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*USMLE* > Labs, clinical signs + symptoms > Flashcards

Labs, clinical signs + symptoms Flashcards

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USMLE® Step 1 flashcards
1
Q

Anterior uveitis (iris inflammation)

2 categories + ex

A

infections (herpes, syphilis, Lyme)

inflammation (HLA-B27-related disease such as AnkSpon; sarcoidosis)

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2
Q

Erythema nodosum (red/violet subcutaneous leg nodules)

3 categories of causes + examples

A

Bacterial infection (S. pyogenes pharyngitis, S. aureus, Chlamydia)

fungal infections (blasto, coccidio, histo)

inflammations (Crohn’s, sarcoidosis, etc.)

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3
Q

Skin sign in Celiac

A

dermatitis herpetiformis

red, pruritic papules, vesicles and bullae that are bilateral and symmetric on extensors, elbows, knees, upper back + butt

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4
Q

acanthocytes

assoc. disease

A

RBCs with projections of diff. lengths; spur cells are most severe form

assoc. with abetalipoproteinemia

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5
Q

bite cells

A

G6PD defic. after monocytes eat Heinz body (Hb aggregates) out of RBCs

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6
Q

target cells

4 causes

A

bullseye look with central Hb aggregation surrounded by halo

seen in obstructive liver disease, thalassemia, IDA and asplenia (increased surface area to volume ratio)

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7
Q

teardrop cells

A

seen in myelofibrosis

when BM is replaced with fibrosis or metastatic cancer, RBCs have to squeeze thru fibrous strands and get deformed

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8
Q

schistocytes

A

fragmented RBCs

seen in DIC and thrombotic microangiopathies (HUS etc.) as fibrin clots exert shear forces on RBCs and cause fragmentation

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9
Q

flame/dot hemorrhage in retina

A

hypertensive retinopathy

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10
Q

cotton-wool spots on retina

A

hypertensive retinopathy; small foci of retinal ischemia

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11
Q

cherry red macular spot

A

central retinal artery occlusion with diffuse retinal ischemia

via atheroscler, cardioembolism, vasculitis (GCA)

also assoc. with Tay-Sachs and Niemann-Pick sphingolipidoses (think hyphens… cherry-red, T-S, N-P)

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12
Q

optic disc cupping

A

glaucoma

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13
Q

hypersegmented neutrophils (>5 lobed nuclei)

A

megaloblastic anemia

folate deficiency (happens faster) or B12 defic. (takes years due to body stores)

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14
Q

anti-mitochondrial antibodies

A

primary biliary cirrhosis

sx include pruritus, jaundice + malabsorption

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15
Q

Kussmaul sign

A

normal = inspiration decreases JVP as venous return increases

Kussmaul = increased JVP on inspiration

cause = impaired R-side diastolic filling via constrictive pericarditis (chronic), restrictive CMP, or tricuspid stenosis

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16
Q

pericardial knock

A

brief, high-frequency precordial sound in early diastole (just after S2; earlier than S3)

seen in constrictive pericarditis

(can be confused with opening snap of mitral stenosis)

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17
Q

Pulsus paradoxus

what is it?
4 causes?

A

drop in SBP > 10 mmHg on inspiration

seen in cardiac tamponade, constrictive pericarditis, severe asthma or COPD

(normally inspiration > increased venous return > right chambers bulge into left + decrease L-sided filling > slight SBP decrease; in PP this effect is more pronounced due to restriction of the movement of R chambers into pericardium)

(the “paradoxus” part is because when SBP decreases significantly, you can detect heartbeats that don’t have corresponding pulses peripherally)

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18
Q

S3

where heard? what is it?

A

rapid cessation of passive diastolic filling into an enlarged ventricle (“ventricular gallop”)

heard with bell at apex, best with pt in left lateral decubitus

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19
Q

HLA associations for T1DM

A

HLA-DQ and DR

specifically HLA-DR3 and DR4 (seen in 90% of T1DM pts)

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20
Q

signs of portal hypertension with no liver abnormalities

cause? how is it different from usual portal htn signs?

A

portal vein thrombosis

a “presinusoidal” cause of portal htn; can have esophageal varices + other portocaval anastamoses with splenic enlargement but NO ASCITES

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21
Q

membranous nephropathy antibody

A

anti-PLA2R

highly specific + correlates to disease activity

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22
Q

hemosiderin

appearance, stain

A

brown or yellow-brown pigments in granules or crystals in cytoplasm of macrophages

prussian blue stain

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23
Q

amyloid protein

stain + appearance; sequelae

A

Congo red stain > pale rose color

can cause CMP, nephrotic syndrome etc.

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24
Q

lipofuscin

appearance + cause of accumulation

A

insoluble yellow-brown pigment (lipids + P-lipids complexed with proteins)

accumulates with age in multiple organs

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25
Q

loud, blowing holosystolic murmur heard at mid or lower LSB

no other symptoms

difference in newborn vs. later infancy?

