Step 3 Flashcards
pain, redness, vision loss, constricted and irregular pupil
anterior uveitis (iritis)
severe photophobia with difficulty keeping eye open
infectious keratitis
corneal foreign body tx most common staph /contacts pseudomonas
erythromycin, cipro
drusen spots with central vision loss
dry macular degeneration
blood vessels from choroid grow behind retina causing detachement
wet macular degeneration
chronic gradual loss of peripheral vision and tx
open angle glaucoma, latanoprost, timolol, carbonic anhydrase inhibitors -zolamide meds
acute eye pain, headache, injection and tx
close angle glaucoma. acetazolamide, timolol, pilocarpine, mannitol
sudden, severe with temporal sparring, amarosis fugax. pale fundus with cherry red spot
central retinal artery occlusion. ocular massage and acetazolamide
subacute, blood and thunder
central retinal vein occulusion
floaters, viterous hemorrhage and retina elevation
retinal detachement, surgery
visual haze floaters, dark streaks, decreased red reflex
vitreous hemorrhage, bed rest with elevation 30-45%
posterior nose bleed occurs where
sphenopalatine artery
bone greater than air, weber louder in affected
conductive most commonly caused by otosclerosis
air greater than bone, weber louder in normal
sensorineural
pruritic, lichenified plaques on flexor surfaces
atopid dermatitis (eczema) topical steroids or topical tacrolimus
immune mediated Type IV hypersensitivity rash acute causing papular lesions, vesicles, weeping erosions. chronically causes hyperkeratosis and lichenification
contact dermatitis, steroids
immune mediated skin disease , nails with pitting and onychiolysis classically involves the distal interphalangeal joints
psoriasis, steroids, light exposure, methotrexate
tender red or violet nodules common in women, sarcoidoisis, inflammatory bowel disesae typically after recent URI or diarrheal illness. red nodules without ulceration on the shins
erythema nodosum , nsaids, potassium iodide
looks like acne without pimples, flushing from spicy food, rhinophyma
rosacea - cleansers, metronidazole. potentally doxycycline, tretinoin
acute inflammatory disease type IV hypersensitity, occures after sulfa drugs, rapidly progressive, symmetric lesions, targetoid papules on hands and palms
erythema multiforme - histamne blockers, prednisone
autoimmune disease targeting desmoglein with oral lesions and nikolsky sign. flaccid bullae
pemphigus vulgaris - steroids
autoimmune disease against basement membrane with large tense bullae
bullous pemphigoid, steroids
pearly papules with central depression that is ulcerated on sun exposed areas
basal cell carcinoma
annular plaques with a thin scale and central clearing
tinea corporis, griseofulvin, itraconazole
red, scaly soles with maceration and fissuring bwtween toes
tinea pedis - friseofulvin, terbinafine
hypopigmented macules in areas of sun , reddish brown in winter
tinea versicolor - itraconazole
hyperkeratosis and yellowing of the nail plate
onychomycosis, terbinafine
erythema and scaling of the scalp with thickened, broken off hairs and scalp kerion
tinea capitis - griseofulvin, itraconazole
pink plaques with scale or eroision spread to lymph nodes, arsenic exposure
squamous cell carcinoma
typical substernal chest pressure or shortness of breath that is exacerbated by exertion and relieed by rest or nitroglycerin
stable angina
any new angina in previously asymptomatic patients or accelerating or new angina at rest
unstable angina
true or false DM is a CAD risk equivalent
true
what determines the difference between unstable angina and NSTEMI
presence of elevated troponin
s4, crackles, venous destension after acute MI
Heart failure, dont give b-blocker give MONA BASH if stable and no signs of heart failure
what drugs improve mortality after MI
aspirin, b-blockers, ACEI, statins, anti platelet agents
post TPA in MI with decreased EF and prolonged QRS
