Some mnomonics from FA and review of UW:

Mnemonics
Management of A-Fib
Anticoagulate
B-blockers
Cardiovert/CCBs
Digoxin
Acute CHF Management
Lasix
Morphine
Nitrates
Oxygen
Position (upright)
Immediate tx for MI
Morphine
Oxygen
Nitroglycerine
Aspirin
Indications for CABG
Unable to perform PCI (diffuse dx)
Left main coronary A dx
Triple-vessel dx
Depressed ventricular func'n
Tx for HTN
ACEIs/ARBs (best for diabetics)
B-blockers (avoid if depression and beware in diabetics)
CCBs (best if hx of headaches)
Diuretics (rst-line)
Causes of 2ndary Htn
Cushing's syndrome and CAH
Hyperaldosteronism (Conn's Syndrome) - hypokalemic
Aortic coarctation (BP of UE> LE)
Pheochromocytoma (episodic, ushing, palpitations)
Stenosis of renal arteries (+bruits)
OCPs
Causes of Pericarditis
CARDIAC RIND
Collagen vascular dx
Aortic dissection
Radiation
Drugs
Infections
Acute renal failure
Cardiac (MI)
Rheumatic fever
Injury
Neoplasms
Dressler's syndrome
DDx for Pleuritic Chest Pain
PE, Pneumonia, Pericarditis, Pneumothorax, Pleuritis
Beck's Triad for Cardiac Tamponade
JVD, Hypotension, Distant heart sounds
Virchow's Triad
Hemostasis, endothelial damage, hypercoagulability
Acute Ischemia
Pain
Pallor
Paralysis
Pulselessness
Paresthesias
Poikilothermia
Drugs that cause Stevens-Johnson Synd
Penicillin, Sulfa, Allopurinol, Rifampin, Lamotrigine
Lichen planus
Planar, Purple, Pruritic, Persistent, Pokygonal, Penile, Perioral, Puzzling,
Koebner's Phenomenon
Melanoma
Asymmetric, irreg Borders, irreg Color, Diameter >6 mm, Evolution
Thyroid Neoplasms
the most Popular is Papillary
Papillae (branching), Palpable LNs, "Pupil" (orphan annie) nuclei,
Psammoma bodies, Positive prognosis
Pheochromocytoma rule of 10s
10% extra-adrenal
10% bilateral
10% malignant
10% in children
10% familial
Adrenal crisis management
Saline 0.9%
Steroids (IV hydrocortisone 100 mg q 8h)
Support
Search for underlying dx
Pheochromocytoma
Pressure (episodic high BP), Pain (h/a), Perspiration, Palpitations, Pallor
MEN-1
Pancreas (gastrinomas, insulinomas, VIPomas), Pituitary adenoma,
Parathyroid hyperplasia
MEN-2A
Medullary ca of thyroid, Pheochromocytoma, Parathyroid Hyperplasia
MEN-2B
Medullary ca, Pheochromocytoma, mucosal neuromas, marnoid habitus
Pellagra
Diarrhea, Dementia, Dermatitis, Death
Charcot's Triad
RUQ pain, Jaundice, Fever/chills
Reynold's Pentad
RUQ pain, Jaundice, Fever/chills, Shock, Alt mental status; present in
suppurative cholangitis, suggests sepsis
Thrombocytopenia DDx
HIT SHOC
HIT or HUS
ITP
TTP or treatment
Splenomegaly
Hereditary (ie: Wiskott-Aldrich)
Other (ie: malignancy)
Chemotherapy
TB Tx
Rifampin, INH (+B6), Pyrazinamide, Ethambutol
Zidovudine AE
anemia
Protease Inhibitors AE
hyperglycemia, hyperlipidemia
Stavudine, Didanosine AE
peripheral neuropathy
Indinavir AE
nephrolithiasis
Lamivudine AE
NONE
Ganciclovir
Leukopenia
Foscarnet
nephrotoxicity
The Major Pathogens Concerning Complete T-cell Collapse
Toxoplasma gondii, MAC, PCP, Candida albicans, Cryptococcus
neoformans, TB, CMV, Cryptosporidium parvum
UTI Bugs
SEEKS PP
Serratia, E coli, Enterobacter, Klebsiella pneumoniae, Staph saprophyticus,
Pseudomonas, Proteus mirabilis
Fever & Rash
Tiny GERMS
Typhoid fever, Gonococcemia, Endocarditis, RMSF, Sepsis
Endocarditis
JR = NO FAME
Janeway lesions (painless), Roth's spots, Splinter hemorrhage, Osler's
nodes (painful), Fever, Anemia, Emboli
CREST Syndrome
Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodaxtyly,
Telangiectasias
SLE Criteria
DOPAMINE RASH
Discoid rash, Oral ulcers, Photosensitivity, Arthritis (non-erosive), Malar
rash, Immunologic, Neurologic (cerebritis, seizures), Elevated ESR, Renal
dx, ANA+, Serositis, Hemolytic anemia
Pediatric Limp DDx
STARTSS HOTT
Septic joint, tumor, avascular necrosis (Legg-Calve-Perthes), RA/JIA, TB,
Sickle cell dx, SCFE (obese pt), HSP, Osteomyelitis, Trauma, Toxic
synovitis
Posterior Circulation Strokes
Diplopia, Dizziness, Dysphagia, Dysarthria
MCA Stroke
Contralateral paresis and sensory loss in face and arm
Homonymous hemianopsia
Aphasia (dominant)
Neglect (non-dominant)
Gaze preference toward side of lesion
Contraindications to tPA
SAMPLE STAGES
Stroke or head trauma w/in last 3mo, Anticoag (INR > 1.7 or prolonged
PTT), MI recently, Prior intracranial hem, Low platelets, Elevate BP
(>185/110), Surgery <2wks ago, TIA, Age <18, GI or urinary bleed in last 3
wks, Elevated or low glucose, Seizures at onset of stroke
Conditions a/w Berry aneurysms that can MAKE SAH more likely
Marfan's syndrome, Aortic coarctation, Kidney dx (ADPKD), Ehlers-Danlos,
Sickle cell anemia, Atherosclerosis, Hx (familial)
Etiology of Seizures
VITAMINS
Vascular, Infection, Trauma, Autoimmune, Metabolic (hyponatremia,
hypomagnesemia, hypoglycemia, hypoxia, drug OD/WD), Idiopathic
(epilepsy), Neoplasm, pSychiatric
BPPV
Benign otolith, Paroxysmal <1 min, Positional, Vertigo
Symptomatic therapy for MS
Baclofen (spasticity), Oxybutinin (hyperactive bladder), Bethanechol
(urinary retention), Fluoxetine (fatigue/depression), Sildenal (ED)
Dementia DDX
neuroDegenerative dx, Endocrine (hypothyroid), Metabolic, Exogenous,
Neoplasm, Trauma, Infection (encephalitis, syphillis), Affective disorders,
Stroke/Structural
Normal Pressure Hydrocephalus
Wet (incontinence), Wacky (dementia), Wobbly (apraxia)
Parkinson's dx
4 PaRTS
Postural instability, Rigidity (cogwheel), Tremor (pill rolling), Slowed mov't
(bradykinesia)
Vaccines NOT safe in Pregnancy
MMR, Polio, Yellow fever, Varicella
(if not immunized against Rubella, give vaccine AFTER delivery)
TORCHeS
Toxoplasmosis, Other (parvovirus, VZV, Listeria, TB, malaria, fungi),
Rubella, CMV, HSV, HIV, Syphilis
BPP
Test the Baby, MAN!
