RX Questions Flashcards
Digoxin mechanism
Digoxin works by inhibiting the Na+/K+ ATPase pump, and causes direct increase of Na+ in the cell. This increase inhibits the activity of the Na+/Ca+2 pump which then increases Ca+2. Ca+2 increase causes an increase in contractility
Toxicity can result in hyperkalemia
Adenosine and AV nodal arrhythmia
Adenosine will abolish AV nodal arrhythmia => Narrow QRS suggests that an electrical signal originates above the ventricles. Also, p-wave obscured by the t-wave.
Adenosine mechanism => Hyperpolarizes AV nodal tissue by increasing potassium conductance and reducing calcium, and it has a very short duration of action
Aortic arch embryology
First arch = maxillary artery
Second arch = Stapedial and hyoidal arteries (only in developing embryo)
Third arch = Common carotid and proximal internal carotid arteries
Fourth arch = Ascending arch of the aorta on the left and proximal right subclavian artery on the right
Fifth arch = Regresses (no arteries)
Sixth arch = Proximal pulmonary arteries and ductus arteriosus
STEMI of the RCA
ECG elevation in II, III, and aVF (inferior leads) => inferior segment of the heart
STEMI of the LAD
ECG elevation in V3, V4 (anterior leads) with ST depression in II, III, and avF.
Symptoms of Congestive Heart Failure (CHF)
Dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, peripheral edema with weight gain. Sudden cardiac death or cardiac arrhythmia
Class I antiarrhythmics
Use Dependent block of Na+ channels in the open/inactivated state (they affect tissue that is more frequently depolarized)
All class 1 drugs decrease the slope of phase 0 of the cardiac action potential.
Tearing chest pain is commonly associated with what cardiovascular complication?
Aortic dissection => ascending dissection can cause pericardial tamponade, mediastinal hemorrhage. Descending can cause acute renal failure due to block of the renal artery.
Beck triad of cardiac tamponade
Jugular venous distention, hypotension, and muffled heart sounds.
Also, pulsus paradoxus is typical. (an abnormally large decrease in stroke volume, systolic blood pressure and pulse wave amplitude during inspiration)
Treatment of cardiac tamponade
Pericadiocentesis allows to immediately decompress the pericardial sac
Coarctation of the aorta and blood pressure
Upper extremity blood pressure will be greater than lower extremity blood pressure.
Coarctation of the aorta happens in 3-10% of Turner Syndrome patients
Wolff-Parkinson White syndrome ECG findings
Wide QRS with short PR intervals and slurring of the initial QRS complexes
WPW is due to an accessory conduction pathway that causes pre-excitation of the ventricle. Slurred upstroke of the QRS complex is called a delta wave.
How does carotid sinus massage alleviate SVT?
Baroreceptors in the carotid sinus respond to arterial wall stretching and massage causes these receptors to fire and thus leads to a decreased heart rate via increased parasympathetic activity
Hodgkin lymphoma common treatment regimen
ABVD
Adriamycin (doxorubicin)
Bleomycin
Vinblastine
Dacarbazine
Side effect of doxorubicin therapy
Cardiomyopathy commonly occurs with doxorubicin therapy
What is the cardinal vital sign for a pulmonary embolism?
Tachycardia
Also:
Tachypnea and pain on inspiration
Bleomycin mechanism of action and select side effects
Bleomycin is a mixture of glycopeptides that produce superoxide and hydroxyl radicals that attack DNA bonds to cause fragmentation.
Side effects include pulmonary toxicity and fibrosis, as well as skin changes and alopecia
Mesonephric (Wolffian) duct development in males
The Wolffian ducts develop into most of the male internal genital structures in response to Testosterone. These structures are BEEDS: Bladder Epididymis Ejaculatory duct Ductus deferens Seminal vesicles
The penis, scrotum, and prostate develop under the influence of DHT and are NOT derived from the mesonephric ducts.
