nbme's Flashcards by danial A

Necrotizing pulmonary vasculitis

Goodpastures syndrome:
vasculitis involving basement membrane of lung and kidneys
hematuria and hemopytisis

collagen 4 BM

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Granulomatosis with Polyangiitis

Wegeners granulomatosis
vasculitis: Upper Resp (sinus), lungs, kidney

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Takayasu arteritis

different pulses on arms
granulomatous inflammation and fibrosis in large arteries

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Shortness of breath, fatigue, tachycardia, tachypnea, jugular venous distention, bilateral basilar crackles, an S3gallop, ejection murmur, and lower extremity edema raise + LVEF 70% + hemoglobin is LOW + dark blood in stools

high- output heart failure

pt has severe anemia –> heart must over compensate by pumping harder and more so that blood (carrying O2) can go to the body

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impaired relaxation and chamber hypertrophy on echo
pulmonary vascular congetion d/t chronic, poorly controlled HTN, or aortic stenosis

Left ventricular diastolic dysfunction

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reduced ejection fraction
echo: enalrged dilated chamber with poor contractillity
2/2 alcohol abuse, beriberi, trypanosoma, chemotherapy, peripartum cardiomyoopathy

left ventricular Systolic dysfunction

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Causes bloody diarrhea + either appendicitis-like (i.e., RLQ) pain or arthritis.

Yersinia enterocolitica

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Bloody diarrhea 1-3 days after infection from consuming poultry, or following exposure to eggs or reptiles

salmonella typhi

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Bloody diarrhea 1-3 days after consumption of beef.

Shigella

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causes bloody diarrhea 1-3 days after consumption of beef.
shiga-like toxin

EHEC
can cause hemolytic uremic syndrome (HUS; triad of renal dysfunction, schistocytosis, and thrombocytopenia).

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WATERY Diarrhea travelers diarrhea

ETEC

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C-diff diagnosis:

stool AB toxin test

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a GI malabsorptive syndrome where the patient can also get arthritis and renal and cardiac disease.
PAS-positive macrophages in the lamina propria.

T. whipplei
tx: ceftriaxone and daily TM/SMX for one year

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Bloody diarrhea in person who went to Mexico.
Can cause “flask-shaped ulcers” in the small bowel and liver abscess.
Demonstrates “erythrophagocytosis,” where RBCs can be seen within it on LM.

Entamoeba histolytica
tx: metronidazole

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Watery diarrhea in person who went to Mexico. - Appears as acid-fast cysts (same stain as TB).

Cryptosporidium parvum
self limiting in normal pt
chronic diarrhea in hiv tx: nitazoxanide

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Steatorrhea in person who went to Mexico. (scuba diving or water ocean)
Steatorrhea = bloating + extremely foul-smelling stool that floats.

Giardia
falagellated protozoan
tx: metronidazole

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Tortuous, superficial vessels in the colonic wall that cause painless bleeding per rectum in elderly.
Classically associated with aortic stenosis

angiodysplasia

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Can cause colovesical fistula (on new 2CK NBME), where a passageway between the colon and bladder forms, leading to UTI and mixed flora in the urine.
- straining throughout life leads to herniation of mucosa + submucosa through the muscularis propria of the colonic wall.
Usually asymptomatic, but can bleed. ______ is most common cause of painless bleeding per rectum in elderly, followed by colorectal cancer, followed by angiodysplasia.

diverticulosis

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LLQ pain + fever in patient over 60.

diverticulitis
dx: CT abdomen with contrast
tx: antibiotics
then colonoscopy should be scheduled later to rule out malignancy (never scope acutely)

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Patient over 75 + 2-3 days of constipation + abdo pain.
Rotation around its mesentery causes “dilation of sigmoid colon”

sigmoid volvulus
abdominal xray: coffe bean sign
- Tx on NBME is “sigmoidoscopy-guided insertion of rectal tube.”

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DKA
2 processes:

Dysregulated fatty acid degradation and ketone synthesis occurs because of the relative state of starvation created through absent insulin signaling.

b-hydroxybutyric acid, acetoacetic acid, and acetone

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DKA
2 processes:

Dysregulated fatty acid degradation and ketone synthesis occurs because of the relative state of starvation created through absent insulin signaling.

b-hydroxybutyric acid, acetoacetic acid, and acetone

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second to fourth decades of life as multiple, recurrent sinus or pulmonary infections, including pneumonia, bronchitis, and sinusitis.

uses ICS – has mild oral thrush

CVID – do a serum immunoglobulin measurement

HIV – not risk factors and oral thrush d/t ICS

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acute onset of dizziness vertigo, ataxia, n/v, hearing loss
(usually but not always after a viral infection)

labrynthitis

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acromegaly

functional pituitary adenoma growth hormone -- upregulatesIGF-1 Diagnosis is made by clinical presentation, measured hormonal levels, and cross-sectional imaging to detect the culprit adenoma. Surgical resection is the preferred treatment. If surgery cannot be performed, somatostatin analogues (e.g., octreotide) and antagonists of the GH receptor (e.g., pegvisomant) can be used.