fetal Tone, Breathing, Mov't, Amniotic uid volume, NST
Preeclampsia
HyPE
Htn, Proteinuria, Edema
HELLP Syndrome
Hemolysis, Elevated LFTs, Low Platelets (<100,000) - increased risk of
abruptio placenta
Ectopic pregnancy
Pain, Amenorrhea, Vaginal bleeding, Ectopic
Postpartum Fever Day 0
Wind
atelectasis, pneumonia
+ve rales, s/p C-section
Postpartum Fever Day 1-2
Water
UTI
+ve fever, CVAT, UA & CS, catheters
Postpartum Fever Day 2-3
Womb
Endomyonetritis
early ROM/labor, emergency C-S
Postpartum Fever Day 4-5
Wound
cellulitis, abscess if incision or episiotomy
Postpartum Fever Day 5-6
Walk
DVT, PE
Postpartum Fever Day 7+
Weaning (breast engorgement, abscess, mastitis)
Wonder drugs
Severe PCOS
HAIR-AN Syndrome
HyperAndrogenism, Insulin Resistence, Acanthosis Nigricans
Acute Pelvic Pain DDx
A ROPE
Appendicitis, Ruptured ovarian cyst, PID, Ectopic pregnancy
Causes of Urinary Incontinence
DIAPPERS
Delirium/confused state, Infection, Atrophic urethritis/vaginitis,
Pharmaceutical, Psychiatric, Excessive output (hyperglycemia,
hypercalcemia, CHF), Restricted mobility, Stool impaction
Cyanotic heart defects
Truncus arteriosus (1 arterial vessel overriding ventricles), Transposition of
great vessels (2 arteries switched), TRIcuspid atresia, TETRAlogy of Fallot,
Total anomalous pulmonary venous return
Non-cyanotic heart defects
VSD, ASD, PDA
DiGeorge Syndrome
CATCH 22
Cardiac (transposition), Abnormal facies, Thymic aplasia, Cleft palate,
Hypocalcemia, 22q11 deletion
Tetralogy of Fallot
PROVe
Pulmonary stenosis, RVH, Overriding aorta, VSD
Meckel's Diverticulum
under 2yo, 2x more common in males, 2 types of tissue, 2" long, w/in 2' of
ileocecal valve, 2% of population
Kawasaki Dx
CRASH and BURN
Conjunctivitis, Rash, Adenopathy (unilateral), Strawberry tongue, Hands
and feet (red, swollen, aky), BURN (fever >104 for 5+ days)
APGAR
Appearance (blue/pale, pink trunk, all pink)
Pulse (0, <100, >100)
Grimace with stimulation (0, grimace, +cough)
Activity (limp, some, active)
Respiratory effort (0, irregular, regular)
Sx of Depressive Episode
SIG E CAPS
Sleep, loss of Interest, Guilt, Energy low/fatigue, low Concentration,
Appetite changes, Psychomotor agitation/retardation, Suicidal ideation
TCA toxicity
Convulsions, Coma, Cardiac arrhythmias
Causes of Delirium
I WATCH DEATH
Infection, Withdrawal, Acute metabolic/substance abuse, Trauma, CNS
pathology, Hypoxia, Deciencies, Endocrine, Acute vascular/MI, Toxins/
drugs, Heavy metals
Sx of Mania
DIG FAST
Distractibility, Insomnia, Grandiosity, Flight of ideas, Activities/Psychomotor
agitation, Sexual indeiscretions, Talkativeness/pressured speech
Characteristics of Personality Disorders
MEDIC
Maladaptive, Enduring, Deviate from cultural norms, Inexible, Cause
impairment in social/occupational functioning
Evolution of EPS
4 hrs: Acute dystonia
4 days: Akinesia
4 weeks: Akathisia
4 months: Tardive dyskinesia
Risk for Suicide
SAD PERSONS
Sex (male), Age, Depressed, Previous attempt, Ethanol/substance abuse,
Rational thought, Sickness, Organized plan, No spouse, lack Social
support
Obstructive Pulmonary Dx
Asthma, Bronchiectasis, CF, COPD, Tracheal or bronchial obstruction
Asthma Exacerbation Tx
Albuterol
Steroids
Theophylline (rare)
Humidied O2
Magnesium (severe)
Anticholinergics (better for COPD)
COPD Tx
Corticosteroids
Oxygen
Prevention (stop smoking)
Dilators (b-agonists, anticholinergics)
Restrictive Lung Dx
If the lungs AIN'T compliant...
Alveolar (edema, hemorrhage, pus)
Interstitial lung dx, Inammatory, Idiopathic
Neuromuscular (myasthenia, phrenic palsy, myopathy)
Thoracic wall (kyphoscoliosis, obesity, ascites, pregnancy, ankylosing
spondylitis)
Features of Sarcoidosis
GRUELING
Granulomas, aRthritis, Uveitis, Erythema nodosum, Lymphadenopathy,
Interstitial brosis, Neg TB test, Gammaglobulinemia
ARDS
Acute onset
Ratio PaO2/FiO2 <200
Diffuse inltration
Swan-Ganz wedge pressure <18 mmHg
Sx of Pneumothorax
Pleuritic pain
Tracheal deviation away from lesion
Hyperresonance
Onset sudden
Reduced breath sounds & dyspnea
Absent fremitus
Xray shows collapse
Causes of Hypernatremia
Diuresis, Dehydration, Diabetes insipidus, Docs (iatrogenic), Diarrhea,
Disease (ie: kidney, sickle cell)
Hyperkalemia Tx
C BIG K
Calcium, Bicarbonate/B-agonists, Insulin, Glucose, Kayexalate
Causes of hypercalcemia
CHIMPANZEES
Ca supplements, Hyperparathyroid/Hyperthyroidism, Iatrogenic (ie:
thiazides, TPN)/Immobility, Milk-alkali syndrome, Paget's dx, Adrenal
insufciency/Acromegaly, Neoplasm, ZE syndrom (MEN-1), Excess Vit A,
Excess Vit D, Sarcoidosis
Anion Gap Metabolic Acidosis
Methanol (tx: ethanol)
Uremia (tx: dialysis)
DKA (tx: insulin, IVF)
Paraldehyde/Phenformin
INH/Iron (tx: Charcoal/GI lavage)
Lactic acidosis
Ethylene glycol (tx: Fomepizole)
Salicylates (tx: alkalinize urine)
Indications for Urgent Dialysis
Acidosis
Electrolyte abnormalities (hyperK)
Ingestions (salicylates, theophylline, methanol, barbiturates, lithium,
ethylene glycol)
Overload (uid)
Uremic sx (pericarditis, encephalopathy, bleeding, nausea, pruritis,
myoclonus)
Sx of Nephritic Syndrome
PHAROH
Proteinuria, Hematuria, Azotemia, RBC casts, Oliguria, Hypertension
Hematuria DDx
I PEE RBCS
Infection, PKD, Execise, External trauma, Renal glomerular dx, BPH,
Cancer, Stones
Possible causes of Pulseless Electrical Activity
Hypovolemia, Hypoxia, H+ (acidosis), Hyper/Hypo-K, Hypothermia, Tablets
(OD), Tamponade, Tension PTX, Thrombosis (coronary & PE)
Body Surface Area
Head 9%
Arms 9% each
Chest 18%
Back 18%
Legs 18% each
Perineum 1%
Postop Fever
Wind: atelectasis, pneumonia
Water: UTI
Wounds: infection, abscess
Walking: DVT
Wonder drugs: drug rxn
Womb: endometritis
306 terms
T wave inversion differential
MI, myocarditis, old pericarditis, myocardial contusion, digitalis toxicity
Muddy brown granular casts
Acute tubular necrosis (see QID 3955)
RBC casts
Glomerulonephritis
WBC casts
Interstitial nephritis and pyleonephritis
Fatty casts
nephrotic syndrome
Braoad and waxy casts
chronic renal failure
Boy with gout
Lesh Nyhan syndrome (HPRT deciency)
PAS positive macrophages on intestinal biopsy (diarrhea, arthritis,
lymphadenopathy)
Whipple disease
double bubble sign on abdominal x-ray
Duodenal atresia, a/w Down syndrome
male infant with recurrent otitis media and pneumonia around 6 months of
age with reduced Igs and B-cells
Brutons agammaglobulinemia
dullness to percussion, egophony and bronchial (INCREASED) breath
sounds, INCREASED tactile fremitus
consolidation
dullness to percussion and DECREASED breath sounds
pleural effusion
medical treatment for HPV anal warts
Podophyllin (topical antimitotic)
OCD neurotransmitter and Rx
serotonin--> SSRIs
workup for suspected liver cancer
AFP, CT/MRI, then biopsy
hypertrophic cardiomyopathy pathophysiology
hypertrophied ventricular septum obstructs left outow tract
mitral stenosis murmur
disastolic rumble at apex and/or opening snap
anascara
generalized edema (pulmonary, ascites, peripheral)
type 1 vs. type 2 Mobitz
Type 1 PR interval increases then a beat is dropped, in type 2, no change
in the PR interval before a beat is dropped
diffuse ST elevation with PR depression
acute pericarditis
12 causes of pulseless electrical activity
6Hs: hypovolemia, hypoxia, hydrogen ions (acidosis), hypothermia,
hypoglycemia, hypo/hyperkalemia; 6Ts: tamponade, tension
pneumothorax, thrombosis (MI, PE), trauma, tablets, toxins.