Molar pregnancy
Non-viable fertilized egg that implants into the uterus. It is caused by a single sperm (90%) or two sperms (10%) combining with an egg that has lost its DNA.
Ultrasound appearance will show “snowstorm” with lucent and echogenic areas.
There will be markedly elevated B-hCG, and the classic TRIAD of symptoms includes hyperemesis, vaginal bleeding, and hyperthyroidism.
Hyperthyroidism is likely secondary to the homology of the alpha subunit of the B-hCG protein with the TSH protein.
What nerve is typically injured when a patient presents with wrist drop?
Radial nerve => innervates the posterior compartments of the arm and forearm, and allows for extension of the wrist.
It also innervates the posterior cutaneous hand except for the distal digits and the last one and a half fingers.
Importantly, the radial nerve is not affected in carpal tunnel syndrome because it does not pass through the carpal tunnel.
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What types of tumors are Psammoma bodies typically found in?
PSaMMomA: https://i2.wp.com/
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Papillary carcinoma of the thyroid Serous (ovary) Meningioma Mesothelioma Appendiceal carcinoid
Parvovirus B19 infection physical exam findings
Slapped cheek appearance = Erythema of the cheeks = IgG antibody formation to the virus.
Commonly also see anemia, and is particularly dangerous to the fetus of a pregnant woman.
HIV protease inhibitor side effects (-vir drugs)
GI intolerance, lipodystrophy, lipoatrophy peripherally and accumulation of fat within the abdomen, breasts, and cervical vertebrae (cervicodorsal fat pad). Hyperlipidemia is also common.
(Think of similar appearance of corticosteroid treatment)
Methotrexate mechanism of action and side effects
Methotrexate impairs DNA synthesis through its action at the dihydrofolate reductase inhibitor. It blocks folic acid production in healthy and cancerous cells alike and kills both.
Leucovirin can “rescue” normal cells by displacing methotrexate and enabling folic acid production to continue for DNA synthesis to resume
What is paroxysmal nocturnal hemoglobinuria (PNH)?
PNH is a rare form of hemolytic anemia that commonly presents with changes in urine color in the morning.
Signs and symptoms include normocytic anemia, elevated unconjugated bilirubin, elevated lactate dehydrogenase, and low haptoglobin.
TRIAD - hemolytic anemia, pancytopenia, thrombosis.
Defect: A defective protein known as glycosylphosphatidylinositol (GPI) (PIG-A gene) anchor is present on the RBC membrane. Normally, this protein attaches to the surface of RBCs to prevent the attachment of complement. However, in this condition, complement attaches and causes RBC lysis. Flow cytometry will show CD55/59 negative RBCs.
Treatment is with ECULIZUMAB, a terminal complement inhibitor.
What is the mechanism of action of nitroglycerin?
Nitroglycerin causes production of the metabolite NO. NO then potently activates guanylyl cyclase, and thus increases cGMP levels in the cell to serve as a substrate to stimulate dephosphorylation of myosin, thus causing arterial and venous dilation.
Mechanism of action of fibrates
Fibrates act via stimulation of peroxisome proliferator-activated receptors (PPAR-a) and acts as a transcription factor to increase HDL levels by inducing apoA-1 and apo-AII, as well as increasing lipoprotein lipase lipolysis to rapidly turnover VLDL and triglycerides
Mechanism of action of cholestyramine
Cholestyramine is a bile acid-binding resin that binds negatively charged bile acids and bile salts in the small intestine and excretes them in the feces, thus decreasing cholesterol concentration absorbed in food. Decreased absorption activates the liver to take up LDL particles and thus decreases total plasma LDL levels.
Where do the major vessels of the abdomen pass through?
The IVC is the only structure that directly passes through the central tendon of the diaphragm muscle. The IVC traverses the diaphragm at the T8 level. One can remember this with the mnemonic “I 8 10 EGGs AAT 12”:I 8=IVC at T8;10 EGGs =EsophaGus and vaGus at T10; andAAT 12=Aorta,Azygos, andThoracic duct at T12.
