
what demographic has the highest instance of IBD
ashkenazi jews
major endocrine glands (10)
- pineal gland
- parathyroid
- thyroid
- hypothalamus
- pituitary
- thymus
- kidney
- adrenal
- pancreas
- ovary/testes
three goals of COPD treatment
prevent, improve, support
what type of bacteria is helicobacter pylori
where is it common
if H pylori is not erradicated what is the risk
gram negative spirochet that causes gastritis
most common in places with poor santitation
85% of ulcers will recur
treatment of H pylori
2 week course of abx with bismuth or PPI
short feed back loop
a feedback loop where a trophic hormone from the pituitary inhibits production of stimulating factors from the hypothalamus
how are hormones sent through out the body
dissolved in blood or bound to carriers
5 risk factors for pancreatitis
alcohol abuse
smoking
female gender
biliary disease
medicaion
what type of peptic ulcer is most common
what age
what age of gastric
duodenal 4:1
35-55
55-70
how is bone density measured
DEXA
what are the conventional screens for HPV
pap smear
liquid based medium
HLA-DR4 is associated with what
is this correlated to incidence
RA
no, only 10-15 percent of twins with HLA-DR4 will have concordant RA
what are the diagnostic considerations for endometriosis
laparoscopy
open surgery
US
what is the relationship of leukotrines to asthma treatment
what is one side effect of increased leukotrienes
modulation of inflammation
LTD4 is a powerful bronchoconstrictor
how is hep b spread
transfusion
exchange of bodily fluids
vertical transmission (mother to off spring)
treatment of osteoporosis
Ca supplements
estrogen
selective estrogen modulators (SERMs)
bisphosphates
symptoms of UC
diarrhea, cramping, rectal bleeding, passage of mucus
hallmarks of allergic asthma
personal or family Hx of allergies
early onset
what type of feedback loop primarily regulates the endocrine system
how is regulation accomplished
negative
secretion of inhibiting or enhancing factors
smoking cessation is only effective 15-20% of the time
why?
what can be done to help the odds
nicotine is highly addictive
multi-faceted programs (education, support groups, meds)
treatment for endometrial cancer
radiation
surgery
hormones
chemo
three types of emergency asthma treatment
epinephrine subcutaneous injection
beta 2 inhalers
glucocorticoids
risk factors for pancreatic cancer
smoking
chronic pancreatitis
obestity
long term diabetes
three examples of antiinflammtory/analgesic treatment of OA
NSAID, joint injections, heat therapy
what causes osteosarcoma in older patients
radiation or transformation from pagets disease
five effects of cortisol
increases glucose production
raises blood pressure
raises blood sugar
lowers lymphcyte and monocyte levesl
two main types of IBD
Ulcerative colitis or crohns
what percept of prenancies are ectopic
what percent of those are in the fallopian tube
0.5%
95% in the fallopian tube
T/F complete control of glucose is bad
true, it decreases longevity
what are the treatments for psoriasis ranked by toxicity
what is the relationship between toxicity and effectiveness
topical, photo, systemic
increasingly effective treatment is increasingly toxic
what are the laboratory signs of cholecystitis
leukocytosis, elevated bilirubin, elevated liver enzymes
what kind of diet will lower the risk of galll stones
low carb high fiber
what can cause CAP pneumonia
what is the most common
bacteria, virus, fungi
strepococcus pneumoniae (65-70%)
symptoms of crohns
recurrent episodes of RLQ pain
malabsorption
steatorrhea
bowel obstruction
where is GERD most common
develop countries 10-20%
why can FSH, LH, TSH, and HCG cross react with each other
they have receptors in the same family
from a clinical perspective, what are the two types of lung cancer
small cell and non small cell
three consequences of bone marrow failure found in multiple myeloma
anemia
bacterial infection
increased bleeding
T/F periodic swelling of joints, with rednesss and pain are common with RA
true
what is the current mortality for hospital pneumonia patients
10%
what is the only behavioral risk factor of RA
smoking
what type of hormones will dissolve in blood
what type of hormones will need a carrier
water soluable