high output heart failure signs/symptoms
wide pulse pressure, brisk carotid upstroke, tachycardia, LVH. Basically,
preload is increased by connection b/w arteries and veins.
high output heart failure differential
congenital vs. aquired arteriovenous stula (ie: PDA, angiomas, pulmonary
or CNS AVF, trauma to arteries, athrosclelrotic stula, etc.) ("wet" beri beri
(thiamine deciency), Paget disease, thyrotoxicosis, and anemia also)
Prinzmetal's angina Rx considerations
treat with nitrites or Ca channel blockers to vasodialate. Do NOT use B-
blockers or aspirin which may cause vasospasm
mitral regurgitation murmur
pansystolic murmur, loudest at the apex with radiation to the axilla
ventricular septal rupture murmur
pansystolic murmur, loudest at the left sternal border, often with an
accompanying thrill, unlikely to radiate to axilla
which drug to treat MI are contraindicated in cocaine related MI/angina?
B-blockers (will aggrevate cocaine induced vasospasm)
BNP >100 suggests
CHF (BNP is secreted in response to ventricular stretch and wall tension,
I.e. volume overload)
how and when do you treat PVCs
only treat if symptomatic, B-blockers are 1st line, Amiodarone 2nd line
presentation of myocarditis in children
u like illness --> heart failure and respiratory distress from CHF
normal changes of heart with aging
decreased CO, decreased max HR, slower contraction and relaxation of
the muscle, decreased diastolic compliance, decreased baroreceptor
responsiveness, pigment accumulation
positive hepatojugular reex in setting of edema
suggests cardiac etiology of edema
chest pain that radiates to back with normal EKG
dissection
which new heart sound is classic for an acute MI?
S4 from diastolic dysfunction and a consequently stiffened left ventricle
what is the inheritence of hypertrophic cardiomyopathy?
autosomal dominant
what is the classic murmur a/w hypertrophic cardiomyopathy?
systolic ejection murmur along left sternal border that decreases with
squatting (incerased preload distends the obstructed outow tract)
digoxin toxicity symptoms
nausea, vomiting, diarrhea, vision changes, arrythmias
classic cause of diastolic dysfunction and Rx
chronic hypertension. treat with diuretics and BP control
rst line diagnostic tests for aortic dissection
TEE or CT scan
dipyridamole mechanism and utility
coronary artery vasodilation (used as a "coronary steal" mechanism during
non-excersice stress testing to identify ischemia)
electric alterans =
pericardial effusion/cardiac tamponade
rst line Rx for hypertrophic cardiomyopathy
B-blockers or cardioselective Ca channel blockers (diltiazem)
recent URI + distant heart sounds
pericardial effusion
"curtain falling down"
Classically RETINAL DETATCHMENT but also Amarouxis fugax (retinal
emboli from ipsilateral carotid artery)
proptosis, opthalmoplegia, diploplia and fever
orbital cellulitis (bacterial sinusitis most common cause)
progressive bilateral loss of central vision
macular degeneration
progressive bilateral loss of peripheral vision
open angle glaucoma
acute onset eye pain and vision loss
closed angle glaucoma
central retinal artery occlusion presentation
sudden painless unilateral blindness, sluggish pupil, chery red spot on
FOVEA
central retinal vein occlusion presentation
rapid painless vision loss of variable severity. A/w HTN. SWOLLEN OPTIC
DISC
yellow-white opacications and retinal hemmorhages in AIDS patient with
CD4 count <50
CMV retinitis
dacrocystitis
infection of the lacrimal sac of the eye (p/w unilateral redness and pus from
medial corner of eye) usually due to Staph or Strep
straight lines appear "wavy" on eye exam
macular degeneration
most common cause of blindness in developed world
macular degeneration
who are most commonly affected by viterous hemmorhage?
diabetics with diabetic retinopathy
main causes of death from burns
#1: hypovolemic shock; #2: sepsis
Graft vs. host disease mechanism
donor T-cell activation against host HLA antigens. CELL mediated immune
response
what is a cystic hygroma
a lymphangioma: dialated lymphatic spaces lined by epithelium that usually
appear on the neck. Compressible and transilluminate
what is an acrochordon
a skin tag
what is the best way to protect yourself against melanoma?
protective clothing
Staph Scalded Skin Syndrome
seen mostly in kids. Caused by an exfoliative toxin which targets
desmoglein 1 (similar to pemphigus vulgaris). Large blisters, positive
Nikolsy sign, fever, generalized rash
what type of hypersensitivity is caused by poison ivy?
contact dermatitis, a type IV hypersensitivity, which is CELL mediated (prior
exposure required)
Type 1 hypersensitivity reaction, mechanism and examples
Antigen cross-links IgE on presensitized mast cells. Antibody mediated.
Anaphylaxis, urticarial drug reactions (a new rash in the hospital).
Type 2 hypersensitivity reaction, mechanism and examples
IgM and IgG bind to antigen on "enemy cell" leading to MAC. Cy-2-toxic.
Autoimmune hemolytic anemia, erythroblastalis fetalis, Goodpasture
syndrome, rheumatic fever
Type 3 hypersensitivity reaction, mechanism and examples
Immune complex (3 things stuck together). Examples include many of the
glomerulopathies and vasculitities.... Most things rheumatological: SLE,
RA, Polyarteritis nodosa, etc. Also includes SERUM sickness (drug
reaction) and ARTHUS reaction (post vaccine)
Type 4 hypersensitivity reaction, mechanism and examples
Sensitized T lymphocytes... cell mediated (not transferrable by serum).
