Term
| 2yo M with recurrent infections and eczema. Workup reveals thrombocytopenia. |
|
Definition
| Wiscott Aldrich. X-linked. |
|
|
Term
| 70yo white M with easy bruising, visual disturbance, and elevated IgM |
|
Definition
| Waldenstrom's macroglobulinemia |
|
|
Term
| 12yo M with bleeding, elevated PTT, and reduced quantitative factor VIII level. Platelets do no aggregate with ristocetin test. |
|
Definition
|
|
Term
| 23yo HIV positive F recently started SMX-TMP with rash, confusion, fever, anemia, thrombocytopenia, tachycardia. |
|
Definition
|
|
Term
| 6yo F with itching, joint pain, skin rash who received penicillin six days previously for strep infection. |
|
Definition
| Serum sickness (Type III hypersens.) |
|
|
Term
| 62yo Jewish M with pruritus, melena, epistaxis, and history of DVTs. |
|
Definition
| Polycythemia vera (itching, epistaxis) Treat with phlebotomy, hydroxyurea for myelosuppression, aspirin for DVT prophy. Risk = develop CML, AML, myelofibrosis. |
|
|
Term
| 12yo M with bony-hard swelling above knee. |
|
Definition
|
|
Term
| 53yo M with painless lumps in neck, fever, weight loss. |
|
Definition
|
|
Term
| 54yo M with fatigue, splenomegaly, anemia, and 'dry tap' on bone marrow biopsy |
|
Definition
| Myelofibrosis with myeloid dysplasia |
|
|
Term
| 64yo black M with bone pain, fatigue, and recurrent URIs |
|
Definition
|
|
Term
| 24yo M with painless lump in neck and CXR with hilar masses. |
|
Definition
|
|
Term
| 8yo M with palpable rash, hematuria, and joint pain. CBC reveals normal platelet count. |
|
Definition
| Henoch-Schonlein Purpura. Small vessel vasculits. IgA deposits. Hemmorhagic urticaria with fever, arthralgias, GI and renal involvement. Associated with URIs. |
|
|
Term
| 21yo F with sudden onset bruisability, edema, and rash following diarrheal illness. Low platelet count. |
|
Definition
|
|
Term
| 61yo M with mycobacterium avium infection, splenomegaly, and leukocytes with cytoplasmic projections seen on CBC. |
|
Definition
| Hairy cell leukemia (B cell) |
|
|
Term
| 45yo M with fever, rash, diarrhea, and jaundice. Elevated IgE level and history of leukemia. |
|
Definition
|
|
Term
| 45yo M with frank rigors 1hr following blood transfusion. |
|
Definition
| Febrile nonhemolytic transfusion rxn |
|
|
Term
| 25yo F with continued bleeding following delivery. |
|
Definition
|
|
Term
| 55yo M with no complaints, found on physical exam to have splenomegaly and leukocytosis. |
|
Definition
|
|
Term
| 65yo M with lymphadenopathy, hepatosplenomegaly, and leukocytosis with smudge cells. |
|
Definition
|
|
Term
| 66yo M with CLL has urine that gets darker during the day. |
|
Definition
| autoimmune hemolytic anemia |
|
|
Term
| 18yo M with pallor, petechiae, and recurrent URIs |
|
Definition
|
|
Term
| 25yo F with recent infection, gingival hyperplasia, and leukocytosis with bone marrow expansion. |
|
Definition
|
|
Term
| 43yo M with epigastric pain and diarrhea refractory to medical management. |
|
Definition
|
|
Term
| 40yo F with intellectual impairment, jaundice, and choreiform movements. |
|
Definition
|
|
Term
| 37yo M with acute pain in anorectal area and BRBPR for 4 months. |
|
Definition
| thrombosed ext. hemorrhoid |
|
|
Term
| 45yo F with pruritus, fatigue, and jaundice. |
|
Definition
|
|
Term
| 33yo M with four months epigastric pain radiating to back relieved by eating and leaning forward. |
|
Definition
|
|
Term
| 36yo F with difficulty swallowing and craving for ice. Physical exam reveals angular stomatitis and glossitis. |
|
Definition
|
|
Term
| 24yo F with crampy abdominal pain and dark spots on lips. |
|
Definition
| Peutz-Jehghers. Multiple polyposis of small intestine, pigmented melanin macules on oral mucosa. Associated with gynecological cancers, but actually a low to moderate colon CA risk. |
|
|
Term
| 51yo M with 4 months pruritus, jaundice, and abdominal pain. Recent 15 pound wt loss. |
|
Definition
| pancreatic CA (CEA, CA19-9) |
|
|
Term
| 65yo M with abdominal pain, nausea, vomiting, and diarrhea. Has been suffering abd. Pain 30 min after eating. |
|