Crigler-Najjar syndrome type I
unconjugated hyperbilirubinemia that is usually fatal within 18 months of life secondary to kernicterus; Multiple genetic defects in the gene for bilirubin uridine diphosphate-glucuronosyltransferase (UGT1) that completely abrogate activity can give rise to this disorder.
What is a hapten?
On its own, ahapten molecule cannot elicit an immune response, as it cannot activate helper T cells.However, when a hapten molecule binds to a protein, the hapten-protein conjugate is capable of eliciting an immune response
Carcinoid tumors
Secrete serotonin, which causes flushing, watery diarrhea, and right-sided valvular heart failure. 5-HIAA is detected in urine.
Treatment involves surgical resection and somatostatin analog (octreotide)
Kawasaki Disease
Small to medium vessel vasculitis that presents in children <4 years old of Asian descent. Signs include fever, conjunctivitis, mucositis, vesicles or ulcers of the lips and oral mucosa, and lymphadenitis. Coronary aneurysms are the worst complication. Treatment includes ASA and IVIg.
Therapy for prinzmetal angina
Prinszmetal angina is characterized by chest pain at rest, often in a young patient with a history of vasospastic disease such as Raynaud or migraines. Treatment is abortive with NTG, or reduced frequency of episodes with calcium channel blockers.
Sulfa derivative diuretics
Acetazolamide, furosemide, HCTZ are all sulfa drugs
Key pathologic finding in hypertrophic obstructive cardiomyopathy (HOCM)
Hypertrophy with asymmetric SEPTAL enlargement without free ventricular wall enlargement. Disease is AD and caused by sarcomeric gene mutation, such as B-myosin heavy chain.
Physical exam findings in HOCM
Dynamic ventricular outflow obstruction during systolic ejection leads to a systolic murmur, dyspnea, lightheadedness, syncope and sudden cardiac death secondary to V-Tach
IVC Compression in pregnancy
IVC compression is common in women during the third trimester of pregnancy when the uterus compresses the IVC and decreases venous return to the heart. This reduces cardiac output, and thus pregnant women should light on their left side or place a pillow under their right hip to remove the uterine weight from the IVC.
Types of Hypersensitivity reactions
Type I - Histamine, allergic reaction - Allergic Anaphylaxis and Atopic Dermatitis
Type II -AntiBody Dependent cytotoxicity
Type III - Immune Complex aggregations of Ag-Ab (PSGN, Lupus, Rheumatoid Arthritis)
Type IV - T-Cell mediated Delayed hypersensitivity
Type I Hypersensitivity
Allergies! Ag binds to IgE on mast cell or basophil, and causes crosslinking to trigger the release of mast cell granules with Histamine. Histamine then causes acute inflammation.
Seen in Allergic rhinitis, Urticaria (hives), anaphylactic shock and allergic asthma
Type II Hypersensitivity
IgG or IgM binds to a cell to cause injury of the own body’s cells.
Seen in Rheumatic Fever, Goodpasture Syndrome, and Hemolytic Disease of the Newborn
Type III Hypersensitivity
Immune Complex aggregates of Ag-Abs deposit in tissues and cause inflammation by Complement activation and attracting neutrophils
Seen in Lupus, PSGN, Polyarteritis nodosa, Rheumatoid Arthritis
Type IV Hypersensitivity
T-cell dependent macrophage activation, i.e. delayed-type hypersensitivity
Seen in Contact dermatitis, PPD, Multiple Sclerosis
Patent ductus arteriosus
PDA is a left-to-right shunt that is associated with maternal rubella infection during pregnancy. It commonly presents with a machine-like murmur, and can lead to late-onset Eisenmenger syndrome (cyanosis due to right-to-left shunt reversal).
The ductus arteriosus remains open through the action of PGE2 and closes with the use of indocmethicin (an NSAID that inhibits PGE2).