lipid soluble
what is the risk factor for breast cancer associated with familial linkage
but…
risk is increased 3-4x if a mother or sister has breast cancer
75% of patients have no history
what joints can be affected by RA
almost any joint except those of the thorax but including the neck
benign variant endometriosis characteristics
later onset
superficial lesions
slow progression
what age is most common for polymyalgia rheumatica
always after age 50, mean 72
two regulators of thyroid function
thyrotropin-releasing hormone (TRH)
thyrotropin (TSH)
FLD causes and management
chronic alcohol use
obestiy
metabolic disease
drug toxicity
primary hyperthyroid
the 99% of hypothyroidism that is caused by failure of the thyroid galdn
what is the relationship between keloids and skin pigmentation
increasing pigmentation increases risk
how common is hashimotos
is there a gender bias
1-4/1000
females 1:4
three results of airway inflammation
bronchial hyperreactivity and bronchospasm
increased secretion and viscosity
bronchial remodeling
what percent of TB are resistant to first line drugs
how does mortality from multi-resistant TB compare to untreated active TB
10-15% of all strains
they are similar
how is fatty liver detected
liver function test
US
CT
what often causes chest pain assocaited with lung cancer
mets to bone
when is direct inoculation a common cause of septic arthritis
complication of joint injection or post surgical
why is inhalation therapy common
maximizes airway dose, minimizes systemic dose to decrease side effects
at what age does mammography have a proven value
between ages 50-70, no value under age 40
symptoms and infectiousness of an active (progressive) TB infection
systemic symptoms (fever, weight loss, cough, hemoptysis, fatigue)
TB bacilli in expired air
what is the treatment plan of hyperthyroid
control symptoms
prevent thyrid storm
plan long term control
what is the main task of the thyroid
to produce T3 ad T4
where does osteosarcoma start
what is the msot common complaint
what is the risk of untreated cancer
in a long bone
bone pain with pathologic fracture
mets to other bones or the lungs
what is the most common cause of hypothyroid
hashimotos thyroiditis
what is the key pathologic feature of TB
why does it form
caseous granuloma
because the immune system cannot eliminate TB
T/F most chronic conditions are no effected by cortisol
false, many (such as DM and HTN) can be exacerbated by cortisol
what is the most common bone disorder in the US
what is the gender bias
involutional osteoporosis
two treatment options for basal or squamous cell carcinoma
outpatient excision or thermal ablation
osteoporosis
loss of calcium from overactive osteoclasts that results in a demineralization of bone with a normal bone matrix
ABCDE for melanoma
assymetry
border
color
diameter
evolution
who is Hep E most dangerous in
pregnany women and immunosuppressed patients
how is fibromyalgia diagnosed
physical exam with trigger points
widespread pain for longer than 3 montsh
prodromal symptoms of Hep A
malaise, anorexia, fatigue, myalgia, RUQ tenderness
what is the risk of a ruptured ectopic pregnancy
death
contrast the course of illness between Hep A and B
they have similar symptoms and rarely fatal, BUT chronic infection is possible that increases risk of cirrhosis and hepatoma
how does early diagnosis effect prognosis of ovarian cancer
but…
early detection increases prognosis
but only 20% of cases are detected earyl
three factors that increase risk for endometrial cancer
two factors that decrease risk
estrogen exposure, insufficient progesteron, genetics
oral contraceptives, progestin use
two benign forms of skin cancer
one maglignant type
basal cell and squamous cell carcinoma
melanoma
three lower GI disorders
acute appendicitis
colorectal cancer
IBS
hypertrophic scars
raised or expanded scars that often form in reaction to suboptimal healing
four risk factors for osteoporosis
genetics
smoking
low calcium intake
early menopause
Which is more common, Hep A or B
hep A 5-6% positive
what is the most common age group to form keloids
10-20
three options for GERD treatment
gastric acid suppression
lifestyle modification
surgery
when would a septicemia cause arthritis