Definition
|
|
Term
| 50yo M with EtOH cirrhosis develops oliguria and abdominal distenstion. |
|
Definition
|
|
Term
| 65yo M alcoholic with RUQ pain, jaundice, anorexia, and distention worsening over two months. |
|
Definition
|
|
Term
| 40yo M with increased pigmentation. PE reveals cardiomegaly. UA reveals glycosuria. |
|
Definition
| hemochromatosis (cirrhosis, bronze diabetes, heart failure) |
|
|
Term
| 24yo F found on dental checkup to have supernumerary teeth. Has father with history of colon polyps and |
|
Definition
|
|
Term
| 44yo M with hematemesis and melena. Has had recurrent painless hematemesis for several years. |
|
Definition
| gastric leiomyoma (#1 benign tumor of stomach) |
|
|
Term
| 83yo M with epigastric pain, anorexia, and frequent vomiting. Guaic positive stools. Palpable mass over L shoulder. |
|
Definition
| gastric CA (atrophic gastritis, pernicious anemia, ulcers, type A blood = risk; Krukenberg tumor = retro peritoneal spread to ovaries. |
|
|
Term
| 68yo F smoker with dysphagia. |
|
Definition
| esophageal CA (squamous > adeno in distal third) |
|
|
Term
| 54yo F with colicky LLQ pain and bloody stools that have returned intermittently over several months. |
|
Definition
|
|
Term
| 45yo M with recurrent epigastric pain that radiates to back and foul-smelling stools. |
|
Definition
| chronic pancreatitis (alcoholism, cystic fibrosis) |
|
|
Term
| 25yo F with diarrhea, foul smelling stools, pruritus, dry skin, and bruising. |
|
Definition
| celiac disease (anti-gliadin Ab, nutrient malabsorption) |
|
|
Term
| 67yo F with several months fatigue, weight loss, intermittent diarrhea with palpable RLQ mass. |
|
Definition
| cecal CA (anemia and + guaic test + virchow's node) |
|
|
Term
| 52yo M with diarrhea and facial flush. |
|
Definition
| carcinoid = primary GI tumors arise from neuroendocrine cells "Kulchitsky cells" and secrete 5-HT, histamine, gastrin, and prostaglandins. Malignant or benign. |
|
|
Term
| 45yo M with AIDS now with painful swallowing. |
|
Definition
| candida esophagitis (candida, rx with oral fluconazole) |
|
|
Term
| 34yo M with mediepigastric pain, periumbilical/flank bruising, and hypotension. |
|
Definition
| acute pancreatitis (Cullen's / Grey Turner's sign, assoc. with gallstones and alcohol) |
|
|
Term
| 33yo F with substernal pain and difficulty swallowing. Sometimes regurgitates food. |
|
Definition
| achalasia (loss of ganglion cells in Auerbach's plexus). Esophageal CA risk. Can arise from Chagas disease (also with cardiomyopathy). |
|
|
Term
| 50yo F with cold nodule in the neck. Normal TSH, T3 and T4. |
|
Definition
| thyroid CA (risk = ionizing rad - papillary CA c best prognosis, also follicular, mixed, and medullary assoc c MENIIa and IIb) psammoma bodies on FNA. |
|
|
Term
| 30yo F with weight loss, 2yrs amenorrhea following delivery of healthy baby. |
|
Definition
| Sheehan's (postpartum pituitary infarction) decreased levels of all trophic hormones, can occur in males and nonpregnant females following trauma, SS anemia, DIC, and stroke) |
|
|
Term
| 33yo F with menstrual irregularity and milky nipple discharge. |
|
Definition
| prolactinoma (most common pituitary adenoma; GnRH suppressed by excessive prolactin, reduces LH and estradiol. In males = HA, impotence, visual disturbance. |
|
|
Term
| 56yo F with flank pain, confusion, constipation, thirst and polyuria. |
|
Definition
| hyperparathyroidism (symptoms of hypercalcemia, bank keratopathy, cystic bone lesions = osteitis fibrosa cystica, adenoma = 1 gland, hyperplasia = 4 gland, renal stones, elevated serum Ca and AP with lowPO4. |
|
|
Term
| 42yo F with hypertension, weakness, and decreased urinary volume. |
|
Definition
| Conn's (hypokalemia, hypernatremia, hypertension, increased urinary aldosterone, low plasma renin). Usually adrenal cortex adenoma, sometimes adrenal cortical hyperplasia. |
|
|
Term
| 53yo F with fatigue, insomnia, depresison. Thinning of skin, hirsutism, vaginal atrophy. |
|
Definition
| menopause (hot flashes, vaginal atrophy, osteoporosis). Post-menopausal bleeding gets biopsy to r/o endometrial cancer. |
