High Yield Flashcards
eye discharge
1-7 days
Gonorrhea
eye discharge 7-14 days
CHlamydia
3 Cs
Cough
coryza
conjunctiva
Measles
Rash starts on the neck
non-pruritic
very high fever
resp symtoms
erythematous pharynx, tonsils
dx:
Roseola
Human Herpes Virus 6
pruritic vesicles
Chicken Pox
Varicella
nonspecific prodrome
rash starts on the face
pruritic
Rubella
slapped cheeks
5th Disease/ Erythema Infectiosum
sanpaper like rash
erythematous maculopapular rash
sore throat
fever
nausea
Scarlet Fever
Diffuse erythematous macular sunburn like rash
acute onset
fever
myalgia
pharyngitis
vomiting
diarrhea
hypotension leading to multi-organ failure
Toxic Shock Syndrome
Periorbital Erythema, bullae vesicles, desquamation,
abscess or some site of infection
Staphylococcal Skin scalded skin disease
petechial purpural rash on the ankle and wrist - generalizes on the palms and soles, fever, rash, headache, myalgia, rep symtoms
Rocky mountain fever
petechial purpural rash on the trunkand extremities - generalizes on the palms and soles, fever, rash, headache, myalgia, rep symtoms
Epidemic typhus
abrupt onset fever, chills, malaise, exanthem, shock, generalized petechiae
Early Meningococcemia
fever, lymphadenopathy, malaise, sore throat, splenomegaly
generalized rash on palms and soles of the foot
Secondary Syphilis
limping, walking, difficulty, no fever
14yo
SCFE
limping, walking, difficulty
4-8 yo
Perthes Disease
smooth, pear shaped
nontender testis
dx
Hydrocoele
bag of worms
Varicocele
bird beak sign
dysphagia for both
Achalasia
What to check in patient having osteoporosis?
Vitamin D
1st line treatment for Ankylosing spondylitis
Naproxen
prefers to be alone
Schizoid
Wants friends but scared
Avoidant
magical thinking
Schizotypal
Paranoid
Paranoid
sociopaths
Antisocial
Cutting, splitting, dramatic, mood swings
Borderline
Attention seeking
Histrionic
Donald trump
Narcisstic
ego syntonic
Obessive Compulsive
Always in relationships
Dependant
What is the best option to treat obesity under the clozapine treatment for resistant schizophrenia?
Aripriprazole
For MDD,
what is the treatment if the patient cant sleep?
Mirtazipine
For MDD,
what is the treatment if the patient is too skinny?
Mirtazipine
For MDD,
what is the treatment if the patient has sexual side effects?
Bupropion
For MDD,
what is the treatment if the patient
has refractory?
ECT or Electroconservative therapy
What is the treatment for ADHD?
Methylphenidate
(Stimulants)
“fugue”drinking and wandering
Dissociative Amnesia
hair pulling
Trichotillomania
multiple personalities
Dissociative Personality DIsorders
What is the treatment for acute alcoholic withdrawal?
Benzodiazepine
What is the treatment for chronic alcoholic withdrawal?
Naltrexone
Disulfuram
Pin-point pupils, resp depression
what drug intoxication is this?
Opioids
withdrawal causes cramps, yawning, aches
Dilated pupils
tachycardia, hypertension and energy
What drug intoxication is this?
Cocaine
withdrawal causes: hunger and crashing
sustained muscle contraction
Acute Dystonua
tx: anticholinergic (benztropine)
mask facies, cogwheel rigidity, shuffling gait, resting tremor
Parkinsonism
tx: Anti-cholinergic (Benztropine)
restlesness
Akathisia
tx: Beta Blocker
lip smacking
Tardive Dyskinesia
Tx; D/C offending agent + Clozapine
cutting, splitting, dramatic, mood swings
Borderline
attention seeking
Histrionic
triad of halitosis, dysphagia and regurgitation
pulsion diverticulum of the posterior esophagus between the thyropharyngeal and cricopharyngeal parts of the inferior constrictor
Zenker diverticulum
upper 2/3 of esophagus
dysphagia to solids
esophagus squamous cell carcinoma
lower 1/3 of esophagus
dysphagia to solids
esophageal adenocarcinoma
damage to the myenteric plexus > failure of relaxation of the lower esophageal sphincter
Idiopathic, Chagas disease
Bird beak sign on barium swallow
dysphagia to both
Achalasia
less sthan 6 wks for diabetic foot ulcer
inv?
Xray
more than 6 wks for diabetic foot ulcer
inv?
