High Yield Flashcards by Sheila Sarmiento

eye discharge
1-7 days

Gonorrhea

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eye discharge 7-14 days

CHlamydia

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3 Cs
Cough
coryza
conjunctiva

Measles

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Rash starts on the neck
non-pruritic
very high fever
resp symtoms
erythematous pharynx, tonsils
dx:

Roseola
Human Herpes Virus 6

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pruritic vesicles

Chicken Pox
Varicella

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nonspecific prodrome
rash starts on the face
pruritic

Rubella

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slapped cheeks

5th Disease/ Erythema Infectiosum

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sanpaper like rash
erythematous maculopapular rash
sore throat
fever
nausea

Scarlet Fever

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Diffuse erythematous macular sunburn like rash
acute onset
fever
myalgia
pharyngitis
vomiting
diarrhea
hypotension leading to multi-organ failure

Toxic Shock Syndrome

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Periorbital Erythema, bullae vesicles, desquamation,
abscess or some site of infection

Staphylococcal Skin scalded skin disease

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petechial purpural rash on the ankle and wrist - generalizes on the palms and soles, fever, rash, headache, myalgia, rep symtoms

Rocky mountain fever

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petechial purpural rash on the trunkand extremities - generalizes on the palms and soles, fever, rash, headache, myalgia, rep symtoms

Epidemic typhus

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abrupt onset fever, chills, malaise, exanthem, shock, generalized petechiae

Early Meningococcemia

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fever, lymphadenopathy, malaise, sore throat, splenomegaly
generalized rash on palms and soles of the foot

Secondary Syphilis

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limping, walking, difficulty, no fever
14yo

SCFE

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limping, walking, difficulty
4-8 yo

Perthes Disease

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smooth, pear shaped
nontender testis
dx

Hydrocoele

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bag of worms

Varicocele

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bird beak sign
dysphagia for both

Achalasia

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What to check in patient having osteoporosis?

Vitamin D

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1st line treatment for Ankylosing spondylitis

Naproxen

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prefers to be alone

Schizoid

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Wants friends but scared

Avoidant

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magical thinking

Schizotypal

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Paranoid

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sociopaths

Antisocial

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Cutting, splitting, dramatic, mood swings

Borderline

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Attention seeking

Histrionic

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Donald trump

Narcisstic

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ego syntonic

Obessive Compulsive

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Always in relationships

Dependant

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What is the best option to treat obesity under the clozapine treatment for resistant schizophrenia?

Aripriprazole

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For MDD,
what is the treatment if the patient cant sleep?

Mirtazipine

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For MDD,
what is the treatment if the patient is too skinny?

Mirtazipine

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For MDD,
what is the treatment if the patient has sexual side effects?

Bupropion

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For MDD,
what is the treatment if the patient
has refractory?

ECT or Electroconservative therapy

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What is the treatment for ADHD?

Methylphenidate
(Stimulants)

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“fugue”drinking and wandering

Dissociative Amnesia

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hair pulling

Trichotillomania

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multiple personalities

Dissociative Personality DIsorders

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What is the treatment for acute alcoholic withdrawal?

Benzodiazepine

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What is the treatment for chronic alcoholic withdrawal?

Naltrexone
Disulfuram

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Pin-point pupils, resp depression
what drug intoxication is this?

Opioids

withdrawal causes cramps, yawning, aches

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Dilated pupils
tachycardia, hypertension and energy
What drug intoxication is this?

Cocaine

withdrawal causes: hunger and crashing

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sustained muscle contraction

Acute Dystonua
tx: anticholinergic (benztropine)

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mask facies, cogwheel rigidity, shuffling gait, resting tremor

Parkinsonism
tx: Anti-cholinergic (Benztropine)

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restlesness

Akathisia

tx: Beta Blocker

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lip smacking

Tardive Dyskinesia

Tx; D/C offending agent + Clozapine

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cutting, splitting, dramatic, mood swings

Borderline

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attention seeking

Histrionic

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triad of halitosis, dysphagia and regurgitation

pulsion diverticulum of the posterior esophagus between the thyropharyngeal and cricopharyngeal parts of the inferior constrictor

Zenker diverticulum

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upper 2/3 of esophagus
dysphagia to solids

esophagus squamous cell carcinoma

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lower 1/3 of esophagus
dysphagia to solids

esophageal adenocarcinoma

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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

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less sthan 6 wks for diabetic foot ulcer
inv?

Xray

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more than 6 wks for diabetic foot ulcer
inv?

