Step 2 Flashcards
4 Ts of mediastinal masses
Find mobile, teratoma, thyroid neoplasm, and terrible lymphoma
ACA stroke syndrome
contralateral motor and sensory deficits that are more pronounced in the lower limb than the upper limb
Acid-base status in adrenal insufficiency
Non-anion hyperkalemic and hyponatremic metabolic acidosis
adenomyosis
presence of endometrial glands in the uterine muscle
affects of increase of pH on ionized calcium
causes more to be bound to albumin
aldosterone in central adrenal insufficiency
relatively preserved in these patients
ALL cell characteristics
PAS positive material, TdT staining positive in 95%
amiodarone toxicitiy
pulmonary fibrosis, thyroid dysfunction, hepatotoxicity, corneal deposits, and skin discoloration
analgesia nephropathy
chronic analgesia use causes papillary necrosis in the kidneys
antibody: primary billiary cirrhosis
anti-mitochondiral antibody
antipsychotic that disrupts thermoregulation and body shivering
fluphenazine IM for poor compliance
aortic stenosis murmur
crescendo-decrescendo murmur at the LLSB
APGAR scores that require further evaluation and resuscitation
<7
ARDS dx criteria
bilateral infiltrate, PCWP <200
area of the intestine that the D-xylose test evaluates
proximal small intestine (celiac’s disease)
associated with dermatomyositis
internal malignancies; MC ovarian
atypical antipsychotic to most likely cause EPS
risperidone
azathioprine toxicity
dose related diarrhea, leukopenia, and hepatotoxicity
Background or simple diabetic retinopathy
Microaneurysms, hemorrhages, exudates, and retinal edema
Baker cyst
excessive fluid production by inflamed synovium, occurs in RA, osteoarthritis, and cartilage tears
Basic labs after diagnosis of hypertension
UA, chemistry panel, lipid profile, baseline EKG
best test for detection of fetal chromosomal abnormalities in first trimester
CVS
best test: primary amenorrhea with presence of uterus
FSH
best way to monitor respiratory status in GBS
vital capacity
biliary consequence of TPN
causes gallbladder stasis and predisposes gallstone formation/bile sludging
blastomycosis cutaneous findings
verrucous or ulcerativew
breastfeeding contraindications
Active untreated TB; HIV; active illicit drug/EtOH abuse
bronchial breath sounds
have full expiratory phase
BUN and creatinine changes during pregnancy
Increase in renal plasma flow and glomerular filtration rate
calcification in fate necrosis
coarse (micro in malignancy)
Calcium oxalate stone predispositions
Small bowel disease, surgical resection or chronic diarrhea; leads to malabsorption of that is the bile salts
cardiac consequences of hemochromatosis
dilated or restrictive cardiomyopathy, conduction defects
cardiac manifestations of Friedrich Ataxia
necrosis and degeneration of muscle fiber; can lead to t-wave inversion/myocarditis
carpal tunnel pathophysiology
deposition of mucopolysaccharide protein complexes in the sheathes of the median nerve
cause of amaurosis fugax
retinal emboli from the ipsilateral carotid
Cause of ascending aortic aneurysms
cystic medical necrosis of connective tissue disorder
cause of calcium oxalate crystal in urine
ethylene glycol poisoning
cause of central primary amenorrhea (low FSH)
pituitary
cause of heat stroke
thermoregulation failure
cause of hydatid cysts
echinococcus granulosus
cause of hyponatremia in central adrenal insufficiency
excessive ADH production from the posterior pituitary
cause of hypotension after epidural
sympathetic fiber block that results in vasodilatation of the lower extremity vessels
cause of premature adrenarche
premature androgen secretion of the adrenal gland
cause of primary dysmenorrhea
increased levels of prostagladins during the breakdown of endometrium
cause of secondary amenorrhea
estrogen deficiency
cause of sickle cell aplastic crisis
infections; e.g. parvo
cause of synringomylia
cavitation of the central cord
causes of exudative effusions
infection, malignancy, PE, connective tissue disease, and iatrogenic causes
Causes of hypercalcemia in malignancy
osteolytic mets, increase PTH-related protein, increased 1,25 vit D and increased IL6
Causes of hypoparathyroidism
Postsurgical, autoimmune, defective calcium sensing
causes of macrocytic anemia with hypersegmented neutrophils
folic acid or cobalamin deficiencies
CD-19 cells
B-lymphocytes
CD-3 cells
T-lymphocytes
celiac’s disease antibody
anti-endomysial
Cervical mucous during the ovulating phase
profuse, clear and thin; will stretch 6cm and exhibit ferning
change in L-thyroxine in patients receiving HRT
increases due to increased liver enzyme production, increased TBG, and increased volume of distribution of thyroid hormone
characteristic microscpoic findings for membranoproliferative glomerulonephritis
dense intramembranous deposits that stain for C3
clopidogrel indications in CAD
1 year s/p UA/NSTEMI, 30 days s/p bare metal stents, 1 year s/p drug eluting stents
CN that controls corneal sensation
V1 branch of trigeminal
coccidioides cutaneous findings
erythema multiforme and erythema nodosum
collagen affected in OI
type I
common association with carpal tunnel syndrome
hypothyroidism
common complication of coronary catheterization
hematoma formation in soft tissues or extension to the retroperitoneal space
common consequence of treated Hodgkin’s lymphoma with chemotherapy and radiation
3.2% develop secondary malignancy
Common extrapulmonary manifestation of mycoplasma pneumonia
Erythema multiforme
common injury after tonic-clonic seizure
posterior dislocation of the shoulder
complete placenta previa management
Cesarean section
Complication of the first two years of menarche
Cycles are irregular, complicated by menorrhagia and are anovulatory
complication of untreated vesicoureteral reflex
UTIs, pyelo, and progressive renal scarring
complications of acute pancreatitis