A PDA is necessary for life when transposition of the great vessels occurs in order to oxygenate the blood. Maintain a PDA with prostaglandin analogs or PGE2.
Marfan Syndrome
Marfan syndrome is an autosomal dominant disease caused by a fibrillin gene mutation, and patients display skeletal abnormalities such as pectum excavatum, hyperextensible joints, tall stature, and long extremities and digits.
It is commonly associated with aortic aneurysms, aortic dissections, and mitral valve prolapse.
Polyarteritis Noda
Small to medium vessel vasculitis that is characterized by inflammation of the renal, cardiac, and GI tract vessels with SPARING of the pulmonary vasculature. 30% are associated with hepatitis B infections. Symptoms are typically non-specific, and include fever, malaise, muscle pain, melena and abdominal pain. Angiogram will often reveal segmental aneurysms, with a “string-of-pearls” appearance. Fibrinoid necrosis is characteristically seen in vessels. It typically occurs in young adults or middle-aged men, and the best treatment is cyclophosphamide or corticosteroids.
Lipofuscin deposits
Lipofuscin is a non-degradable pigment formed from iron-catalyzed oxidation from autophagocytosed organelles. Lipofuscin gives a brown and granular appearance to cells that is a benign finding in elderly patients. It is commonly found in the liver, kidney, heart, retina, adrenals, ganglions, and non-replicating cells of the body.
Histologic finding of rheumatic heart disease
Commonly Aschoff bodies with Anitschokow cells (large macrophages with wavy nuclei) https://i.ytimg.com/
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Signs and symptoms of Turner syndrome
XO karyotype
Signs - short stature, webbed neck, streaked ovaries, primary amenorrhea, difficulties with mathematics
Cardiovascular complications include coarctation of the aorta, bicuspid aortic valve, and increased risk of aortic dilation with rupture
Dressler syndrome
Autoimmune phenomenon that results in fibrinous pericarditis that develops 2-10 weeks post-MI and presents as chest pain with pericardial friction rub that is a continuous heart sound heard diffusely over the chest
Inotropic
Changes the force of contraction of the heart
Positive Inotropic drug - Digoxin
Negative Inotropic drug - diltiazem
Chronotropic
Heart rate
Positive chronotropy - dopamine
Negative chronotropy - acetylcholine
Dromotropic
Impulse conduction from the SA->AV node (Ca+2)
Positive dromotropic - phenytoin
Negative dromotropic - verapamil
Takayasu Arteritis - “Pulseless disease”
Typically in large and medium arteries with thickening of the aortic arch and great vessels due to granulomatous inflammation. Symptoms include fevers, arthritis, night sweats, myalgias, skin nodules, ocular disturbances, and WEAK PULSES IN THE UPPER EXTREMITIES.
Common in young Asian women and associated with elevated ESR.
Tuberous sclerosis
Tuberous sclerosis is an AD genetic condition (TSC1, TSC2) characterized by proliferation of multi-nucleated atypical astrocytes that form tubers throughout the cerebral cortex and periventricular areas. Class triad - seizures, intellectual disability, facial angiofibromas (adenoma sebaceum)
Half of patients develop rhabdomyomas in the AV valves or ventricle walls causing outflow tract obstruction. TS is also linked to angiomyolipomas of the kidney.
Drugs associated with lupus-like syndrome
Procainamide, clonidine, sulfa drugs, hydralazine, isoniazid, pheytoin, etanercept.
Lupus-like syndrome can be indicated by antihistone antibodies and ANA
What is the most common congenital cardiac anomaly?
Ventricular septal defect, characterized by a harsh/blowing holosystolic murmur best heard at the left sternal border
Tetralogy of Fallot
PROVe iT:
Pulmonic stenosis
Right ventricular hypertrophy
Overriding aorta
Ventricular septal defect (VSD)
in Tetralogy of Fallot
TB Prophylaxis
Isoniazid and pyridoxine.