MRI
above dentate or pectinate line
drains via Superior Rectal vein
painless visceral innervation
Internal Hemorrhoids
below dentate or pectinate line
drains via inferior rectal vein
painful somatic innervation
External hemorrhoids
Antibiotic of choice for meningococcal meningitis for children 5yo
Ceftriaxone
Signs of chronic liver failure
spider nevi
trauma, brief loss of consciousness > lucid interval > comatose
biconvex lens shape density
pterion injury
middle meningeal rupture
Epiderual hematoma
elderly, acohol use
progressive confusion and headache
crescent shaped density
bridging vein rupture
Subdural hematoma
berry aneurysm
thunderclap severe headache
nuchal rigidity
prevent vasospasm with nimodipine
Subarachnoid Hemorrhage
Cerebral hemorrhoid angiopathy
rapidly progressive symptoms with focal neurological deficits
increased ICP
Intracerebral hemorrhage
which drug causes hypotension
Hydrochlorothiazide
Tibial tubercle swellign pain in young boy with no fall
Osgood Schlatter
someone walking and havign pains on the leg but is releived on sitting or at rest
Common Iliac artery
- Vascular claudication
Repeat CAG
psychotic symtoms and choreiform movements
Atrophy of Caudate nucleus
Huntington’s disease
Repeat GAA
ataxia, scoliosis, pes cavus
hypertrophic cardiomyopathy
Friedrich’s ataxia
Repeat CTG
cataracts, male baldness, myotonia
testicular atrophy
Myotonic dystrophy
repeat CGG
elongated face, enlarged ears and testes
Mitral Valve prolapse
Fragile X Syndrome
deliver dead baby
Inform coroner
precipitated by head movemenent
episodes last for several seconds
Benign Paroxysmal Vertigo
(BPPV)
treatment : Epley Maneuver
Episodic lastign only for 20+ minutes to hours
vertigo + hearing loss + tinnitus + +/- aural fullness
treatment” salt restricted diet and thiaZIDE DIURETICS
Meniere’s disease
Single vertigo episode that often lasts days
can follow viral URI, abnormal head trust
supportive treatment
Vestibular Neuritis
(AKA labyrinthitis)
dizzines + vertigo (slow growing tumor)
vertigo + hearing loss /- CN VII and CN VI symptoms
Treatement : Surgery / radiation or MRI surveillance
Acoustic Neuroma
absence vibratory sensation, positive Romberg sign, sensory ataxia
Treponema pallidum
Tabes Dorsalis
Upper motor neuron sym
sensory and cerebellar ataxia and diminished vibratory sensation
cause by Vit B 12 def
Subacute combined degenerative
Lower motor neuron weakness
osten asymmetric
cause by Poliovirus
Poliomyelitis
Progressive neurodegenerative disorder
upper and lower motor neuron symp
Amyotrophic Lateral Sclerosis
Young person after vigorous exercise and neck injury develops facial neurologic deficits
Carotid Artery Dissection
Unrestrained passenger in motor vehicle accident prevents comatose with diffuse “punctuate”hyperdensities or CT head
Diffuse Axonal Injury
Young person with recent ankle injury in crutches develops wrist drop
Radial Nerve Palsy
new onset, unilateral, blurry vision, washed out appearance
Optic Neuritis
Bilateral ptosis
constipation
resp difficulty after food exposure
Botulism
Middle aged adult with headache, visual deficits and mass crossing the corpus callosum in imaging
Glioblastoma multiforme
What is the most common cause of horner Syndrome
Lung cancer
patient with 40 pack year hix of smoking, hemoptysis, unilateral ptosis and miosis
Horner Syndrome
morning headache
nausea, vomiting with mass in cerebral cortex
Astrocytoma
Sudden onset, severe, unilateral, periorbital headache with tearing and conjunctival injection
Cluster headache
Patient with recent surgery and immobilized in hospital beds and develops unilateral foot drop
Common Peroneal Injury
most appro way of collecting urine in a 1 yr old patient
Suprapubic tap
elderly patient presents with memory loss over weeks or months ,
appears distress and loss interest or in hobbies
Pseudodementia
(Major depressive disorder)
Infant with subdural hematoma, retinal hemorrhages, and metaphyseal corner fracture
Non-accidental trauma
Patient with Parkinsonian symptoms, orthostatic hypotension, ataxia
Multiple System Atrophy
(Shy-Drager Syndrome)
Transient, unilateral, painless vision loss in an elderly patient
Amaurosis fugax then will progress to CRAO if not treated
Young patient with myoclonic jerks upon awakening from sleep
Juvenile myoclonic epilepsy
cannabis is contraindicated in ?
Family history of Schizo
Pop sound
left knee swollen
laxity when pulled anteriorly
Positive test: anterior drawer and Lachman
Anterior cruciate ligament
Positive posterior drawer test
tibia forced posteriorly with fixed ankle eg dashboard injury
Posterior Cruciate Ligament or PCL
knee clicking
Positive Mcmurray or Thessaly test
Meniscus
often injured combination of ACL and meniscus (unhappy triad)
laxity on valgus stress
Medial Collateral Ligament or MCL
positive test: Laxity on varus stress
Lateral Collateral Ligament
High riding patella
Positive test: inability to extend knee or flex hip with knee straight
Patellar tendon
Iron deficiency anemia
Ferritin
Sudden onset of scrotal edema
testis in horizontal position
absent cremasteric reflex
no relief with testicular elevation
absent doppler flow
torsion of the spermatic cord
Testicular Torsion
Remnant of the mullerian duct
insidous onset, focal testicular tenderness at upper pole, blue dot sign
enlarged testicular appendic, possible hydrocele, normal blood flow
Torsion of Appendix testis
STI or UTI causing inflammation of the epididymis
Tenderness at the posterior pole of testis
relief of pain with elevation (Prehn’s sign), dysuria
Ultrasound: nIncreased blood flow to epididymis
Epididymitis
best test to diagnose HIV
Western Blot
young male with increased bilirubin and rest of the liver function tests are normal
dx?