pleural effusion, ARDS, ileus, and renal failure
Condition characterized by defective mineralization of bone
osteomalacia
Condition characterized by defective mineralization of bone and growth plate cartilage
Rickets
Condition characterized by disordered skeletal remodeling
Paget’s disease of the bone
Conditions other then taponade that have pulses paradoxus
Severe asthma or COPD
confirmatory testing: muscular dystrophy
muscle biopsy, CK for screening
confirmatory tests for SLE
anti-Smith or anti-dsDNA
contraindication to breastfeeding
maternal HIV infection
Cri-du-chat deletion
5p
cyclosporin toxicity
nephrotoxicity, hyperkalemia, HTN, gum hypertrophy, hisutism, and tremor
cystinuria screening
cyanide nitroprusside test
damage that occurs in ethylene glycol poisoning
kidney damage
damage that occurs in methanol poisoning
eye damage
ddx: anterior mediastinum mass
thymoma
ddx: elevated peak pressure with elevate plateau pressure
decreased pulmonary compliance: edema, atelectasis, PNA, or right mainstem intubation
ddx: elevated peak pressure with normal plateau pressure
pathological process causing increased resistance of airways: bronchospasm, mucous plug, biting ET tube
ddx: Howell-Jolly bodies
absence of spleen, splenic infarct, infiltrative d/o of spleen, or splenic congestion
ddx: middle mediastinum mass
bronchogenic cysts, tracheal tumors, pericardial cysts, lymphoma, lymph node enlargement, and aortic aneurysms
DDx: normotensive patients with hypokalemia and metabolic alkalosis
diuretics, vomiting, Bartter synfrom, Gitelman syndrome
ddx: posterior mediastinum mass
meningocele, enteric cysts, lymphomas, diaphragmatic hernias, esophageal tumors, and aortic aneurysms. ALL neurogenic tumors
definitive syphilis dx
dark field microscopy, patients may not have formed antibodies for serologic testing
device to use with pulmonary foreign body
rigid broncoscopy
differentiate types of COPD
chronic bronchitis: normal DLCO, emphysema: decreased DLCO
digoxin toxicity
nausea, vomiting, diarrhea, vision changes, and arrhythmias
DPL indication
hemodynamically unstable with inconclusive FAST examination
drug category: trihexyphenidyl
anticholinergic
drug contraindicated during ACS
dihydropyridine CCBs because the cause peripheral vasodilation and reflex tachycardia leading to worsening ischemia
drug to increase appetite and weight in cancer related anorexia/cachexia
progesterone analogs (megestrol acetate)
drugs that cause folic acid deficiency
phenytoin (impaired absorption), methotrexate, TMP-SMX (antagonize)
drugs that cause interstitial nephritis
cephalosporins, PCN, sulfonamides, NSAIDs, rifampin, phenytoin and allopurinol
drugs that increased the risk of bleeding in those taking warfarin
acetaminophen, NSAIDs, amiodarone, and antibiotics
dx: adult parvo
Anti-B19 IgM
dx: ALL
bone marrow bx
dx: CLL
flow cytometry
DX: developmental dysplasia of the hip
< 6 months: ULS
> 4-6 months: X-ray
…
dx: endometriosis
laparoscopy
dx: esophageal perforation
gastrografin esophography
dx: esophageal rupture
water-soluble contrast esophagram
dx: histoplasmosis
antigen detection in urine or serum
dx: major depressive disorder
5/8 symptoms x 2 weeks, significant functional impairment
dx: melanoma
excisional biopsy
dx: primary hyperaldosteronism
PA:PRA level >30
dx: pyloric stenosis
ULS
dx: SBP
paracentesis with PMN >250 and positive ascites cultures
dx: vasovagal syncope
upright tilt table testing
dx: Zollinger-Ellison syndrome
serum gastrin levels > 1000
dysfunctional uterine bleeding
heavy vaginal bleeding that occurs in absence of structural or organic disease
earliest renal abnormality in diabetes
glomerular hyperfiltration
ECG changes in coarctation
LVH, increased GRS voltage and ST- and T-wave changes
eczema herpeticum
primary HSX associated with atopic dermatitis
electrolyte abnormality in SAH
hyponatremia, cerebral salt wasting syndrome
elevated in CAH 21-hydroxylase deficiency
17-hydroxyprogesterone
elevated in folic acid and cobalamin deficiencies
homocysteine
endocrine disease that causes proximal myopathy
hyperthyroidism
epi: FSGS
AA, obesity, heroin use, and HIV
epi: stress fractures
athletes/nonathletes who increase physical activity, female runners with oligomenorrhea and poor eating habits
factoral study design
randomization into 2 interventions with additional study of 2 or more variables
Familial conjugate hyperbilirubinemia with dark granular pigment in hepatocytes
Dubin-Johnson
features of bacterial sinusitis
sx >10 days, severe sx, fever>39, purulent discharge/face pain, >5 days worsening after improving URI sx
first line agents for HTN in pregnancy
labetalol and methyldopa (ACEi and ARBs teratogenic)
first line therapy for controlling stable angina symptoms
beta-blockers
first line tx HTN in pregnancy
methyldopa, central acting alpha agonist
first renal change in diabetes that can be quantitated
thickening of the glomerular basement membrane
first step in management: suspected congenital diaphragmatic hernia
Placement of orogastric tube
first step in primary amenorrhea evaluation
is there at uterus present
first step in suspected child abuse
full PE
first step in thrombosis of a central line
removal of catheter
Friedrich Ataxia inheritance pattern
AR; trinucleotide repeats
Gaucher’s deficient enzyme
beta-glucosidase
GBS screening in pregnancy
35 to 37 weeks gestation
goal of colposcopy during pregnancy
exclusion of invasive cancer
Gold standard for evaluating cervical incompetence
Transvaginal ultrasound
greatest risk factor for future suicide attempts
past history of suicide attempts
hallmark of prolonged seizures
cortical laminar necrosis
Hallmark ventricular aneurysm EKG findings
Persistent ST elevation after recent MI and deep Q waves in the same leads
hearing tests suggestive of conductive hearing loss
bone conduction>air conduction on Rinne test
height goal by first birthday