This is in the setting of a positive PPD but negative CXR without signs/sx of TB.
Histiocytosis X (Langerhan’s cell histiocytosis)
Abnormal proliferation of mononuclear phagocytic-like cells called histiocytes. Histiocytes are dendritic cells related to Langerhan’s skin cells.
Symptoms include hepatosplenomegaly, lymphadenopathy, cystic lung and lytic bone lesions, and cutaneous eruptions.
Histiocytes in this are stellate cells with an oval or irregular pale nucleus, pale cytoplasm, and cytoplasmic granules (Birbeck granules) that resemble tennis rackets. The defective cell stains positively for S-100 and CD1a.
RSV (respiratory syncytial virus)
Causes bronchiolitis in infants and young children (<5 years). In RSV, viral surface contains fusion proteins (F protein) which cause membranes of nearby cells to merge and form “syncytia”. RSV can be diagnosed via direct immunofluorescence of the viral antigen.
Top Causes of Hypercalcemia
1) Primary hyperparathyroidism
2) Hypercalcemia of malignancy (especially lung CA)
3) Granulomatous Disease
4) Vitamin D intoxication
5) Vitamin A intoxication
6) Hyperthyroidism
7) Thiazide diuretics
8) Milk-Alkali Syndrome (ingesting Calcium containing products)
9) Immobilization
10) Adrenal insufficiency
11) Acute renal failure
12) Familial hypocalciuric hypercalcemia
Parathyroid Hormone mnemonic
PTH - Phosphate Trashing Hormone (wastes phosphate and increases calcium)
Pulmonary surfactant is primarily composed of what substance?
Phosphatidylcholine
Surfactant keeps the alveoli from collapsing, but is not produced in adequate amounts until the ~36th week of gestation. Maternal administration of glucocorticoids can help induce surfactant production in fetuses that are at risk for prematurity.
Legionnaire’s disease
Often occurs in the elderly with fever, chills, nonproductive cough, and diarrhea in 50% of patients. Hyponatremia is also common.
Often the respiratory symptoms are progressive. Legionella pneumophila gram stains poorly, so identification is typically made via silver stain. Isolation of the organism on buffered charcoal yeast extract agar helps confirm the diagnosis.
Transmission is often via aerosolized water such as humidifiers or air conditioning units.
Physiologic dead space calculation
Vd = Vt ((PaCO2 - PeCO2)/(PaCO2))
(Dead) taco paco peco paco
Coccidioidomycosis
A disease caused by the spores of the Coccidioides immitis fungus endemic to the soil California, southern Arizona, Utah, Nevada, New Mexico, and Texas.
It is a dimorphic soil fungus with barrel-shaped anthriconidia. Inhalation can infect the lungs, bloodstream, skin, bones, joints, lymph nodes, adrenals, and CNS.
Chlamydophila pneumoniae infection
C. pneumoniae is an obligate intracellular bacterium that causes ATYPICAL pneumonia with dry, hack cough, sore throat, fever, and headaches. CXR may be normal or patchy. Cytoplasmic inclusions are often observed on sputum samples of patients with this infection. This also classically presents with eosinophilia, with an increase in eosinophil count in sputum.
Bacillus anthracis infection
Can cause cutaneous anthrax, inhalational anthrax, or GI anthrax.
Inhalation anthrax (wool-sorter’s disease) has two phases: 1) malaise, dry cough, chest pressure. 2) ARDS with hypoxemia and hemorrhagic mediastinitis with blood pleural effusions.
Treatment requires penicillin, doxycycline, ciprofloxacin, or levofloxain within 24 hours to prevent death by septic shock.
Spores from sheep or goat skin are the primary mode of transmission. This is a gram-positive rod in chains with a protein capsule.
Apical lung cancer signs (Pancoast tumor)
Left shoulder pain, weakness in the left hand, smoking history. These tumors also compress the inferior cervical ganglion and lead to Horner syndrome.