Gilbert Syndrome
tenderness upon addduction of arm across torso
palpable deformity at the superior aspect of the shoulder
Acromioclavicular joint dislocation
Flattened deltoid prominence
prominent acromion, abducted, externally rotated shoulder
posterior trauma in vulnerable position (eg throwing motion)
Anterior Shoulder dislocation
fall of outstreched hand (FOOSH)
anterior shoulder flattening
arm held in adduction and internal rotation
Posterior shoulder dislocation
arm drop positive
decreased abduction with intact sensation
Rotator cuff tear
OLD CRAB
old age
Calcium elevated
Renal Failure
Anemia
Bone lytic lesions
Multiple Myeloma
bone pain and deafmess
ALP raised
calcium and Phosphorus normal
PSA < 4
dx?
Paget’s Disease
watery rhinorrhea, itchy eyes, sneexing
Allergic Rhinitis
tx: Intranasal Glucocorticoids
> oral antihistamines
Seasonal variation
no obvious trigger
later onset (20+ years)
Non-allergic rhinitis
Rhinorrhea, nasal congestion, sore throat, cough +/- fever
Viral Sinusitis
tx: supportively
> 10 days , fever > 39 + 3 days purulent discharge
Bacterial Sinusitis
Tx: Amoxicillin + clavulanic Acid
swelling of PIP, MCP joint worsening in the morning and improves with work
Rheumatoid Arthritis
The fastest study to be conducted in order to see the effect of the drug in an Alzheimers disease study
Randomized Clinical Trial
sharp chest pain radiating to the back, unequal blood pressures R vs L arm
Aortic Dissection
patient with substernal chest pain, worsens after eating and at night
GERD
Recent Viral illness, chest pain improves when leaning forward, fever, scratching sound on cardiac auscultation
Acute Pericarditis
reproducible with palpation of chest wall
Costochrondritis
recent viral illness , sharp chest pain, worsens with deep inspiration, scratching sound on auscultation that disappears while breath-holding
Viral Pleurisy
patient on furosemide, ACEI but edema is still present along side with SOV and PE
What drug to add?
Spironolactone
severe, acute, epigastric abdominal pain radiating to the back
Acute Pancreatitis
Long standing history of GERD, refractory symptoms, now with acute epigastric pain, rebound, abdominal rigitidity
Perforated Peptic Ulcer
Obese patient with long history of coronary artery disease, presents with abdominal pain, precipitated with eating, recent food avoidance and weight loss
Chronic Mesenteric Ischemia
Middle Age, female with epigastric abdominal pain radiating to the right side and back, fever, leukocytosis
Acute Cholecystitis
severe, unilateral flank pain
groin pain
periodically worsens and improves
Nephrolithhiasis
Patient on PPI, H pylori present initially, now has come for follow up after 6 weeks what will you do?
A. Endoscopy
B. Urea Breath test
B. Urea Breath test
adult male presented with retrosternal pain aggravated by food, what will you do?
Endoscopy of the upper GIT
What is the treatment of choice for Peptic Ulcer disease?
Upper GIT endoscopy
Female child is worried about cleanliness what therapy is useful for her?
Behavioral Therapy
Tx for OCD
Exposure and Response Therapy
Tx for Adjustment disorder
Psychodynamic therapy
tx for Tourettes Syndrome
Habit Reversal Therapy
Tx for ASD
Behavioral Modification Program
Tx for Persistent depressive disorder
Insight Oriented Psychotherapy
Tx for Grief
Supportive Therapy
Tx for ODD
Family Therapy
Tx for Kleptomania
Insight Oriented Therapy
Tx for Separation anxiety disorder
CBT and Psychotherapy
Tx for ADHD
Behavioral Therapy
Tx for Specific Phobia
Systematic desensitization and Exposure therapy
tx for all dissociative disorders
Psychotherapy
Alcoholic + agitation
Diazepam
Non-alcoholic + agitation
IM Haloperidol
Alcoholic + Psychosis
IM Haloperidol
Non-acoholic + Psychosis
IM Haloperidol
What med to start in Schizophrenia?
Risperidone
breathlessness + murmur
eg case: 5 yo boy wheeze present since 10 days not able to drink milk due to breathlessness , o/e 3/5 murmur present
dx?
Congestuve Heart Failure
Heart failure + low EF
Tx?