50% increase
hemi-neglect lesion
non-dominant parietal lobe
hemophilic arthropathy
iron deposition and synovial thickening with fibrosis
Henoch-Schonelein purpura predisposition
children susceptible to intussusception
Hep E in pregnant women
progression to fulminant hepatitis, especially in 3rd trimester
hereditary spherocytosis pathophys
AD inheritance of abnormal ankryin gene leading to abnormal scaffolding
histoplasma endemic areas
Mississippi and Ohio River Valleys and Central America
how acyclovir causes nephropathy
precipitates in renal tubules causing obstruction and acute renal failure
how dipyridamole works for perfusion scanning
redistribution of blood flow to ‘non-diseased’ segments by inducing coronary steal
how immunizations should be given with pre-term children
given at chronological age, must weigh at least 2 kg before given hep B vaccine
how long to continue antidepressant when treating episode
6 months following the patient’s response
how to differentiate Bartter/Gitleman from diuretics/vomiting
> 20-40 urine Cl
how to differentiate COPD from asthma
bronchodilator response test
how to differentiate emoblic vs. thrombotic limb ischemia
acute onset vs. insidious onset
How to differentiate leukemoid reactions from chronic myeloid leukemia
leukocyte alkaline phosphatse high in leukemoid, low in CML
How to prevent chlamydial conjunctivitis during birth
Maternal prenatal testing, or erythromycin ointment is not effective
how to start opioid pain management
begin with short acting doses, then titrate up to longer acting doses
How trichomonas changes the vaginal milieu
Disrupts normal vaginal pH, increases it between 5-6
Howell - Jolly bodies
Nuclear remnants of red blood cells usually removed by the spleen
Howell-Jolly bodies
nuclear remnants within RBCs, typically removed by the spleen
hypertrophic osteoarthropathy
clubbing and sudden onset of arthropathy in a chronic smoker
hyposthenuria
In sickle cell disease and sickle cell trait, kidneys impaired ability to concentrate urine
imaging: hydatid cysts
eggshell calcification of hepatic cysts on CT
Immunofluorescent findings in bullous phemphigoid
pruritis, tense bullae, urticarial class, IgG and C-3 distributed linearly along the basement membrane zone
important in achalasia workup
endoscopy to r/o esophageal cancer
important management step in androgen insensitivity
gonadectomy after completion of puberty to avoid risk of testicular carcinoma
important screening for cirrhosis dx
endoscopy for varices, ascites prevention, and liver ULS q 6 months for HCC
important tx in CML with Philadelphia chromosome
tyrosine kinase inhibitor
increased risk of seborrheic dermatitis
Parkinson’s and HIV
increased risk with RA
osteopenia and osteoporosis
indicated before trastuzumab initiation
echocardiogram because risk of cardiotoxicity, especially in those with low EF
indicates poor prognosis in CLL
thromnocytopenia
Indication for steroids in PCP
PaO2 < 70, A-a gradient > 35
indication: metformin in PCOS
impaired glucose tolerance
Indication: pica especially for ice
Iron deficiency anemia
Indications for aortic valve replacement
Symptomatic; severe AS undergoing CABG or other valvular surgery; poor LV systolic function or hypertrophy
indications for bladder/renal ULS in children
<24 months with febrile UTI, recurrent UTI, fmhx of urological disease, HTN, poor growth, lack of response to appropriate tx
indications for carotid endarterectomy
symptomatic 70-99% occlusions, asymptomatic 60-99%
indications for endometrial biopsy in endometrial bleeding
> 35, HTN, diabetes or obesity present
indications for endoscopy for dyspepsia
> 55 with alarm symptoms: weight loss, dysphagia, or persistent vomiting
indications for external cephalic version
> 37 weeks, no contraindications to vaginal delivery and fetal well being established
indications for GBS ppx in unknown status
18 hours, GBS bacteruria during pregnancy, hx prior GBS sepsis baby
indications for hospitalization for anorexia nervosa
dehydration, electrolyte disturbance, bradycardia, severe weight loss
indications for parathyroidectomy in asymptomatic hyperparathyroid patients
Ca>1mg upper limit of normal, <T-2.5, reduced renal function
initial manifestation of hypocalcemia
hyperactive DTRs
Innervation: common peroneal nerve
Muscles of the interior and lateral leg; sensation to anterolateral leg and dorsum foot
Innervation: for moral nerve
Anterior compartment of the thigh, responsible for knee extension and hip flexion
Innervation: obturator nerve
New York compartment of the thigh; controlled abduction of the thigh; sensation over the medial side
Innervation: tibial nerve
Posterior compartment of the thigh and leg; flexion of the knee and digits, and plantar flexion of the foot
instructions for laryngomalacia
hold child upright for 1/2 hour after feeding, never feed lying down
instructions for sildenafil when patient on alpha blocker
given with at least 4 hour interval to reduce risk of hypotension
iron overload infection predispostion
listeria and yersinia enterolitica
JAK2 mutation association
PCV
Jones criteria for rheumatic fever
major- carditis, migratory polyarthritis, Sydenham chorea, subcutaneous nodules and erythema marginatum
Klumpke palsy
traction of C8, T1; hand paralysis; ipsilateral horners
lab indications for thyroid testing
hyperlipidemia, unexplained hyponatremia, elevated serum muscle enzymes
labs of osteomalacia
vit D deficiency, low-normal calcium, low phosphate, increased PTH, elevated all phos
labs: central precocious puberty
basal LH increased with GnRH stimulation
labs: hereditary spherocytosis
Low to normal MCV, increased MCHC (because of dehydration), negative coombs test
labs: PIGN
UA: hematuria, RBC casts, proteinuria
Serum: C3 complement levels low
…
lactation suppression
tight-fitting bra, avoid nipple manipulation and ice packs/analgesics to relieve pain
