Random Flashcards
Reduced (10-30% of normal) UGT activity; indirect hyperbilirubinemia, usually asx/transient jaundice
Gilbert’s syndrome
Autosomal recessive; none (Type I) or little (Type II) UGT activity; indirect hyperbilirubinemia
Crigler Najjar Syndrome
MRP2 gene mutation; mild conjugated hyperbilirubinemia; grossly black liver; asx except with illness/pregnancy
Dubin Johnson Syndrome
Similar to Dubin Johnson syndromes but milder + no black liver
Rotor’s Syndrome
Gastrin secreting tumor —> HCL hypersecretion
Zollinger-Ellison syndrome
Screening for HCC
Alpha-FP, US
Rupture of distal esophagus after repeated, forceful vomiting
Boerhaave’s Syndrome
Mucosa lower esophageal constrictions at squamocolumnar junction; associated with hiatal hernia
Schatzki Ring
Pharyngoesophageal pouch/false diverticulum
Zenker’s Diverticulum
AST>ALT
Alcoholic hepatitis
ALT>AST
Viral hepatitis
Post MI pericarditis
Dressler’s syndrome
Meds that decrease mortality in HF
ACEi, ARB, BB, nitrates, hydralazine, spironolactone
Electrolyte abnormalities in ACEi, loop diuretics, K-sparing diuretics, and thiazides
ACEi - hyperkalemia
Loop - hypOkalemia, hypOcalcemia, hypOnatremia, hyperglycemia, hyperuricemia
K-sparing - hyperkalemia
Thiazide - hypOnatremia, hypOkalemia, hyperglycemia, hyperuricemia
Distant muffled sounds, increased JVP, hypotension
Beck’s triad, pericardial tamponade
Heart swinging in fluid; ECG sign (pericardial effusion)
Electric alternans
Signs of constrictive pericarditis
Pericardial knock
Kussmaul’s sign
Pulses paradoxus
Signs of cardiac tamponade
Kussmaul’s sign
Pulses paradoxus
Beck’s triad
Nonatherosclerotic inflammatory dx of small + medium arteries/veins; strongly associated with tobacco
Buerger Disease
ECG: RBB pattern, ST elevation V1-V3, T wave inversion V1+V2; may cause syncope, v-fib, sudden cardiac death
Brugada syndrome
Usually seen with lung SCC
Pancoast Syndrome
Hypercalcemia
Cavitary lesions
Dilated neck veins, facial plethora, prominent chest veins, common in small cell lung cancer
SVC syndrome
Shoulder pain, Horner’s syndrome, atrophy of hand/muscles; often seen in NSCLC (esp squamous cell)
Pancoast Syndrome
Diarrhea due to increased serotonin; flushing, tachycardia, bronchoconstriction, hemodynamic instability
Carcinoid syndrome/tumor
Palpable edema and swelling of costal cartilages with costochondritis
Tietze syndrome
Criteria for exudates (Light’s criteria)
Pleural fluid protein >0.5
LDH for pleural fluid:serum >0.6 OR Pleural fluid LDH > 2/3 upper limit of normal LDH
Pneumonia, increased LFTs, GI sxs, hyponatremia
Legionella
PNA with cavitary lesions
S. Pneumonia
S. Aureus
Klebsiella
Gram + cocci in pairs
S. Pneumo
Gram + cocci in clusters
S. Aureus
Gram - rods
H. Flu
Klebsiella
Pseudomonas
Mississippi + Ohio Valley; bird/bat poop; PNA
Histoplasmosis capsulatum
PNA; southwest US soil
Coccidioides
PNA w abscess
S. Aureus
Klebsiella
Anaerobes
PNA w bullous myringitis
S. Pneumo
Mycoplasma
PNA w/ rusty blood-tinged sputum
S. Pneumo
PNA with currant jelly sputum
Klebsiella
PNA with green sputum
H. Flu
Pseudomonas
PNA w/ foul smelling sputum
Anaerobes
Causes of anion gap metabolic acidosis
Methanol Uremia DKA Propylene Glycol Izoniazid, infection Lactic Acidosis Ethylene Glycol Rhabdo/ Renal failure Salicylates
Causes of non-gap metabolic acidosis
Hyperalimentation Acetazolamide Renal Tubular Acidosis Diarrhea Ureto-pelvic shunt Post-hypocapnia Spironolactone
Causes of metabolic alkalosis
Vomiting
Diuretics
Post-hypercapnia
Causes of respiratory alkalosis
CNS disease Hypoxia Anxiety Mech ventilators Progesterone Salicylates/Sepsis
Determining an acid base disorder
Look at pH
Look at PCO2: if going in opposite direction from pH —> respiratory
Look at HCO3: if going in SAME direction as pH —> metabolic
Age for Lung CA screen for smokers
55-80
Treatment for primary biliary cirrhosis
Ursodeoxycholic acid
Cholestyramine
Copper acculturation in brain, kidney, cornea;
Wilson’s Disease
Periumbical ecchymosis; sign of pancreatic hemorrhage
Cullen’s sign
Flank ecchymosis; sign of hemorrhagic pancreatitis
Turner’s sign
Palpable, non-tender, distended gallbladder it’s associated jaundice (CBD obstruction); associated with pancreatic cancer
Courvoisier’s sign
Pancreatic tumor markers
CEA, CA-19-9
Painless rectal bleeding; may cause intussesception, volvulus, or obstruction
Meckel’s diverticulum
Current jelly stools, vomiting, colicky abdominal pain, sausage-shaped mass
Intussesception
Asthma, nasal polyps, allergy to aspirin
Samter’s triad
Hyperkeratosis, hemorrhage, hematologic (anemia)
Vitamin C deficiency
Peripheral neuropathy, symmetric impairment of sensory, motor, and reflexes, anorexia, muscle cramps, wasting
“Dry” beriberi (thiamine deficiency)
High output failure, dilated cardiomyopathy, edema (deficiency)
“Wet” beriberi (B1 deficiency)
Ophthalmoplegia, ataxia, global confusion
Wernicke’s encephalopathy
Memory loss and confabulation; thiamine deficiency
Korsakoff’s dementia
Lesions of mouth, magenta-colored tongue, angular cheilitis, pharyngitis, photophobia/corneal lesions, scrotal dermatitis
Oral-ocular-genital syndrome (B2/riboflavin deficiency)
Diarrhea, dementia, dermatitis
Pellagra (B3/niacin deficiency)
Autoimmune destruction of parietal cells that secrete intrinsic factor
Pernicious anemia (B12 deficiency)
Autosomal recessive; urine with musty/mousy odor; vomiting; mental retardation
PKU
Traveler’s diarrhea; drinking unsanitary water; watery diarrhea, abdominal cramping, vomiting
Enterotoxogenic E. Coli
RLQ pain with LLQ palpation; appendicitis
Rovsing sign
RLQ pain with internal and external hip rotation with bent knee; appendicitis
Obturator sign
RLQ pain with right hip flexion/extension; appendicitis
Psoas Sign
Tenderness at the point 1/3 the distance from the anterior superior iliac spine and navel; appendicitis
McBurney’s point tenderness
Abdominal pain out of proportion to exam
Acute Mesenteric Ischemia
Chronic, dull abdominal pain that is worse after meals
Chronic Mesenteric Ischemia
Characteristics specific to ulcerative colitis (7)
Tenesmus Bloody diarrhea Primary sclerosing cholangitis Toxic megacolon Sandpaper appearance on endoscopy “Stovepipe sign” - loss of haustra on barium study \+PANCA
Characteristics specific to Crohn’s disease (8)
Transmural Weight loss No visible blood usually Perianal dx (fistulas, strictures, abscesses, granuloma) B12 + Fe deficiency Skip lesions w/ cobblestone appearance on endoscopy “String sign” on barium \+ASCA
20y; autosomal dominant; polyposis; mucocutaneous hyperpigmentation; increased risk of CRC/ovarian CA
Peutz-Jehgers Syndrome
CRC biomarkers
CEA
Age for colonoscopy screening
Start at age 50, q10
Start at age 40 if relative >60y with CRC, q10
Start at age 40 if relative <60y with CRC, q5
Contaminated fried rice; incubation period 1-6h; vomiting, cramps, diarrhea
bacillus cereus
fecal/oral contamination; cramps lower abdominal pain, high fever, tenesmus, explosive mucoid/blood/watery diarrhea, leukocytosis (>50k);
shigella
contaminated milk, tofu, or pork; mimics appendicitis; invasive infectious diarrhea
yersinia enterocolitica
invasive; fecal-oral transmission from poultry products and exotic pets; abdominal pain, fever, cramping, “pea soup stools”; self-limited
salmonella gastroenteritis
invasive; fecal-oral transmission from poultry products and exotic pets; abdominal pain, fever, cramping, “pea soup stools”, intractable fever, bradycardia, “rose spots”
typhoid fever (salmonella)
invasive infectious diarrhea; undercooked beef, unpasteurized milk, day care centers, contaminated water; bloody diarrhea, crampy abd pain, vomiting; cytotoxins
enterohemorrhagic E Coli
invasive infectious diarrhea; contaminated poultry, raw milk, water, dairy cattle; watery–>bloody diarrhea, fever, HA, abd pain; Guillan-barre syndrome
campylobacter jejuni enteritis
contaminated water from streams/wells; frothy, greasy, foul non-bloody diarrhea
giardia lamblia
GI colitis; liver abscess
amebiasis
farmers/contaminated soil; malabsorption, weight loss, steatorrhea, nutritional deficiency, arthritis, neurologic sxs
Whipple’s disease
lesion seen in anterior shoulder dislocation; groove on humeral head
Hill-Sachs lesion
lesion seen in anterior shoulder dislocation; glenoid inferior rim fracture
Bankart lesion
common nerve injury in anterior shoulder dislocations
axillary nerve
rotator cuff tears are more common above what age? Whats more common in younger patients?