A

small VSD - non-cyanotic so no other sx at first

larger VSD or later Eisenmenger > HF, failure to thrive, and diaphoresis with feeding

NOT HEARD JUST AFTER BIRTH > pulmonary vascular resistance declines in first week and significant L-to-R shunt can begin > heard by age 4-10 days

most small VSDs close spontaneously

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26
Q

Peripheral Pulmonary Stenosis

murmur? cause?

A

stenosis in a more distal branch of the pulmonary artery

murmur heard AFTER FIRST DAY of life when ductus arteriosus closes

low-grade, mid-systolic, high pitch/blowing ejection murmur

heard in pulmonary area (2nd ICS LSB) with radiation to AXILLA and BACK

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27
Q

Labs in sarcoidosis

what’s altered and why?

A

hypercalcemia / calciuria - 1-alpha-hydroxylase form activated macrophages produces PTH-independent vitamin D

elevated serum ACE - due to lung inflammation

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28
Q

S3

causes

A

generally, abnormal ventricular enlargement (eg volume overload > eccentric hypertrophy)

normal in healthy adult <40 or pregnancy; age >40 suggestive of…
severe mitral regurg
chronic aortic regurg
Dilated CMP
HIGH OUTPUT - in pregnancy or hyperthyroid

29
Q

S4

what is it? how does it sound? causes?

A

sudden rise in END-DIASTOLIC pressure as blood strikes a stiff ventricle after atrial contraction (“atrial gallop”)

low-frequency, late diastolic sound

causes of CONCENTRIC LV hypertrophy such as chronic hypertension or severe aortic stenosis

30
Q

Light Criteria

what for + what are they?

A

to determine if a pleural effusion is an exudate (infection, malignancy or AI disease) vs. transudate (HF, cirrhosis, nephrosis)

pleural/serum protein ratio > 0.5
-or-
pleural/serum LDH ratio > 0.6
-or-
pleural LDH >2/3 of normal upper limit serum LDH
(normal upper limit = 90 U/L, so >60 U/L
31
Q

Courvoisier sign

A

painless palpable gallbladder in jaundiced patient

sign of pancreatic head adenocarcinoma causing obstruction of gallbladder evacuation

32
Q

Labs in dermatomyositis

name of Ab and what it targets

A

anti-Jo1 (most specific) - targets histidyl-tRNA synthetase

ANA

creatine kinase and aldolase (may be high via muscle damage)

33
Q

anti-hemidesmosome Ab

A

bullous pemphigoid

34
Q

anti-desmosome Ab

A

pemphigus vulgaris

35
Q

hypotension, jugular distension, clear lungs

signs/sx of MI

what is it? other hemodynamic parameters

A

isolated right ventricular infarct (RCA occlusion)

DECREASED pulmonary capillary wedge pressure

36
Q

S4

how + when is it best heard?

A

bell over apex, pt in left lateral decubitus

on EXPIRATION (increased flow from lungs back to left atrium)

37
Q

ALP vs. GGT

A

ALP - group of enzymes with metabolic activity in many tissues (but mainly BONE + LIVER)

GGT - mostly in liver + biliary epithelium; in other tissues as well, but not in bone! can help differentiate btwn liver and bone causes of ALP increase

38
Q

urinary eosinophils

MCC, less common causes, trigger, other sx

A

MCC is ACUTE INTERSTITIAL NEPHRITIS from drugs (nsaids, penicillins)

may be due to kidney transplant rejection or pyelonephritis

rash, fever + eosinophilia

39
Q

Arteriovenous nicking

A

funduscopic finding in chronic htn

early sign of retinopathy due to exudative vascular changes via endothelial necrosis

40
Q

“Xanthochromia”

A

blood in CSF

non-specific, but if SAH suspicion is high and CT is negative, is highly sensitive for SAH

41
Q

Hypokalemia

s/s?

A

muscle weakness
cramps
possible rhabdomyolysis

42
Q

Hyponatremia

s/s?

A

nausea
malaise
headache
CNS - mental status, seizures

cramps usually only in chronic hyponatremia

43
Q

Leser-Trelat sign

A

many seborrheic keratoses suddenly

sign of GASTRIC ADC or other internal malig. (maybe via IGF-1 production)

44
Q

Internuclear Ophthalmoplegia

what is it? what causes it?

A

impaired adduction during lateral gaze

“convergence testing” (cross-eyed) is normal > not a medial rectus issue, rather a nerve conduction issue

seen in MS

(demyelinating lesions in the MEDIAL LONGITUDINAL FASCICULUS impair saltatory conduction from the ABDUCENS NUCLEUS (pons, controls lateral rectus of unaffected eye + transmits lateral gaze signal to CN III nucleus)

45
Q

CSF tap:

normal glucose, high protein, RBCs

A

“Traumatic tap”

46
Q

CSF tap:

low glucose, very high protein, very high neutrophils

A

bacterial meningitis

47
Q

CSF tap:

normal glucose, high protein, RBCs and lymphos

A

Herpes encephalitis

also see acute-onset fever, HA, mental status and FOCAL DEFICITS / SEIZURE

predominantly TEMPORAL LOBE; see temporal edema on img (virus goes via olfactory tract to olfactory cortex in medial temporal lobe)

RBCs are via hemorrhagic inflammation of temporal lobe

48
Q

CSF tap:

low glucose, high protein, lymphos

A

Fungal or TBC meningitis

49
Q

CSF tap:

normal glucose, high protein, normal cellularity

A

Guillain Barre Syndrome

called “albuminocytologic dissociation”; prob via incr. permeability of “blood-nerve barrier” at nerve roots

progressive, symmetric ascending weakness

50
Q

CSF tap:

normal glucose, normal -or- high protein, lymphos

A

viral encephalitis

OTHER than herpes (herpes has RBCs via temporal hemorrhagic inflammation)

51
Q

HbA2

when is it seen? what does it cause? what testing does it interfere with?