Lactose intolerance labs
Positive hydrogen breath test, positive stool test for reducing substances, low stool pH and increased stool osmotic gap
legionella tx
azithromycin or levofloxacin
lesch-nyhan inheritance pattern
X-linked recessive
Light’s criteria
protein fluid/protein serum >0.5, LHD ratio >0.6, or LDH is 2/3 upper limit of normal serum
live vaccines not contraindicated in HIV
MMR and varicella if CD4>200
location of Broca’s area
dominant posterior frontal lobe
location that most medulloblastomas develop
cerebellar vermis
long term risk in turner’s syndrome
osteoporosis from lower estrogen levels
lung cancer with least smoking association
adenocarcinoma, peripheral
lung disease in cystic fibrosis abx
penicillin/cephalosporin + aminoglycoside
MAC ppx in HIV CD4<50
azithromycin
major cause of anemia in patients with ESRD
EPO deficiency
malignancy risk with Hashimoto’s
thyroid lymphoma
malignant hypertension
in patients with long term HTN, associated with retinal hemorrhages, exudates, and papilledema
manifestations of systemic sclerosis
GERD, right heart failure, and HTN from involvement of esophagus, pulmonary arteries and kidneys
Maternal quadruple screen in down syndrome
Increased levels of beta hCG and inhibin a, decreased levels of MSAFP and estriol
MC cause of unilateral, acute lymphadenitis
S aureus
MC complication of sickle cell trait
painless hematuria
MC complication supracondylar fracture in the pediatric population
Radio artery compression, must assess radial artery pulse when fracture is reduced
MC epiglottitis in adults
H flu and S. pyogenes
MC form of glomerulopathy associated with HIV
focal segmental glomerulosclerosis
MC injured nerve in association with fracture of midshaft humerous
radial nerve, runs on posterior surface of humerous
MC kidney stone
Calcium oxalate
MC locations of hypertensive ICH
basal ganglia, thalamus, pons and cerebellum
MC malignant tumor of the eyelid
BCC
MC manifestations of polycythemia in newborns
respiratory distress, poor feeding, and neurologic manifestations
MC organ injury in blunt trauma
splenic laceration
MC predisposing factor to aortic dissection
HTN
MC side effects of EPO for anemia tx
worsening HTN, HA, and flu like sx
MC side effects of levodopa/carbidopa
hallucinations, confusion, agitation, dizziness, somnolence and nausea
MC site for ulnar nerve entrapment
elbow, medial epiconylar grove
MC site of actual skeleton involvement of us
cervical spine
MC site of hypertensive hemorrhages
putamen, internal capsule lies adjacently
MC thyroid nodule
benign colloid nodules
MC valular abnormality in non IVDU
mitral valve prolapse
MC valvular abnormality in IVDU
mitral regurgitation
MCC abnormal MSAFP
gestational age error
MCC complication of PUD
hemorrhage
MCC congenital hypothyroidism in USA
thyroid dysgenesis
MCC constrictive pericarditis
radiation, viral, cardiac surgery
MCC constrictive pericarditis in developing countries
TB
MCC constrictive pericarditis in US
viral, radiation, then cardiac surgery
MCC death in dialysis patients
CV disease
MCC death in renal transplant patients
CV disease
MCC death s/p MI
reentrant ventricular arrhythmia (ventricular fibrillation)
MCC foot drop
neuropathy, L5 radiculopathy, and traumatic damage to the common peroneal nerve
MCC hip pain in children
Transient synovitis
MCC megaloblastic anemia in alcoholics
folate deficiency
MCC mitral regurgitation
mitral valve prolapse from myxomatous degeneration of the mitral valve leaflets
MCC mucopurulent cervicitis
Chlamydia trachomatis
MCC nephrotic syndrome in adults that is not from systemic disease
membranous nephropathy and FSGS
MCC nephrotic syndrome in children
minimal change disease
MCC nephrotic syndrome renal thrombosis
membranous glomerulonephritis
MCC nephrotic syndrome with Hodgkin’s lymphoma
Minimal change disease
MCC of communicating hydrocephalus in children
SAH
MCC of glomerulonephritis in adults
IgA nephropathy; several days after URI
MCC of orbital cellulitis
bacterial sinusitis
MCC painless hematuria in adults
bladder tumors
MCC pulmonary complications in systemic sclerosis
interstitial fibrosis
MCC purpura in children
thrombocytopenia, clotting factor deficiencies and vasculitis; if nor thrombocytopenia, then think vasculitis
McMurray’s sign
indicative of middle mediscus tear, palpable or audible snap occuring while slowly extending the leg at the knee from full flexion
measles types of virus
paramyxovirus
mechanism behind urinary retention in anti-cholinergics
failure of detrusor contraction, controlled by PNS input from pelvic splanchnic
Mechanism impaired in the post-splenectomy patients
Anti-body mediated opsonization in phagocytosis
mechanism of hypercalcemia in malignancy
production of PTH related peptide
medical treatment for ALS
Riluzole: glutamate inhibitor
metal that causes allergic contact dermatitis
nickelm type IV hypersensitivity
method to decreased contrast induced nephropathy
non-ionic contrast
microprolactinoma
<10mm
mild pre-eclampsia
BP>140/90, protein excretion >.3g/24hrs
missed abortion
dead fetus still retained in the uterus; disappearance of nausea and vomiting in early pregnancy
Most common cause of travelers diarrhea
E. Coli
most common deficiency of CAH
21-hydroxylase
most common type of pediatric supratentorial and intratentorial tumors
benign astrocytomas
most consistent reversible risk factor for pancreatic cancer
cigarette smoking
most effective fetal weight estimation parameter in suspect FGR
abdominal circumference
Most important risk factor in SCC
sunlight exposure
most likely mass of the rostral midbrain
pinealoma or germinoma
most reliable sign for spinal osteomyelitis
tenderness to gentle percussion over the spinous process
most serious potential sequelae of kawasaki’s disease
coronary artery aneurysms