40
tendonitis/subacromial bursitis/impingement
tests for impingement
supraspinatus strenght test (“empty can”)
Hawkins (elbow/shoulder flexed @ 90)
Drop arm test (unable to lift past shoulder)
Neer test (thumbs down, forward flex)
What sensation should you check with FOOSH injuries?
deltoid to r/o brachial plexus injury
Management for humeral shaft fracture
sugar tong splint
What nerve should you check with humeral shaft fracture?
radial nerve; wrist drop
common signs of thoracic outlet syndrome
brachial plexus: pain/paresthesia, esp ulnar side
subclavian vein/artery: swelling/discoloration/cyanosis
“Tram tracks” on CXR
Or “signet-ring” sing on CT
Bronchiectasis
Side effects of HIV drugs
Rifampin - orange body fluids
Isoniazid - hepatitis and peripheral neuropathy
Pyrazinamide - hepatotoxicity and polyarthralgias
Ethambutol - optic neuritis
Most common electrolyte disturbance of sarcoidosis
Hypercalcemia
Treatment for pulm HTN
Sildenafil
Carcinoid tumor rx
Octreotide
anterior fat pad on xr
radial head fracture (adults) suprachondylar fracture (peds)
complications of suprachondylar fractures
median/radial nerve + brachial artery injury
what nerve injury should you look out for in an olecranon fracture?
ulnar nerve
“goose egg” swelling near elbow with limited flexion
olecranon bursitis
proximal ulnar shaft fracture with anterior radial head dislocation
Monteggia fracture
mid-distal radial shaft fracture with dislocation of the distal radio-ulnar joint
Galeazzi fracture
“ivory white” calcified pleural plaques on CXR
asbestosis
lateral epicondylitis (inflammation of the extensor carpi radialis brevis muscle tendon)
tennis elbow
medial epicondylitis (inflammation of the pronator teres/flexor carpi radialis tendon)
golfer’s elbow
what nerve/vessel injuries must be ruled out with a elbow dislocation?
brachial artery
median/ulnar/radial nerve
lightly tapping (percussing) over the nerve to elicit a sensation of tingling or “pins and needles” in the distribution of the nerve; carpal/cubital/tarsal tunnel
Tinel’s sign
make a strong pinch between the thumb and index finger and grip a flat object such as a piece of paper between the thumb and index finger; attempts to pull the object out of the subject’s hands to test for CUBITAL tunnel
Froment’s sign
cast for scaphoid fracture
thumb spica
distal radial fracture with dorsal/posterior (“dinner fork”) angulation
Colles fracture
complication of Colles fracture
extensor pollicus longus tendon rupture
cast for Colles/smith fracture
sugar tong splint
distal radial fracture with ventral/anterior (“garden spade”) angulation
smith’s fracture
carpal bone injury with a “piece of pie” sign on AP XR or “spilled teacup” on lateral
lunate dislocation
avascular necrosis of lunate bone d/t lunate fracture
Kienbock’s disease
cast for lunate fracture
thumb spica
autonomic dysfunction following bone/soft tissue injury; pain out of proportion, swelling, extremity color changes, increases nail and hair growth
complex regional pain syndrome
what prophylaxis is recommend for complex regional pain syndrome?
vitamin C for fractures
avulsion of extensor tendon; unable to straighten distal finger
mallet (baseball) finger
disruption of extensor tendon at base of middle phalanx –> hyper flexion of middle joint
Boutonniere deformity
ulnar collateral ligamental injury of the thumb; unstable MCP joint; thumb far away from digits
Skier’s(acute)/Gamekeeper’s(chronic) thumb
cast for gamekeeper’s/skier’s thumb
thumb spica
cast for boxer’s fracture
ulnar gutter splint
intraairticular fracture through the base of the first metacarpal (MCP) bone
Bennet/Rolando Fracture
SALTER classification
S (I) - same A (II) - above L (III) - lower T (IV) - through R (V) - rammed/compression
tenosynovitis of abductor pollicus longus and extensor pollicus brevis; pain along radial aspect of wrist–> forearm
DeQuervain’s tensynovitis
flex both wrists for 30-60 sec to reproduce carpal tunnel symptoms
Phalen’s test
signs of carpal tunnel
Tinel’s sign
Phalen’s test
thenar muscle wasting
contracture of palmar fascia due to nodules/cords; fixed flexion at MCP joints
Dupuytren Contracture
treatment for Dupuytren contracture
steroid/collagenase injections, PT, surgery
main complications of hip dislocation
avascular necrosis
sciatic nerve injury
difference in presentation between hip dislocation and hip fracture
dislocation: leg shortened and internally rotated
fracture: leg shortened and externally rotated
idiopathic avascular necrosis of femoral head in children 4-10 yrs old; painless limp, pain in hip/knee/groin, internal rotation of leg
Legg-Calve-Perthes Disease
hip disorder common in 7-16y old obese, male children; hip/thigh/knee pain with external rotation of leg
Slipped Capital Femoral Epiphysis
inward bowing of knees
vaLgus
outward bowing of knees
vaRus
sign of PCL injury
pivot shift test, posterior drawer test
sign of ACL injury
lachman’s test, anterior drawer test
knee popping, locking, giving away, +McMurray’s sign
meniscal tear
best xray view for patellar fracture
sunrise view
palpable defect above knee d/t quadriceps tendon rupture
patella baja
palpable defect below the knee d/t patellar tendon rupture
patella alta
important complication to look out for in tib-fib dislocation (which often reduces itself
popliteal artery rupture
sign of peroneal nerve injury
foot drop
pseudothrombophlebitis syndrome that mimics DVT
Baker’s cyst rupture
common in runners; knee pain behind or around patella; worse with climbing or sitting; apprehension sign with patella pressure
patellofemoral syndrome
most common knee pain in runners; lateral knee pain
IT band syndrome
pain or resistant to adduction of leg parallel to table; IT band syndrome
Ober test
most common ligament damaged in ankle sprain
anterior talofibular collateral ligament
what are the Ottawa ankle rules?
ankle films: pain along lateral or medial malleolus
foot films: mid foot or 5th metatarsal/navicular pain
both: unable to walk >4 steps
spiral proximal fibular fracture d/t rupture of distal talofibular syndesmosis
Maisonneuve fracture
fracture of distal tibia from impact with talus
Pilon (tibial plafond) fracture
post tibial nerve compression from overuse or restrictive footwear; pain numbness @ medial malleolus, heel, and sole
tarsal tunnel syndrome
diabetic foot
Charcot’s joint
painful mass near tarsal heads; reproducible pain on palpation + mass
Morton’s neuroma
transverse fracture through diaphysis of 5th metatarsal
Jones fracture
triggers for G6PD
infections, stress, fava beans, aspirin, and other drugs.