ACEIs
others: ARBS and BetaBlockers
G1PO patient at 32 weeks with gestational diabetes presents with uterine fundus measuring 36 cm
Polyhydramnios (GDM > fetal glucosuria > excess amniotic fluid)
G2P1 patient presents for prenatal appointment at 21 weeks with blood pressure 145 / 91 amd 3 + pitting extremity edema
Preeclampsia
Patient at 7 weeks gestation with persistent nausea and vomiting
now has orthostasis and electrolyte abnormalities
Hyperemesis Gravidarum
Pregnant patient with generalized pruritus, worse on the palms, elevated bile acids
Intrahepatic Cholestasis of pregnancy
G3P2 with chronic hypertension presents with decreased fetal movement and uterine fundus smaller than expected for gestational age
Oligohydramnios
6 day fever, red eyes, oral and tongue redness, hand and foot swelling
conjunctivitis, rash, adenopathystrawberry tongue, hand and foot erythema, fever
(CRASH -F)
Kawasaki Disease
1 yo male with urinary tract infection, stools 1-2 x per week, blood on toilet paper, anal fissures
Constipation
Child with red , itchy eyes, runny nose and rash spreading from head to rest of the body
Measles
5wk old previously healthy male with projectile vomiting, formula colored
Pyloric Stenosis
No childhood immunizations
Bilateral jaw swelling
presenting with nuchal rigidity and Brudzinki sign
Mumps
severe headache, nuchal rigidity, Brudzinski and Kernig sign
additional hints: military, college stuents, questionable vaccination history
labs: CSF analyzis and lumbar puncture
Menigitis
paracentesis with peritoneal fluid analysis
abdominal tendertness +/- ascites
Cirrhotic patients, subtle, low grade temp
Spontaneous bacterial Peritonitis
dysuria, urinary frequency, suprapubic tenderness, CVA tenderness
hints: recurrent symptoms, female, urinary incontinence
Urinary Tract infection
crackles, dullness to percussion
Pneumonia
dullness to percussion but no crackles
and there is diminished breath sounds
Pleural Effusion
surgical tissue culture
local erthyema and induration and pain and regional lymphadenopathy
hint: bed bound (decubitus ulcers)
Superficial skin infection
RUQ pain
Jaundice
palpable mass
Biliary Cyst
Child with UTI, fever, dysuria, loin pain
Pyelonephritis
ADHD treatment
Dextamphetamine
early diastolic murmur
AR
or PR
Mid diastolic Murmur
MS
TS
ASD
VSD
PDA
MR
TR
Carey Coombs mumur of mitral Valvulitis
Austin Flint murmur in AR
Secondary flow murmur
Pre-systolic murmur
Severe Mitral Stenosis
large head, skin hyperpigmentation
Fragile X
inv: Karyotyping or cytogenetic testing, DNA test
Acyanotic + newborn + holosystolic murmur (left border) + later breathlessnesss
VSD
6 wks + murmur + cyanotic + special (spell)
TOF
1 cay + cyanotic + resp difficulty + murmur vital deteriorating
TGA
shunt reversal
Essenmeger
Indomethacin
machine murmur
PDA
boot shaped
TOF
Management - PGE2 / Surgery
HTN + female + unequal BP
Coarctation
Content of the Epigastric hernia
Extraperitoneal Fat
Crushing, substernal chest pain with ST elevation in V1, V2, V3 with shortness of breath, crackles and LE edema
STEMI
unrestrained passenger in motor vehicle accident presents with unilateral diminished breath sounds and dullness to percussion
Hemothorax
young person with unilateral upper extremity swelling, pain, erythema following vigorous exercise
Deep Vein thrombosis
Older man with recent history of abdominal surgery presents with severe abdominal pain, constipation and irreducible mass in left lower quadrant
Incarcerated Inguinal Hernia
Immediately after completing a marathon, a runner collpases without loss of consciousness and minimally elevated temperature
Exercise associated postural hypotension
Increased IOP 25 mmHg, halos and hazy
Txt?
Pilocarpine
young patient with moderate chest pain and worsened palpation
Costochondritis
Miner presents with ataxia, irritability, gingival inflammation and excess salivation
Mercury Poisoning
Sudden onset severe headache in an elderly patient
Subarachnoid hemorrhage
Sudden onset severe, unilateral, periorbital headache with tearing and conjunctival injection
Cluster headache
Elderly patient with extensive smoking history presents with fatigue, malaise and bilateral upper extremity edema, headache worse with supine positioning
SVC (Pancoast tumor)
Hand skills of 3 yo
Copy a circle using a crayon
dyspareunia, dysmenorrhea, painful defectation
What is the dx?
Endometriosis
Confirms the need for cesarean section
CTG
sudden gush of vaginal bleeding 1500 cc
Uterus was soft and nontender
Uterine Atony
fall into an outstretched hand now with arm in adduction and internal rotation
xray shows widening of the Glenohumeral joint space
Posterior shoulder dislocation
Repeated bilateral lower extremity pain and swelling after strenous exercise with spontaneous resolution
Chronic Exertional Compartment Syndrome
Young patient with no PMH, presents with encephalopathy, anion gap metabolic acidosis, hyperglyecmia
Diabetic Ketoacidosis
Fall from roof with Spinal tenderness, spinal Xray wotj decreased vertebral body height at T8
Vertebral compression fracture
Recent bar fight with severe tenderness of medial hand at the 5th metacarpal
Boxers Facture
produces ectopic PTHrp –> HYPERCALCEMIA
biopsy: keratin pearls, intracellular bridging cavitation
Squamous Cell Carcinoma
SIADH, Lambert Eaton Myasthenia
Cushing syndrome, encephalitis
Small Cell Carcinoma
Hypertrophic osteoarthropathy
Adenocarcinoma
secretes HCG - gynecomastia
Large Cell Carcinoma
rarely produces carcinoid syndrome
Bronchial carcinoid tumour
60yo M, 15pack smoking hx, PE reveals fine inspiratory crackles, decreased FEV1 and FVC and normal FEV1/FVC. DLCO IS DECREASED.