a systemic infection, comonly in immuno suppressed patients or IV drug usres
isoniazid and rifampin
first line TB drugs
how effective is gardasil against cervical cancer
what about genital warts
prevents 70-90% of cervical cancer
only some protection
medications used in treatent of RA
NSAIDs
physical therapy
glucocorticoids
DMARDs
what is the main risk factor for melanoma
why is the incidence increasing but the mortality decreasing
sun exposure
sun worship - early detection, better treatment
what is the mortality for acute pancreatitis
5-25% depending on severity
three ways to use hormone suppression to treat endometriosis
contraceptives
Pituitary down regulation
mild androgens
what are the laboratory tests that will confirm hyperthyroid
very low or absent TSH
very high T4
sometimes autoimmune tests are positive
gram positive sources of HAP pneumonia
strep and staph
how many joints does gout usually effect
one
what is the main complication of osteoporosi
increased risk of fracture
treatment for endometriosis
NSAIDs for dysmenorrhea
ovarian suppresssion
surgery
why is follow up in TB treatment so important
monitor compliance, clinical response, and drug toxicity
dscribe the abdominal pain associated with appendicitis
periumbilical and epigastric, migrating to the right lowe quadrand
differing pain in gastric ulcers
intermittent heartburn type vs chronic boring pain with deep ulcers
two parts of the adrenal gland
medulla
cortex
symptoms of gastric cancer
none, in the early stages
upper abdominal pain
anorexia/weight loss
blood loss anemia
diagnosis of gastric cancer
double contrast upper GI xray
esophagogastroduodenoscopy (EGD)
what percent of patients will develop latent TB
what about progressive TB
90-95%
5-10%
what is the prognosis of small cells lung cancer with and without treatment
with 10-16 months
without 6-17 weeks
diagnostic factors of pancreatitis
elevation of pancreatic enzymes
fever and leukocytosis
Ct imaging
what is the function of the adrenal medulla
secretes epi/norepinephrine
what will the response to T3 be
increased…
energy utilization
protein synthesis
sensitivity to other hormones
what is the prognosis of lung cancer 1 and 5 year
1 year, 40%
5 year, 15%
three goals of asthma treatment
reduce inflammation
dilate terminal airways
improve airway secretions
three risk factors for gastric cancer
chronic H pylori
smoking
diet high in nitrates but low in vitamin c
symptoms of pancreatic cancer
gnawing visceral midabdominal pain
weight loss
jaundice from biliary obstruction
5 common locations of distant endometriosis
umbilicus
intestine
upper abdomen
lung
brain
what is the prognosis of RA
what percent untreated people will have disability
what percent will have a work disability
it depends, there is a fluctuation of disease
80% will have disability within 12 years
50% will have work disability within 10 years
how common is psoriasis
what is the typical age of onset
what is the gender bias
very common (1-3%)
15-25 yrs
none
five ways to treat breast cancer
surgery
radiation
chemo
anti estrogen driugs
antibodies against growth factors
why are men at less risk of involutional osteoporosis
men start with a higher bone density
describe the use of glucocorticoid as an emergency asthma therapy
oral is as effective as paenteral
takes 6-12 hours
reduces hospitalization
what is the definitive surgical treatment for endometriosis
hysterectomy and oophorectomy
5 locations in the body with especially high numbers of T3 receptors
brain
heart
muscle
kidneys
gonads
common etiology prior to 1981
stress
enviromment (smoking, spicy food)
alchool
glucocortioids and NSAIDs
treatment of pancreatic cancer
surgical resection
chemo
radation
what is more common, secondary or primary bone cancer
secondary
treatment strategy for RA
relieive pain with NSAIDs and physical therapy
prevent joint damage with disease modifying drugs
possibly repair damage
five non-insulin treatments of DM
reduce insulin resistance
stimulate secretion fo endogeneous insulin
reduce glucagoon
reduce glucose absorption
enhance urinary secretion
what is injected into a joint for OA
local anesthetic, glucocortcoids, hyaluronic acid
what is the strategy for decreasing bronchial secretions in asthma treatment