most serious side effect of hydroxychloroquine therapy for SLE
retinopathy, eye exams q 6 months
most specific arrhythmia for digitalis toxicity
atrial tachycardia with AV block (increased ectopy and increased vagal tone)
Most specific marker for diagnosis of acute hepatitis B
IgM anti-HBc
most specific test for androgen-producing adrenal tumors
DHEA-S
most useful indicator for dehydration
BUN/Cr ratio
murmur from acute aortic dissection
aortic root dilatation–>aortic regurgitation
must do in all patients with clavicular fracture
careful neuro-vascular examination to r/o injury to underlying brachial plexus and subclavian artery
must do in young patients with systemic hypertension
evaluation for the presence of coarctation
MVP murmur
mid systolic click over the apex, short systolic murmur at the apex if regurg present, squatting decreases the murmur
mycophenolate toxicity
marrow suppression
negative TB test in those with no risk factors and who are healthy
<15mm
nephrotic disease associated with hep B
membranous glomerulonephritis
nephrotic syndrome associated with african americans and HIV
focal segmental glomerulosclerosis
new clubbing in patients with COPD
indicative of development of lung cancer
next best step: solitary pulmonary nodule on CXR
CT scan
next best test after abnormal MSAFP levels
ultrasound to confirm GA, defect fetal anomalies, detect multiple gestation and confirm viable pregnancy
next step: CIN I in low risk lesion on Pap smear
repeat Pap at 6 and 12 months, or repeat HPV in 12 months, if positive again, repeat colposcopy
next step: high clinical suscpicion of PE
early empiric anticoagulation prior to confirmatory testing
Next step: LISL in young/high risk women
colposcopy
Next step: proteinuria, isolated in children
repeat dipstick on 2 different occasions
next step: pt with PAD symptom but normal ABI
exercise testing with post-excercise ABI
next step: pyelonephritis that does not respond to 2-3 days of tx
ULS or other imaging techiques
next step: recurrent chalazion
histopathologic investigation, increased risk of underlying sebaceous carcinoma; BCC also common malignancy of the eyelid
next step: simple renal cyst
benign, no further evaluation
Next step: threatened abortion
f/u ULS in one week after it has been determined that fetus is still alive
NF-1 characteristics
cafe-au-lait spots, macrocephaly, feeding problems, short stature, learning disability
NF-2 characteristics
acoustic neuromas and cataracts
normal BPP score
8-10; only repeat 1-2x/week in those with high risk pregnancies
nutritional deficiency that is heat sensitive
folic acid
One of the few conditions that presents with bilateral trigeminal neuralgia
Multiple sclerosis
only region of bladder covered by peritoneum
dome of the bladder, most susceptible to injury
Optic complication of neurofibromatosis type one
Optic glioma in 15%
order of frequency of brain mets by primary cancer
Lung>Breast>unknown>melanoma>colon
ototoxic drugs
aminoglycosides, chemotherapy, ASA and loop diuretics (high doses)
outflow obstructions in HOCM
septal hypertrophy and systolic anterior motion of the mitral valve
Paget disease of bone labs
normal calcium and phosphate, increased alk phos and urinary hydroxyproline
Parinaud’s syndrome
paralysis of vertical gaze associated with pupillary disturbances and eyelid retraction
Parinaud’s syndrome lesion
rostral midbrain at level of the superior colliculus and CN III (Collier’s sign)
part of DTaP vaccination that causes reactions
pertussis component
pathophys: immobilization hypercalcemia
increased osteoclastic bone resorption
Pathophysiology between hypothyroidism and hyperprolactinemia
Prolactin production inhibited by dopamine, simulated by serotonin and TRH
Pathophysiology of aspirin sensitivity syndrome
Pseudo - allergic reaction, from prostaglandin and leukotriene misbalance insusceptible individuals
pathophysiology of membranoproliferative glomerulonephritis type II
antibody against C3 convertase, leading to persistent complement activation
PCT associations
hep C infection, substance ingestion (etoh, estrogens)
peak airway pressure formula
resistive pressure + plateau pressure
persistent complex bereavement disorder
12 months of depressive symptoms and loss of function after the death of a loved one
pH consistent with transudative effusion
> 7.2, <7.2 indicates pleural inflammation
physiologic leukorrhea
copious vaginal discharge that is white/yellow, non malodorous, and occurs in the absence of other symptoms or findings on the vaginal exam
plateau pressure formula
elastic pressure + PEEP
pleural fluid characteristics in esophageal rupture
low pH, high amylase
post-exposure ppx for varicella
immunocompetent: vaccine, immunocompromised: VZIG w/in 10 days of exposure
post-tictal acid/base disturbance
normal to have anion gap acidosis that resolves 60-90 min after the seizure
postoperative cholestasis
prolonged surgery, hypotension, extensive blood loss into tissues, massive blood replacement
ppx in chloroquine resistant malaria locations
mefloquine (sub-saharan africa and india)
ppx in rheumatic fever
continuous abx ppx to prevent recurrent strep pharyngitis and limit the progression of rheumatic disease
CNS stimulation, GI disturbance, cardiac
PR theophylline toxicity
sudden onset of eye pain, photophobia, and mid-dilated pupil
PR: acute glaucoma
fever, CP, leukocytosis and widened mediastinum on CXR s/p cardiac surgery
PR: acute mediastinitis
females, episodic, abdominal pain, nausea, vomiting, diarrhea and sweating, no photosensitivity
PR: AIP
RA, enlarged kidneys and hepatomegaly, amyloid deposits on polarized light
PR: amyloidosis nephrotic syndrome
premature, low birth weight; diminished RBC production, shortened RBC lifespan, blood loss; iron deficiency not the cause
PR: anemia of prematurity
false positive VRDL, prolonged PTT, and thrombocytopenia