MRI

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above dentate or pectinate line
drains via Superior Rectal vein
painless visceral innervation

Internal Hemorrhoids

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below dentate or pectinate line
drains via inferior rectal vein
painful somatic innervation

External hemorrhoids

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Antibiotic of choice for meningococcal meningitis for children 5yo

Ceftriaxone

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Signs of chronic liver failure

spider nevi

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trauma, brief loss of consciousness > lucid interval > comatose
biconvex lens shape density
pterion injury
middle meningeal rupture

Epiderual hematoma

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elderly, acohol use
progressive confusion and headache
crescent shaped density
bridging vein rupture

Subdural hematoma

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berry aneurysm
thunderclap severe headache
nuchal rigidity
prevent vasospasm with nimodipine

Subarachnoid Hemorrhage

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Cerebral hemorrhoid angiopathy
rapidly progressive symptoms with focal neurological deficits
increased ICP

Intracerebral hemorrhage

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which drug causes hypotension

Hydrochlorothiazide

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Tibial tubercle swellign pain in young boy with no fall

Osgood Schlatter

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someone walking and havign pains on the leg but is releived on sitting or at rest

Common Iliac artery
- Vascular claudication

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Repeat CAG
psychotic symtoms and choreiform movements
Atrophy of Caudate nucleus

Huntington’s disease

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Repeat GAA
ataxia, scoliosis, pes cavus
hypertrophic cardiomyopathy

Friedrich’s ataxia

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Repeat CTG
cataracts, male baldness, myotonia
testicular atrophy

Myotonic dystrophy

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repeat CGG
elongated face, enlarged ears and testes
Mitral Valve prolapse

Fragile X Syndrome

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deliver dead baby

Inform coroner

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precipitated by head movemenent
episodes last for several seconds

Benign Paroxysmal Vertigo
(BPPV)
treatment : Epley Maneuver

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Episodic lastign only for 20+ minutes to hours
vertigo + hearing loss + tinnitus + +/- aural fullness
treatment” salt restricted diet and thiaZIDE DIURETICS

Meniere’s disease

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Single vertigo episode that often lasts days
can follow viral URI, abnormal head trust
supportive treatment

Vestibular Neuritis
(AKA labyrinthitis)

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dizzines + vertigo (slow growing tumor)
vertigo + hearing loss /- CN VII and CN VI symptoms
Treatement : Surgery / radiation or MRI surveillance

Acoustic Neuroma

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absence vibratory sensation, positive Romberg sign, sensory ataxia
Treponema pallidum

Tabes Dorsalis

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Upper motor neuron sym
sensory and cerebellar ataxia and diminished vibratory sensation
cause by Vit B 12 def

Subacute combined degenerative

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Lower motor neuron weakness
osten asymmetric
cause by Poliovirus

Poliomyelitis

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Progressive neurodegenerative disorder
upper and lower motor neuron symp

Amyotrophic Lateral Sclerosis

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Young person after vigorous exercise and neck injury develops facial neurologic deficits

Carotid Artery Dissection

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Unrestrained passenger in motor vehicle accident prevents comatose with diffuse “punctuate”hyperdensities or CT head

Diffuse Axonal Injury

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Young person with recent ankle injury in crutches develops wrist drop

Radial Nerve Palsy

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new onset, unilateral, blurry vision, washed out appearance

Optic Neuritis

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Bilateral ptosis
constipation
resp difficulty after food exposure

Botulism

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Middle aged adult with headache, visual deficits and mass crossing the corpus callosum in imaging

Glioblastoma multiforme

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What is the most common cause of horner Syndrome

Lung cancer

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patient with 40 pack year hix of smoking, hemoptysis, unilateral ptosis and miosis

Horner Syndrome

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morning headache
nausea, vomiting with mass in cerebral cortex

Astrocytoma

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Sudden onset, severe, unilateral, periorbital headache with tearing and conjunctival injection

Cluster headache

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Patient with recent surgery and immobilized in hospital beds and develops unilateral foot drop

Common Peroneal Injury

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most appro way of collecting urine in a 1 yr old patient

Suprapubic tap

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elderly patient presents with memory loss over weeks or months ,
appears distress and loss interest or in hobbies

Pseudodementia
(Major depressive disorder)

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Infant with subdural hematoma, retinal hemorrhages, and metaphyseal corner fracture

Non-accidental trauma

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Patient with Parkinsonian symptoms, orthostatic hypotension, ataxia

Multiple System Atrophy
(Shy-Drager Syndrome)

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Transient, unilateral, painless vision loss in an elderly patient

Amaurosis fugax then will progress to CRAO if not treated

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Young patient with myoclonic jerks upon awakening from sleep

Juvenile myoclonic epilepsy

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cannabis is contraindicated in ?

