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

Labs, clinical signs + symptoms 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
loud, blowing holosystolic murmur heard at mid or lower LSB no other symptoms difference in newborn vs. later infancy?
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
26
Peripheral Pulmonary Stenosis murmur? cause?
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
27
Labs in sarcoidosis what's altered and why?
hypercalcemia / calciuria - 1-alpha-hydroxylase form activated macrophages produces PTH-independent vitamin D elevated serum ACE - due to lung inflammation
28
S3 causes
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
S4 what is it? how does it sound? causes?
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
Light Criteria what for + what are they?
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
Courvoisier sign
painless palpable gallbladder in jaundiced patient sign of pancreatic head adenocarcinoma causing obstruction of gallbladder evacuation
32
Labs in dermatomyositis name of Ab and what it targets
anti-Jo1 (most specific) - targets histidyl-tRNA synthetase ANA creatine kinase and aldolase (may be high via muscle damage)
33
anti-hemidesmosome Ab
bullous pemphigoid
34
anti-desmosome Ab
pemphigus vulgaris
35
hypotension, jugular distension, clear lungs signs/sx of MI what is it? other hemodynamic parameters
isolated right ventricular infarct (RCA occlusion) DECREASED pulmonary capillary wedge pressure
36
S4 how + when is it best heard?
bell over apex, pt in left lateral decubitus on EXPIRATION (increased flow from lungs back to left atrium)
37
ALP vs. GGT
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
urinary eosinophils MCC, less common causes, trigger, other sx
MCC is ACUTE INTERSTITIAL NEPHRITIS from drugs (nsaids, penicillins) may be due to kidney transplant rejection or pyelonephritis rash, fever + eosinophilia
39
Arteriovenous nicking
funduscopic finding in chronic htn early sign of retinopathy due to exudative vascular changes via endothelial necrosis
40
"Xanthochromia"
blood in CSF non-specific, but if SAH suspicion is high and CT is negative, is highly sensitive for SAH
41
Hypokalemia s/s?
muscle weakness cramps possible rhabdomyolysis
42
Hyponatremia s/s?
nausea malaise headache CNS - mental status, seizures cramps usually only in chronic hyponatremia
43
Leser-Trelat sign
many seborrheic keratoses suddenly sign of GASTRIC ADC or other internal malig. (maybe via IGF-1 production)
44
Internuclear Ophthalmoplegia what is it? what causes it?
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
CSF tap: normal glucose, high protein, RBCs
"Traumatic tap"
46
CSF tap: low glucose, very high protein, very high neutrophils
bacterial meningitis
47
CSF tap: normal glucose, high protein, RBCs and lymphos
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
CSF tap: low glucose, high protein, lymphos
Fungal or TBC meningitis
49
CSF tap: normal glucose, high protein, normal cellularity
Guillain Barre Syndrome called "albuminocytologic dissociation"; prob via incr. permeability of "blood-nerve barrier" at nerve roots progressive, symmetric ascending weakness
50
CSF tap: normal glucose, normal -or- high protein, lymphos
viral encephalitis OTHER than herpes (herpes has RBCs via temporal hemorrhagic inflammation)
51
HbA2 when is it seen? what does it cause? what testing does it interfere with?
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
anti-smooth muscle Abs
autoimmune hepatitis
53
Murphy sign what is it? positive in what? negative in what?
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
Systemic Sclerosis (Diffuse Scleroderma) antibody
Anti-Scl70 (aka anti-DNA topoisomerase I)
55
CREST syndrome antibody
anti-centromere
56
CREST acronym
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
most specific Ab for SLE
anti-dsDNA
58
Ab for DRUG-INDUCED Lupus
anti-histone | no renal/CNS involvement in drug-induced
59
Abs for Sjogrens
Anti-Ro (SSA) and Anti-La (SSB)
60
How is the extent pulsus paradoxus measured?
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
Labs in hypovolemia 4 things (think renal / urinary parameters + 1 related to how many lab values will change in general)
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" 4. Hemoconcentration - albumin, Hb, urate etc. concentrations will all rise due to low volume
62
Main, most specific urinalysis sign of pyelonephritis how does it form? what other disease can it be seen in?
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
ERYTHROCYTE GLUTATHIONE REDUCTASE activity can be reduced in deficiency of what? why? (s/s of this?)
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
increased serum protoporphyrin levels occur in what? (3 conditions)
iron deficiency anemia lead poisoning erythropoietic protoporphyria
65
C-ANCA what is the actual protein targeted? 1 example of disease with C-ANCA?
usually PROTEINASE-3 Wegener's granulomatosis (aka granulomatosis with polyangiitis)
66
P-ANCA what is the actual protein targeted? examples of diseases with P-ANCA (5 total: 2 vasculitides, 2 GI disorders, 1 autoimmune)
usually MYELOPEROXIDASE CHURG-STRAUSS (eosinophilic granulomatosis with polyangiitis) MICROSCOPIC POLYANGIITIS ULCERATIVE COLITIS and PRIMARY SCLEROSIS CHOLANGITIS RA
67
main serum marker correlating with disease severity in GIANT CELL ARTERITIS (temporal arteritis)
IL-6
68
basophilic stippling in what (2)? is what?
1. sideroblastic anemias - Pb poison, MDS, x-linked 2. thalassemias seen in PERIPH not marrow (sideroblasts in marrow) is AGGREGATED RIBOSOMES
69
sideroblasts seen where? stain? what makes the rings?
in MARROW of sideroblastic anemias PRUSSIAN BLUE stain excess IRON in MITOCHONDRIA

*USMLE* (28 decks)

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