Idiopathic Pulmonary Fbrosis
FEV1/FVC < 70%
DLCO normal
Asthma
FEV1/FVC < 70%
DLCO decreased
Emphysema
FEV1/FVC > 70%
DLCO normal
Morbid obesity
GBS
Myasthenia
FEV1/FVC > 70%
DLCO decreased
Idiopathic Pulmonary Fibrosis
Sarcoidosis
Pneumoconioses
FEV1 / FVC <70%
DLCO normal
Asthma
pleural chest pain + productive cough , CXR normal
next inv
ECG
Hematuria, flank pain, palpable kidney
Renal cell carcinoma
pleuritic chest pain and SOB, recently had surgery in the last few days. PE shows tachycardia. Next step?
Start anticoagulation
30yo female with hx of Marfan syndrome presents with sharp chest pain radiating to the back. She is in pain but stable what is the next best step?
Chest Xray
30yo female with hx of Marfan syndrome presents with sharp chest pain radiating to the back. She is in pain but stable. CXR - Widened mediastinum what is the next best step?
CT angiography
skin granule clear yellow coloured
out-pouched lesion, hypercholesterolemia and hyperlipidemia
Eruptive Xanthomatosis
Renal calyx stone 0.5 cm size labs were CA - 2.82 increase, Uric acid 0.44. Asked which drug to use?
Furesemide
(IV fluids first line - then furesemide)
breat pain
10 mm cyst at 6 oclock and was 2 cm near the nipple (areola)
What’s next?
FNAC
enlarged thyroid which was bleeding
bluish discoloration
hoarseness and wheezing
Rotation of the head feels dizziness
What is the unequivocal reason for surgery?
Hoarseness
Adolescent
pain at tibial tuberosity
shows fragmentation at tibial tuberosity
Osgood Schlatter Syndrome
young athlete
pain just below the patella
Patellar tendinitis
young female
worsens while seated for prolonged periods
Patellofemoral Syndrome
older, obese
Minimal morning stiffness, worsens throughout the day, relieved with rest or sleep
Osteoarthritis
Middle age
Significant morning stiffness, improves through out the day, worsens with rest or sleep
Rheumatoid Arthritis
hyperpigmentation of ankles, history of LE edema
location: medial malleolus pain
Chronic Venous insufficiency
painless (severe neuropathy)
sole of the 1st metatarsal
Diabetic Foot ulcer
painful, palpable “cord-like”swelling of veins
Associated with Buerger syndrome and GI malignancy
Superficial Thrombophlebitis
flat, painful , streaks extending proximally from skin infection (cellulitis, erysipelas)
represents infection spreading up to lymphatic channels
Lymphangitis
claudication, pain while sleeping, rest pain, history of ACS
tips to toes
Peripheral Artery Disease
Finkelstein’s positive
Proximal thumb, compression within thumb extensor
DeQuervain’s Tenosynovitis
Pain at night, improves with shaking out hands can be secondary to many conditions such as pregnancy, hypothyroidism, obesity and diabetes
location: palmar aspect of the first three fingers (can spare the palms on exams)
Can also occur secondary to lunate bone dislocation
Carpal Tunnel Syndrome
Location: Anatomical Snuffbox (between abductor pollicis brevis and longus)
fall on outstretched hand
Xray is initially normal
Scaphoid Fracture
palmar usually 3rd or 5th finger
painless, fibrosis of palmar fascia, painless cord
Dupuytren’s contracture
not increasing height
from 75th percentile to 50th percentile and is still 25th percentile
Wrist scan
Fever, friction rub, dyspnea
may lead to cardiac tamponade
treated supportively (aspirin - dont overkill with NSAIDS)
Acute Pericarditis
(Within 1-3 days post MI)
Holosystolic murmur
Location at the mitral valve
Papillary Muscle Rupture
(Within 3 -5 days post MI)
Left sternal border
Holosystolic murmur, may have palpable thrill
abnormal 02 Saturation in RV and LV
Interventricular Septal Rupture
(Within 3 -5 days post MI)
Ventricles leak blood into the pericardium
Cardiac tamponade is almost always how this is tested
LV free wall rupture
(Within 5-14 days post MI)
Weeks to months later
post MI
similar presentation as acute pericarditis
Treated with NSAID and colchicine
Dressler’s Syndrome
Weeks to months later
post MI
Presents with persistent ST elevations
and congestive heart failure
Complicatins: mural thrombi, can embolize > stroke, acute Limb ischemia
Ventricular aneurysm
carotid or abdominal bruit
atherosclerosis = older individuals
fibromuscular dysplasia = younger, usually women
c
Renal Artery Stenosis
episodic, triggered by anesthesia or orthostatic changes
Secondary Hypertension
Pheochromocytoma
signs of hyperthyroid, sweating, hyperreflexia, diarrhea, anxiety
Secondary Hypertension
Hyperthyroidism
overproduction of Aldosterone (adrenal Adenoma or Hyperplasia)
Renin Low (negative feedback) aldosterone elevated
Secondary Hypertension
Primary Hyperaldosteronism
usually due to excess renin
Renin High, aldosterone high
causes Renal artery stenosis, PKD, renin secreting tumor
Secondary Hypertension
Secondary Hyperaldosteronism
Estimates prevalence by taking a single snapshot (usually survey) that looks for exposure and outcome at the same time
Cross Sectional Study
Reports similarities between multiple cases (infectious disease outbreak)
Case Series
Groups patients into diseased and not diseased, looks back in previous record for exposure
Case Control Study
Groups patients into EXPOSE and UNEXPOSED, follows over time for outcome
Prospective Cohort Study
Certain patients get intervention other patients get placebo, monitors for outcome differences
Randomized Controlled trial
Identifies patients with exposure and without exposure, looks back in previous record for differences in outcomes?