sob/WHEEZING for 2 days just came back from long trip peripheral edema, JVD, S3 gallop, and crackles on lung examination

pulmonary edema: tx: **diuresis** to reduce the patient's hypervolemic state and lower cardiac filling pressure, pulmonary venous, and pulmonary capillary pressure. **Nitroglycerin, a venodilator, can also be utilized to shift fluid into capacitance vessels and lower preload. **Positive pressure ventilation can also reduce alveolar and interstitial edema and drive fluid back into circulation. vs pulmonary embolism would have way more acute symptoms of pleurtic chest pain and hemopytisis with hypotension

2 days of fever chills left flank pain, hypotension, tachycardia, WBC on urine

pyleonephritis must cover gram neg rods (ecoli) IV ceftriaxone

nephrotic syndrome 3 types complications: (2) workup: tx:

minimal change disease, membranous nephropathy, FSGS loss of normal size and charge filtration of glomerular capillary (dminised intravascular oncotic pressure) (Pie C) Complications include hypercoagulability caused by urinary loss of antithrombin-3 and infection caused by urinary loss of gamma globulins. Workup includes renal biopsy and treating underlying causes such as HIV, hepatitis, and systemic lupus erythematosus. Treatment involves the use of glucocorticoids and immunomodulators, though treatment-refractory disease is common. Patients may ultimately require renal replacement therapy or transplantation.

innfection or inflammation traveling within the lymphatic system and presents with streaking, sometimes traveling away from areas of cellulitis or abscess.

Lymphangitis spororthrixx

obstruction or excision of lymphatic channels, such as in cases of lymphoma or after lymph node dissection. It is typically localized to a single upper, single lower, or bilateral lower extremities,

lymphedema

severe substernal chest pain that increases with respiration and bent over On exam, pericarditis demonstrates a diastolic friction rub, described as a harsh sound heard in diastole

pericarditis Treatment requires anti-inflammatory medications such as indomethacin, glucocorticoids, and/or colchicine.

MI whats on ABG

primary metabolic acidosis (lactic acidosis from hypoperfusion with decreased CO) vs respiratory alkalosis from increased ventilation in pulmonary embolism

A history of mental retardation/intellectual disability, early satiety, post-prandial emesis, weight loss, and focal alopecia

a bezoar can lead to a gastric outlet obstruction which results in vomiting of undigested food with resultant weight loss from malnutrition can be hair (alopecia hair loss), chewing gum, or large pill

scarring and obstruction of the intrahepatic AND extrahepatic biliary tree

sclerosing cholangitis ulcerative coloitis no tx may need liver transplant

intrahepatic bile duct strictures and eventually leads to hepatic fibrosis

Primary biliary cirrhosis associated with thyroid dz, sjorgen, rheumatoid arthritis anti-mitochondrial antibody

can eventually lead to mitral insufficiency, which presents with a holosystolic murmur;

myxomatous degernation of mitral valve

joint inflammation, pancarditis, subcutaneous inflammatory nodules, erythema marginatum, and Sydenham chorea. diastolic murmur radiating to the axilla.

RheuMitral-atic heart disease mitral stenosis

first-line screening test in the diagnosis of cardiac ischemia from coronary artery disease, but in patients with an ST-segment baseline ECG abnormality {left or right bundle- branch block, left ventricular hypertrophy, early repolarization, or ventricular aneurysm),

ECG exercise stress test instead do Exercise stress echo

patients who are able to exercise but who have a baseline-abnormal ECG that would make a stress ECG difficult to analyze for ischemia (e.g., such as a baseline bundle-branch block that results in ST-segment repolarization change, or inverted T waves).

Exercise stress echocardiography

It presents with pruritus, especially after hot showers, secondary to increased mast cell production and degranulation. Additionally, it can present with episodic severe, burning pain with red-blue discoloration secondary to blood clot formation in extremity vessels, referred to as erythromelalgia.

polycythemia vera JAK2 mutation HIGH PLATELETS hyperviscoisty can lead to blurred vision tx: **phlebotomy**

Rheumatoid arthritis subcartilaginous cysts around joints | tx

oral ibuprofen (nSAIDS)

An x-ray of the chest shows a large cavitary lesion with an air-fluid level in the superior segment of the right lower lobe of the lung.

lung abscess

An x-ray of the chest shows a large cavitary lesion with an air-fluid level in the superior segment of the right lower lobe of the lung.

lung abscess

external ear pain exacerbated with movement of the tragus or pinna, purulent discharge, and an edematous/erythematous external ear canal often containing **granulation** tissue.