application of anticholinergic/antimuscarinic agents to improve air way diamter
what pattern is lost with cushing syndrome
the diurnal pattern which causes higher cortisol in the morning and lower at night
three symptoms of GERD
esophageal pain
nausea
coughing
two types of beta 2 agonists and one example of each
short acting (albuterol)
long acting (salmetrol)
what causes graves disease
auto-antibodies that bind and active TSH receptors
what is the prognosis of cirrhosis
severe cirrhosis 6 month survival at 50%
moderate 5-10 yrs
potential complications of chronic pancreatitis
opiod addiction
DM
malabsorption from enzyme deficiencies
pancreatic cancer
treatment of septic arthritis
intravenous abx
removal of hardware
two types of lupus
systemic
discoid (only skin)
serous and mucinous cystadenocarcinoma are examples of what type of ovarian cancer origin
epthelial
three risk factors for OA
age, joint loading/repetitive stress, obestity
what is the advantage of SERM treatment in osteoporosis
selectively effects estrogen receptors in bone
preventing Hep B
screening to protect blood supply
Hep B vaccine for children
HBIG for exposure
prevention of transmission at bith
diagnostic process for TB
HP
sputum culture with acid fast stain
skin test
lab test
chest xray
three facts about peptide/protein/glycoprotein hormones
water soluble
interact with cell membrane
work through second messanger
what is the paradox of osteoporosis treatment
there are approved drugs to improve bone density and reduce fractures
BUT
there are significant risks
explain the saying “female, forty, fat, and fertile”
delineates the risk factors for gall stones
what is the risk of untreated cholecystitis
ischemia leading to perforation/rupture, followed by abcess, peritonitis, and death
treating viral hepatitis
infereron
antivirals to reduce the risk of liver failure
there is a cure
direct treatment of cirrhosis
anti viral drugs for hepatitis
anti-inflammatory and immunosuppresive drugs in the case of an autoimmune disorder
liver transplant
what does tight management of DM entail
diet
frequent blood assays
medication 3-4 times daily
flexible dosing
what happens in hashimotos
the thyroid is infiltrated with T and B cells
exophthalmos
cause
protrusion of the eyes found in 20-40% of Graves patients
caused by lymphcytic infilitration of the eyes
four types of receptor hormone interactions
agonists (stimulate receptors)
antagonists (block receptors)
down regulation
change receptor affinity
what is the usual presentation of breast cancer
a painless lump found by the patient
four common of osteoporosis
cushings
hyperparathyroidism
chronic renal disease
involutional
what percent of people with ecoptic pregnancy will have at least one risk factor
50%
three atmospheric triggers of asthma
pollution
cold air
abrupt weather changes
what can happen if a homone is present in high enough concentrations
the hormone can interact with receptors of the same family
T/F what percent of all humans have been infected with TB
30-40 percent
four facts regardings breast cancer and age
increasing risk
rare before…
mean age
diagnosis time
risk increases with age
rare before 40
mean age of diagnosis 60-61
time from origin to diagnosis 2-8 years
when pursuing surgical treatment of ovarian cancer, what needs to be removed
uterus, ovaries, fallopian tubes, omentum
how long does it take for a breast cancer tumor to double in size
20-100 days
what nervous system are many of the symptoms of hyperthyroidism related to
sympathetic nervous system
- restlessness
- insomnia
- tremor
- weight loss
- heat intolerance
endometriosis
endometrial glands and stroma outside the uterus
two types of esophageal cancer
squamous cell (most common)
adenocarcinoma
three conditons associated with GERD
Barrett’s esophagus
Esophageal carcinoma
esophageal stricture
what links receptors of the same “family)
they have a similar structure
what factors decrease risk for ovarian cancer
pregnancy
oral contraceptive use
tubal ligation
how much does liver failure incrase the risk of liver cancer
3-5% per year
how does cortisol exacebate HTN?
DM
HTN: increase salt intake
DM: increase blood sugar
what is the benefit of antacids
but?