Retrospective Cohort Study
Patient with longstanding COPD and a harsh , holosystolic murmur at the Lower left sternal border
TR - COR PULMONALE
Young person with diastolic murmur with opening snap
Mitral Stenosis
Kussmaul Sign
Constrictive pericarditis, restrictive cardiomyopathy
new onset of blisters with slough with pressure, oral involvement
Pemphigus vulgaris
Patient with history of hypothyroidism of summer travels presents with depigmented areas on back
TInea versicolor
Redness, swelling and pain in the neck with raised, sharply demarcated edges and early onset of fever
Erysipelas
2leg swelling and pain in neck with raised, sharply demarcated edges and early onset of fever
Cellulitis
A man with face redness and swelling and jugular veins prominence,
inv?
Chest CT
photosensitive rash in a patient with history of Hepatitis C virus
Porphyria cutaena tarda
Diabetic patient with recurrent, painful, redness and swelling in armpits and groin
Hidradenitis Suppurativa
middle-aged male, hyperreflexia, fasciculations and muscle atrophy
Amyotrophic lateral Sclerosis (ALS)
Young, adult female with headache that worsen with Valsalva, vision loss when bending over
Idiopathic Intracranial Hypertension
Severe, unilateral headache located over the ye, rhinorrhea, Horner Syndrome
Cluster Headache
Most likely cause of locar intracerebral hemorrhage in adults
Cerebral Amyloid Angiopathy
Most likely cause of subcortical intracerebral hemorrhage in adults
Hypertension
Obese patient with shooting pain of lateral thigh
Lateral Femoral Cutaneous Nerve compression
or Meralgia Paresthica
Sudden onset left leg weakness, urinary incontinence, emotional instability
Anterior cerebral artery stroke
Right sided facial numbness, left sided arm and leg numbness, dysphagia, hoarseness
Lateral Medullary ischemic stroke or Wallenbuerg Syndrome
Holosystolic, mitral valve
Infectious endocarditis + mitral valve prolapse
Mitral regurgitation
Crescendo > decrescendo > aortic area
Dimished S2 sound, pulsus parvus et tardus, radiation to carotids
Aortic Stenosis
Early decrescendo, left sternal border
hyperdynamic “water hammer”pulse, head bobbing
Aortic Regurgitation
opening snap + diastolic rumble, mitral area
Chronic Rheumatic disease
Can lead to atrial Fibrillation
Mitral Stenosis
Fever, jaundice and abdominal pain
yen
Cholangitis
How is achalasia diagnosed
Barium Swallow
- failure of LES to relax
corkscrew appearance
heartburn, chest pain, dysphagia and odynophagia
Esophageal Spasm
most accurate diagnosis - Manometry
What autoimmune condition is associated with esophageal aperistalsis?
Scleroderma
CREST - Calcinosis, Raynaud, Esophageal Dysmotility, Sclerodactyly, Telangectasias
What is the initial treatment of hiatal hernia
Weight loss and PPIS
a patient diagnosed with AIDS had pain on swallowing
medication?
Fluconazole - treat the candida
burning sensation on the tongue , difficulty in swallowing, microcytic anemia
Esophageal webs
- Plummer Vinson Syndrome -
triad of: microcytic anemia, esophageal web and dysphagia
TX: Iron replacement
dysphagia, halitosis and regurgitation
inv?
Barium Swallow - Zenkers Diverticulum
Severe vomiting, what is the tx?
No treatment (self-resolving)
- Mallory Weiss - epinephrine and cauterization can help
Inv to diagnose esophageal cancer?
EGD with biopsy
epigastric pain, nausea, vomiting, hematemesis, GI bleed
inv ? tx? dx?
Upper Endoscopy
Acute Gastritis
Stop the offending agent , antacids, H2 blockers, triple therapy for H pylori - Amoxicillin, Clarithromycin, Omeprazole ACO
Chronic Gastritis is most commonly caused by
H. pylori and NSAIDs - ANT PYLORI - Antrum
Type B- antrum
Most accurate test for H pylori
Biopsy
An enlarged left supraclavicular lymph node is associated with
Gastric Cancer
- Virchow Node - also Sister Mary Joseph node - palpable lymph node near the umbilicus
Coughing that awaken her from sleep about twice a week.
tx ?
Medium dose inhlaed costricosteroids with SABA
Patient undergoes ventriculoperitoneal shunt placement for hydrocephalus
Following morning, his wife finds him lying in bed, very confused and complaining of headache.
Unable to walk. The surgeon who performed the procedure is concerned about these new symptoms.
Subdural hematoma
CXR reveals mediastinal mass
Coughing up hair
Cystic Teratoma
Abdominal pain and black stools
Dx?
Upper GI endoscopy
Intermiitent watery diarrhea, nausea, bleching and abdominal pain
Most helpful in making the diagnosis
Stool fr microscopy for ova and parasites
progressive pain in his knees
tenderness, a swollen and prominent tibial tubercle
Diagnosis?