Horner syndrome
Triad of ptosis, miosis, and anhydrosis on the ipsilateral side of the face.
Chronic granulomatous disease
Symptoms include fungal and catalase-positive bacterial infections.
Caused by defective neutrophil phagocytosis due to a lack of NADPH oxidase activity. DHR flow cytometry can assess the production of superoxide radicals and can detect cells with low fluorescence will have low NADPH activity.
Mycoplasma pneumonia testing and possible complications
M. pneumoniae can be detected through elevated cold agglutinin titers in the serum that cause RBCs to clump together at cold temperatures. Half of M. pnuemoniae infected patients will have positive cold agglutinins 1-2 weeks after infection.
M. pneumoniae infection typically affects young adults and complications include cold autoimmune hemolytic anemia and erythema multiforme.
Chagas disease
Chagas disease is caused by Trypanosoma cruzi, a protozoan transmitted by Triatoma (reduviid/kissing) bugs endemic to South America. T. cruzi localizes mainly in the heart and nerves of the myenteric plexus, causing myocarditis and dysmotility of esophagus, colon, and ureter. Cardiac involvement includes ventricular dilation and congestive heart failure with myocytic necrosis and fibrosis. Intracellular parasites are often seen on tissue sections. Achalasia, megacolon, and megaureter are known complications of Chasa disease.
Paget disease of the nipple (mammary PD)
Breast adenocarcinoma that involves the skin and lactiferous sinuses of the nipple. This disease presents with eczematous lesion in the nipple, excoriations, ulceration, and serosanguineous discharge. The histology shows large cells with clear cytoplasm and hyperchromatic nuclei (“halo cells”). This commonly presents in the 50s, although can present at any time.
Torticollis
Painful muscle spam of the neck - often associated with acute dystonic reaction after placement on a D2 antagonist
B-blockers and cocaine use contraindication
B-blockers are not given with cocaine because this leads to unopposed a-adrenergic effects. This increases a1-agonism that would result in vascular smooth muscle contraction.
PCP (PJP) treatment
PCP is a commonly seen infection in immunocompromised patients, and TMP-SMX can be given prophylactically to prevent occurrence of PCP and also to treat acute episodes.
Additionally, TMP-SMX is used to prevent Toxoplasmosis infection in immunocompromised patients.
Mycobacterium avium (MAC) infection
Manifests with fever, cough, weight loss, and diarrhea commonly. Typically seen in patients with CD4+ cell counts <50. Can be prevented in AIDS patients by giving prophylactic Azithromycin.
Systemic Lupus erythmatosus
RASH OR PAIN: Rash (malar or discoid) Arthritis (nonerosive) Serositis Hematologic disorder (cytopenia) Oral/nasopharyngeal ulcers Renal disease Photosensitivity ANA Immunologic disorder (anit-dsDNA, anti-Sm, antiphospholipid) Neurologic disorders (seizures, psychosis)
Classically presents with rash, joint pain, fever, and female of reproductive age with African-American descent.
Libman-Sacks Endocarditis
Nonbacterial, verrucous thrombi /vegetations usually on mitral or aortic valve
Clinical signs of tension pneumothorax and cause
Tachypnea, dyspnea, tachycardia, hypotension, altered mental status, and jugular venous distension with radiographic tracheal and mediastinal deviation AWAY from the affected side. This is due to air trapping in the wound during each inhalation, and free air increases in the thoracic cavity after each breath.
Lithium toxicity
Polyuria (nephrogenic diabetes insipidus), weight gain (hypothyroidism), and tremor are often seen. Polydipsia, gastric distress, and ataxia are also possible.
Hypothyroidism is caused by inhibiting thyroid hormone secretion.
Teratogenic effects of Lithium
Lithium can cause Ebstein anomaly, in which the tricuspid valve is displaced inferiorly into the right ventricle, causing a small functional right ventricle with enlarged right atrium
Hydatid cysts
Walled-off cystic lesions in the liver often causes by the tapeworm Echinoccocus granulosus. These can become quite large and their rupture can cause anaphylaxis.