POISON IVY, contact dermatitis, transplant rejection, TB skin tests
Raised sharply demarcated advancing margins on cheek, raised borders...
sounds a little bit like cellulitis... sometimes following pharyngitis or minor
trauma
Eryspielas, a Group A Strep infection (usually)
Toxic Epidermal Necrolysis vs. Steven Johnson
>30% vs. <10% skin involvement respectively
pink or brown scaly plaque with central clearing followed by a
maculopapular rash along skin tension lines
Pityriasis rosea
which vitamin can help in the treatment of measles?
Vitamin A (for ALL better now)
malabsorbtion plus papulovesicular rash on extensor surfaces
dermatitis herpetiformis
scabies presentation and treatment
pruritic papules over penis/breasts. Treat with 5% permethrin cream
overnight
tinea versicolor
areas of body does not tan, spagetthi and meatball appearance on KOH,
treat with antifungal creams/shampoo
vittiligo
areas of complete depigmentation (like Sanja) usually around mouth
caused by autoimmune destruction of melanocytes
tinea corporis
ring worm. Advancing ring shaped lesions with scaly border and central
clearing
which drug can precipitate acute renal failure in patients with bilateral renal
artery stenosis?
ACE inhibitors
in a patient with decient C1 esterase inhibitor which products build up to
cause angioedema?
C2b and bradykinin
"lizard skin" that gets worse in winter
Ichyosis vulgaris
eczema herpeticum
a complication of atopic dermatitis where there is a HSV infection (vesicles)
overlying previous areas of atopic dermatitis. CAN BE LIFE
THREATENING. START ACYCLOVIR!!!
xanthelesma (what is it and what disease is it associated with)
cholesterol lled yellow plaques that appear in the corner of the eye. Can
be idiopathic but are also associated with PRIMARY BILIARY CIRRHOSIS
(anti-mithochondrial antibodies)
lesions on palms and soles differential and Rx
1) secondary syphilis: non-pruritic, symmetric, STD, BEGINS ON TRUNK
and spreads to palms and soles, generalized LYMPHADENOPATHY--treat
with Penicillin
2) Rocky Mountain Spotted Fever: HEADACHE, fever, rash starts on
WRISTS--treat with doxycycline (or chloramphenicol for pregnant women)
3) Hand Foot and Mouth disease: coxsackie A virus, in children, involves
oral mucosa--supportive care only.
4) Kawasaki disease: young asian children, prolonged HIGH fever,
CONJUNCTIVITIS, strawberry tounge, UNILATERAL lymphadenopathy,
desquimation of ngertips, hepatitis, arthralgias;
5) Bacterial endocarditis
6) disseminated N. gonorrhea (painful pustules and joint pain)
treatment for dermatitis herpetiformis
gluten free diet and DAPSONE
phototoxic drug eruption in teen with acne would be caused by which drug?
doxycycline
porphyria cutanea tarda presentation
painless blisters and increased skin fragility of back of hands and facial
hyperpigmentation and hypertrcihosis. Can be precipitated by estrogen and
alcohol and is often associated with Hep C
herpetic whitlow
HSV 1 or 2 infection of the hand/nger. Self limited. P/w throbbing pain in
nger with vesicles
chalazion
a chronic granulomatous lesion of the eye lid due to obstruction of the
meibomian gland. Initially painfull swelling progresses to painless, rubbery,
nodular lesion. If recurrent, biopsy is required to rule out malignancy
(meibomian sebaceous carcinoma vs. basal cell carcinoma)
Henoch Schonlein Purpura tetrad
1) lower extremity purpura 2) abdominal pain 3) renal disease 4) arthritis/
arthralgias (HSP is the most common form of systemic vasculitis in
children)
pain bullas and skin necrosis over breast, buttocks and thighs in a patient
recently diagnosed with Ab
Warfarin induced skin necrosis
Rosacea: presentation and Rx
telangectasias and redness/ushing of face, especially with hot drinks or
emotions. Treat with topical antibiotics (metronidazole)
Paget's disease Rx
if asymptomatic with minor elevations in Alk Phos and no involvement of
weight bearing bones, NO treatment. If symptomatic, treat with
bisphosphonates.
untreated hyperthyroidism can cause (2)
1) rapid bone loss; 2) arrythmias
what is the most common form of congenital adrenal hyperplasia and how
does it present?
21-hydroxylase deciency (increased ACTH, +/- salt wastig,
hyperandrogenism (virilization)
androgen producing adrenal tumors will show an elevation in the serum
levels of?
DHEA-S
Hypokalemia, alkalosis and normotension differential (4)
1) Surreptitious vomiting 2) Diuretic abuse 3) Gittleman syndrome (like
thiazide abuse) 4) Barter syndrome (like loop diuretic abuse)
chloride sensitive vs. chloride resistant metabolic alkalosis
chloride sensitive: (Urine Cl <20) basically due to volume contraction
(diuretics or vomiting); chloride resistant: (Urine Cl >20) basically due to
volume expansion (hyperaldo, Gittleman, Bartter)
which metabolic abnormality can cause refractory hypokalemia?
hypomagnesemia
which meds cause hyperkalemia? (7)
1) **ACEi, ARBs and spironolactone 2) Propranolol 3) Digitalis 4)
*Succinylcholine 5) NSAIDs 6) Heparin 7) **Trimethoprim (TMP-SMX)
what percentage of results lie within 1, 2 and 3 standard deviations of the
mean?
1 standard deviation=68%
2 standard deviations=95%
3 standard deviations=99.7%
mean, median, mode denitions
mean=the average number
median=the middle number
mode=the most common number
in a normal distribution they are all equal!
which live vaccine can be given to HIV patients?
MMR can be given to HIV patients with a CD4 count >200 who do not have
an AIDS dening illness.
what drugs can cause pancreatitis (6)
1. Anti-seizure drugs (Valproic acid)
2. Diuretics
3. Inammatory Bowel drugs (sulfasalazine, 5-ASA)
4. Immunosupressants (azathioprine, L-asparginase)
5. HAART drugs (didanosine, pentamidine)
6. Antibiotics (metronidazole, tetracycline)
(these drugs cause a jIIHAAD on the pancreas)
Another (descriptive) name for Reyes syndrome
Fatty liver encephalopathy, associated with Aspirin use in children <15
"Balloon degeneration with polymorphic cellular inltrates" in liver
acute alcoholic hepatitis
"Panlobular mononuclear inltration with hepatocyte necrosis and bridging
necrosis" in liver
acute viral hepatitis
"Portal necrosis +/- bridging brosis" in liver
chronic active hepatitis
"inammatory destruction of small intrahepatic biliary ducts"
primary biliary cirrhosis
"macrovesicular steatosis with PMN inltrates and necrosis" in liver
alcoholic or non-alcoholic steatohepatitis (fatty liver)
how do chronic Hep B and Hep C differ in their symptomatic
manifestations?
HepC classically presents with waxing and waning transaminase levels, but
few symptoms. Patients may complain of arthralgias or myalgias.
Extrahepatic sequela are cryoglobulinemia, Porphyria cutanea tarda and
glomerulonephritis.