A condition causing red blood cells to break down in response to certain triggers leading to fever, dark urine, abdominal and back pain, fatigue, and pale skin
G6PD
disruption of the articulation between the medial cuneiform and the base of the 2nd metatarsal +/- metatarsal fractures
Lisfranc injury
most common site for herniated disc
L5-S1
tests for herniated disk
straight leg raise
signs of a herniated disk at L4
anterior thigh pain
weakness with ankle dorsiflexion/knee extension
loss of knee jerk
signs of a herniated disk at L5
lateral thigh/leg, hip, and groin pain/parasthesia
weakness with big toe extension
signs of a herniated disk at S1
posterior leg/calf and plantar foot pain/parasthesia
weakness with plantarflexion
loss of ankle jerk
new onset bowel retention/incontinence, saddle anesthesia, bilateral leg pain, decreased anal sphincter tone
cauda equina syndrome
what alleviates/worsens spinal stenosis?
worsens: extension, prolonged standing
alleviates: flexion, sitting/walking uphill
scoliosis, cafe au lait spots, skin tags, axillary freckles
neurofibromatosis
measurement of the severity of scoliosis
Cobb’s angle (>10=scoliosis)
defect in pars interarticularis of spine from repetitive hyperextension
spondylolysis
forward slipping of vertebrae on another
spondylolithesis
most common organism seen in acute osteomyelitis in newborns (<4mos)
GBS
most common organism seen in acute osteomyelitis in children (>4mos) as well as general acute/chronic osteomyelitis
S. Aureus
most common organism seen in acute osteomyelitis in those with sickle cell disease
salmonella
most common organism seen in acute osteomyelitis in those with puncture wound or IVDU
pseudomonas
most common organism(s) in septic arthritis
S. Aureus
N. Gonorrhea (sexually active young adults)
Strep
what amount of WBCs from an arthrocentesis would be considered a septic joint?
> 50K
what pressure is diagnostic of compartment syndrome?
> 30-45mmHg
bimodal distribution; bone pain/swelling; “sun ray burst” on XR; mixed sclerotic/lytic lesions
osteosarcoma
which is the malignant tumor: osteosarcoma or osteochondroma?
osteosarcoma
most common in children/males; bone pain/joint swelling; “onion peel” appearance on XR
Ewing’s sarcoma
pedunculate benign bone tumor that often grows away from bone
osteochondroma
autosomal dominent; abnormal bone remodeling; high ALP (normal Ca + phos), bone pain, stress fracture or warmth, DEAFNESS, headache; COTTON WOOL appearance of skull on xray
Paget’s disease
treatment for Paget’s
bisphosphanates and calcitonin
diagnostic tests fo SLE
ANA (non-specific)
Anti-dsDNA + anti-smith (specific but not sensitive)
associated with SLE; may cause frequent miscarriages, livedo reticularis (discoloration of skin); increased risk of arterial and venous thrombosis
antiphospholipid ab syndrome (APLS)
calcinosis cutis, Raynaud’s, esophageal motility d/o, sclerodactyly, telangectasia
CREST syndrome (limited cutaneous systemic sclerosis)
treatment for Raynaud’s
CCB (amlodipine)
diagnostic tests for scleroderma
anti-centromere ab (CREST/limited cutaneous)
anti-scl-70 ab (diffuse cutaneous/multi-organ involvement)
ANA (non-specific)
treatment for scleroderma
DMARD (methotrexate)
CCB (for Raynaud’s)
diagnostic tests for Sjogren’s
ANA antiSS-A (Ro) antiSS-B (La) RF Schirmer test (decreased tear production)
treatment for Sjogren’s
artificial tears, pilocarpine (cholinergic)
treatment for fibromyalgia
TCA
SSRI
Cymbalta
Exercise
progressive symmetrical proximal muscle weakness, dysphagia, skin rash, polyarthralgias, muscle wasting
polymyositis
diagnostic tests for polymyositis and dermatomyositis
aldolase, CK (muscle enzymes)
anti-Jo 1 Ab (specific)
anti-SRP Ab (polymyositis)
Anti-Mi-2 Ab (dermatomyositis)
HELIOTROPE (blue/purple) eyelid discoloration, GOTTRON’s papule (knuckles), malar rash (INCLUDING nasolabial folds), “SHAWL or V sign”
dermatomyositis
fever, joint pain, malaria rash SPARING nasolabial folds
SLE
triggers for gout attack
purine-rich foods (alcohol, oily fish, yeasts), diuretics, ACEi/ARBs, HIV meds, aspirin
arthrocentesis finding indicative of gout
negatively birefringent NEEDLE-shaped urate crystals
acute management of gout
NSAIDS (indomethacin), colchicine, steroids (if severe)
chronic management of gout
allopurinol (inhibits xanthine oxidase), colchicine
calcium phosphate deposition in joints; most commonly in knee
pseudogout
arthrocentesis finding indicative of pseudogout
positively birefringent RHOMBOID-shaped crystals
treatment for pseudogout
steroids, NSAIDS, colchicine (prophylaxis)
symmetric MCP/PIP/wrist/knee/MTP/shoulder/ankle joint pain, worse with REST, morning joint stiffness, boutonniere/swan neck deformities
RA
diagnostic tests for RA
RF (initial)
anti-cetrullinated peptide ab (specific)
ESR,CRP
triad of RA + splenomegaly + low WBC
Felty’s syndrome
pneumoconiosis + RA
Caplan syndrome
treatment for RA
DMARDs, NSAIDs, steroids
DIP/thumb/knee/hip/spine pain, worse with ACTIVITY, evening joint stiffness
osteoarthritis
XR RA vs osteoarthritis
osteo: osteophytes, ASYMMETRIC joint space loss
RA: osteopenia, SYMMETRIC joint space loss
daily arthritis, high fevers, SALMON-colored migratory rash, hepatosplenomegaly, lymphadenopathy, pericardial/pleural effusions, hepatitis
systemic juvenile idiopathic arthritis
important part of managing juvenile idiopathic arthritis
frequent eye exams to check for iridocyclitis
labs notable for rhabdomyolysis
increased CPK >20k
increased LDH, ALT
hyperkalemia
hypocalcemia
main complication of rhabdo
acute tubular necrosis
list the large, medium, and small vessel vasculitis syndromes
large: GCA, takayasu
medium: kawasaki, polyarteritis nodosa
small: eosinophilic GPA, wegeners GPA, microscopic polyangitis, HSP
large vessel vasculitis that affects aorta, aortic arch, and palm arteries; usually follows illness; can cause MI, TIA, CVA, HTN crisis, lower extremity claudication, aneurysms; diminished pulses, bruits, asymmetric BPs, cool extremities
Takayasu arteritis “pulseless disease”
treatment for Takayasu arteritis and GCA
high dose corticosteroids
most common in children; conjunctivitis, polymorphous rash, arthritis, cervical lymphadenopathy, strawberry tongue
Kawasaki disease
complications of Kawasaki
coronary artery aneurysms, MI
treatment for Kawasaki
IV IgG + high dose aspirin
systemic vasculitis of medium/small arteries; microaneurysms ; associated with HBC/HCV; HTN, renal failure, fevers, myalgias, neuropathy, livedo reticularis
polyarteritis nodosa
small vessel vasculitis with asthma, hypereosinophilia, chronic rhinosinusitis
eosinophilic granulomatosis with polyangiitis (EGPA or Churg Strauss)
which syndromes are P-ANCA positive?