PR: antiphospholipid antibody syndrome (APS)
Normal internal genitalia with ambiguous external genitalia, deficiency in and then it converts androgens to estrogens
PR: aromatase deficiency
late exposure to maternal factor, normal head size, decreased abdominal circumference
PR: asymmetric IUGR
Down syndrome; increased mobility between the atlas and access; behavioral changes, torticollis, urinary incontinence, and vertebrobasilar symptoms; upper motor neuron symptoms
PR: Atlantoaxial instability
recurrent infections after passing 6 months, impaired ability destroying encapsulated organisms, lack of IgA predisposes giardia infection
PR: B cell deficiencies
tetany, night blindness, neuropathy, dermatitis, arthritis, and hepatic injury
PR: bacterial overgrowth
multi-systemic inflammatory condition, recurrent ulcers, skin lesions; seen in Turkish, Asian, and Middle Eastern population
PR: Behcet’s syndrome
slurred speech, unsteady gait, and drowsiness, no nystagmus, no pinpoint pupils, no respiratory depression
PR: benzo overdose
AV block, bradycardia, hypotension, wheezing, and potential cardiogenic shock
PR: beta blocker overdose
isolated, round, smooth, ring-enhancing intracranial lesion on CT in immuncompetent patient with known extra cranial infection
PR: brain abscess
parasthesias of first 3.5 digits, occasionally thenar eminence atrophy
PR: carpal tunnel syndrome
hyperextension injury, elderly, spondylosis; weakness >upper extrmities, than lower, localized deficit of pain and temperature sensation
PR: central cord syndrome
mucopurulent urethral discharge, absent bacteriruia, and hx of multiple sex partners
PR: Chlamydial urethritis
waxing and waning transaminase levels, but few symptoms
PR: chronic hep C
The equinus and varus of the calcaneum and talus, varus of the mid foot, and adduction of the forefoot
PR: clubfoot
seborrheic dermatitis; pupular, scaly; eyebrows, nasolabial folds, and scalp
PR: cradle cap
palpable purpura, glomerulonephritis, non-specific systemic symptoms, arthralgias, hepatosplenomegaly, peripheral neuropathy, and hypocomplementemia, most have hep C
PR: cryoglobulinemia
Travelers in tropical regions, pruritic elevated serpiginous skin lesions; contact through sand
PR: cutaneous larva migrans
inflammatory changes in the medical canthal region of the eye; usually staph or beta-hemolytic strep
PR: dacryocystitis
new mothers who hold infants with outstretched thumbs; abductor pollicis longus and extensor pollicis brevis tendons affected, passive stretch elicits pain
PR: De Quervain tenosynovitis
Macrocytic pure red aplasia associated with congenital anomalies such as short stature, webbed neck, cleft lip, shielded chest and triphalangeal phones
PR: diamond Blackfan syndrome
palatal ulcers, hepatosplenomegaly and pancytopenia, Mississippi and ohio river basins
PR: disseminated histoplasmosis
bloody diarrhea, abdominal pain, lack of fever, no travel history
PR: E coli diarrhea
micrognathia, microcephaly, rocker bottom feet, overlapping fingers, absent palmar creases, VSD
PR: Edward’s syndrome
dysparenunia, dysmenorrhea, and dyschezia
PR: endometriosis
hypocalcemia, calcium oxalate deposition in kidneys; flank pain, hematuria, ARF, anion gap acidosis
PR: Ethylene glycol poisoning
autosomal recessive inheritance, bone marrow failure, poor growth, morphological abnormalities, macrocyclic anemia
PR: fanconi’s anemia
small body size, microcephaly, digital hypoplasia, nail hypoplasia, hirsutism, cleft palate and rib anomalies
PR: fetal hydantoin syndrome
chronic, widespread pain d/o with fatigue, poor sleep and depression; multiple trigger points of tenderness
PR: fibromyalgia
combination of neurologic (ataxia, dysarthria), skeletal (scoliosis, feet deformities) and cardiac (hypertrophic cardiomyopathy)
PR: Friedreich ataxia
Ashkenazi Jews, adolescents, anemia, easy bruising, thrombocytopenia, bone pain, erlenmeyer flask deformity on distal femur
PR: Gaucher’s disease
adult-onset asthma symptoms after meals, exercise, or lying down
PR: GERD induced asthma
pain, swelling, and decreased ROM at the involved site; radiograph with osteolytic lesions (soap bubble) in epiphyseal regions of long bones
PR: giant cell tumor of bone
mild DM or hyperglycemia, necrotic migratory erythema, diarrhea, anemia, and weight loss, glucagon >500pg/mL
PR: glucagonoma
hypoglycemia, lactic acidosis, hyperuricemia, and hyperlipidemia; doll-like facies, thin extremities, short stature, protuberant abdomen
PR: glucose-6-phosphatase deficiency
Triad of systemic vasculitis, upper and lower airway granulomatous inflammation, and glomerulonephritis; nasal cartilage destruction and vasculitic cutaneous lesions are common
PR: Granulomatosis with polyangitis (Wegener’s)
excessive amounts of estrogen; precocious puberty in young/post-menopausal bleeding in elderly; must differentiate from excessive androgens
PR: granulosa cell tumor
Marfan’s features, mental retardation, thromboembolic events, downward this location of the lens
PR: homocystinuria
IgA-mediated vasculitis of small vessels, results in rashes, arthralgias, abdominal pain and renal disase
PR: HSP
Low calcium and elevated phosphorus in the presence of normal renal function
PR: hypoparathyroidism
dry and rough skin with horny plates over the extensor surfaces of limbs
PR: ichthyosis vulgaris
prolonged premature rupture, maternal fever, leukocytosis, uterine tenderness or tachycardia
PR: intraamnotic infection
Intermittent bloody discharge from one nipple, benign, masses not appreciated
PR: intraductal papilloma
IC paitnet, fever, cough, dyspnea, or hemoptysis, CXR cavitary lesion, CT pulmonary nodules with halo sign with air crescent
PR: invasive aspergillosis
children, isolated thrombocytopenia after viral infection
PR: ITP
Solitary painful, but it long bone lesion with overlying swelling and hypercalcemia in children