the provide rapid pain relief but the effect is short lived and there is no indication that they promote healin
what is the intial pathophysiology of OA
how does that progress
thickening followed by atrophy and damage to cartiliage which causes loss of cartilage and inflammation
the entire joint wil become involved and cause bone erosion
what is the percent break down of gallstone composition
choleterol (80-85%)
calcium bilirubinate (<20%)
what is the cause of gout
a disorder which causes an accumulation of uric acid from gout and protein metabolism
diagnostic factors for pancreatitis
PE findings
CT
US
what demographic is more likley yo hae endometriosis
infertile women 25-35%
four ways to reduce risk of colorectal cancer
screening
low dose aspirin
high fiber, low fat diets
hormone replacement in women
what is the most common medication for type II DM
metformin (glucophage)
treatment of UC
aminosalicylates
glucocorticoids
surgery
what types of substances are synthesized in the liver
clotting factors
albumin
CHO
bile
what is the surgical treatment for acute cholecystitis
laproscopy after the swelling has gone down unless there is sign of peritonitis
what is the treatment for appendicitis
non surgical
laparoscopy/laparotomy
Ice, iv, transport
how is endometrial cancer diagnosed
post menopausal bleeding
endometrial biopsy/d & c
ultrasound
MRI for staging
what is the prognosis of septic arthritis
usually good unless there are major ortho complication like after joint replacement
what produces leukotrienes
three types
the action of 5-lipoxygenase on arachadonic acid
LTC4, LTD4, LTE4
three non-asthmatic causes of wheezing
heart disease
COPD
inhaled foreign body
four causes related to asthma that reduce airway diameter
bronchospasm
vascular congestion
edema
thick sputum
three sites of distant metastases in ovarian cancer
liver
lung
bone
treatment for sensitive TB
first line drugs based on sensitivity for 2-3 months
two to three drugs for additonal 4-7 months
what lab tests confirm hypothyroid
Low T4
very high TSh
treatment of mild pancreatitis
bed rest with NPO
analgesia
Iv fluids
clinical manifestations of asthma
chronic dry cough
wheezing
SOB
sleep disturbances
poor exercise tolerance
chest tightness
risks for ectopic pregnancy
salpingitis
prior ectopic pregnancy
prior tubal surgery
cigerette smoking
symptoms of the chronic vs acute bleeding
black tarry stools vs hematemesis
what are the risk factors for gall stones
gender
old age
obesity
child bearing
diet
three common symptoms of pneumonia
productive cough
fever/chills
dyspnea
treatment of severe pancreatitis
intensive care
aggressive fluid and electrolyte replacement
possibly antibiotic use
when wil acute synovitis occur in RA
what is the delay between onset of RA and diagnosis
weeks to months after diagnosis
9 months
central sensization theory of fibromyalgia
genetic defect in CNS pain signalling the involves cytokines and neurotransmitters (glutamate, dopamine)
common treatment of osteosarcoma
amputation or excision of the tumor
chemo
five main functions of the liver
bilirubin elimination
blood filtering
synthesis of important substances
drug detoxificaiton
mineral and vitamin storage
diagnosis of pancreatic cancer
CT/Pet scan
laparotomy with biopsy or resection
why is there a clincial distinciton between small cell lung cancer and others
because it is very aggressive and usually not able to be excised
symptoms of endometriosis
dysmenorrhea
dysparenunia
constant deep seated pelvic or rectal pain
infertility
two breast cancer mutations that increase risk
what type of genes are mutated
what is the life time risk with the mutation
BRCA 1 and 2
tumor suppressor mutations
50-85%
sources of organisms that typically cause pneumonia
community acquired (CAP)
hospital acquired (HAP)
what is the median survival time for multiple myeloma
three causes of death
4-6 up from 3 years
renal failure, infection, complications from chemo
because of the risk of giant cell arteries, what should all new onset myalgia patients get
sed rate (ESR)
symptoms and infectiousness of latent TB
usually none with a positive skin test
no expired TB
keloid scars
idiopathic benign neoplastic extension of scars
what demographic is most likely to have asthmai
inner city population
three examples of topical psoriasis treatment
corticosteroids
anthralin
coal tar
five hypothyroid symptoms
- cold intolerance
- hair loss
- weight gain
- weakness
- dry skin
pancreatitis
acute or chronic inflammation of exocrine pancreas
fatty liver disease
steatosis (fatty deposits) in the liver common in obese adult that distorts the normal structure of the liver
suportive strategy for COPD
airway support
supplemental oxygen
dyspareunia
painful intercourse
treatment for CAP
antibiotics, hospitalization for 25%, supportive care