EGPA, microscopic polyangitis, UC/PSC
which syndromes are C-ANCA positive?
Wegener’s
small vessel vasculitis; necrosis of nose, lungs, kidney; URI and LRI sxs, SADDLE-NOSE deformity, glomerulonephritis (hematuria, proteinuria)
Wegener’s (GPA; granulomatosis with polyangiitis)
treatment for Wegener’s and microscopic polaynagiitis
steroids + cyclophosphamide
small vessel vasculitis that affects arterioles, venules, and capillaries; purpura, cough, dyspnea, hemoptysis, acute glomeronephritis
microscopic polyangiitis
IgA vasculitis; IgA deposition into skin + kidney most common in children; palpable purpura, abdominal pain, arthritis, hematuria; SELF-LIMITING
Henoch-Schonlen purpura
IgG Ab against type IV collagen in glomerular basement membrane + alveoli; often post URI; HEMOPTYSIS + glomerulonephropathy
Goodpasture’s syndrome
treatment for Goodpasture’s syndrome
steroids + cyclophosphamide
asymmetric inflammatory arthritis, conjunctivitis/uveitis, urethritis; seen with chlamydia
Reiter’s syndrome (reactive arthritis)
back stiffness (esp morning), better with activity, peripheral arthritis, sacroiliitis; “BAMBOO spine” on XR
ankylosing spondylitis
marker for ankylosing spondylitis, reactive arthritis, and psoriatic arthritis
HLA-B27
asymmetric “sausage digits”; sacroiliitis, pitting of nails, chronic uveitis; “pencil in cup” deformity on XR
psoriatic arthritis
bitemporal hemianopsia
optic chiasm lesion
total blindness of ipsilateral eye
optic nerve or retina lesion
homonymous hemianopsia
contralateral optic tract lesion
nasal hemianopsia
ipsilateral LATERAL optic chiasm lesion
2 common conditions associated with blepharitis
Down’s syndrome
eczema
non-tender eyelid swelling; larger, firmer and less painful than stye/hordeolum
chalazoin
redness to nasal side of lower lid; lacrimal gland infection
dacrocystitis
signs of an orbital floor (maxillary, zygomatic, palatine) fracture
decreased visual acuity
diplopia (esp w/ upward gaze)
orbital emphysema
treatment for orbital floor fractures
nasal decongestants
prednisone
clinda/unasyn
ophtho referral
gradual bilateral/blurred loss of central vision + color vision; DRUSEN (diffuse, small, round, yellow-white spots on outer retina)
macular degeneration
central vision loss/blindness, COTTON WOOL spots, neovascularization
diabetic neuropathy
floaters, flashing lights, progressive unilateral vision loss, shadow “CURTAIN” vision loss in peripheral–>central pattern
retinal detachement
decreased vision, pain with ocular movements, proptosis; most common in children; associated with URI
orbital cellulitis
most common organisms in orbital cellulitis
S. pneumo, GABHS, H. Flu, S. Aureus
acute UNILATERAL peripheral vision loss; unilateral ocular pain; halos around lights; “steamy cornea”; “cupping” of optic nerve; increased IOP (>21)
acute narrow-angle glaucoma
treatment for acute narrow-angle glaucoma
acetazolamide (decreases aqueous humor production)
BB (timolol)
cholinergic (pilocarpine)
iridotomy
gradual BILATERAL peripheral vision loss; tunnel vision
chronic open angle glaucoma
treatment for chronic open angle glaucoma
prostaglandin analog (latanoprost) BB (timolol)
treatment for allergic conjunctivitis
olopatadine (topical antihistamine)
common organisms in NEONATAL infectious conjunctivitis
day 2-5: gonorrhea
day 5-7: chlamydia
day 7-11: HSV
pain, photophobia, reduced vision, hazy cornea; rapidly progressing; sight-threatening
keratitis
what is optic neuritis most commonly associated with?
multiple sclerosis; autoimmune
ethambutol (HIV med)
unilateral color vision loss; visual field defects; ocular PAIN worse with eye movement; papillitis
optic neurtitis
treatment for optic neuritis
IV methyprednisone
unilateral ocular pain/redness/photophobia; blurred/decreased vision; associated with systemic inflammatory diseases
uveitis
acute, sudden, monocular vision loss; pale retina with cherry-red macula
central retinal artery occlusion
treatment for central retinal artery occlusion
no good treatment options acetazolamide (decrease IOP) ocular massage thrombolysis anterior chamber paracentesis (drop pressure to dislodge clot)
acute, sudden, monocular vision loss; extensive retinal hemorrhages (“blood & thunder” appearance)
central retinal vein occlusion
most common pathogen in otitis EXTERNA
pseudomonas
most common pathogens in otitis INTERNA (as well as acute sinusitis)
S. pneumo
H. flu
Moraxella
S. pyogenes (GAS)
which two conditions are associated with malignant otitis externa?
DM
immunocompromised
unilateral hearing loss, tinnitus, HA, facial numbness, disequilibrium
acoustic/vestibular neuroma (CN VIII)
episodic vertigo, NO hearing loss; worse with head position changes; horizontal nystagmus
Benign Paroxysmal Positional Vertigo
continuous vertigo, N/V, ear pain, +/- fever; vestibular (CN VIII) neuritis + hearing loss/tinnitus
Labyrinthitis
treatment for labyrinthitis
steroids
meclizine (antihistamine, antiemetics)
hearing loss, tinnitus, ear fullness, episodic vertigo (lasting min/hrs), horizontal nystagmus
Meniere’s Disease
treatment for Meniere’s disease
meclizine (antihistamine, antiemetic)
HCTZ
avoid salt, caffeine, chocolate, EToH
graduation tissue that over time erodes ossicles, painless otorrhea, vertigo, brown/yellow discharge with strong odor from ear
cholesteatoma
salivary stones
sialolithiasis
salivary gland infection
sialadenitis
treatment for sialadentitis/sialithisasis
sialogogues
ducts involved in sialolithiasis
Wharton’s duct
Stenson’s duct
LACY white lesions of oral mucosa; associated with HCV
oral lichen planus
white patchy oral lesions that canNOT be rubber off; painless; precancerous
oral leukoplakia
non-painful, “feathery” white plaque in oral/buccal mucosa that canNOT be scraped off; associated with EBV and immunocompromised
oral hairy leukoplakia
white, curd-like plaques that bleed when scraped off; associated with immunocompromised
oral candidiasis (thrush)
diagnostic method for Candida albicans infection
KOH smear
treatment for thrush
nystatin
most common pathogens in peritonsillar abscesses
GAS
S. Aureus
polymicrobial
cellulitis of the sublingual and submaxillary spaces in the neck; most commonly from dental infections; swelling/erythema of upper neck/chin + pus on floor of mouth
Ludwig’s Angina
can be used for abortion up to 9 weeks of GA
mifeprostone + misoprostol
can be used for abortion up to 7 weeks of GA
methotrexate + misoprostol
can be used for abortion at 4-12 weeks of GA
D&C
can be used for abortion at 13-24 weeks of GA
D&E (dilation and evacuation)
amenorrhea d/t increased prostaglandins
primary dysmenorrhea
amenorrhea d/t pelvic pathology
secondary dysmenorrhea
management for premenstural dysphoric disorder
fluoxetine/sertraline/SSRI
OCP
absence of spontaneous mentruation before age 15
primary amenorrhea
absence of menses for 3 (previously regular) or 6 (previously irregular) menses
secondary amenorrhea
What is the cause of premature ovarian failure and what disorder is it related to?