PR: Langerhans cell histiocytosis
Asian patient, insensate hypopigmented patch of skin; skin biopsy shows acid-fast bacilli
PR: leprosy
all age groups, testosterone and possible estrogen production, inhibition of FSH and LH levels
PR: leydig cell tumors
AA pregnant, bilateral solid ovarian massess, hirsutisim and virilization; benign and self limited
PR: lutemoa of pregnancy
3 Ps: precocious puberty, pigmentation (cafe au lait spots) and polyostic fibrous dysplasia
PR: McCune Albright syndrome
forceful torsion of the knee with foot planted; popping sound and severe pain; McMurray’s sign
PR: medical meniscus tear
congential foot deformity, feet that overcorrect both passively and actively into abduction; mild cases spontaneously correct
PR: metatarsus adductus
hypotension, non-responsive to fluids with normal/elevated CVP/PCWP, evidence of injury on the anterior chest
PR: myocradial contusion
AD inheritance, delayed muscle relaxation, temporal wasting, emaciated extremities
PR: myotonic muscular dystrophy
afebrile, irritative voiding symptoms
PR: non-inflammatory chronic prostatitis
African-American; gradual loss of peripheral vision, eventual tunnel vision; optic disc cupping
PR: open angle glaucoma
Autosomal dominant, diffuse telangiectasias, recurring expenses, and widespread AV malformations
PR: Osler-Weber-Rendu syndrome
blue sclerae, hearing loss, recurrent fractures and opalescent teeth
PR: osteogensis imperfecta
Osteoclast dysfunction, mosaic pattern of lamellar bone, increased alkaline phosphatase, femoral bowing
PR: Paget’s disease
hemolytic anemia, venous thrombosis and diminished hematopoiesis
PR: paroxysmal nocturnal hemoglobinuria (PNH)
accessory conduction pathways through AV node, vagal maneuvers and medications that reduce conduction through AV node resolve PSVT
PR: paroxysmal supraventricular tachycardia (PSVT)
splenomegaly, pruritis with hot baths, gout attacks
PR: PCV
mucocutaneous blistering that is flaccid, intercellular IgG deposits, anti-bodies against desmoglein
PR: pemphigus vulgaris
hyperviscosity (dizziness/HA), pruritus (especially after shower), and splenomegaly; dx confirmed with JAK2 mutation
PR: polycythemia vera
Decreased estrogen, increased FSH and LH; FSH elevation in the setting of >3 months of amenorrhea woman under each 40
PR: primary ovarian failure
inflammation, fibrosis, and stricturing of bile ducts, associated with UC, unexplained fever and cholestatic LFTs
PR: primary sclerosing cholangitis
urethritis, conjunctivitis, mucocutaneous lesions, enthesitis, and asymmetric oligoarthritis
PR: reactive arthritis
nonspecific, sore throat, hyperemic/edematous OP membranes, chelitis, stomatitis, glossitis, normocytic-normochromic anemia, seborrheic dermatitis, and photophobia
PR: riboflavin deficiency
Secondary pneumonia complicating a viral upper respiratory infection, necrotizing bronchopneumonia resulting in pnematocoeles
PR: S aureus PNA
lack close friends, odd behavior, and magical thinking
PR: schizotypal personality disorder
dry eyes, mouth, dental carries, difficulty swallowing, anti-SSA/SSB
PR: Sjogren syndrome
forward slip of vertebrae (L5/S1); back pain, neurologic dysfunction, palpable step off
PR: Spondylolithesis
post-influenza PNA, nursing homes, IVDU, CF
PR: Staph PNA
repetitive overhead motions; pain with active ROM, passive internal rotation, and forward flexion at the shouder
PR: subacromial bursitis
rapid, progressive ascending paralysis, absence of fever, absence of sensory abnormalities and normal CSF
PR: tick paralysis
microcephaly, hepatosplenomegaly, deafness, chorioretinitis, and thrombocytopenia
PR: TORCH infections
IBD with worsening sx, signs of sepsis, xray with dilated colon
PR: toxic megacolon
follicular conjucntivitis, pannus (neovascularization) in the cornea, major cause of worldwide blindness
PR: Trachoma
GI complaints followed by triad of periorbital edema, myosotis, and eosinophilia subungal splinter hemorrhages and conjunctival/retinal hemorrhages
PR: trichinellosis
cyanotic congenital heart disease, LAD, 90% VSD, 30% TGA, associated defects necessary for survival
PR: Tricuspid atrestia
Middle-aged adults, superficial unilaterally hit pain exacerbated by external pressures upper-level bye
PR: trochanteric bursitis
malabsorption, living in endemic area > 1 month, blunting of villi with infiltration of chronic inflammatory cells
PR: tropical sprue
hyperphosphatemia, hypocalcemia, hyperkalemia, and hyperuricemia
PR: tumor lysis syndrome
Antepartum hemorrhage with fetal heart changes progressing from tachycardia to bradycardia, become sinusoidal pattern; occurs suddenly after ruptured membranes
PR: vasa previa
sudden loss of vision, onset of floaters, fundus is hard to visualize
PR: vitreous hemorrhage
Multisystemic, arthralgias, weight loss, fever, diarrhea and abdominal pain; PAS - positive material in the lamina propria of small intestine
PR: Whipple’s disease
choric steroids, EtOH, hemoglobinopathies; progressive hip/groin pain without restriction of ROM, MRI gold standard
PR:avascular necrosis of the hip
PR:pelvic abscess
lower abdominal pain, malaise, low-grade fever and tender pelvic mass on rectal exam
Pre-proliferative diabetic retinopathy
Cotton wool spots
predisposes to anaphylactic reaction to transfusion
IgA deficiency
preferred diagnostic tool in aortic dissection
TEE
preferred hormonal contraception for lactating mothers
progestin only because does not affect milk production/volume and not associated with thrombosis
pregnancy complications in patients with anoerxia nervosa or previous dx
miscarriage, IUGR, hyperemesis gravidarum, premature birth, and postpartum depression
ophthalmoplegia, pain with EOM, proptosis, and vision impairment
presentation specific to orbitial cellulitis
arthritis of the MCP, PIP, wrist and ankle joints
presentation: adult parvo