Osgood Schatter Disease
progressive pain in his knees
tenderness, swollen and prominent tibial tubercle
Oagood-Schlatter disease
Infant has persistently hard, pellet-like stools
Enlarged head
HR 75 bpm, T 35C
Child is still jaundiced
Large anterior and posterior fontanells, distended abdomen and umbilical hernia
Congenital Hypothyroidism
Abdominal pain and rasj on the back of the legs and buttocks
proteinuria and microhematuria
HSP, or anaphylactoid purpura
Rash and abdominal pain
What other fininds is he likely to have?
Arthritis or Arthralgia
Recounts his stressful memories from a car accident 5 years ago
Tx?
Sertralie - PTSD
Red confluent macular rash on her eyelids
Dermatomyositis
Chest paib, SOB and dizziness
can barely talk
temp 37.8 C BP 85/50 mmHg
HR 125 bpm, RR 26 bpm
O2 91%
Treament:
Anaphylactic Shock
Primary toxicity of Doxorubicin (Adriamycin)
Cardiomyopathy
Right-handed construction worker presents with complaints of nocturnal numbess and pain involving the Right hand.
Symptos wake him and then relived by shaking his hand
Atrophy of the thenar eminence
Tinel sign is positive.
Dx
Carpal Tunnel Syndrome
- median nerve entrapment associated with excessive use of the wrist
Brief, shrill cry
Breath Holding spell
Bilateral interstitial Infilrates and No Cardiomegaly
Pneumocystis Jiroveri Pneumonia
Facial diplegoa and difficulty sucking and swallowing
Child has been colicky
Botulism
Anxiety disorders
Obsessive Compulsive disorders
Localization of encephalitis to the medial temporal or orbital frontal regions of the brain is most consistent of
Herpes Simplex virus
Parents came to you concerning about 7 yo daughter who had recently devloped axillary ahri
Girl’s weight is at 50th percentile, height 25th percentile and tanner staging 1.
Next management?
Perform bone age study
Which of the ff signs would indicate a more serious hyperemesis gravidarum
Hypokalemia
newborn has bilateral catarcts and microphthalmia
intrauterine growth retardation
Hemorrhagic skin lesions scattered throughout the day
Harsh Systolic murmur heard at the Left Sternal border and radiating to the lung fields
Dx?
Congenital Rubella
Hypogonadism and anosmia of Kallman Syndrome usually attract medical attention during which stage of life
Adolescence
Sudden onset of Bilious emesis
UGI - midgut volvulus with the site of obstruction at the third portion of the duodenum
Anomalies of Intestinal rotation and fixation
Jugular venous distention and Exophthalmos
Massive tricuspid Regurgitation
Displaced scaphoid fracture management
ORIF
Picture of a man’s cheek and a brown black lesion about 4cm. The lesion has been there for the past 10 yeard and it didnt bother him until 3 wks ago when it started becoming itchy. What’s the next best step?
Excisional Biopsy
Complains of ear pain for past 1 week. On ear otoscopic examination, the tympanic membrane appeared normal and no discharge.
No rash seen on her face.
Dx?
Tongue Carcinoma
Man underwent surgery for the fracture of femur. Then he developed pulmnary embolism and he dies of cardiac arrest.
What is the primary cause of death?
Cardiac Arrest
Shuffling gait, mask-like face, akinesia, rigidity, tremor
Dx?
Parkinsonism
What is the diagnostic tool?
MRI brain
ECG strip with no p waves and heart rate about 60 bpm
Atrial Fibrillation
A 22 old wants to enter football team and was asked to do check up.
No palpitations, chest pain or dyspnea. He has no complaints.
ECG shows bradycardia with delta waves in lead 2.
Wolff Parkinson White Syndrome
38 yo old man came in coplaining of bloody diarrhea with mucus for past 6 months.
Has on and off abdominal pain. Has history of travel to Vietnam two years ago.
Ulceraive Colitis
complaint of difficulty in eating his food and always coughs during his meals
Barium swallow
relaxed LES
Acid injury leads to ulceration of distal esophagus mucosa
Barrett’s esophagus
most common cause of nocturnal cough
Major symptoms of heartburn and regurgitation
GERD
Rhinorrhea, fever and cough that is associated with vomiting.
There is intercostal recession and bilateral wheezes.
He is irritable and not eating well
Best treatment?
Penicillin
He cries when she changes his nappy for the past few days
He has a fever on examination,he cries when the doctor moves both his legs
DDH
Infected ingrown toenail
Best initial mgt?
Wedge Resection
ED with confusion and drowsiness.
He is known diabetic on insulin and he skipped his breakfast today to play golf with his friend
Blood glucose was 2.0 mmol/L
What to give next?
50% Glucose Bolus injection
Previous 2 children was naturally conceived via IVF.
To whom will you refer her to for conitnuity of antenatal care?
Obstetrician specialist
Breastfeeding well and gaining weight
Has jaundice but appears fine except for Cephalohaematoma that is now 3cm
Bilirubin level was 300 and conjugated was 8
What is the cause
Breast Milk Jaundice
Eosinophilic esophagitis with history of eczema management
Fluorinated Steroid
dysnea, tracheal tug present but chest was clear
after admission was given oxygen and IV fluids
What is your diagnosis?