cardiac resynchronization
post MI with symptoms and decreased EF <35%
give ICD
symptoms of HF, diastolic murmur heard best at apex with an opening snap associated with rheumatic fever
mitral stenosis, HR control
blowing systolic murmur at the apex and radiates to the axilla if acute leads to rapid pulmonry edema, cardiogenic shock, ruptured chordae tendinae due to MI usually and ultimately leads to AF
mitral regurgitation
acute needs surgery
chronic needs repair EF <60
midsystolic click, increased by valsalva maneuvers presents with palpitations or dyspnea
mitral valve prolapse
systolic crescendo-decrescendo murmur radiating to the carotids along the right sternal border, parvus et tardus presents with chest pain, syncope, HF, shortness of breath
aortic stenosis avoid overdiuresis do surgery
diastolic murmur along left sternal border with wide pulse pressure radiate to apex
aortic regurgitation - afterload reduction with ACE and hydralazine
systolic crescendo and decrescendo murmur at the left sternal boarder that is worse on standing and valsalva
Hypertrophic obstructive cardiomyopathy
caused by alcohol or tachycardia presents with ischemia, tachycardia, HTN, or chagas
dilated cardiomyopathy - ACE, ARB, B-blockers, spironolactone, digoxin
findings show LVDH and low voltage on EKG caused by sarcoid, amyloidosis, hemochromatosis, cancer, and glycogen storage
restrictive cardiomyopathy
ventricular septum hypertrophy that is not symmetric that is generally due to autosomal cardiac sarcomere in a dominant pattern associated with sudden cardia death
hypertrophic cardiomyopathy give b-blocker, verapmil or dysopyramide
distant or muffled heart sounds, incrased JVP, and pulsus paradoxus
pericardial effusion
postprandial abdominal pain, food fear, bloody diarrhea
mesenteric ischemia
gemfibrozil and nictoinic acid do what
increase HDL and decrease triglycerides
fever, rigors, HF, neurologic impairment, back pain, roth spots (white hemorrhages on retina), osler nodes, janeway lesions, pulmonary symptoms, (systemic emboli)
acute endocarditis, needs surgery for hemodynamic istability, heart failure, valve destruction
give prophylaxsis with PCN for dental procedures
strep bovis associated with
gi malignancy
any patient with s aureus bacteremia needs
evaluation for endocarditis , dukes criteria
hip pain preceded by URI
toxic synovitis
ulnar shaft fracture with radial head dislocation
Monteggia fracture
distal 1/3 radius fracture with a distal radioular dislocation
galeazzi fracture
FOOSH injury - distal radial fracture with dorsal displacement
colles fracture
this fracture needs splinting even if there is tenderness in the area due to frequent development of avascular necrosis
scaphoid fracture
proximal fibula injury aka
maisonneuve fracture
shoulder disloaction typically causes
axillary nerve injury
supracondylar fractures lead to what
radial nerve injury
narrow regular complex tachycardia is typically, tx
SVT, adenosine
narrow irregular complex is typically, tx
AF, rate control metoprolol or diltiazem
wide complex tachycardia is typically , tx
VT, amiodarone
develops slowely over 24 hours and freatures rigidity rather than clonus (due to drugs)
neuroleptic malignant syndrome
indication for emergent dialysis - AEIOU
acidosis - can be fixed with bicarb electrolytes - hyperkalemia Ingestion - lithium or aspirin overload - kidney failure uremia - encephalopathy, serositis, pericarditis
herb used for BPH, causes
saw palmetto, increased bleeding
herm used for anxiety and insomnia, causes
kava kava, liver toxicity
herb used for depression, causes
st. johns wart, serotonin syndrome, decreased INR, digoxign toxicity, HTN crisis
Herb used for HLD
Garlic
Herb used for High triglycerides
fish oil
herb used for osteoarthritis
glacosamin and chondritin
used after menopause, causes
black cohosh, liver toxicity
herb used for memory enchancement, causes
ginko biloba, bleeding and intracranial bleeding