HepB are less likely to have the above sxs.
what annual preventative screening should be done in ulcerative colitis
patients?
colonoscopy to detect colon cancer beginning 8-10 years after diagnosis.
pregnant female with pruritus +/- jaundice and elevated bile acids and liver
enzymes in the third trimester
Intrahepatic cholestasis of pregnancy
acute fatty liver of pregnancy
often asymptomatic, but may have nausea, malaise, headache abdominal
pain. 50% also have PREECLAMPSIA and 60% will develop acute RENAL
FAILURE. Biopsy will show microvesicular fat deposition in hepatocytes,
but NO NECROSIS. Labs can show elevated PT and LFTs
what are the most common complications of MUMPS?
orchitis
aseptic meningitis
encephalitis
pancreatitis
rare: myocarditis, arthritis
what is the treatment for Lyme disease in adults and children
Doxycycline for adults. Amoxicillin in pts. <8 and in pregnant and lactating
women
boy with frequent nosebleeds and a mass in the nose and bony erosions
has:
angiobroma -> needs specialist evaluation and possibly surgery.... can be
deeply invasive because it is unencapsulated
Hemolytic Uremic Syndrome causes this kind of hemolysis
microangiopathic hemolytic anemia (schiztocytes and giant platelets....
looks like DIC)
anisocytosis
high RDW (different cell sizes)
neurological sxs + anemia + renal sxs.
lead poisoning
elevated leukocyte alkaline phosphatase score in setting of extreme WBC
elevation
Leukemoid reaction
HIV medication which causes PANCREATITIS
DIDANOSINE (an RTI)
HIV medication which causes life threatening hypersensitivity reaction
ABACAVIR (an NRTI)
HIV medication class which causes LACTIC ACIDOSIS
NRTIs
HIV medication class which causes Stevens-Johnson Syndrome
NNRTIs
HIV medication which causes LIVER FAILURE
NEVIRAPINE (an NNRTI)
HIV medication which causes CRYSTAL INDUCED NEPHROPATHY
INDINAVIR (a protease inhibitor)
most common leukemia in kids
ALL (All Little ones)
Multiple Myeloma presentation:
CRAB
Calcium (hyper)
Renal insufciency -> decreased EPO
Anemia
Bone pain/lytic lesions
Prussian blue stain is used to detect
Iron
what drugs can be used to treat the u?
amantadine/rimantadine
neuramidase inhibitors: oseltamivir/zanamivir (tamiu)
neutropenia denition
ANC count of less than 1,500/mm3 (multiply neutrophils + bands in
differential with WBC count). Less than 500 is severe neutropenia
what commonly causes a folate deciency?
1) alcoholism, poor nutrition
2) TMP-SMX, methotrexate
3) anti-seizure medications (phenytoin)
Anterior mediastinal mass differential:
"the 4 Ts"
Thymoma
Teratoma (and other germ cell tumors)
Thyroid cancer
Terrible lymphoma
Serum B-HCG and AFP in Seminoma vs. other germ cell tumor
Seminoma: AFP always normal, B-HCG may be elevated
Other germ cell tumors: both are often elevated
which viruses commonly cause viral meningitis in kids?
echovirus and coxsackievirus
Fanconi anemia
Short stature, ! incidence of tumors/ leukemia, aplastic anemia (genetically
inherited; often progresses to AML)
Due to DNA cross-link repair deciency
Babesiosis
fever and hemolytic anemia in NE US; Ixodes tick; maltese cross on blood
smear; treat with quinine and clindamycin
CMV vs. HSV ulcers in HIV esophagitis
CMV: shallow, large, irregular, linear with intranuclear and intracytoplasmic
inclusions
HSV: small, deep, well circumscribed with intranuclear inclusions
what entity that is not infective endocarditis can give you splinter
hemorrhages?
Trichinellosis. Orbital edema, myositis, eosinophillia (parasitic infection from
uncooked pork)
Rx for bacterial sinusitis
augmentin (amoxicillin + clavulinic acid)
drug for hairy cell leukemia
CLADribine (put clothes on the hair...)
what oral medicine is active against MSSA?
dicloxacillin, cephalexin or clindamycin
new onset DM with joint pain +/- hepatomegaly
hemochromatosis
anemia, renal failure, hypercalcemia in elderly patient
multiple myeloma
these substances can increase the effect of Warfarin
alcohol
vitamin E
garlic
ginko
ginseng
St. John's wort
several antibiotics (by decreasing vit. K absorption)
hyperglycemia, red itchy skin rash, +/- blisters, diarrhea, weight loss, +/-
DVT
glucagonoma
absence of urine erythropoetin
polycythemia vera
thrombocytopenia, prolonged PTT and positive VRDL
anti-phospholipid antibody (SLE), actually prothrombotic state.
cutaneous and visceral nodular angioma-like blood vessel growths in
immunocompromised patient
sounds a bit like Kaposi's but is actually Bartonella (bacillary angiomatosis)
mucormycosis treatment
i.e horrible facial infection seen in diabetics
treat with surgical debriedment and amphotoericin B
post inuenza pneumonia (species)
Staph aureus
Latent TB treatment
Isoniazid + pyridoxine (to prevent neuropathy) for 9 mos.
Check LFTs periodically
dry cough, dyspnea and fever in HIV pt
PCP pneumonia
treat with TMP-SMX
add steroids if PaO2 <70 or Aa gradient >35
empiric antibiotic used for animal bites (and human bites)
Augmentin (amoxicillin/clavulinic acid)
transplant patient with fever, dry cough (atypical pneumonia like ndings)
and diarrhea. Not Legionella
CMV pneumonitis with GI involvement
actinomyces vs. nocardia (location and treatment)
actinomyces: cervicofacial--penicillin G
noocardia: pulmonary/disseminated--TMP-SMX
what infection sounds like TB but isn't
Noocardia
tick bite, fever, HA/N/V, no rash but leukopenia/thrombocytopenia. Dx and
Rx
Dx: Erlichosis.
Rx: Doxycycline
malaria prophylaxis
chloroquine
unless going to India or Africa (chloroquine resistant P. falciparum), when
Meoquine (meyin' to India) is used
Diarrhea in AIDS patient (3)
1) Cryptosporidium: profuse, watery, non bloody. cysts on acid fast staining
of stool. Treat with Nitazoxanide and HAART
2) CMV: bloody diarrhea, negative stool culture, large cells with inclusions
on biopsy. Treat with Ganciclovir or Foscarnet and HAART
3) MAC: non-bloody, major systemic sxs, elevated ALK PHOS and LDH.
Treat with clarithromycin, prevent with azithromycin, and HAART
halo sign on CXR in immunocompromised pt
aspergillosis
Tick bite differential: Lyme vs. Erlichosis vs. Rocky Mountain Spotted Fever
vs. Babesiosis vs. Colorado tick fever vs. Tularemia vs. Q fever
1) Lyme: erythema migricans, arthritis, AV block, Bells Palsy--doxycycline
or Erythromycin if <8 or pregnant
2) Erlichosis: no rash, HA, leukopenia/thrombocytopenia--Doxycycline
3) RMSF: HEADACHE, fever, wrist rash--Doxy or chloramphenicol (if
preggers)
4) Babesiosis: NE United States, fever, hemolysis, jaundice--quinine+clinda
or atovaquone+azithro
5) Colorado tick fever: western US and Canada, just a fever... supportive
care only
6) Tularemia: fever, conjunctivitis, lymphadenopathy, myalgias and ULCER
AT SITE OF INNOCULATION. No rash. --supportive care only
7) Q fever: cattle, goats, sheep. u like syndrome, hepatitis or pneumonia
(Q=query for difcult to diagnose). Can rarely become chronic and affect
the heart as culture negative endocarditis--doxycycline
smooth round big cyst with daughter cysts is most likely found in the liver of
a.....
sheep farmer
these cysts can also be called "hytadid cysts" and appear anywhere in the
body.... liver is most common though
Caused by:
--Echinococcus granulosus (a parasite)
A pig farmer contract this parasitic disease:
Neurocysticercosis: A condition characterized by brain cysts resulting from
parasitic infection by the pork tapeworm, T. solium
A midwest HIV positive patient develops fever, weight loss, dry cough,
palatal ulcers and hepatosplenomegaly. CXR shows a cavitary lesion and
hilar lymphadenopathy. Dx and Rx
Histoplasmosis--> Amphotericin B followed by itraconazole
elevated Alk Phos and LDH in AIDS pt with fever and diarrhea
Disseminated MAC
Ring enhancing brain lesion in AIDS pt differential (4)
1) toxoplasmosis: multiple small lesions in basal ganglia (not on TMP-SMX)
-most common CNS lesion in AIDS pts
vs.