treatment of crohns
symptomatic
diet
antibiotics
corticosteroids
resecetion of the terminal ileum or other segments
what is the main cause of lung cancer
smoking (13x higher) or exposure to smoke (1.5-2x)
what is the effect of smoking cessation on lung cancer risk and prognosis
risk of lung cancer declines but more slowly than CVD
even with cancer the prognosis is better for those who quit
five symptoms of DKA
tachycardia
dehydration
SOB
lethargy
coma
what is the full name of T3
T4
which is the main functional hormone of the thyroid
triodothyroinine
tetraiodothyroinine
T3
dietary factors associated with colorectal cancer
high fat and meat, low fiber
how is mutiple myeloma diagnosed
Xray
anemia
high IgG or Ig components
bone marrow biopsy with plasma cell prolifferation
though the exact pathogenesis of pancreatitis is unknow, what are two suspected causes
edema/obstruction of the ampulla of vater
direct injury to secretory cells
define arthritis
a group of conditions characterized by inflammatoy changes to varous joints of the bodyh
primary adrenal hyperplasia causes
idiopathic
neoplasm
congenital
T/f all gout will havy hypernuricema
true, but not all hyperuricemia will have gout
main symptoms of emphysema
chronic bronchitis
SOB with exertion and SOB at rest
chronic productive caugh with mucopurulent sputum
what is the function of TRH
stimulates the production of TSH and prolattin
T/F both chronic bronchitis and emphysema have alveolar loss and obstrution
true
what is the function of the adrenal cortex
secretes glucocorticoids, androgens, mineralocorticoids
what is the most common symptom of multiple myeloma
bone pain in the back or ribs that is worse with movement and beter at rest
types of leukotriene blocking drugs
leukotriene receptor antagonists
5-lipoxygenase inhibitor
diet management of gout
decrease protein
stop chemo
allopurinol
what are the most common viral causes of cirrhosis
hep A, B, and C
three causes of Cushings
iatrogenic
secondary adrenal hyperplasia
primary adrenal hyperplasia
describe the etiology of type II DM
a very slow loss of beta cells causd by genetic or obestity
three causes of contact dermatitis
allergic reaction similar to poison ivy/oak/sumac
conservative treatment of cholecystitis
NPO w/ IV fluids
analgesics
IV antibiotics
what wil happen if the thyroid gland is dysfunctional
what can also happen?
TRH and TSH will be produced in high amounts
prolactin can also be produced
what is the long term complication of asthma
airway remodeling in response to chronic inflammation that can lead to decline in pulmonary function
what is the mean age of diagnosis of Gastric cancer
what is the gender bias
63, men 2:1
what is the prognosis of gastric cancer based on stage
1 60%
2 44%
3 20%
4 3%
ulnar deviation is typical of what type of arthritis
RA
what levels of lipase and amylase wuld indicate pancratitis
3x the normal limit
what other cancers are associated with BRCA 1 and 2
ovarian
pancreatic
fallopian
prostate
preventing Hep C
screening to protect blood supply
no HCIG
no vaccine
what causes cushings disease
what is the distinction between this and secondary adrenal hyperplasia
an ACTH secreting tumor on the pituitary
there isn;t one
three possible treatment plans for cushings
stop glucocorticoids
surgery
antiglucocorticoid medication
treatment for small cell lung cancer
combination chem with radiation
what do beta blockers do in treating hyperthyroid
four results of treatment
block sympathetic pathways
rapid reduction in anxiety, restlessness, tremor, palpitations
two common drugs that cause osteoporosis
glucocorticoids or heparin
three types of liver failure
alcoholic
biliary
infectious (post necrotic)
what is the leading cause of hospitalization among children and teens
asthma
what are two methods of lowering T3 and T4 in hyperthyroidism
prevent hormone release
stop T3 and T4 production
how common is fibromyalgia
what is the gender/age bias
common, 3-10%
usually women ages 20-50
four types of lung cancer
most commin in bold
squamous 30%
small cell 15%
large cell 10%
adenocarcinoma 35%
what is the prognosis of pneumonia
stabilization in 3-5 days
full recovery in 4-12 weeks dependant on age
describe tie etiology of Type I DM
an autoimmune disorder that causes rapid loss of beta cells
two main types of asthma
which is most common
allergic and idiosyncratic
allergic
three upper GI disorders
peptic acid disorders
gastric cancer
esophageal cancer
treatment of non-small cells carcinoma
surgery and chemo
two treatment options for ovarian cancer
surgery
chemo
what is the most common abdominal surgical emergency
appendicitis
causes of endometriosis
retrograde mensturation that allows viable endometrial cells to implant on pelvis structures or travel in lymph that the immune system fails to elimante