herb used for ulcers and virus, causes
licorice, HTN, hypokalemia
herb used for weight loss, causes
ephedra, HTN, sudden death, stroke, seizure
herb used for weight loss in china, causes
aristolochic acid, nephrotoxicity (RTA)
toxidrome presents with diarrhea, urination, miosis, bronchorrhea, bronchospasm, bradycardia, emesis, lacrimation, salivation, examples
cholinergic , mushrooms, organophosphates, pilocarpine, pyridostigmine
toxidrome presents with fever, flushing, dry mucous membranes, psychosis, mydraisis, tachycardia, and urinary retension, examples
anticholinergic - antihistamines, antipsychotics, atropine, jimson weed, scopolamine, TCA
toxidrome presents with coma, respiratory depression, and miosis, examples
opiods, heroin, morphine, oxycodone
toxidrome presents with CNS depression, respiratory depression, and coma, examples
sedative hypnotic , alcohol, barbs, benzo
toxidrome presents with disorientation, panic, seizures, hypertension, tachycardia, tachypnea, examples
sympathomimetics, amphetamines, cocaine, PCP
toxidrome presents with tremor, torticollis, trismus, rigidity, oculogyric crisis, opisthotonos, dysphonia, and dysphagia
extrapyramidal - haloperidol, metoclopramide, phenothiazines
opiate overdose tx
naloxone - may cause pulmonary edema
anticholinergic overdose treatmetn
benzo for symptom control
sympathomimetic toxidrome tx
benzodiazepine
organophasphate tx
atropine
hallucinogenic toxidrome tx
benzodiazepine
ethylene glycol ingestion tx
fomepizole or ethanol
monkey bites transmit this which has 80% fatality rate
Herpes B virus, treat with valacyclovir
anaphylactic - igE mediated
type I
cytotoxic antibody mediated
type II
immune complex mediated
Type III
type IV Delayed (CD4 mediated)
Type IV
difference between heat exhaustion and stroke
temperature dysregulation, AMS, and paradoxical shivering
associated with explosive exit wound, causes VF and due to household or commercial electricity
alternating current, worst kind
electricity causes discrete exit wound and asytole due to batteries, industry, and lightning
direct c urrent
traume and loss of vision with vitreous humor leak and teardrop shaped pupil, tx
puptured glove, eye shield
dental avulsion treatment
reimplant, rinse but dont scrub
polyuria, polydipsia, and polyphagia
DM
aspart
novolog
lispro
humalog
regular
humulin
glargine
Lantus
acidemia causes potassium to shift where to cause what
extracellulary, hyperkalemia
hyperglycemia with neurolgic symptoms
HHS
hyperglycemia with hyperventilation and abdominal pain
DKA
presents with fatigue, weight gain, constipation (ileus), dry skin with increased TSH and decreased T4
primary hypothyroidism, levothyroxine
altered mental statues, hypothermia, and hemodynamic instability
myxedema coma, levothyroxine
weight loss, tachycardia, anxiety, diarrhea, afib, tremor
primary hyperthyroidism, PTU or methimazole
high fever, tachycardia, cardiac failure, dehydration, altered mental statues
thyroid storm,
propranolol for tachycardia
glucocorticoids to block t4 conversion
methimazole or PTU
presents like primary hyperthyroidism but has increased TSH and T4 due to adenoma usually
2nd hyperthyroidism, remove tumor, b-blockers
atibody against TSH receptor, diffuse pailness goiter, proptosis, pretibial myxedema
graves disease, ptu or methimazole prior to ablation
tender thyroid usually hyperthyroidism folled by hypothyroidism in setting of viral illness
subacute thyroiditis, NSAIDS
painless thyroid enlargement with anti TPO antibody present
hashimoto thyroditis
what trimester do you gie methimazole
2-3rd
wat trimester do you give PTU
1st
what is the difference between hot nodule and cold nodule
hot noduels are rarely malignant
cervical lymphadenopathy, dysphagia, dyspnea, and hoarseness
thyroid cancer
most common thyroid cancer
papillary spreads lymphatically
thyroid cancer spreads through blood to bone and lungs
papillary