primary amenorrhea, bilateral inguinal masses, and breast development without pubic/axillary hair
presentation: androgen insensitivity
burst fracture of vertebra, total motor loss below the lesion, loss of pain/temperature, intact proprioception
presentation: anterior cord syndrome
slow growing papule with pearly, rolled borders and overlying telangiectasia
presentation: BCC
onset of HA, focal neuro deficits after and episode of acute otitis media
presentation: brain abscess
male infant, recurrent PNA and otitis media, serum Igs and circulating B-cells decreased
presentation: Bruton’s agammaglobulinemia
dysphagia, severe pain, heavy salivation and mouth burns, no alteration in consciousness
presentation: caustic ingestion
ipsilateral ataxia, nystagmus, intention tremors, and loss of coordination
presentation: cerebellar tumors
infant presents with cyanosis that is aggregated by feeding and relieved by crying
presentation: choanal atresia
s/p bone marrow transplant with lung and intestinal involvement
presentation: CMV pneumonitis
HIV, AMS, EBV DNA in CSF, solitary weakly ring enhancing lesion
presentation: CNS lymphoma
HTN, mild hypernatremia, hypokalemia, and metabolic alkalosis
presentation: Conn’s syndrome
hepatomegaly, ascites, and increased JVP due to decreased diastolic filling
presentation: constrictive pericarditis
cyanotic heart disease, anomalies of the craniofacial skeleton, absent thymus, absent parathyroid glands, recurrent infections
presentation: DiGeorge syndrome
fever, pharyngitis, and lymphadenopathy that is symmetric and posterior
presentation: EBV
chronic pelvic pain worse premenstrual, dysmenorrhea, and pain with intercourse/defecation
presentation: endometriosis
dysmenorrhea, heavy menses, and enlarged uterus
presentation: fibroid uterus
child, nocturnal pain, no obvious PE or lab findings
presentation: growing bone pain
hypogonadism, arthropathy, diabetes, and hepatomegaly
presentation: hereditary hemochromatosis
preterm infants with respiratory distress and hypoxia not responding to oxygen therapy
presentation: hyaline membrane disease
chronic, associated with pelvic pain worsened by bladder filling or intercourse accompanied by urgency, frequency and nocturia
presentation: interstitial cystitis
male adolescent with epistaxis, localized mass, and bony erosions to the back of the nose
presentation: juvenile angiofibroma
cooling towers, cough, severe, GI sx, confusion, intracellular poor gram stain
presentation: legionella
< 1 month, bilious vomiting, abdominal distention and passage of bloodstained stools
presentation: midgut volvulus
fatigable muscle weakness that involves the extraocular and bulbar muscles
presentation: myasthenia gravis
central scotoma, afferent pupillary defect, changes in color perception and decreased visual acuity
presentation: optic neuritis
constant visceral epigastric pain radiating to back, jaundice, and anorexia with weight loss
presentation: pancreatic cancer
> 50, neck pain, shoulder pain, pelvic girdle pain >1 month, morning stiffness and ESR >40
presentation: polymyalgia rheumatica
6 weeks within surgery, eye pain, decreased visual acuity, swollen eyelids/conjunctiva, hypopyon, corneal edema and infection
presentation: postoperative endophthalmitis
painless blisters, increased skin fragility on dorsal hands, facial hypertrichosis and hyperpgimentation
presentation: prophyria cutanea tarda
tachypnea, tachycardia, and hypoxia 24 hrs w/in injury, patchy alveolar infiltrate
presentation: pulmonary contusion
renal insufficiency with hyperkalemia and non-anion gap metabolic acidosis
presentation: RTA type 4
euvolemic hyponatremia, decreased serum osmolarity, elevated urine osmolalirity, increased urine sodium concentraion, failure to correct with normal saline infusion
presentation: SIADH
hyperviscosity of blood owing to excess IgM production
presentation: Waldenstrom’s macroglobulinemia
thrombocytopenia with eczema skin lesions and history of multiple bacterial infections
presentation: Wiskott-Aldrich syndrome
Runners, pain between 3rd and 4th toe, reproducible by palpation, clicking sensation while palpating
presentation:morton neuroma
adequate hydration and oral hygiene
prevention: parotitis
Proliferative or malignant diabetic retinopathy
Consists of newly formed vessels
pseudocyesis
rare, women present with all signs of pregnancy, normal endometrial stripe, negative pregnancy test
qualities of a benign murmur
asymptomatic, normal S2, <2 grade, no clicks, normal pulses, no other abnormalities
rare neurological side effect of isoretinoin A
pseudotumor cerebri
Reaction when taking amoxicillin with EBV infection
Polymorphism maculopapular rash
reason for low glc in exudative effusions
high metabolic activity of leukocytes within the pleural fluid
reason for pain in PE
pulmonary infarction
relation between NPV and sensitivity
as sensitivity increased, NPV increases
relation between PPV and specificity
as specificity increases, PPV increases
renal disease that hep C leads to
membranoproliferative glomerulonephritis
required in all patients with new onset lupus nephritis
renal biopsy
response phase
50% reduction in baseline severity of psychiatric illness
reversible risk factors for PACs
tobacco and EtOH
Reye’s syndrome histo-pathology
extensive fatty vacuolization of the liver without inflammation
Risk factor for RDS maternally
Diabetes
risk factor that leads to highest risk of stroke
HTN
Risk factors for brain abscess
Congenital heart disease, head trauma, infections of job - mouth, meningitis, and cranial instrumentation
risk for untreated hyperthyroid disease
rapid bone loss from increased osteoclastic activity; cardiac tachyarrhythmias
Risk of DES in pregnancy
Female offspring increased risk of clear-cell adenocarcinoma of the vagina and cervix
risk of lidocaine in ACS treatment
increased risk of asystole