follicular failure to produce E/P or resistant to LH/FSH
Turner’s syndrome
What is the progesterone challenge?
tests estradiol levels
10mg medroxyprogesterone x10days
+bleeding = enough estrogen
scarring of uterine cavity secondary to postpartum or D&C or infection
Asherman’s syndrome
treatment for Asherman’s syndrome
estrogen
endometrial tissue within myometrium; SYMMETRIC, SOFT, TENDER, “boggy” uterus; menorrhagia, dysmenorrhea
adenomyosis
45X0, short webbed neck, no breast development, premature ovarian failure (high FSH/low estrogen)
Turner Syndrome
46XX, no breast development, amenorrhea, low FSH/low LH
HPA insufficiency
46XY, normal breast development, high T, amenorrhea
androgen insensitivity
most common pathogens in endometritis/chorioamnioitis
GAS
S. Aureus
“chocolate cyst” on laparoscopy
endometriosis
GnRH analog
Leuprolide
What TVUS finding is indicative of endometrial cancer/hyperplasia?
endometrial stripe >4mm
risk factors for endometrial cancer
nulliparity, chronic anovulation/PCOS, obesity, estrogen replacement therapy, tamoxifen
thin, yellow vaginal discharge, pH >5.5, pruritis
atrophic vaginitis
estrogen modulator; used for infertility
clomiphene
urine leakage due to increased intrabdominal pressure
stress incontinence
treatment for stress incontinence
kegal exercises, biofeedback
midodrine (increases urethral sphincter tone)
urine leakage accompanied by preceding urge; urgency/frequency, nocturia; OVERACTIVE detrusor muscle
urge incontinence
treatment for urge incontinence
bladder training
tolterodine (bladder relaxant)
oxybutynin (antispasmodic/anticholinergic)
urinary retention/incomplete emptying; UNDERACTIVE detrusor muscle or bladder outlet obstruction
overflow incontinence
treatment for overflow incontinence
catherterization
bethanacol (cholinergic, increases detrusor activity)
alpha blocker used for BPH; decreases urethral resistant
tamsulosin
risk factors for ovarian cancer
family hx infertiliy nulliparity >50y BRCA1/BRCA2 PROTECTIVE: OCPs, high party
ovarian cancer mets to umbilical lymph nodes
Sister Mary Joseph’s node
serum marker for ovarian cancer
CA-125
Diagnostic labs for PCOS
increased testosterone
increased DHEA-S
increased LH:FSH 3:1
treatment for PCOS
OCP spironolactone leuprolide clomiphene (for fertility) metformin
which cancer/condition is linked to DES exposure?
clear cell cervical cancer and vulvular cancer
cervical insufficiency
thin, grey vaginal discharge, fishy odor, pH >5
bacterial vaginosis
diagnostic lab for bacterial vaginosis
clue cells on KOH prep
frothy, yellow/green vaginal discharge, strawberry cervix, pH >5
trichomoniasis
thick, curd-like/cottage cheese vaginal discharge
candida vulvovaginitis
diagnostic lab for candida vulvovaginitis
hyphae, yeast on KOH prep
PAINFUL genital ulcer caused by H. Ducreyi
chancroid
“CAULIFLOWER LIKE” lesions (condyloma acuminata), genital warts
HPV
PID + hepatic fibrosis/scarring (perihepatitis; RUQ pain)
Fitz-Hugh Curtis Syndrome
what is the most common pathogen in toxic shock syndrome
S. Aureus (enterotoxins)
most common pathogens in cystitis/pyelo
E. coli
Staph Saprophyticus
What levels of WBC in UCx is needed to diagnose a UTI?
> 100k
hypoestrogenic/hyperandrogenic medication for endometriosis
danazol
estrogen antagonist in breast, agonist in bone/endometrium
tamoxifen
what is a beta-HCG >100k indicative of?
molar pregnancy
At what week are pregnancy women screened for gestational diabetes? With which test?
24-28
50g oral glucose challenge; >130 –> 3hr test
100g GTT (3hrs); 2/3 hours must be high
when is Rhogam given?
at 28 weeks + within 72 hours of delivery
meds to delay preterm delivery
terbutaline (b2 agonist)
magnesium sulfate
med for morning sickness/hyperemesis gravidarum
pyroxidine (B6)+doxylamine
BP meds safe in pregnancy
hydralazine*
methyldopa (weak BP med)
labetalol
nifedipine
hemolytic anemia, elevated liver enzymes, low platelets ; often associated with severe preeclampsia
HELLP syndrome
what are the delivery windows for gestational diabetes? preeclampsia? chronic HTN?
GD: 38 weeks
Preeclampsia: 34-36 weeks
Chronic HTN: 39-40 weeks
When is a pregnancy woman screened for GBS?
32-37 weeks
What does APGAR stand for?
Appearance/color Pulse Grimace Activity Respiration *scores 0-2
medications to give during postpartum hemorrhage
oxytocin
misoprotsol
what common conditions/tumors are seen in MEN I/II?
I: hyperparathyroidism, pituitary tumors, pancreatic tumors
II: hyperparathyroidism, pheochromocytoma, medullary thyroid cancer
What is the main cause of secondary hyperparathyroidism?
chronic kidney failure (can’t convert vitamin D –> stimulates PTH)
clinical signs of hyperparathyroidism (hypercalcemia)
strones, bones, abdominal groans, psychic moans
DECREASED deep tendon reflexes
shortened QT interval
clinical signs of hypocalcemia
Trousseau + Chvostek sign
increased deep tendon reflexes
prolonged QT interval
treatment for hypercalcemia
furosemide
calcitonin
treatment for osteoporosis
vitamin D
high impact exercise
bisphosphonates
Raloxifene (selective estrogen receptor modulator)
sever osteoporosis, blue sclerae, presenile deafness
osteogenesis imperfecta
bone pain, muscle weakness, bowing of legs, “looser lines” on XR
osteomalacia + ricketts
bone pain, muscle weakness, bowing of legs, but high phos and “salt and pepper” skull on XR
renal osteodystrophy
treatment for Addison’s disease (1ry) and 2ry adrenal insufficiency
1ry: glucocorticoids (hydrocortisone) + mineralocorticoids (fludrocortisone
2ry: glucocorticoids
common lab abnormalities in adrenal crisis
hyponatremia, hyperkalemia, hypoglycemia
adrenal aldosteronoma
Conn syndrome
most common cause of secondary hyperalosteronism (d/t increased renin)
renal artery stenosis
signs of hyperaldoseronism-induced hypertension
hypokalemia
diastolic more elevated than systolic
proteinuria, hypoalbuminemia, hyperlipidemia, edema, +/- periorbital edema (children), anemia, DVT, FROTHY URINE
nephrotic syndrome
*hyplipidemia/anemia/DVT is a result of low protein –> liver compensates by creating lipoproteins
associated with viral infections; mostly children; nephrotic syndrome with NO cellular changes but + podocyte damage on electron microscope
minimal change disease
treatment for minimal change disease
prednisone
nephrotic syndrome associated with sclerosis/fibrosis of the glomerulus; associated with HTN (esp AA)
focal segmental glomerulosclerosis
nephrotic syndrome associated with thickened glomerular basement membrane due to immune complex deposition (SLE, viral hepatitis, etc); most common in white male >40
membranous nephropathy
diagnostic test for nephrotic syndrome
24h urine collection with >3.5g/d of protein
OVAL FAT BODY on miscropscopic examination of urine
HTN*, hematuria (RBC CASTS, “coco-cola colored” urine), proteinuria, AZOTEMIA (elevated BUN)
acute glomerulonephritis
usually 1-days post-URI or GI infection; IgA deposits in kidney –> glomerulonephritis
IgA nephropathy (Berger Disease)
cola-colored dark urine, puffy eyes, facial edema; post-pharyngeal/impetigo infection
post-infectious glomerulonephritis
diagnostic labs for post-infectious glomerulonephritis
anti-streptolysin titers
low complement
treatment for IgA nephropathy/Berger disease/rapidly progressive GN/SLE GN
ACEi
corticosteroids
diagnostic test for acute glomerulonephritis
UA (RBC casts, proteinuria)
BUN/Cr (elevated)
renal biopsy
clinical differences between nephrOtic and nephritic/glomerulonephritis
nephrotic: glomerular damage; hyperlipidemia, pleural effusion/DVTs, frothy urine, FATTY CASTS/oval fat bodies
nephritic: immune-mediated; azotemia, hematuria, HTN, oliguria, AZOTEMIA, RBC CASTS
usually from prerenal AKI or aminoglycosides; epithelial and MUDDY BROWN casts on UA; hyperkalemia, hyperphosphatemia
acute tubular necrosis
treatment for ATN
IV fluids, remove offending agents
Intrinsic AKI; inflammatory/allergic; most commonly caused by PCN, NSAIDS, sulfa drugs; fever, eosinophilia, urine esosinophiles, rash, WBC casts
acute tubulointerstitial nephritis
what do WAXY casts on UA indicate?