what causes septic arthritits
bacteria infection of a joint from bloood or direct joint inoculation
signs of pancreatitis
acute epigastric pain
N/V
fever
abdominal tenderness and distention
asthma defintion
chronic episodic airway disease with effective treatment but no known cure
incidence and prognosis of pancreatic cancer
>30,000 increasing over the last 2 decades
overall very poor
does removing or blocking fallopian tubes increase to decrease risk of ovarian cancer
decrease
miliary TB is most common in what patients
is this more or less lethal than other
infants, elderly, immunocompromisd adults
very lethal
symptoms of cirrhosis
chronic RUQ pain
jaundice
edema
portal hypertension
reduced coagulation
reduced drug metabolism
surgical repair of OA
joint replacement
when are antacids contraindicated
tablets or liquid more effective
renal failure
liquid better than tablets
clinical features of osteoporosis
wrist, hip, or vertebrae fracture
loss of height due to fracture
chronic back pain
two ways that hormone-receptor complexes elicit effects in target cells
2nd messanger
DNA transcription leading to protein production
methods to manage FLD
stop using alcohol
lose weight with bariatric surgery if necessary
four liver and biliary tract disorders
heptaitis
fatty liver
cirrhosis
gallbladder disorder
what will induce a conversion of latent to active TB
immunosuppresion through HIV infection, glucocorticoids, chemo, poverty
three forms of immunotherapy against melanoma
interferon
tumor vaccines
lymphocyte training
complications of appendectomy
perforation leading to peritonitis or pelvic abcess
death from septicemia
three typical causes of COPD
how does it rank as common cause of death
smoking (99%)
other debris (coal dust/silica)
genetics (cystic fibrosis)
three types of coagulopathies
low platelet counts
clotting factor deficiencies
excessive anticoagulation
common antibiotics for CAP
cell wall inhibitors (amoxicillin/ampicillin)
protein inhibitors (macrolides)
fluoroquinolones (nucleic acid inhibitors)
what drugs stop the production of T3 and T4
when are they most effective
thioamides
when combined with beta blockers and potassium iodine
clinical findings of fibromyalgia
chronic diffuse pain
fatigue, sleep disorders, headache
increased pain sensation
pannus formation
inflammatory response to inflammation from RA causes destruction of cartilage and erosion of bone
what is the screening test for lung cancer
what are the pros and cons
yearly low dose CT for 3 yeras in patients 55 or older with a 30 yr pack history
pro: provides a modest increase in survival
cons: costly, high false positive
what is the effect of birth control on the risk for the following cancers
breast
ovarian
cervical
endometrial
possible increased risk
decreased risk
no impact
decreased
four types of breast cancer screenings
monthly self exam
annual breast exam
mammography
blood test for tumor markers
what is the most common form of skin cancer
what is the common cause
what is the risk if left untreated
basal cell carcinoma
UV light
local destruction, rarely metastasis
treatment of colorectal cancer
surgical resection for all patients
chemo
immunotherapy
where does the majority of chronic Hep B fall in the population
90% in neonates and infants
1-5% in normal adults
two characteristics of acute epigastric pain associated with pancreatitis
abrupt onset of severe, boring pain that often radiates to the lower bac
risk factors for pneumonia
smoking, alcoholism, comorbid disease, immunosuppression
three systemic treatments of psoriaisis
cyclosprin
methotrextate
retinoids
aggressive variant endometriosis characteristics
early onset
invasive lesions
rapid progression
what is the effect of thyrotropin (TSH)
increased T3 and T4
three amino acid hormones
dopamine
thyroxine
catecholamines
two possible pathophysiolgies of IBD
abnormailites of intestinal microflora
possible auto immune mechanisms
risk fastors for colorectal cancer
dietarty fcators
HPV
IBS (crohns or UC
how does insulin promote anabolism
increase glycogen production and storage
promotes triglyceride synthesis in fat cells
incrases protein synthesis in muscle
what is the treatment for gallstones
laproscopy
stone dissolution with bile salts
define hepatitis
acute inflammation of the liver that disrupts normal function and causes scarring
three environmental changes that can cause an endocrine response
nutritional
thermal
existential
what is the etiology of psoriasis
it is a T cell mediated immune disease which also involves TNF and interleukins
five treatment options for keloids
corticosteroid injections
cryotherapy
radiation
surgical excision
laser reduction
what is one medication that increases the risk of gall stones
one that decreases
cephalosporin
aspirin
which are more prominent, alpha or beta cells?