A

in BETA THALASSEMIA

high in trait; very high in major

compensation for beta globin chain underproduction

resulting MICROCYTIC rbcs are prone to HEMOLYSIS

increased cell turnover > FALSE LOW HbA1c in diabetics

52
Q

anti-smooth muscle Abs

A

autoimmune hepatitis

53
Q

Murphy sign

what is it?
positive in what? negative in what?

A

doc puts hand under ribs @ R midclav
pt breathes out, then on inhalation doc watches for wincing + stopping of inhalation due to pain

positive - cholecystitis

negative - choledocholithiasis, pyelonephritis, ascending cholangitis

54
Q

Systemic Sclerosis (Diffuse Scleroderma) antibody

A

Anti-Scl70 (aka anti-DNA topoisomerase I)

55
Q

CREST syndrome antibody

A

anti-centromere

56
Q

CREST acronym

A

CALCINOSIS - subcut Ca deposits +/- pain
RAYNAUD’S - via cold/emotional stress
ESOPH DYSMOTILITY - distal fibrosis
SCLERODACTYLY - starts as a NON-PITTING EDEMA
TELANGIECTASIA - face, hands, upper trunk, mucosa

57
Q

most specific Ab for SLE

A

anti-dsDNA

58
Q

Ab for DRUG-INDUCED Lupus

A

anti-histone

no renal/CNS involvement in drug-induced

59
Q

Abs for Sjogrens

A

Anti-Ro (SSA) and Anti-La (SSB)

60
Q

How is the extent pulsus paradoxus measured?

A

BP cuff on arm > inflate to above BPsys > listen for when intermittent sounds are first heard on EXPIRATION ONLY, then for when sounds are heard through WHOLE RESP. CYCLE

the difference between these is the drop in BP during inspiration …. normally 10 mmHg or less…. >10 mmHg is pulsus paradoxus

61
Q

Labs in hypovolemia

4 things (think renal / urinary parameters + 1 related to how many lab values will change in general)

A
  1. High BUN/creatinine ratio - >20:1
  2. low urine sodium / FENa - <20 mEq/L or <1%
  3. high urine spec. gravity / osmolality - >1.015 or >450 mOsm/kg

1-3 are signs of “prerenal azotemia”

  1. Hemoconcentration - albumin, Hb, urate etc. concentrations will all rise due to low volume
62
Q

Main, most specific urinalysis sign of pyelonephritis

how does it form?

what other disease can it be seen in?

A

WBC casts

WBCs precipitate with Tamm-Horsfall proteins secreted by tubular epithelium

also seen in ACUTE INTERSTITIAL NEPHRITIS, but this will have signs of AKI (BUN, creat, etc.) as opposed to urinary symptoms

63
Q

ERYTHROCYTE GLUTATHIONE REDUCTASE activity can be reduced in deficiency of what?

why?

(s/s of this?)

A

vitamin B2 (riboFLAVIN)

because glutathione reductase uses FAD (made from B2) and NADPH as cofactors to reduce S-S bonds on glutathione

(normocytic anemia with lip, mouth, tongue inflamm (cheilosis, stomatitis, glossitis))

64
Q

increased serum protoporphyrin levels

occur in what? (3 conditions)

A

iron deficiency anemia
lead poisoning
erythropoietic protoporphyria

65
Q

C-ANCA

what is the actual protein targeted?

1 example of disease with C-ANCA?

A

usually PROTEINASE-3

Wegener’s granulomatosis (aka granulomatosis with polyangiitis)

66
Q

P-ANCA

what is the actual protein targeted?

examples of diseases with P-ANCA

(5 total: 2 vasculitides, 2 GI disorders, 1 autoimmune)

A

usually MYELOPEROXIDASE

CHURG-STRAUSS (eosinophilic granulomatosis with polyangiitis)
MICROSCOPIC POLYANGIITIS

ULCERATIVE COLITIS and PRIMARY SCLEROSIS CHOLANGITIS

RA

67
Q

main serum marker correlating with disease severity in GIANT CELL ARTERITIS (temporal arteritis)

A

IL-6

68
Q

basophilic stippling

in what (2)? is what?

A
  1. sideroblastic anemias - Pb poison, MDS, x-linked
  2. thalassemias

seen in PERIPH not marrow (sideroblasts in marrow)

is AGGREGATED RIBOSOMES

69
Q

sideroblasts

seen where? stain? what makes the rings?

A

in MARROW of sideroblastic anemias

PRUSSIAN BLUE stain

excess IRON in MITOCHONDRIA

*USMLE* (28 decks)

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