tumor of parafollicular c cells that secrete calcitonin and assoicated with MEN 2A or 2B
medullary
undifferentiated thyroid cancer with poor prognosis
anaplastic
this is the best marker to determine if thyroid tissue remains or cancer of the thyroid has returned
thyroglobulin
presents at fatigue, constipation, polyuria, polydipsia and abdominal pain with increase in PTH and Calcium
priamry hyperparathyroidism tx acutely with IV hydration and furosemide
presents as fatigue, constipation, polyuria, polydipsia and abdominal pain with decreased or normal PTH and increased calcium
secondary hyperparathyroidism
presents with altered mental statues, polyuria, short QT syndrome, and dehydration in the setting of high calcium
hypercalcemic crisis >13, dialysis
t score > -1
normal
tscore -1 to -2.5
osteopenia
tscore
osteoporosis, tx -dronate drugs then raloxifene
presents as skin atrophy, proximal muscle weakness, moon face, buffalo hum, psychiatric disturbances, hypertension, hyperglycemia, growth retardation, hisutisim, what is the best test
hypercortisolism (cushings), dexamethasone test to mesaure cortisol excess
for dexamethsone cortisol testing if
cortisol is normal
cortisol is high
not cushing
do high dose dexamethasone supression test
on high dose dexamthasone supression testing
acth undectectable
acth no suppression
acth supressed
adrenal tumor
ectopic acth syndrome
pituitary tumor (cushing disease)
hypotension, postural dizziness, syncope, hyponatremia and hyperkalemia, hyperpigmentation with increased ACTH and decreased aldosterone
addison disease or primary adrenal insufficiency, steroids, fluudrocortisone
fatigue, generalized weakness and weight loss with decreased ACTH and normal electrolytes
secondary adrenal insufficiency
hypernatremia and hypokalemia presents with hypertension, metabolic alkalosis
primary hyperaldosteronism
malignant hypertension with edema causes by renin secreting tumores
secondary hyperaldosteronism
causes of hyperaldosteronism include
adrenal adenoma
bilateral adrenal hyperplasim
what are the treatments
1 - adrenalectomy
2- spironolactone
wome get falactorrhea and amenorrhea in the absence of pregnancy with osteopenia
prolactinoma
men get decreased libido, CN III palsy, temporal field visual loss
prolactinoma, dopamine agonist like cabergoline or bromocriptine
DM and htn with increased hat and ring size
acromegaly, somatostatin analogues like octreotide or lanreotide
presents with HTN, headache, palpitations, and sweating
pheochromocytoma, phenoxybezamine followed by propranolol to prevent htn crisis
measure 24 hour metanephrines
parathyroid hyperplasia, pancreastic islet cell tumor, pituitary adenoma
wermer syndrome or MEN 1
parathyroid hyperplasia, thyroid medullary cancer, pheochromocytoma
sipple syndrome or MEN 2A
thyroid medullary cancer, pheochromocytoma, mucocutaneous neuromas, marfan habitus
MEN 2B
esophageal issue associated with hiatal hernia
schatzki ring
dysphagia, cervical esophageal webs, and iron deficiency anemia
plummer vinson syndrome
cancer of esophagus at the top
what about the bottom
scc, smoking alcohol
adenocarcinoma, gerd
birds beak on barium swallow
achalasia
intermittent symtpoms with chest pain triggered by hot and cold liquids, corkscrew esphagus on barrium swallow
esophageal spasm
calcinosis cutis, raynaud syndrome, esophageal dysmotility, sclerodactyly, and telangiectasia
CREST syndrome
ulcers
relieved by eating
worse with eating
duodenal
gastric
triple therapy - amoxicillin, clarithromycin or metronidazole, PPI
abdominal pain, chronic diarrhea, and ulcer disease with elevated serum gastrin or secretin
zollinger ellison syndrome associated with MEN1
abdominal pain associated with altered bowel function with relief after defecation, pain is migaratory, variable and poorly localized
IBS, high fiber diet
diarrhea that severe and often bloody with fever at times
bacterial diarrhea, avoid abx unles invasive or c diff