|
|
Term
| 48yo F with weakness, lethargy, cold intolerance. |
|
Definition
| hypothyroidism (weight gain, constipation, coarsening of facial features, hair loss, hoarseness, depression, loss of outer third of eyebrows, delayed recovery phase of achilles. Most common = Hashimoto's |
|
|
Term
| 46yo M with impotence, fatigue and decreased peripheral vision. Is also hypotensive. |
|
Definition
| hypopituitarism: Low FSH, LH, TSH, ACTH. Most common cause adenoma compressing anterior pituitary. |
|
|
Term
| 29yo F with seizure. Has history of thyroid surgery two years ago. |
|
Definition
| hypoparathyroidism (circumoral and foot numbness, fasciculations, chvostek's sign, trousseau's sign, brittle nails, low serum calcium, elevated PO4, low Mg, low PTH. Most commonly d/t thyroidectomy, symptoms d/t hypocalcemia. |
|
|
Term
| 24yo F with weight loss despite good appetite, anxiety, menstrual irregularity, and tremors. |
|
Definition
| hyperthyroidism = diarrhea, heat intolerance, palpitations, tremors, increased T4, decr. TSH. Hot nodule with decreased uptake in surrounding tissue and other lobe d/t atrophy of remainder of gland. Rx with propranolol, PTU, methimazole. |
|
|
Term
| 45yo F with anterior neck fatigue, history of RA, and cold intolerance. |
|
Definition
| Hashimoto's (anti-thyroglobulin and antimicrosomal Abs, often assoc with other autoimmune dx including SLE, pernicious anemia, Sjogren's, hepatitis, HLA-DR5/3. May see thyrotoxicosis early during disease course. |
|
|
Term
| 55yo M with obesity, thirst, and excessive appetite. |
|
Definition
| DM2. Can develop nonketotic hyperosmoler coma but not DKA. |
|
|
Term
| 44yo F with irritability, easy bruising, weight gain, and glucosuria. |
|
Definition
| Cushing's (truncal obesity, moon facies, buffalo hump, hirsutism. Elevated plasma cortisol with high ACTH, hypokalemia, leukopenia, osteoporosis, adrenocortical hyperplasia and pituitary adenoma. |
|
|
Term
| 60yo M with rash composed of red plaques with scaling and nodules. Has not responded to steroid rx. |
|
Definition
| Mycosis fungoides. Malignant cutaneous helper T-cell lymphoma; disseminated disease with exfoliative dermatitis and lymphadenopathy = Sezary syndrome. "Red man's disease". CBC shows lymphocytosis. |
|
|
Term
| 68yo outdoor construction worker, raised bleeding lesion over upper lip. |
|
Definition
| basal cell carcinoma. Most common skin cancer. Light-skinned people. Sun-exposed areas, slow growing, metastatic disease rare. Increased incidence in xeroderma pigmentosum. |
|
|
Term
| 60yo farmer with skin lesions on forehead, upper lip, dorsum of hands. Scaly rough plaques. |
|
Definition
| actinic keratosis. Most common precancerous dermatosis --> squamous cell CA. Signs that preceed malignancy include elevation, ulceration, inflammation, and enlargement >1 cm. |
|
|
Term
| 35yo M with cramping in calves with walking, smokes 3 ppd. PE reveals pallor and cyanosis of distal extremities. |
|
Definition
| thromboangiitis obliterans = occluded small and medium arteries, no atherosclerosis, inflammation of all layers of arterial wall. Smoking cessation critical. Amputation may become necessary of fingers/toes. |
|
|
Term
| 79yo F with unilateral HA, jaw pain, visual disturbance in ipsilateral eye. |
|
Definition
| temporal arteritis. Most common vasculitis in US. Often coexists with polymyalgia rheumatica. Ophthalmic artery occlusion --> blindness. Biopsy positive 60%, so treat on clinical picture with steroids before biopsy. |
|
|
Term
| 50yo M with palpitations and CP. Has had multiple sexual partners. Has diastolic murmur. |
|
Definition
| Syphilitic aortitis. Signs include collapsing pulse, wide pulse pressure, LVH with strain, mid-diastolic murmur at apex = Austin-Flint, VDRL / FTA-ABS positive. "Tree bark" calcification of arch and ascending aorta on CXR, tertiary stage syphillis. |
|
|
Term
| 30yo F with HTN and elevated plasma renin. |
|
Definition