Treatment for hydatid cysts
Albendazole chemotherapy with puncture, aspiration, injection and reaspiration (PAIR) for large cysts. Surgical excision creates a large risk of ruptured cysts.
Tabes dorsalis
Caused by tertiary syphilis. Causes degeneration of dorsal columns and roots:
- Progressive sensory ataxia with impaired proprioception and poor coordination
Associated with Charcot joints, shooting pain, Argyl Robertson pupils.
Exam will show absent DTRs and + Romberg sign.
Pellagra
Niacin (Vitamin B3) deficiency
Diarrhea Dementia Dermatitis Death (Glossitis)
Casal necklace in neck distribution of C3/C4 dermatome
Tryptophan deficiency can produce the same symptoms because niacin is derived from tryptophan.
Leukocyte adhesion deficiency (LAD) syndrome
Deficiency of the B2-integrin subunit and defects in several proteins (LFA-1 included). LFA-1 is an adhesion protein on the surface of neutrophils required for extravastion from the bloodstream to inflammatory sites.
Paget Disease of Bone
1) Osteolytic lesion with bone resorption
2) Mixed disorganized bone formation
3) Osteoblastic-induced sclerosis
4) Quiescient stage with normal/minimal osteoclastic/osteoblastic activity
Alkaline phosphatase marks bone FORMATION - it will be elevated during the second phase
vWF functions
1) Platelet adhesion
2) Protein carrier for factor VIII
vWF deficiency leads to low levels of factor VIII
Pancoast tumor
Malignant neoplasm of the superior sulcus of the lung with destructive lesions of the thoracic inlet and involvement of the brachial plexus and cervical sympathetic nerves.
This is accompanied by severe pain in the shoulder region radiating towards the axilla and scapula along the ulnar aspect of the hand muscles, atrophy of hand and arm muscles, Horner syndrome, and compression of the blood vessels with edema. SVC syndrome can present similarly. Pancoast tumors are MOST COMMONLY due to squamous cell carcinoma, but adenocarcinoma and large cell carcinomas can also been seen.
Marfan’s syndrome findings
AD disorder = Displaced lens, increased arm span, reduced upper-to-lower body segment ratio, scoliosis, aortic involvement (dilation of aortic root), aortic dissection, mitral valve prolapse, Arachnodactyly (fingers and toes abnormally long and slender), and Dural ectasia (widening or ballooning of the dural sac surrounding the spinal cord), pectus excavatum
Pericarditis signs, symptoms, and common causes
Chest paint that worsens with deep inspiration and is relieved with leaning forward. Pericardial friction rub on auscultation sounds like scratchy, leathery sound during systole and diastole. ECG findings include diffuse ST-segment elevation and depression of the PR wave. Commonly caused by coxsackie B virus (a + naked ssRNA icosahedral virus)
Squamous cell carcinoma of the lung history and PTHrP production
Large hilar mass with cavitation seen in patient with a history of smoking often suggests SCC. SCC is commonly associated with the excessive production of PTHrP which causes hypercalcemia.
Pneumocystis jirovecii pneumonia treatment
First line treatment is TMP-SMX. Second-line treatment is with pentamidine if patient is allergic to sulfas,
True positive and false negative
TP = (Sensitivity) x number with disease
FN = (1-Sensitivity) x number with disease
Babesiosis
Febrile illness caused by Babesia microti that is carried by the Ixodes tick endemic to the Northeastern US. Lab studies show anemia, thrombocytopenia, and intraerythrocytic ring forms (Maltese crosses)
Burkitt Lymphoma features
Burkitt Lymphoma is commonly seen with EBV infection, has a “starry sky” appearance on histology, and has the c-myc gene translocation (t(8;14)). This is a high-grade lymphoma that commonly involves the jaw and responds well to short-term, intensive high-dose chemotherapy