Bronchiolitis
Washes hand frequently to avoid HIV
OCD
Postpartum 4 wks patient developemnt left breast redness pain, fever 39 and started on Antibiotic
What is next
Feed frequently from the left breast - Mastitis
Alcoholic patient chronic, presented with abdominal pain, tenderness, distention, hepatomegaly LFT abnormal, abdominal paracentesis done. What test to confirm the diagnosis
Neutrophils - best initial if asking for the treatment
What is the gold standard test for peritonitis
A polymorphonuclear cell count that is greater than 250 cells
Patient came with sore throat, examinationn shows red swollen uvula deviated patient drooling temp 38
dx?
I and D
Treatment for Social Anxiety
SSRI
Cognitive
Behavioral
Characterized by an irrational fear and avoidance of objects and situations
Phobic Disorders
Social phoba, feels anxious, palpitations
What is the nezt step
Propanolol
Young lady lost her job, recently being with loow mood and lack of interest, sleep disturbances, not interested in working
married to a loving husband
What is the diagnosis?
MDD
Male with his wife travelled to Thailand after returning
presented with fever, conjunctivitis,
rash on the neck, trunk and hands
What investigation to confirm the diagnosis?
Measles antibodies
Dengue + retro orbital pain + fever + rashes
+ headache + joint pain
Zika Virus
- Zerology and PCR
Coryza, cough and conjunctivitis
Kopliks spots
Measles
High fever + malaise + generalized lymphadenopathy
+ blanching + erythematous maculopapular
Exanthem Stage
Low grade fever + headache + arthralgia + myalgia
+ non-purulent conjunctivitis + malaise +
maculopapular rash + pruritic rash
Zika Virus Infection
RUQ pain + fever + jaundice
Cholangitis
rolling of eyes + uprolled eye + Pt conscious + no neurologic deficits
Benztropine
- Acute Dystonia
Abdominal distention + Constipation + since 3 days not even passing gas
Sigmoid volvulus
Elderly female patient with constant abdominal pain + distention + nausea
+ vomiting + mild blood noted in the rectum + patient is on metoprolol
Initial test
Abdominal Xray
What is the best test from the previous?
CT angiogram
Creatinine raised, urea raised
no rbc, other vitals are normal
What’s next?
Stop Ibuprofen
Patient with cough, weight loss, Xray showed left apical mass,
Left sided Horner syndrome + abdominnal xray
What is the inv?
CT chest - Pancoast
Menstruation associated itchyness and redness without any discharge
Do nothing
Acute onset, severe testicular pain and swelling
Tender testicle and elevated
Dx?
Testicular torsion
Impetigo rash picture asking for Dx
Impetigo
Female patient with long term treatment with Risperidone who noticed that milk come out from her nipple
switch to Quetapine
joint pain + morning stiffness + symmetric joint swelling
elevated anti-cyclic citrullinated peptide (anti-CCP) antibodies
dx?
Rheumatoid Arthritis
Impetigo - antibiotics started 24 hr ago and rashes fully covered with water tight dressing
Immediately return to school
Patient has 0.9 cm pituitary adenoma on treat,ent with Bromocriptine
Now she want to conceive. Prolactin was 1315
What to do next?
Cabergoline
Abdominal distetion 2+ peripheral edema
Had variceal banding
Urine socium 5 mmol
Cause of Acute kidney Injury
Renal Hypoperfusion
TURP was done in patient with BPH and biopsy showed less than 5% low grade dysplasia
Mgt?
To complete TURP - to relive BPH symptoms
20 yo guy with hematuria +++ and proteinuria + 2 days after URTI and remain unchanged til next week when follow up apt
Mesangial IgA nephropathy
Young girl Bell’s palsy
come to ED within 6 hrs
mentioned left ear examination
Oral Prednisolone and oral Acyclovir
Facial weakness + Right ptosis + drooling from the Right corner of her mouth since this morning
Erythematous vesicular rash is noted in the R ear canal
Next step?
Oral Acyclovir
itchiness + jaundice + mild RUQ pain
high ALP, gamma GT, bilirubin
Dx
ERCP
Initial test is HBsAg
Chronic Hepatis B
Initial test is HCV antibody
Injection drug use
Chronic Hepatitis C
AMA
itching raised ALP
Primary Biliary Cholangitis
MRCP
Inflammatory Bowel Disease
Primary Sclerosing Cholangitis
Transferring saturation, ferritin
Diabetes + joint pain
Haemachromatosis
Ceruloplasmin
neurological Signs + haemolysis
Wilsons Disease
Lung Disease
alpha 1 antitrypsin level
Alpha 1 antitrypsin level
A stone located in Hartmanns pouch or in the cystic uct itself can cause compression on the adjacent common hepatid duct
Mirizzi Syndrome
Positive Antimitochondrial M2 antibodies AMA - M2
uncommon cause of chronic liver disease
occurs in females and is usually diagnosed between the ages of 30-65
itch, fatigue and cholestattic pattern of abnormal liver
Transient elastography can be useful for staging the severty of the disease
Primary biliary CHolangitis
Growth within a milk duct in the breast, usually near the nipple
May be associated with breast cancer
Duct Papilloma
Milky discharge
Galactorrhea
Nonpurpureal lactation
Hyperprolactinemia or Pituitary Adenoma
Toothpaste
Duct ectasia or Comedomastitis
usually in perimenopausal women
Multicolored Sticky
Associated with pain, itching, swelling in the nipple
Duct ectasia