chronic ATN or ESRD
what do WBC casts on UA indicate?
AIN (acute interstitial nephritis)
Pyelonephritis
what do MUDDY BROWN casts on UA indicate?
ATN
what do RBC casts on UA indicate?
vasculitis or acute glomerulonephritis
What other complications are associated with polycystic kidney disease?
cerebral “berry” aneurysms
mitral valve prolapse
most common cause of HYPOphosphatemia
primary hyperparathyroidism
most common cause of HYPERphosphatemia
renal failure (then primary hypOparathyroidism)
diagnostic test for CKD
GFR and spot UAblumin/UCreatinine Ratio (ACR)
diagnostic test for diabetes insipidus
fluid deprivation test
desmopressin stimulation test
equation for serum osm; what is a normal serum osm?
2Na [+ (Glu/18) + (BUN/2.8)]
normal: 285-295
diagnostic labs for testicular cancer
alpha-fetoprotein
beta-hcg
most common organisms for UTI/pyelo
E. Coli
staph saprophyticus
enterococci (if indwelling catheter)
most common organisms for prostatitis
E. Coli
Pseudomonas
G/C in men <35y
treatment for BPH
finasteride (5-alpha reductase inhibitor)
tamsulosin (alpha blocker; increases urinary outflow)
clinical signs of renal cell carcinoma
hematuria flank/abdominal pain palpable mass L-sided varicocele HTN Hypercalcemia
most common renal tumor in children; painless, palpable abdominal mass, hematuria, HTN, anemia
Wilm’s tumor (nephroblastoma)
treatment for nephrolithiasis
<5mm: IV fluids, analgesics, tamsulosin
>7mm: shock wave lithotripsy, uretoscopy/stent
>10mm/struvite: percutaneous nephrolithotomy
Uric stones: alkalize urine >6.5
treatment for priapism
terbutaline (vasoconstriction)
phenylephrine (vasoconstriction)
needle aspiration
dopamine agonists used in Parkinson’s (younger patients to delay levodopa use)
bromocriptine
pramiprexole
treatment for Tourett’s
dopamine-blocking agents (haloperidol, risperdone)
post-infection immune response (usually campylobacter, CMV, EBV, GI/URI) leading to demyelination; lower –> upper parasthesias/weakness
GBS
diagnostic test for GBS
CSF with high protein and normal WBC
treatment for GBS
plasmaphoresis
IVIG
autoimmune antibody against ACh receptors; progressive weakness with muscle use, ptosis, weakness with chewing; can progress to respiratory failure
myasthenia gravis
diagnostic tests for myasthenia gravis
ice pack test
+ACh-receptor antibodies
treatment for myasthenia gravis
pyridostigmine/neostigmine (ACh-esterase inhibitor)
plasmapheresis/IVIG for MG crisis
what are some clinical signs of MS?
weakness, paresthesias, fatigue, TRIGEMINAL NEURALIA, OPTIC NEURITIS
Uhthoff’s phenomenon (worsening of sxs with heat/exercise)
Lhermitte’s sign (neck flexion –> lightening-shock pain down spine)
diagnostics tests for MS
MRI w/ contrast: white matter plaques
CSF: increased IgG
nystagmus, staccato speech, intentional tremor
Charcot’s triad (associated with MS)
treatment for MS
acute: steroids, plasma exchange
relapse/progressive: beta-interferon
treatment for cluster HAs
acute: 100% O2
prophylaxis: verapamil
treatment for migraine HAs
triptans, metoclopramide (for nausea), propanolol
diagnostic test for pseudotumor cerebri
CT scan FIRST to r/o mass
LP
treatment for pseudotumor cerebri
acetazolamide (diuretic)
treatment for trigeminal neuralgia
carbamazepine (tegretol), gabapentin
what are the main pathogens associated with Bell’s palsy?
HSV, VZV, lyme
treatment for Bell’s palsy
prednisone, artificial tears, acyclovir
Bell’s palsy caused by VZV
Ramsey-Hunt Syndrome
CN responsible for inferior rectus (moving eye down)
CN III
CN responsible for superior oblique rectus (moving eye to look down+in)
CN IV
CN responsible for lateral rectus (lateral gaze)
CN VI
most common pathogens in bacterial meningitis (based on age)
<1mos: GBS
1mos-18y: N. Meningitidis (assc with petechial rash); S. Pneumo
18y-50y: S. Pneumo, N Meningitidis
>50y: S. Pneumo, Listeria
inability to straighten knee with hip flexion; sign of meningitis
Kernig’s sign
neck flexion produces knee/hip flexion; sign of meningitis
Brudzinski’s sign
CSF findings in viral vs. bacterial meningitis
bacterial: high protein, high WBC (neutrophils), low glucose
viral: high protein, high WBC (leukocytes), normal glucose
most common causes of VIRAL meningitis
echovirus, coxsackie
most common causes of VIRAL enchephalitis
HSV-1
mild form of depression that lasts for >2 yrs
dysthymic disorder
What is buspirone used to treat?
GAD (1st line SSRI)
What is a major contraindication for bupropion/Wellbutrin?
seizure d/o
What is are some important complications of MAOIs?
MAOI + tyramine: HTN crisis
MAOI + SSRI: serotonin syndrome
MAOI + TCA: delirium + HTN
what are the various clusters of personality disorders?
