IM-3 Flashcards
Beau’s lines
horizontal lines or indentations in nails indicating catabolic event, high fever, lack of adequate nutrition or even cachexia in past 120 days (bc nails take that long to grow)
Mee’s nails
Arsenic poisoning seen as single white line in each nail
Reil’s lines
Single white line in each nail, indicating infection
Banded leukodynia
same horizontal white lines that could be caused by a myriad of diseases like acute renal failure, chronic renal failure, malaria , psoriasis or sickle cell disease, cardiac failure, MI, pneumonia etc.
Muehrcke’s lines
paired white lines “IN” each nail indicate hypoalbinemia seen in patients with liver disease, nephrotic syndrome or kwashiorkor - dissapear after albimin is restored.
When is it indicated to use Gold therapy?
rheumatologic conditions like RA. Used in refractory cases and show up as single horizontal yellow band in each nail.
Where does the conversion of pro-insulin to insulinn occur?
pancreatic beta islet cells
What do low levels of C-peptide but high insulin indicate?
high c-peptide and high insulin?
Exogenous insulin is being injected.
Insulin is endogenously manufactured
Bussaca nodules
(white nodules on iris) pathognomonic for granulomatous uveitis that can occur in any granulomatous dz like (TB, leprosy, sarcoid chronic granulomatosis, sarcoid)
Bushfield spots
Down’s Syndrome (but many normal children have spots that are similar) Absence does not r/o
Kunkmann-Wolffian bodies
Spots similar to brushfield spots that appear on normal iris that are less distinct, less numerous and more peripheral than Brushfield spots
Bitoti’s spots
Vitamin A deficiency (pearly white to yellow foamy spots on either side of conjunctivva, not the iris) Can indicate either a previous or current vitamin A def.
Lisch nodules
claer, but yellow brown pigmented dome shaped nodules that protrude from the iris.
How to calculate total cholesterol?
TG/5 + LDL + HDL
What are the top 2 secondary causes to hypercholesterolemia?
choledocholithiasis and hypothyroidism
Why would choledocholithiasis cause high cholesterol?
obstruction of the common bile duct prevents cholesterol from leaving the liver and exiting body via stool
Is constipation a cause or result of diverticulosis?
Cause of diverticuloisis. That’s why it’s reccomended to eat fiberous food when pt has diverticular disease.
What type of medium must diptheria be cultured on?
Tinsdale agar
What is the most common reason with inherited angioedema?
C1 esterase inhibitor deficiency. (C1 esterase is an enzyme that inhibits plasma kallikrein. Deficiency causes excess kininogen and release of excess kinin mediators causing vascular leakage –> results in edema into deeper tissues of dermis and subQ tissues.)
What is the key player of angioadema as a result of allergic txn?
Histamine release from IgEmediated mast cells and basophils with consequent exudation from BVs and edema.
Plumbism
aka Lead poisoning
Any decreased metabolic state causes what kind of anemia?
megaloblastic
What are the EKG findings of hypothermia?
J waves - appear once the body drops to a core temp of 25-30 degrees. They are characterized by notching of the junction between the QRS complex and the ST segments
What are pts greatest risk for in severe hypothermia
V. tach
How do you re-warm sombody’s core temp?
warm GI irrigation with saline enemas and NG tube with warmed D5NS without potassium
What EKG finding will be caused in hypooglycemia?
Prolonged QT
Best way to measure hypothermia
rectal temp
What is the DDx of Fever of unknown origin after pancultures are negative?
- TB
- Sarcoid
- Lymphoma
Virus spread by skin to skin contact in adults usually on around genitals, sex is most common reason
Molluscum contagiosum - small solid individual papules with tiny central umbilication. Not specificlally associated with hair follicles, but often near.
What type of ventillation is used to wean patients off the ventillator when pt has been on for a period of time with no respiratory muscle atrophy?
Intermittent mandatory ventilation
How to wean pts with respiratory muscle atrophy?
Use Control/Assist vevntiallator
What ventillatory setting to use when pt is hypoxic and refractory to O2 therapy?
PEEP (maintains positive pressure in alveoli even during expiration. This improves lung compliance and therefore oxygenation
Deficiency in X linked galactosidase causing cardiac failure and renal failure, but not serious CNS problems. UA shows lipiduria and proteinuria >3.5
Fabry’s disease
What are angiokeratomas?
Purple- maroon papular lesions often in clusters that are pathonomonic for Fabry’s disease
Pt is of childbearing age has developed multiple fluctuant masses on the trunk and limbs. Pt also has HA and fatigue and is overweight. States the masses are painful and worse with periods.
Adiposis dolorosa
What is the definition of chronic mesenteric ischemia?
Artherosclerosis of 2 or more of the mesenteric vessels ie celiac or SMA of IMA thus decreasing blood flow to bowel. . cornary