2) CNS lymphoma: solitary and periventricular (usually), EBV PCR positive.
3) bacterial abscess... much rarer
4) TB... with positive PPD.... also rare
MAC prophylaxis
Prevent MAC with a MACrolide: azithromycin when CD4 < 50
septic arthritis in sexually active person
N. gonorrhea
painful genital lesion differential and Rx
1) HSV: vesicles, small--Acyclovir
2) Chancroid (H. ducreyi): large, necrotic--Azithromycin or ceftriaxone
non-painful genital lesion differential and Rx
1) HPV: warts, small, itchy--cryotherapy
2) primary syphilis: single lesion, 1cm, regional lymphadenopathy--penicillin
3) Granuloma inguinale (Klebsiella): beefy red ulcer, rolled edge, white
border, granulation tissue, DONOVAN BODIES on biopsy--doxycycline or
azithromycin
Anorexia nervosa complications (7)
1) Osteoporosis *****
2) elevated cholesterol and carotene
3) prolonged QT interval
4) Euthyroid sick syndrome (a/w starvation, severe illness)
5) anovulation, amenorrhea, estrogen deciency
6) hyponatremia
7) Pregnancy: prematurity, small for gestational age
post traumatic CXR with mediastinal deviation to the right, and an opacity
in LLL with decreased breath sounds to match
suspect a ruptured diaphragm with herniation of abdominal content into
thoracic cavity
migratory thrombophlebitis
think about pancreatic cancer
how is prolactin regulated?
secretion from anterior pituitary tonically inhibited by dopamine from
hypothalamus
inhibits own secretion by increasing dopamine synthesis
*dopamine agonists (bromocriptine) inhibit prolactin secretion and can be
used in Tx of prolactinoma; dopamine antagonists (mostly antipsychotics)
and estrogens (OCPs, pregnancy) stimulate prolactin secretion
TRH and Serotonin ! prolactin secretion, i.e. HYPOTHYROIDISM
this type of ovarian tumor secretes estrogen
granulosa cell tumor
this type of ovarian tumor secretes androgens
Sertoli-Leydig cell tumor
condyloma lata vs. condyloma acuminata
condyloma lata: at, velvety lesions caused by secondary syphilis
condyloma acuminata: genital warts
what happens to LH and FSH in PCOS?
there is an increased LH/FSH ratio (>2:1)
what is the use for leuprolide
GnRH analog: synthetic peptide used in pulse therapy to stimulate gonadal
steroid synthesis (infertility); used in continuous or depot therapy to shut off
steroid synthesis, especially in prostate carcinoma, and also in central
precocious puberty.
what is mccune-albright syndrome
MCA: Think PPP
Precocious puberty
Pigmentation (cafe au lait spots, unilateral)
Polyosteotic brous dysplasia (bone defects)
Lab ndings in breast milk jaundice vs. biliary atresia
breast milk jaundice: unconjugated (indirect) hyperbilirubinemia
biliary atresia: conjucated (direct) hyperbilirubinemia
what is the Rx for local impetigo?
topical mupirocin or oral erythromycin
problems of an infant of a diabetic mother
1) caudal regression syndrome (sacral agenesis)
2) transposition
3) duodenal atresia
4) anencephaly and neural tube defects
Beckwith-Widemann syndrome
"WIDTH AND WIDE, MAN" everything is too big
-macrosomia
-macroglossia
-visceromegaly
-neonatal hypoglycemia
-OMPHALOCELE
-due to up regulation of IGF2
WAGR syndrome
Wilms tumor
Aniridia (absence of iris)
Genital/gonadal tumors
Retardation (mental and motor)
Denys-Drash syndrome
-Wilms' tumor
-male pseudohermaphrodism
-early onset renal failure characterized by mesangial sclerosis
congenital hypothyroidism
-UMBILLICAL HERNIA
-LARGE TONGUE
-weakness, sluggishness, poor feeding
-hypotonia
-bloating
UNIVERSALLY SCREENED FOR IN UNITED STATES
Marfan syndrome (features and genetics)
tall stature
long ngers
hypermobility of joints
hyperelastic skin
Fibrillin-1 gene (FBN1)
most common type of childhood tumor
benign astrocytoma (can be infratentorial or supratentorial)
Ehlers-Danlos syndrome
similar to Marfan
hyperexible joints
hyperelastic skin
-easy bruising
-poor wound healing
NOT TALL AND NO LONG FINGERS
-a COLLAGEN structure problem
Gram positive diplococci
Strep pneumo
Gram positive cocci in clusters
Staph
Gram negative cocci
Neisseria
Gram positive rods
Listeria and Bacillus
Gram negative rods
Pseudomonas
Haemophilus
Klebsiella
Legionella
chronic diarrhea and recurrent sinopulmonary infections in young child
Cystic brosis
marfan features + mental retardation + thromboembolic events + downward
dislocation of the lens =
homocystineuria (recall that elevated homocystine causes endothelial
damage and athrosclerosis)
mental retardation + musty odor
PKU
Gonococcal vs. Chlamydial conjunctivitis in neonates
Gonococcal much more purulent. EARLY onset (rst few days). Treat with
ceftriaxone
Chlamydial more indolent with LATER onset (after a week or two) but a/w
pneumonia. treat with ORAL erythromycin
incontinence differential:
1) urge incontinence (detrussor hyperactivity): feels urge to go to the
bathroom, but doesn't make it in time. Nocturia and frequency are common.
Can also be a/w bladder cancer or infection/inammation. Oxybutynin
(anticholinergic), TCAs
2) overow incontinence: large post void residual. a/w diabetic neuropathy.
3) stress incontinence (pelvic oor muscle weakness): incontinent with
coughing/sneezing. Kegel excersices. Surgery. Alpha-agonists.
SIADH
this results from an excess of ADH (Antidiuretic Hormone) which causes
the kidneys to reabsorb excess water, which decreases urine output &
increases uid volume.
Causes hyponatremia, water retention, weight gain, concentrated urine,
muscle cramps & weakness.
The low osmolality of blood allows uid to leak out of vessels & causes
brain swelling.
Hyponatremia-->confusion
dysgerminoma
Malignant germ cell tumor, rare, identical to male testicular seminoma,
women under 30, solid mass, hyperechoic, most common neoplasm seen
in pregnancy along with serous cystadenoma
endometrioma
benign cyst that 80% of the time results from endometriosis. mass may be
large and lled with old blood. also called chocolate cyst. wall is usually
thick with bright reectors. results in extreme pain.
granulosa cell tumor
secretes estrogen
--precocious puberty in kids.