A: weird, odd eccentric
B: dramatic, emotional, impulsive
C: anxious, fearful, dependent
personality disorder: social withdrawal, hermit-like behavior, prefers to be alone, flat affect, “cold”
schizoid personality disorder
personality disorder: odd, eccentric, peculiar thought patterns WITHOUT psychosis, “magical thinking”, discomfort with close relationships
schizotypal personality disorder
personality disorder: distrustful, suspicious, easily insulted, preoccupation with loyalty
paranoid personality disorder
personality disorder: deviates sharply from norm, harmful, volatile, violates the rights of others, sets fires, harms animals, may begin as conduct disorder in child
anti-social personality disorder
personality disorder: unstable, unpredictable, **mood swings, moments of intense anger; unable relationships, cannot tolerate “being alone”
borderline personality disorder
personality disorder: overly emotional, dramatic, seductive, attention-seeking
histrionic personality disorder
personality disorder: grandiose often excessive sense of self-importance, needs praise and admiration, entitled, lacks empathy, Trump
narcissistic personality disorder
personality disorder: desires relationships but avoids them; “inferiority complex”, timid, shy, lacks confidence
avoidant personality disorder
personality disorder: submissive behavior, constantly needs to be reassured, relies on others, will not initiate things
dependent personality disorder
personality disorder: perfectionist, requires a great deal of order and control, preoccupied with minute details
obsessive-compulsive personality disorder
meets criteria for schizophrenia but <6mos duration
schizophreniform disorder
schizophrenia + mood disorder
schizoaffective disorder
paranoid delisions about things that could happen in real life
delusional disorder
> 6 mos duration, functional decline + 2 of the following: hallucinations, delusions, disorganized speech, disorganized/catatonic sxs, negative sxs
schozophrenia
negative vs positive sxs of schizophrenia
negative: flat emotional affect, social withdrawal, lack of emotional expression/communication (insufficient dopamine)
positive: hallucinations, delusions, disorganized speech, movement disorders (excess dopamine)
treatment for schizophrenia
clozapine, risperidone, olanzapine
physical symptoms but no physical cause found; preoccupation with medical/surgical therapy
somatization disorder
neurologic loss of sensory or motor function; caused by psychological factors
conversion disorder
preoccupation with the fear or belief that one has a serious, undiagnosed disease
illness anxiety disorder (hypochondiasis)
persistent pattern of negative, hostile, defiant behavior, hyperactivity, blames others
oppositional defiant disorder
social and academic difficulty, lack of remorse, sets fires, harms animals, sexually uninhibited; <18y
conduct disorder
purple, polygonal, planar, pruritic papule with fine scales; or lacy lesion of oral mucosa; immune response
lichen planus
herald patch, salmon-colored macule/papule, Christmas tree pattern
pityriasis rosea
treatment for pityriasis rosea
none
treatment for lichen planus
topical steroids
silver/white scales, raised, dark red plaques, nail pitting, **punctuate bleeding with removal of plaque; SAUSAGE DIGITS, PENCIL-IN-A-CUP DEFORMITY
psoriasis
treatment for psoriasis
high dose steroids, UVB light therapy
overgrowth of Malassezia yeast; fine scaling with hypo/hyper pigmentation; “spaghetti and meatball” appearance on KOH
pityriasis versicolor
usually over sebaceous glands (scalp, face, eyebrows, body folds); erythematous plaques with fine white scales; “cradle cap” in infants; usually due to a fungus
seborrheic dermatitis
treatment for seborrheic dermatitis
selenium sulfide or ketoconazole
most common drugs to cause hypersensitivity reactions
abx, NSAIDS, allopurinol, thiazide diuretics
acute/self limiting rash, often due to infections (HSV) or drugs (sulfa, beta-lactams); dusty-violet target lesions
erythema multiforme
sloughing of skin, often a reaction to drugs (sulfa) or infection (mycoplasma); <10% of body
Steven-johnson syndrome
sloughing of skin, often a reaction to drugs (sulfa) or infection (mycoplasma); >30% of body
toxic epidermal necrolysis
sign of a blistering skin condition; skin will slough off with touch
Nikolsky sign
treatment for rosacea
metronidazole, clonidine (for flushing)
most common with prolonged sun exposure; may be pre-cancerous; dry, rough, “sandpaper” skin, hyperkeratotic plaques
actinic keratosis
small papule/plaque, velvety warty lesion “grease/stuck on appearance”
seborrheic keratosis
treatment for seborrheic keratosis
none
common cause of plantar and genital warts (chondyloma acuminata)
HPV
diagnosis of HPV (wart)
whitening of lesion with acetic acid
PAINFUL, self-limited, inflammatory nodule on anterior shins; usually due to estrogen exposures (OCPs, pregnancy), sarcoid, infections/inflammatory disease
erythema nodosum
most common skin cancer type; slow growing, translucent, PEARLY, WXY papule with central ulceration and raised rolled borders
basal cell carcinoma
skin cancer often preceded by actinic keratosis, HPV infection; most common in lips, hands, neck, and head; red, elevated nodule, white scaly or crusted bloody margins
squamous cell carcinoma
aggressive skin cancer, ABCDE; most common skin cancer death
malignant melanoma
self-limiting; single or multiple DOME_SHAPED, flesh-colored/pearly white, waxy papule with central umbilication, POX VIRUS
molluscum contagiosum
treatment for lice
permethrin shampoo
treatment for scabies
permethrin topical
treatment for tinea captitus, tinea barbae, tinea pedis, tinea corporis
griseofulvin or topical antifungal
urticarial plaques, tense bullae that don’t rupture easily; no Nikolsky sign; treated with steroids
bullous pemphigoid
classification for minor and major burns
minor: <10% TBSA adult, <5% children, does not involve face hands/feet, perineum, joints, circumferential
major: >25% adult, >20%children
treatment for keloids
corticosteroid injections
high fever 3-5 –> rose pink maculopapular blanch able rash trunk/back –> face; caused by HHV6/7
Rosealo (sixth’s disease)
fecal oral spread esp late summer/early fall; vesicular lesions on reddened base on hand/foot/mouth, mild fever, URI sx
coxsackie
two complications of coxsackie
pericarditis/myocarditis
pleurodynia (severe CP with swelling over diaphragm)
strongly associated with celiac disease; IgA complex deposition into dermal papillae; pruritic, papulovesicular rash on extensor surfaces and scalp
dematitis herpetiformis
low grade fevers, myalgia, HA, painful parotid gland swelling; sometimes associated with orchitis and acute pancreatitis in children; paramyxovirus
mumps
high fever, cough, coryza, conjunctivitis, Koplik spots, brick-red maculopapular rash on face beginning at hairline–>extremeties/palms/soles; paramyxovirus; main complication is otitis media
rubeola (measles)
fever, cough, anorexia, lymphadenopathy, pink/light-red spotted maculopapular rash face –> extremities, joint pain, photosensitivity; togavirus
rubella (German measles)
“blueberry muffin rash”, sensorineural deafness, cataract, mental retardation, heart defects
rubella during 1st trimester
pathogens of TORCH syndrome
Toxoplasmosis Other (syphilis, VZV, HIV, fifths disease) Rubella CMV HSV
coryza, fever, “slapped cheek”, lacy rash on extremities, spares palms and soles; sometimes associated with arthropathy; parvovirus B19
erythema infectiosum (fifth’s disease)
most common side effect of vancomycin
“red man’s syndrome”/flushing
most common side effect of macrolides (azithromycin)
prolonged QT
most common side effect(s) of fluoroquilolones
tendon rupture, QT prolongation
most common side effect of clindamycin
c.diff colitis
most common side effect of tetracyclines (doxy)
teeth discoloration (do not give to pt <8), photosensitivity
most common side effect of PCN/cephalosporins
allergic reaction, nephrotoxicity
painless black eschar on exposed skin areas, rapidly progresses to dyspnea/shock, medistinum widening on CXR
anthrax
transmitted by cat/cat litter; mono-like illness that can lead to encephalitis and chorioretinitis; RING-ENHANCING LESIONS ON HEAD CT
toxoplasmosis
diagnostic test for HSV
PCR, Tzanck smear
diagnostic test for CMV
antigen tests, “owl’s eye” appearance on bx
Which virus is associated with Hodgkin’s lymphoma?
EBV
What is a complication of fifth’s disease/eryhtema infectiosum in patients with sickle cell?
aplastic crisis
skin eruptions at the SAME STAGE simultaneously; flu-like sxs
small pox/variola
prophylaxis for HIV patients with CD4 200-500
INH (tuberculosis)
prophylaxis for HIV patients with CD4 <200
Bactrim (PCP)
Itraconazole (histoplasmosis)
prophylaxis for HIV patients with CD4 <100
Bactrim (toxoplasmosis)
Cryptococcus (Fluconazole)
prophylaxis for HIV patients with CD4 <50
azithromycin (MAC)
valganciclovir (CMV retinitis)
At what CD4 count is HAART initiated?
