UWORLD Misc Flashcards
Vitiligo
- macular depigmentation around acral and peri-orificial areas
- autoimmune destruction of melanocytes
- few pts remit
leprosy lesion
-areas of hypopigmentation with anesthesia
Gram negative rod nosocomial pneumonia
- Pseudomonas!
- 4th generation cephalosporin (e.g. cefepime) or Pip-Tazo
- Ceftriazone NOT effective
Molluscum contagiosum
- single or multiple round, dome shaped papules with central umbilication
- caused by poxvirus
- children: trunk and extremities
- adults: STI
- AIDS: disseminated, including face. diff to treat (CD4< 100)
- Tx: curettage or liquid nitrogen
Lichen Planus
- inflammatory (autoimmune?) condition
- pruritic, violaceous, flat papules with fine white streaks
- Tx: retinoids, steroids
Dermatitis herpetiformis
- uncommon disease with pruritus, papules, and vesicles over elbows, knees, buttocks, posterior neck, scalp
- Associated with HLA B8, DR3, DQw2
- associated with Celiac
Pneumoconiosis
- occupational restrictive (normal or high FEV1/FVC with low VC) lung disease
- Can have pleural calcifications (asbestos)
- Decreased DLCO (ILD)
Labs B12/Folate deficiency
- Both are involved in conversion of homocysteine to methionine. So deficiency will result in elevated homocysteine
- B12, unlike folate, converts methylmalonyl-CoA to Succinyl-CoA. So in B12 deficiency MMA will be elevated (normal in folate)
Alpha-fetoprotein
elevated in testicular germ cell tumors, HCCs, other cancer
Vanillylmandelic acid
elevated in urine of pts with Pheochromocytomas
Ferritin levels
increased in iron deficiency anemia and elevated in hemochromatosis, sideroblastic anemia, and acute inflammatory states
Tx aortic dissection
- BBs (labetolol): want to dec bp and HR, reduce stress on aorta
- Vasodilators can cause reflex tachycardia, used if refractory to BBs
Nifedipine
- anti-HTN
- vasodilator
Hydralizine
- anti-HTN
- vasodilator
AVF (causes, signs)
- Congenital: PDA, angiomas, pulmonary AVF, CNS AVF
- Acquired: Trauma, Iatrogenic (e.g. femoral cath), atherosclerosis (e.g aortacaval fistula), cancer
- Signs: widened pulse pressure, brisk carotid upstroke, systolic flow murmur, tachycardia, flushed extremities
- Can develop LVH and HF (due to increased preload). CO is HIGH (high-output Cardiac failure).
Causes of high-output cardiac failure
- AVF
- Thyrotoxicosis
- Paget disease
- Anemia
- Thiamine deficiency
cyclophosphamide (MoA, use, SEs)
- alkylating agent used as immunosuppressant
- in SLE, reserved for pts with renal/neuro involvement
- SEs: hemorrhagic cystitis, bladder carcinoma, sterility, myelosuppression.
Drugs causing cochlear dysfunction
cisplantin, carboplatin (testicular, ovarian, bladder cancer)
Aminoglycosides
drugs causing optic neuritis
ethambutol (TB), hydroxychloroquine (antimalarial, SLE, RA, etc)
drugs causing digital vasospasm (Raynaud’s)
BBs and ergotamine
Drugs causing thyroid dysfunction
amiodarone and lithium
PE findings consolidation of lung
dullness to percussion, bronchial breath sounds (as long as airways are patent). Egophany
PE findings pleural effusion
decrease in chest wally movement, dullness to percussion, decreased breath sounds. Can have Egophany
PE findings pneumothorax
hyper-resonance on percussion and decreased or absent breath sounds
PE findings emphysema
hyper-resonance bilaterally, vesicular breath sounds which are significantly decreased. May have wheezing
PE findings ILD
resonance on percussion, vesicular breath sounds, fine crackles at end inspiration
Monitoring respiratory function in GBS
bedside VC! If it falls below 15 mL/kg and trending downward is v worrisome for resp failure
Splenic abscess (RFs, presentation, organisms, Dx, Tx)
RF: Infection (e.g. endocarditis) w spread. Hemoglobinopathy (e.g. SCD), Immunosuppression, IVDU, Trauma
- Sx: classic triad: fever, leukocytosis, LUQ pain. Can also have Left pleural effusion, splenomegaly.
- Staph, Strep, Salmonella
- Dx: Abd CT
- Tx: broad-spectrum Abs, splenectomy. Percutaneous drainage in poor candidates.
Presentation Pulm embolism
- Dyspnea, tachypnea, normal lung exam, right axis deviation
- Ct angio
- Perfusion defect on V-P scan
Contraindications CT angio
contrast allergy, renal insufficiency
Cryoprecipitate
used to replete fibrinogen
RBC transfusion indications
-previously health pt: Hg <10
TTP-HUS
Sx: pentad of neuro, renal, fever, thrombocytopenia, MAHA
- pathogen: autoAbs or deficiency in ADAMTS13 –> vWF aggregates and PLT destruction
- path: schistocytes on smere
- Tx: plasma exchange to remove Abs/replete ADAMTS13
Herpangina
- kids. Vesicles on tonsils/soft palate.
- Sore throat, fever, pain w swallowing
- Coxsackie A virus
Diphtheria
- acute respiratory illness causing pseudomembranous pharyngitis
- low-grade fever, unilateral nasal discharge, pharyngitis, cervical lymphadenopathy
- Tx: maintain airway, Abs to prevent transmission
Type 2 RTA
- Proximal
- Urine pH can be s syndrome, amyloidosis, multiple myeloma, Paroxysmal nocturnal hemoglobinuria, Toxins (HAART, Ifosfamide, lead, cadmium)
Kawasaki disease
Vasculitis of medium-sized arteries
- Young children
- Conjunctivitis, fever, lymphadenopathy, rash, erythema of lips/tongue/palate, peripheral edema.
- Coronary Artery aneurysms
- Tx: IVIG, SAS, c
B12 deficiency (Sx, RFs)
- Anemia w neuro deficits
- strict vegans (stores last 3-4 yrs)
Folate deficiency (Sx, RFs
- Anemia (alone, no neuro .. contrast B12)
- “Tea and Toast” diet – all cooked foods (heat-sensitive)
- Stores last 4-5 months
Vitamin C deficiency
Scurvy: perifollicular hemorrhage, swollen gums, poor wound healing
Vitamin D deficiency
-Osteomalacia and hypocalcemic tetany
Vitamin E deficiency
-RBC fragility, hyporeflexia, blindness
Thyroid hormone resistance
- Rare AD mutx to T3/T4 Receptor
- Elevated T3/T4 with signs of hypothyroidism
Graves
- Autoimmune d/o with stimulating Abs to TSH R
- TSH suppressed
Hashimoto thyroiditis
- chronic autoimmune thyroiditis
- Thyroid peroxidase Abs –> transient hyperthyroidism due to inflammatory destruction of follicles.
- TSH suppressed
Thyroidin pregnancy
- nml pregnancy –> upregulation of thyroid production due to stimulation of TSHRs by hCG
- feedback intact, so TSH will be suppressed
hypercoag vs hypocoag skin
- hypocoag: bruising/hemorrhage
- Hypercoag: necrosis
Heterophile antibody test
-EBV test
Primary HIV vs mononucleosis
- rash, diarrhea more common with HIV
- tonsillar exudates more common in mono