invasive give bactrim
c diff give oral vanc
diarreha that friends and family have, no fever
viral diarrhea , loperamide
diarrhea outbreatk in
day care
travel
parasitic diarrhea
giardia
entamoeba
give metronidazole
acute diarrhea duration
chronic
<2 weeks
>4-6 weeks
small bowel villous atrophy and crypt hypertropy resulting in malabsorption and iron deficiency anemia associated with dermatitis herpetiformis and gi malignancy
celiac sprue
tx or varacele bleed
prevention of vaacele bleed
ocretotide
propranolol
mid epigastric pain that radiates to the back and relieved by sitting forward. ocassionaly has jaundice and fever
pancreatitis
tx for necrotizing pancreatitis
imipenem or fluoroquinolone plus metronidazole
post prandial abdominal pain for 30 minutes with RUQ pain
biliary colic, rocephin plus metronidazole
fever, jaundice, and RUQ pain
cholangitis, ciprofloxacin
Fever, jaundice, RUQ pain, shock, and altered mental status aka reynolds pentad
suppurative cholangitis
high transaminase should make you think of
hepatitis
SAAG (serum ascities albumin gradiet) >1.1
portal htn –> cirrhosis, HF, budd chiari
SAAG <1.1
no HTN –> peritonitis, cancer, pancreatitis, trauma, nephroti csyndrome
tx of hepatic encephalopathy
rifaximin and lactulose, TIPS procedure predisoses you to this
SBP tx
rocephin or fluoroquinolone
fatigue, DM, arthritis, skin pigmentation, infertility, transaminitis, cardiomyopathy with increased FE saturation, ferritin and transferrin levels
hereditary hemochormotosis, phlebotomy
liver disease with neurophychiatric symtpoms and kayser fliesher rings. decreased copper and ceruloplasmin
wilson disease, penicillamine, trientine, oral zinc
young nonsmoker with panacinar emphysema
alpha 1 antitrypsin disorder, give antitrypsin and liver transplant
transamintis with ana, asmam, lkma and igG
autoimmune hepatitis, steroids and azathioprine
fatigue, pruritic, jaundice, fat malabsorption, osteoporosis
primary biliary chirrosis, ursodeoxycholic acid, cholestyramine, fat soluble vitamins
fatigue, pruritus, RUQ pain, ana, anti smooth muscle antibody, p-anca, associated with gi maligancy
primary sclerosisng cholangitis, ursodeoxycholic acid, cholestyramine, fat soluble vitamines
determines if antibodies are bound to the RBC membrane and is indicative of hemolytic anemia
direct coombs test
determines if there is antibodies to Rh factor in a mothers blood
indirect cooms test
can present with pica, low ferritin with wide RDW
iron deficiency anemia, iron supplementation
chronic hemolytic andemia and splenomegaly with increase in hemoglobin a and hemoglobin 4
hemoglobin H disease
growth retardation, heaptosplenomegaly, jaundice, and bony deformations as infant. normal RDW and basophilic stippling on smear
b- thalasemia major
causes HF, hepatic dysfunction, glucose intolerance, and secondary hypogonadism requiring chelation therarpy
iron overload secondary to repeat blood transfusions
always consider this cancer in microcytic anemia
colon cancer
low iron, low TIBC, normal transferrin with increased hepcidin
anemia of chronic disease, treat underlying issue
seen in mycoplasma and mono infection with sings of intravascular lysis, spherocytes and positive coombs test
cold agglutinin autoimmune hemolytic anemia
jaundice, spleenomegaly, spherocytes, cooms test positive, lysis in spleen
warm autoimmune hemolytic anemia
hemolysis during infection or sulfa drugs with bite cells
g6pd deficency
schistocytes and helmet cells caused by shearing through coagulated capillaryes
microangiopathic hemolytic anemia
hemolytic anemia, thrombocytopenia, and AKI with no neurological sign typically associated with gastroenteritis in children and shiga toxin
HUS
hemolytic anemia, thrombocytopenia, aki, fever, and neurological signs due to vWF and autoantibody against ADAMTs13
thrombotic thromcocytopenic purpura