necrotizing otitis externa usually d/t pseudomonas or enterobacteriaecea in poorly controlled diabetes or immmunocompromised tx: iv abx vs treatment of non-necrotizing otitis externa (swimmers ear mild external ear pain watery discharge swelling and erythema of external acoustic meatus) consists of adequately cleaning the ear, acidifying the canal, and administering fluoroquinolone (ciprofloxacin or ofloxacin) ear drops.

hyperPTH + polyuria and volume depletion d/t

nephrogenic DI Polyuria and associated volume depletion are secondary to the direct effects of hypercalcemia on the kidney, which results in renal resistance and lack of response to anti-diuretic hormone (ADH), known as nephrogenic diabetes insipidus. The resistance to ADH results in insufficient aquaporin expression in the collecting tubules of renal nephrons, leading to increased urine volume, which manifests clinically as polyuria and volume depletion.

iga nephropathy vs postinfectious glomerulonephritis

iga within days: normal C3 postinfectious: more than 2-6weeks later: low serum C3, and anti-strepO and anti-DNase titers gropuA beta-hemolytic sreptococci

* Older (teenagers usually) * Posterior lymphadenopathy * Abdominal pain (from splenomegaly) * Rash if given amoxicillin

infectious mononucleosis EBV

Fever, lock jaw (trismus), ear pain, **uvular deviation**

peritonsilar abscess

Anterior LAD, **unable to move neck**

retropharyngeal abscess

Inspiratory stridor * Improves with prone position

laryngomalacia

Biphasic (inspiratory and expiratory) stridor * Improves with neck extension

vascular ring

Expiratory stridor * History of prolonged (> 2 weeks) intubation

tracheomalacia

* Cause: prematurity -> insufficient surfactant -> alveoli collapse * Physical exam: respiratory distress, grunting, nasal flaring * X-ray findings: ground glass appearance (collapsed alveoli) + **air bronchograms** (bronchi still intact) * Other: pre-term (<37 weeks) * Treatment: positive pressure ventilation, may need intubation (follow pediatric ACLS algorithm)

neonatal respiratory distress

Cause: rapid expulsion -> inability to exhale pulmonary fluid * Physical exam: brief tachypnea, resolves by day 2 * X-ray findings: **perihilar streaking** + **fluid in fissures** * Other: look for C- section or rapid vaginal delivery * Treatment: Supportive

transient tachypnea of newborn

* Cause: post-term fetus - > more likely infant has passed meconium -> risk to aspirate * Physical exam: Green colored amniotic fluid * X-ray findings: **Patchy consolidation** (pockets of inhaled meconium) * Other: look for post- term (40+ weeks gestation) * Treatment: Intubation + suction beneath trachea

aspiration of meconium

Slanted epicanthal folds, single palmar crease, sandal toe (gap between 1st and 2nd toe), Brushfield spots on iris

trisomy 21 ALL alzheimers

Happy demeanor, seizures, gap between teeth, intellectual disability

Angelman (15q11-13 maternal deletion)

History of hypotonia as infant, obesity, short stature, behavioral problems

Prader-Willi (15q11-13 paternal deletion)

Friendliness with strangers, “elfin” face, supravalvular aortic stenosis

Williams syndrome (7q deletion)

* High pitched cry, microcephaly

Cri-du-chat (5p deletion)

Midline defects (cleft lip, aplasia cutis of scalp), polydactyly, holoprosencephaly

Patau (Trisomy 13)

“Prominent occiput,” clenched & overlapping fingers, micrognathia or retrognathia

Edward’s (Trisomy 18)

* Narrow epicanthal folds, smooth philtrum, thin upper vermilion border

Fetal alcohol syndrome

Omphalocele, large tongue, right arm and leg enlargement, Wilms tumor

Beckwith-Wiedemann syndrome

Choanal atresia, heart defects, ear anomalies

CHARGE syndrome

Tracheoesophageal fistula, anal abnormalities, scoliosis

VACTERL tracheal collapse (obstruction)

Hypotonia, jaundice, umbilical hernia, large tongue

Congenital hypothyroidism

Self-aggression, crystals found in diaper, poor tone

Lesch-Nyhan syndrome

* Long head, large ears, intellectual disability

Fragile X syndrome

Nephrotic syndrome, genitourinary abnormalities, Wilms tumor

Denys-Drash syndrome

* Hearing loss, microcephaly, periventricular calcifications

CMV

Harsh, holosystolic murmur at lower left sternal border

VSD

Harsh, holosystolic murmur at lower left sternal border

VSD

Continuous murmur in interscapular region * Continuous “machine-like” murmur in infraclavicular region

coarctation of aorta PDA

Recurrent Staph, Serratia, Pseudomonas infections, family history of males with recurrent infections

chronic granulomatous disease

History of delayed umbilical cord separation (> 21 days), recurrent skin infections with no pus, extremely high blood neutrophil count

Leukocyte adhesion deficiency