--endometrial hyperplasia (vaginal bleeding) post-menopausal women
Sertoli-leydig cell tumor
Ovarian tumor that secretes testosterone
Rapid onset of hirsutism
Dx - Marked increase of testosterone, increase in LH/FSH
Tx - removal of involved ovary
mucinous cystadenoma
benign tumor of the ovary that contains thin-walled MULTILOCULAR cysts
atypical pneumonia with negative sputum gram stain and a polymorphic
rash
mycoplasma pneumonia
atypical pneumonia with diarrhea +/- neurological sxs
Legionella pneumonia
"sausage digit" dx. and rx
dx: psoriatic arthritis
rx: NSAIDs, Methotrexate.
STEROIDS ARE CONTRAINDICATED
joint pains, painless skin lesions, tendon tenderness and new sexual
partner in 24 year old female
disseminated gonococcal infection
before ordering a CT scan for suspected PE (or anything else) you should
establish that:
1) no contrast allergy
2) adequate renal function (creatinine <2.0)
Causes of priapism (4)
1) trazoDONE or PRazosin
2) Sickle Cell Disease and leukemia
3) Neurologic (spinal cord)
4) Trauma to cavernous artery
Pts. with severe proteinuria are at increased risk for: (4)
1) infections (nephrotic syndrome pts. should get pneumococcus vaccine)
2) hypercoaguability (renal vein thrombosis most common, but PE, DVT
possible)
3) anemia (looks like Fe deciency but doesn't respond to Fe)
4) Vit. D deciency
what nephropathy is associated with cancer? (plus an exception)
Membranous glomerulonephritis
BUT... Hodkin's Lymphoma is a/w Minimal Change Disease
numerous small hemorrhages and blurring of gray-white matter junction
following head trauma
diffuse axonal injury
purulent arthritis in sexually active individual
gonococcal arthritis until proven otherwise
central vs. peripheral precocious puberty
central:
--pubertal (high) levels of LH
--LH increases with GnRH stimulation
--IMAGING OF BRAIN IS MANDATORY
--treat with continuous GnRH for IDIOPATHIC CENTRAL PUBERTY,
surgery to resect tumor.
peripheral:
--low levels of LH
--LH does not change with GnRH stimulation
--look for estrogen secreting source
pruritus and atrophied and whitish appearance of vagina in post
menopausal woman. Dx and Rx
-lichen sclerosis
-punch biopsy to r/o SCC and establish dx, steroid cream to treat
which type of arrythmia goes along with a wide QRS?
bradyarrythmia
which type of arrythmia goes along with a prolonged QT?
tachyarrythmia
what maneuver will increase the murmur heard in hypertrophic
cardiomyopathy? (i.e. young athlete about to drop dead)
Valsalva maneuver (increased intrathoracic pressure causes compression
of heart, making the outow obstruction by the septum more prominent....
and it also decreases preload)
painless loss of vision with pallor of optic disc, cherry red fovea, boxcar
segmentation of retinal arteries and veins
Central retinal artery occlusion
painless loss of vision with optic disc swelling, retinal hemorrhages, cotton
wool spots
Central vein occlusion
painless loss of vision with whitened edematous retina along the arterioles
Retinal emboli
what test is done to conrm a diagnosis of acromegaly (GH hypersecretion)
administer a glucose load then measure GH, it should drop in normal
individuals, but stay the same or increase in disease
what additional testing needs to be done if you suspect a migraine?
none
Testing is required only if:
1) focal neurological sxs.
2) fever
what electrolyte abnormality can be seen following a subarachnoid
hemorrhage?
hypoNATREMIA
what is the treatment of acute kidney transplant rejection?
IV steroids
pronator drift test for what kind of lesion?
Upper motor neuron
Pruritus plus maloderous vaginal discharge, pH of 5.0
Trich
Kawasaki disease dx.
High fever for >5 days
-conjunctivitis
-oral lesions, strawberry tongue
-rash
--risk of Coronary Artery ANERURISM
how do you differentiate between post streptococcal glomerulonephritis and
IgA nephropathy in a patient with hematuria and recent URI
Strep: normal complement levels, later onset >10 days
IgA: low complement, onset after 5 days
herceptin (breast cancer) toxicity
cardiac
abdominal trauma with pain radiating to the shoulder suggests?
chemical peritonitis due to spillage of blood, urine, or bowel contents
irritating the phrenic nerve on the diaphragm
what is a logical way that acute pre-renal renal failure would cause
acidosis?
by making the patient uremic (i.e. not excreting the inorganic acids
produced by the body)
What is the antidote for TCA toxicity and how does it work?
Sodium bicarbonate
-works by unblocking cardiac Na channels and thus narrowing the QRS
complex
malignant otitis externa is caused in 95% of the time by:
Pseudomonas (wet in the ear!... like hot tub folliculitis... swimmer's ear.
Treat with Ciprooxacin
what is the most common form of thyroid cancer?
papillary
(medullary secretes calcitonin but is uncommon and a/w MEN 2a/b)
Fixed split S2
ASD
Pulsus parvus et tardus
slow and late carotid upstroke
--Aortic stenosis
opening snap
mitral stenosis
early diastolic murmur
aortic regurgitation
late diastolic murmur
Mitral or Tricuspid stenosis
holosystolic murmur
VSD, tricuspid regurgitation, mitral regurgitation
what complication of RA can sometimes imitate a DVT
a ruptured Baker's cyst in the popliteal fossa
what happens to plasma Calcium levels with changes in pH?
increasing pH causes increased afnity for Ca by albumin, thus reducing
the free Ca and causing an effective hypocalcemia
when the kidneys retain HCO3 they will sacrice which other electrolyte?
Chloride
what types of masses will be found in the three mediastinal compartments
(anterior, middle, posterior)
anterior: thymus, thyroid
middle: bronchial, tracheal, lymphatics, aortic arch
posterior: spinal, esophageal, aortic root, hernias, lymphatics
tacrolimus toxicity
NEPHROTOXICITY
hyperkalemia
hypertension
tremor
cyclosporine toxicity
NEPHROTOXICITY
hyperkalemia
hypertension
tremor
HIRSUTISM
GUM HYPERTROPHY
azathioprene toxicity
Dose related diarrhea
liver toxicity
leukopenia
mycophenolate toxicity
bone Marrow toxicity
what are the risk factors that would make an endometrial biopsy necessary
in the face of heavy menses/intramenstural bleeding
>35 years old
--obese
--HTN
--DM
extrahepatic complications of Hep C (8)
1) membranoproliferative glomerulonephritis
2) cryoglobulinemia
3) B-Cell lymphomas
4) autoimmune disease
5) lichen planus
6) porphyria cutanea tarda
7) ITP
8) plasmacytomas
what do you do if you suspect that a kid has minimal change disease?
start them on empiric steroids.
do not start with biopsy in nephrotic syndrome in kids
what are the indications for renal biopsy in kids?
>8 years old at onset
--resistant to steroids
--present at birth
--signicant hematuria
--frequent relapses
renal biopsy contraindications
Absolute:
--bleeding disorders
--single kidney
--uncontrolled hypertension.
Relative contraindications:
--suspected renal infection
--hydronephrosis
--possible vascular lesions.
what happens to the ABG in atelectasis, PE, pleural effusion, pulmonary
edema?