alpha (75% to 20%)
Cirrhosis
irreversible inflamatory disease that disrupts the liver function and structure
what is the pathophysiology of psoriasis
excessively rapid turnover of the epidermis (3-5 days instead of 21-30 days)
two types of pancreatic disorders
pancreatitis
pancreatic cancer
three potential complications of pneumonia
pleural empyema
lung abcess
pleural effusion
how does insulin inhibit catabolism
inhibits glycogen break down
inhibits amino acid and fatty acid break down
three types of uterine cancer
cervical cancer
endometrial cancer
leiomyosarcoma
pathophy of RA
autoimmune response causes inflammation of the synovial membranes of multiple joints
four conditions that are most commonly caused by DM
chronic renal failure
neuropathic pain
blindness
gangrene caused limb amputation
three types of secondary bone cancer
mets from lung, breaks, prostate
four complications of peptic ulcers
pain 100% of the time
bleeding 10%
perforation 3-5%
gastric outlet obstruction 2%
what drug will cause hypothyroid
amiodirone
what is the average length of pregnancy
266 days from conception
280 days from LMP
what types of HPV are associted with warts
what are associated with cervical cancer
6, 11, 42, 43
16, 18, 33, 35, 45
what drug can stop the relase of T3 and T4
potassium iodine
describe the negative feedback loop that regulates adrenal function
pituitary secretes ACTH
adrenal cortex secretes cortisol
cortsol inhibits ACTH secretion
what is the risk of cirrhosis with chronic Hep B
40%
two main types of peptic ulcers
duodenal and gastric
four small neurpeptide hormones
GnRH
TRH
vasopressin
somatostatin
what is the familial genetic influence with psoriasis
1/3 of people will have a positive FHx
70% chance that twins will have this together
which type of arthritis is more common (and the most common cause of disability in the US)
Osteoarthritis
medication used to decrease glucagon secretion
glucagon like peptide 1
what is the treatment for type I DM
type II
type I = insulin
type II = insulin plus other stuff
specific radiograhpic findings on xray
sunburt or codmans triangle
lesion tthat needs to be surgically or needle biopsy
causes of hepatitis
medication, chemicals, parastites, viruses
four theories for the cuase of fibromyaligia
virus, depression, sleep disorders, central sensitiization
what is a common iatrogenic cause of cushings
prednisone
three treatments of cervical cancer
radial hysterectomy and lymph node dissection
radiation
chemo
two long term control options for hyperthyroid
thyroid excision or destruction
continued antithyroid drugs
IUP
intrauterine pregnancy
four causes of hypothyroid
post thyroidectomy/ablation
hashimotos thyroiditis
Drug induced
dietary iodine deficiency
describe the incidence of psoriasis from the follow ethnicities
caucasians
african americans
native americans
most common
uncommon
very rare
where does glucagon like peptide naturally come from
what does it do
L cells in the intestine
opposes insulin
T/F horomes are secreted continuously
false they are usually in pulses
what percent of the population has RA
what is the gender ratio
when do most people get RA
1%
female 3:1
80% between 35-64
dermatological manifestation of vascular insufficiency
venous stasis ulcers
signs and symptoms of acute cholecysitis
RUQ, nausea, fever
common triggers of allergic ashtma
allergies
psychological
medications
infections
habits
atmospheric
main symptoms of esophageal cancer
dysphagia
weight loss
pain
what is the most common type of primary bone cancer
multiple myeloma
two other symptoms of diabetes that aren’t the 3 Ps
weight loss despite increased appetite
fatigue
diagnostic process of pneumonia
symptoms plus
CXR
Labs
point of care tests