chronic hemolysis caussing gallstones, poorly healy ulcers, jaundice, splenomegalsy, and heart failure, vaso-occulsive crisis
sickle cell anemia
sudden decrease in hemoglobin and reticulocyte cound caused by parvovirus b19
aplastic crisis, transfuse
fever, chest pain, cough, wheezing, tachypnea, new pulmonary infiltrate on CXR in sickle cell patinet
acute chest syndrome, oxygen, transfusion, rocephin, erythromycin
defect in ankryin or spectrin, speelomegaly, incresed RDW and MCHC, jaundice, confirmed by osmotic fragility test and howell jolly bodies
hereditary spherocytosis, vacinate against encapuslated organisms
shortness of breath with normal CXR, dizziness, confusion, headache, and seizures after exposure to benzocaine, dapsone, sulfa
methemoglobinemia, methylene blue
major difference in symptoms between folate and b12 deficiency
neurological symtpoms are found in b12 deficiency and b12 deficiency will have increased is methylmalonic acid
headache, blurry vision, fatigue, itching after a hot shower, Jak2 mutation
polycythemia vera, phlebotomy
visual complaints, headaches, or erythromelalgia (pain in hands and feet)
essential thrombocytosis, hydroxyurea
fever, sweats, weight loss, and hepatosplenomegaly, dry tap
primary myelofibrosis, transfusion, hydroxyurea, and splencetomy
plateletes <90,000
thrombocytopenia
eleveted PT or PTT
coagulopathy, give FFP to normalize
petechiae is a sign of
platelet deficiency
cavity or joint bleeding is a sign of
clotting factor deficiency
petechiae and easy brusising with igG antibodies
idiopathic throbocytopenic purpura (ITP) aka autoimmune thrombocytopenia, steroids
petechiae and easy brusing after heparin
HIT, platelet factor 4 antibodies found on serotonin release assay
recurrent spontaneous bleeding with increased PTT
intrinsic pathway likely hemophilia A (8) or hemophilia B (9)
recurrent sponteneous bleeding with inceased PT
extrinsic pathyway factor 7 disease
increased in both PTT and PT with recurrent sponteneous bleeding
common pathway factor 5, 10, 2
mucocutaneous bleeds, increased bleeding time, joint bleeds due to inability to form hemostatic plug
von Willebrand Disease, desmopressin (antidiuretic hormone)
mutation that disrupts activated protein C with slows the breakdown of factor 5 to 8
factor 5 leiden
issue with mutation that stabilized and increased prothrombin
prothrombin g20210a
warfrin is a resk of skin necrosis with this
protein c or s deficiency
inability to inhitib thromin and factor 10 resulting in heparin resistance
anti-thrombin II deficiency
found in any thrombosis and >3 miscarriages before 10 weeks or 1 after 10 weeks with postive anticardiolipin or lupus anticoagulant
antiphospholipid syndrome
fever, chills, and malaise after blood product
febrile reaction, leukocyte reduced RBC
fever, chills, pain, hypotension, flushing after blood produce due to ABO incompatibility
acute hemolytic reaction, supportive plus furosemide
jaundice, anemia, hemoglobinuria, fever
delayed hemolytic reaction, tylenol for fever
urticaria, itching, fives after blood product
allergic reaction, benadryl
shortness of breath, hypoxemia, bilateral chest infiltrates, 1-6 hours post transfusuion, ARDS
TRALI , ventilation support
shortness of breath, edema, fluid overload
TACO, furosemide
myeloblast and lymphoblast overgrowth, what is it called if this is <20 %
acute leukemia, meylodysplastic syndrome
overgrowth of metamyelocytes and lymphocytes
chronic leukemia
overgrowth of any lymphocyte, b cell is generally more than T cell
lymphoma
viral like syndrome with bone pain, pallor, petechiae, adenopathy, testicular and CNS involvement, anterior mediastinal mass typically in children with down syndrome
acute lymphocytic leukemia
fever, brusising, fatuge, infection, gingival hyperplasica, seen in people with previous chemo or radiation, increased urice acide, auer rods
acute myelogenous leukemia 15:17 gene translocation, 7+3 anthracycline based chemo or in AML M3 given all trans retinoic acide