PCO2 is low from hyperventilation
PO2 is low from inadequate oxygenation
what needs to be checked before starting someone on Lithium?
creatinine and TFTs (can cause hypothyroidism)
hepatic adenoma should be associated with (and the dreaded
complications are):
young women on OCPs with solitary mass in Right Lobe of liver
complications: intra-tumor hemorrhage, malignant transformation
Pulseless electrical activity should be treated with:
chest compressions and epinepherine. NOT cardioversion
what lab ndings are indications for ordering TFTs?
Hyperlipidemia
Hyponatremia
elevated CK
anemia
what is the etiology of most ASCENDING aortic aneurism vs.
DESCENDING aortic aneurisms?
Ascending: cystic medial brosis (Marfan or connective tissue disease of
aging)
Descending: athrosclerosis
what is the treatment for a prolactinoma
medical management rst with bromocriptine or cabergoline
surgery for cases that are refractory to medical treatment
a xed, solid breast mass with calcications. needle biopsy shows foamy
macrophages with fat globules
fat necrosis of the breast. Not cancer
fever and sore throat in patient on antithyroid drugs suggests:
agranulocytosis
--stop offending agent and start IV broad spectrum antibiotics.
how do you calculate the corrected Ca? what are the normal values that
pertain to this?
Corrected Ca= 0.8(4-serum albumin)+serum Ca
normal value for albumin is 4
normal value for Ca is 8.4 to 10.2
acute heart failure treatment
"LMNOP" Lasix, Morphine, Nitrates, Oxygen, Positioning and pressors
NOT BETA BLOCKERS IN ACUTE EXACERBATION
when do you anticoagulate someone for ab? when do you do a Heparin
bridge?
CHADS2 score >2: anticoagulate
If hx of prior stroke, Heparin bridge
absolute indications for dialysis: (4)
1) uid overload unresponsive to medication
2) hyperkalemia unresponsive to medication
3) uremic pericarditis
4) refractory metabolic acidosis
relative indications for dialysis: (3)
1) GFR <10
2) Cr >8
3) severe uremic sxs
contraindications for dialysis: (2)
1) debilitating chronic disease
2) severe irreversible dementia
what are the indications for surgical correction of a pediatric umbillical
hernia? (4)
1) persists past the age of 3-4
2) >2cm
3) becomes strangulated
4) progressively enlarges
ngernail clubbing in COPD patient suggests:
malignancy (COPD is not usually a/w clubbing)
elevated JVP, peripheral edema and hyperinated lungs without inltrates
in a COPD patient suggests:
cor pulmonale (pulmonary htn)
lithium toxicity presents with:
ataxia
tremor
seizures
hyperreexia
nephrotic syndrome common causes/epidemiology
Children: minimal change disease
AA adults/HIV/heroin/obesity: FSGS
post viral: IgA
Hep C: membranoproliferative
when evaluating a woman with hirsutism, DHEAS levels and testosterone
levels are signicant in this way:
DHEAS: specic for ADRENAL androgen producing tumors
Testosterone: produced by both ADRENAL and OVARIAN tumors
Thus:
--low DHEAS + high testosterone = ovarian tumor
--high DHEAS +/- normal testosterone = adrenal tumor
MEN 2a/2b both have pheochromocytoma and medullary thyroid CA
(calcitonin), how do they differ?
2a: primary parathyroidism (not a tumor)
2b: mucosal neuromas and marfanoid habitus. Mucosal neuromas are
present on the tongue, lips, eyelids, GI tract
other than polycystic ovaries on ultrasound, how does PCOS present?
1) hirsutism or signs of testosterone excess
2) amenorrhea or oligomenorrhea
3) obesity, in 50% of patients
4) infertility
5) glucose intolerance
what is the most common cause of nephrotic syndrome in adults?
membranous glomerulonephritis
a chi square test compares what types of data?
compares proportions
a "two sample" test compares what types of data?
compares two MEANS. Only the two sample T test is useful. It is used to
calculate the P value of a study
ANOVA test compares what types of data
THREE or more variables
rheumatic fever major signs and symptoms:
"no Rheum for SPECCulation"
Subqutaneous nodules
Polyarthrits
Erythema marginatum
Chorea
Carditis
proximal muscle weakness and lupus like rash on face or possibly
overlying knuckles
dermatomyositis
increased risk for cancer
anti-Mi-2 antibodies against helicase
rapidly progressive skin lesions that develops into non-tender nodules with
central necrosis in an immunocompromised patient with a fever suggests
infection with:
pseudomonas
(this is ecthyma gangreneosum)
CSF ndings in HSV encephalitis
lymphocytic, increased protein, lots of RBCs, normal glucose
exudates from tuberculosis are characterized by:
high LYMPHOCYTE count
high protein
slightly low glucose
SLE manifestations
"I'M DAMN SHARP" for guring out that this person has SLE
--immunoglobulins: anti-dsDNA, anti-Smith
--malar rash
--discoid rash
--ANA
--mucous membranes (oral ulcers)
--neurological (seizures, psychosis)
--serositis (pleuritis, pericarditis)
--hematological (anemia, cytopenias)
--arthritis
--renal (membranous)
--photosensitivity (sunburns)
mallory weiss vs boerhave's tear
mallory weiss is partial thickness
boerhave's is full thickness
how is calcium regulated?
PTH increases the number and activity of osteoclasts. The result is
elevated bone resportion which releases ionic calcium (Ca2+) and
phosphates into the blood. PTH also acts on the kidneys. First, it slows the
rate at which Ca2+ and Mg2+ are lost from blood into the urine. 2nd it
increases loss of HPO4 from blood into the urine. B/c more HpO4 is lost in
the urine than is gained from the bones, PTH decreases blood HPO4 level
and increases blood Ca2+ and Mg2+ levels. Third effect of PTH on the
kidneys is to promote formation fo the hormone cacitrol, the active form of
vitamin D. Calcitrol increases the rate of Ca2+, HPO4, and Mg2+
absorption from the gastrointestinal tract into the blood
what happens to blood pH in septic shock?
increased anaerobic metabolism causes lactic acidosis
young healthy patient who presents with heart failure, arrythmias or chest
pain following a URI should be suspected of having:
myocarditis... most likely Coxsackie
how is infertility in PCOS treated?
weight loss.... then clomiphene and metformin
exudative pleural effusion w/o signs of infection
think cancer (breast or lung cancer)
pruritus plus thick white discharge, pH of 4.0
vaginal candidiasis
how do you remember normal heart chamber pressures?
nickle, dime, quarter, dollar
RA: 5
LA: 10
RV: 25
LV: 100
roughly....
testicular pain that improves with elevating the testicles
epididymitis
testicular pain that does not improve with elevating the testicles and with an
absent cremasteric reex
testicular torsion
how do the EKG ndings of hyperkalemia progress?
1) peaked T waves
2) attening of P waves
3) PR prolongation
4) widened QRS with "sine wave" pattern
6) cardiac arrest
what is lid lag and what is it associated with?
lid lag=visible sclera on downward gaze
associated with hyperthyroidism (but different from proptosis)
cataracts vs. open angle vs. closed angle glaucoma
cataracts: vision problems at night, glare
open angle: loss of peripheral vision then central vision
closed angle: painful
steroids should be given in preterm labor if the fetus is:
24-34 weeks
QT prolongation on EKG, what do you do?
give Mag Sulfate to avoid torsades de pointes
pulsus paradoxus
decrease in systolic BP of more than 10mmHg with normal inspiration;
palpated as weakened pulse with inspiration.
--cardiac tamponade
CHADS2 score
C-CHF
H-HTN
A- Age >75
D-Diabetes
S- prior stroke/TIA