Family history of Schizo

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Pop sound
left knee swollen
laxity when pulled anteriorly
Positive test: anterior drawer and Lachman

Anterior cruciate ligament

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Positive posterior drawer test
tibia forced posteriorly with fixed ankle eg dashboard injury

Posterior Cruciate Ligament or PCL

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knee clicking
Positive Mcmurray or Thessaly test

Meniscus

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often injured combination of ACL and meniscus (unhappy triad)
laxity on valgus stress

Medial Collateral Ligament or MCL

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positive test: Laxity on varus stress

Lateral Collateral Ligament

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High riding patella
Positive test: inability to extend knee or flex hip with knee straight

Patellar tendon

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Iron deficiency anemia

Ferritin

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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

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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

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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

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best test to diagnose HIV

Western Blot

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young male with increased bilirubin and rest of the liver function tests are normal
dx?

Gilbert Syndrome

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tenderness upon addduction of arm across torso
palpable deformity at the superior aspect of the shoulder

Acromioclavicular joint dislocation

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Flattened deltoid prominence
prominent acromion, abducted, externally rotated shoulder
posterior trauma in vulnerable position (eg throwing motion)

Anterior Shoulder dislocation

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fall of outstreched hand (FOOSH)
anterior shoulder flattening
arm held in adduction and internal rotation

Posterior shoulder dislocation

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arm drop positive
decreased abduction with intact sensation

Rotator cuff tear

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OLD CRAB
old age
Calcium elevated
Renal Failure
Anemia
Bone lytic lesions

Multiple Myeloma

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bone pain and deafmess
ALP raised
calcium and Phosphorus normal
PSA < 4
dx?

Paget’s Disease

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watery rhinorrhea, itchy eyes, sneexing

Allergic Rhinitis
tx: Intranasal Glucocorticoids
> oral antihistamines

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Seasonal variation
no obvious trigger
later onset (20+ years)

Non-allergic rhinitis

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Rhinorrhea, nasal congestion, sore throat, cough +/- fever

Viral Sinusitis
tx: supportively

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> 10 days , fever > 39 + 3 days purulent discharge

Bacterial Sinusitis
Tx: Amoxicillin + clavulanic Acid

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swelling of PIP, MCP joint worsening in the morning and improves with work

Rheumatoid Arthritis

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The fastest study to be conducted in order to see the effect of the drug in an Alzheimers disease study

Randomized Clinical Trial

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sharp chest pain radiating to the back, unequal blood pressures R vs L arm

Aortic Dissection

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patient with substernal chest pain, worsens after eating and at night

GERD

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Recent Viral illness, chest pain improves when leaning forward, fever, scratching sound on cardiac auscultation

Acute Pericarditis

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reproducible with palpation of chest wall

Costochrondritis

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recent viral illness , sharp chest pain, worsens with deep inspiration, scratching sound on auscultation that disappears while breath-holding

Viral Pleurisy

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patient on furosemide, ACEI but edema is still present along side with SOV and PE
What drug to add?

Spironolactone

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severe, acute, epigastric abdominal pain radiating to the back

Acute Pancreatitis

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Long standing history of GERD, refractory symptoms, now with acute epigastric pain, rebound, abdominal rigitidity

Perforated Peptic Ulcer

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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

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Middle Age, female with epigastric abdominal pain radiating to the right side and back, fever, leukocytosis

Acute Cholecystitis

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severe, unilateral flank pain
groin pain
periodically worsens and improves

Nephrolithhiasis

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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

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adult male presented with retrosternal pain aggravated by food, what will you do?

Endoscopy of the upper GIT

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What is the treatment of choice for Peptic Ulcer disease?

Upper GIT endoscopy

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Female child is worried about cleanliness what therapy is useful for her?

Behavioral Therapy

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Tx for OCD

Exposure and Response Therapy

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Tx for Adjustment disorder

Psychodynamic therapy

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tx for Tourettes Syndrome

Habit Reversal Therapy

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Tx for ASD

Behavioral Modification Program

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Tx for Persistent depressive disorder

Insight Oriented Psychotherapy

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Tx for Grief

Supportive Therapy

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Tx for ODD

Family Therapy

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Tx for Kleptomania

Insight Oriented Therapy

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Tx for Separation anxiety disorder

CBT and Psychotherapy

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Tx for ADHD

Behavioral Therapy

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Tx for Specific Phobia

Systematic desensitization and Exposure therapy

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tx for all dissociative disorders

Psychotherapy

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Alcoholic + agitation

Diazepam

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Non-alcoholic + agitation

IM Haloperidol

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Alcoholic + Psychosis

IM Haloperidol

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Non-acoholic + Psychosis

IM Haloperidol

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What med to start in Schizophrenia?

Risperidone

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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

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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

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

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