lymphagenopathy and hepatosplenomegally often incidental finding on CBC, smudge cells on smeart, cyclin d1, CD5 and 23+. can be associated with ITP
chronic lymphocytic leukemia or mantle cell lymphoma t:11-14 translocation, fludarabine based regimen
b symptoms but in blastic phase has bone pain, bleeding, purpura, splenomegaly with CD11, trap and CD103, cbc shows 150000 wbc
chronic myelogenous leukemia , hairy cell leukemia has all the postiive cd things, philadelphia chromosome bcr-abl gene t9:22
give imatinib
cervical or mediastinal lymphadenopathy with b symptoms. has reed sternberg cells, mediastinal mass, contiguous speread
hodgkin lymphoma, ABVD adriamycin (doxorubicin), bleomycin, vinblastine, cacarbazine
assoicated with EVC, HTLV, MALToma, b symptoms, non-continguous spread
non-hodgkin lymphoma, r-chop which is rituximab, cyclophosphamide, doxorubicin, vincristine, presdnisone
occurs afte radiation resulting in hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia, leading to renal failure, gout, and stones
tumor lysis syndrome, hydration, allopurinol
CRAB, hypercalcemia, renal failure, anemia, bone lesions
multiple myeloma, bortezomib or lenalidomide
low plasma cells, low M protein, no crab symtpoms
MGUS
difference between smoldering myeloma and multiple myeloma
CRAB symptoms
bone pain, abdominal pain, kidney stones, delerium, fatiuge, bone lesions, decreased urine output
multiple myeloma
ductal carcinoma in situ or infavsive cancer of the nipple with unilateral itching, burning, and nipple erosion
paget disease
cancer treatment
premenopausal
postmenopausal
her2-neu
tamoxifen and raloxefene
anastrozole
traztuzumab/herceptin
chornic cough, hemoptysis, weight loss, or postobstructive pneumonia in smoker, , radon, or asbestos
lung cancer
shouder pain, miosis, ptosis, anhidrosis and lower brachial pexopathy
pancoast syndrome
lung cancer in periphery
adenocarcinoma
lung cancer in central area
squamous cell
paraneoplastic syndromes of lung cancer
CLASH carcinoid -small cell lambert eaton - small cell ACTH - small cell SIADH - small cell hypercalcemia - squamous cell
painless jaundice, palpable gallbladder, migratory thrombophlebitis, venous thrombosis, b symptoms, abdominal and lumbar back pain, DM new onset
pancreatic cancer, whipple
admonimal pain with transamonitis and increase bilirubin
hepatocellular cancer
flushing, abdominal pain, diarrhea, and new tricuspid regurgitation
carcinoid tumors (increased seritonin or chromogrann A), give octreotide
hypoglycemia that is recurrent with relief on glucose adminsitration
insulinoma
profuse watery diarrhea that causes hypokalemia
VIPoma
persistent hyperglycemia with necrolytic erythema
glucagonoma
gross painless hematuria
bladder cancer
urinary frequency, anemia, hematuria, low back pain
prostate cancer
testicular cancer difference between seminoma and nonseminoma
seminoma has a normal a-fetoprotein, nonseminoma has increased alphfetoprotein
heamturia, flank pain, mass, b symptoms, paraneoplastic effects (erythrocytosis, hypercalcemia)
renal cell carcinoma
vegf tyrosine kinase inhibitors pazopanib
nivolumab, atezolizumab
rapamycin inhibitor everolimus
menorrhagia, postcoital bleeding, pelvic pain, vaginal discharge
cervical cancer
progressive headache or focal neurologic deficit, spacsitc paresis, urinary incontinence, seizure
meningioma, resection
headache, wakes patient form sleep, vomiting, worse with valsalva, butterfly lesion
glioblastoma multiforme, resection
ca125
ovarian cancer
ca15-3
breast
ca19-9
pancrestic
CEA
GI cancer, colon
AFP
liver, yolk sac (testicular) cancer
hCG
choriocarcinoma
PSA
prostate cancer
LDH
lymphoma
calcitonin
medullary thyroid cancer
chromogranin A
carcinoid
b2 microglobulain
multiple myeloma
drug causes dilated cardiomyopathy
doxorubicin
drug causes renal and ostotoxiciy with neuropath
cisplatin
drug cuases hemorrhagic cystitis
cyclophosphamide