<350 (or viral load >55k)
“dew drops on a rose petal”; rash in different stages simultaneously
chicken pox
strawberry tongue, sandpaper rash, facial flushing, Forchheimer spots
Scarlet fever
Blood smear: RBCs stick together like a “stack of coins: (Rouleaux formation)
multiple myeloma
macrocytosis on blood smear
B12/folate deficiency
Liver dx
aplastic anemia
microcytosis on blood smear
iron deficiency anemia
thalassemia
lead poisoning
Howell-Jolly bodies on blood smear (small, dense RBC inclusions)
patient with splenectomy
Blood smear: bite cells (bite like mark on cells from phagocytes)
thalassemia
G6PD
Blood smear: schistocytes
mechanical RBC damage hemolytic anemia (TTP, HUS, DIC)
Blood smear: target cells (hypo chromic RBC with round area of central pigment)
sickle cell, thalassemia, Hgb SC
Blood smear: tear-shaped cells/dacrocytes
thalassemia, hemolytic anemia
Blood smear: ringed sideroblasts, basophilic stippling (blue granules in RBC)
lead poisoning
electrolyte abnormalities in reseeding syndrome
hypokalemia, hypophosphatemia, hypomagnesium
Blood smear: burr cells
uremia
Blood smear: Auer Pod
AML
Blood smear: smudge cell
CLL
Blood smear: reed-sternberg cell
Hodgkin lymphoma
Main causes of vitamin B12 deficiency
pernicious anemia, EToH, Crohn’s, veganism, PPI
MACROCYTIC ANEMIA; pallor, glossitis, stomatitis, GI sxs, peripheral neuropathy
B12 deficiency anemia/pernicious anemia
diagnostic test to look for B12 deficiency
Schilling test
ileocecitis, pseudoappendacitis, common in Scandinavia and Europe
Yersinia enterocolitica
microcytic decreased serum Fe decreased ferritin increased TIBC decreased transferrin saturation
iron deficiency anemia
what should you consider in a patient that has microcytic anemia with normal Fe and no response to iron supplementation?
alpha or beta thalassemia
treatment for moderate/severe alpha thalassemia
moderate: folate, avoid oxidative stress
severe: blood transfusions, deferoxamine, BMT
when do patients become symptomatic with B-thalassemia and why?
at 6 months, the fetal hgbF wears off
treatment for severe beta-thalassemia
weekly transfusions, deferoxamine, BMT
microcytic hypo chromic anemia with basophilic stippling, ringed sideroblasts in bone marrow, abdominal pain, constipation, neuro sxs, fatigue, learning disabilities
lead poisoning
normocytic anemia
decreased serum Fe
increased ferritin
decreased TIBC
anemia of chronic disease
normocytic, hemolytic anemia schistocytes increased reticulocytes increased indirect bili decreased haptoglobin
G6PDD
defect in RBC membrane –> sphere-shaped cells, anemia, jaundice, splenomegaly, Coombs negative
hereditary spherocytosis
what can cause a prolonged PTT?
heparin, DIC, vWD, hemophilia A+B
what can cause a prolonged PT?
warfarin overdose, vitamin k deficiency, DIC
immune-mediated; thrombocytopenia, microangiopathic hemolytic anemia, kidney failure/uremia, neurologic sxs, fever; NORMAL COAGS
Thrombotic Thrombocytopenic Purpura
treatment for Thrombotic Thrombocytopenic Purpura
plasmapheresis (to remove ab), steroids
usually preceded by enterohemorrhagic E. coli, shigella, or salmonella GASTROENTERITIS*; thrombocytopenia, microangioapthic hemolytic anemia, kidney failure
hemolytic uremic syndrome
treatment for hemolytic uremic syndrome
usually self limiting but plasmapheresis if severe
triggered by infections, malignancies, or obstetric conditions; elevated PTT/PT/INR, decreased fibrinogen, severe thrombocytopenia, elevated D-dimer
DIC
when to transfuse platelets
<20k
isolated thrombocytopenia (normal coags); most common post viral infection in children; immune-mediated; mucocutaneous bleeding, purpura, bruises, petechiae, bullae
idiopathic/autoimmune Thrombocytopenic Purpura
treatment for idiopathic/autoimmune Thrombocytopenic Purpura
children: observation, IVIG
adults: corticosteroids, IVIG
most in males, prolonged PTT, normal PT/platelets – corrects with mixing study; excessive hemorrhage in response to trauma, hemarthrosis, epistaxis, bruising
Hemophilia A (factor 8) or Hemophilia B (factor 9)
treatment for Hemophilia A+B
factor 8/9 infusion
desmopressin for HEMOPHILIA A ONLY* (transiently increases factor 8)
bleeding with minor cuts, mucocutaneous bleeding, easy bruising, epistaxis, petechiae, prolonged PTT
von willebrand disease
treatment for moderate/severe von willebrand disease
desmopressin, cryoprecipitate
vWF + Factor VIII prior to procedures
avoid aspirin
what causes a prolonged PT? PTT? Bleeding time?
PT: vit k deficiency, DIC
PTT: hemophilias, vWF def, DIC
Bleeding time: thrombocytopenia, vWF def, DIC
lymphocyte neoplasm; bimodal (peaks at 20y + 50y); assoc with EBV; painless lymphadenopathy, hepatosplenomegaly, CYCLIC FEVERS, night sweats, weight loss; Reed-Sternberg cell
Hodgkin’s lymphoma
lymphocyte neoplasm; mostly peripheral, in old pt and immunocompromised; painless lympadenopathy, splenomegaly, B symptoms rarer
Non-Hodgkin’s lymphoma
neoplasm associated with monoclonal Ab proliferation; BREAK = bone pain/bone lytic lesions, recurrent infections, elevated calcium, anemia, kidney failure
multiple myeloma
diagnostic labs for multiple myeloma
SPEP (IgG/IgA spike), UPEP (Bence-Jones proteins: kappa or lambda), skull xray with “punched out lesions”
treatment for multiple myeloma
stem cell transplant, chemotherapy
childhood leukemia; pancytopenia, fatigue, petechiae, bruising, lethargy, bone pain, CNS sxs, hepatosplenomegaly, LAD; HYPERCELLULAR BM w/ >20% BLASTS
acute lymphocytic leukemia
treatment for ALL
chemo (highly responsive)
B clonal malignancy, >50y adults; often asx and diagnosed on blood tests; peripheral smear with well-differentiated lymphocytes and scattered “SMUDGE CELLS”
chronic lymphocytic leukemia
treatment for CLL
observant if indolent or PO chemo
most common in adults >50y; anemia, thrombocytopenia, neutropenia, splenomegaly, gingival hyperplasia; AUER RODS >20% BLASTS IN BONE MARROW
acute myeloid leukemia
treatment for AML
chemotherapy, BMT
treatment for tumor lysis syndrome
allopurinol
signs of tumor lysis syndrome
hyperkalemia, hyperuricemia, hyperphosphatemia, hypOcalcemia, acute renal failure
most asx until they develop BLAST CRISIS (acute leukemia); strikingly elevated WBC and LDH, splenomegaly; associated with PHILADELPHIA CHROMOSOME
chronic myeloid leukemia
translocation between chromosome 9 + 22; CML
Philadelphia chromosome
overproduction of all 3 cell lines; JAK2 mutation; hyperviscosity, pruritis (ESP IN HOT BATH*), splenomegaly, flushed face
polycythemia vera
treatment for polycythemia vera
phlebotomy, hydroxyurea
autosomal recessive; increased iron absorption and storage; cirrhosis, cardiomyopathy, bronze skin
hereditary hemochromatosis
which hemophilic conditions cause hypercoagulability (increased DVTs and PEs)?
factor V leiden mutation
protein C deficiency
antithrombin III deficiency