| Renovascular hypertension. "String-of-pearls" pattern seen on renal angio. +/- renal artery bruit. Mostly fibromuscular dysplasia (young female), atherosclerosis (older male), <5% of all HTN. Rx with ACE-I but contraindicated in bilateral RAS. |
|
|
Term
| 34yo F in 27th week of pregnancy with dyspnea and orthopnea. History of recurrent strep pharyngitis as child. |
|
Definition
| Mitral stenosis. Opening snap and mid-diastolic murmur at apex. +/- LVH and a-fib. |
|
|
Term
| 37yo M with fatigue and dyspnea with exertion. Pansystolic murmur at the apex with radiation to the axilla. |
|
Definition
| Mitral insufficiency. Common causes: mitral valve prolapase, ischemic papillary muscle, endocarditis, rheumatic. S3 may be present. |
|
|
Term
| 42yo M with CP, headache and confusion. Has history of HTN. |
|
Definition
| malignant HTN. Severe diastolic hypertension, papilledema, hematuria, proteinuria, small scarred kidneys. Rx with sodium nitroprusside or IV beta-blockers to prevent end-organ damage due. |
|
|
Term
| 21yo M with DOE and an episode of syncope while playing tennis. |
|
Definition
| HCM. Signs = S4, SEM incr by valsalva, decr by squatting. EKG shows LVH. Echo: asymmetrical septal hypertrophy, ant. motion of mitral valve. Rx with beta-blockers, avoid sports, amiodarone may prevent fatal arrythymia, surgical myomectomy. |
|
|
Term
| 29yo F recently delivered baby, now with dyspnea and pedal edema. |
|
Definition
| dilated cardiomyopathy. Systolic dysfunction, decr ejection fraction Peripartum period (3 mo.), alcoholism, hypothyroidism, Freidreich's ataxia, previous myocarditis coxsackie B, adriamycin, tricyclic antidepressants, lithium, cyclophosphamide. |
|
|
Term
| 60yo M with COPD with severe dyspnea at rest, bulging neck veins, and peripheral edema. |
|
Definition
| cor pulmonale. Right heart failure d/t pulmonary cause, usually COPD. Other causes include pulmonary fibrosis, pneumoconioses, recurrent PE, PPHTN, obesity with sleep apnea, kyposcoliosis. |
|
|
Term
| 24yo M with angina, DOE, occasional fainting, and systolic ejection murmur to right of sternum. |
|
Definition
| aortic stenosis. Crescendo-decrescendo SEM, paradoxical splitting. Causes include congenital bicuspid valve, degenerative calcification, rheumatic. |
|
|
Term
| 31yo M with ankylosing spondylitis develops severe SOB. |
|
Definition
| aortic insufficiency. Signs include bounding pulse, wide pulse pressure, diastolic decrescendo murmur at left sternal border. Causes include rheumatic, ankylosing spondylitis, marfan's, reiter's, tertiary syphillis. |
|
|
Term
| 35yo M with nonproductive cough and chest pain worse with inspiration, relieved by sitting up. |
|
Definition
| pericarditis. +/- friction rub, incr JVP (c inspir = Kussmaul's sx), elevated ESR, CPK-MB nl, diffuse ST elev., pericardial effusion. Coxsackie A/B, TB, staph/strep, amebiasis, actinomycoses, CRF, SLE, scleroderma, RA, CA, MI, trauma. |
|
|
Term
| 25yo F with myalgias and low-grade fevers starting one week after a dental extraction. |
|
Definition
| subacute bact. endocarditis. Ass. c rheumatic dx, mvp, etc. AB prophy prevents. Janeway = periph hemmorhage, Osler's = painful, Splinter hem. = subungal linear, Roth's spots = oval retinal. Strep viridans = most common subacute. |
|
|
Term
| 25yo M with SOB and ankle edema following severe URI. |
|
Definition
| viral myocarditis. Cocksackie B > Borrelia burdorferi (Lyme), trypanosome cruzi (Chagas), hypersensitivity rxn in SLE or drug rxn, radiation, sarcoidosis. Echo: dilatation c low EF. ASO titers not elevated. ESR elevated. |
|
|
Term
| 35yo M develops pruritus and blistering rash over shins following camping trip. |
|
Definition
| Contact dermatitis = type IV hypersensitivity rxn. Papulovesicular rash c oozing and crusting. Rx c topical and systemic corticosteroids. Also occurs with various irritants, diaper rash. |
|
|
Term
| 5yo M with yellow crusty lesions behind the ear and around the mouth. |
|
Definition
| impetigo. "honey-colored" lesions. Group A strep. Rx with cephalosporin, pcn, or erythromycin. ASO titer negative. Highly communicable. Staph. aureus superinfection may cause bullous impetigo. Group B strep impetigo in newborns. |
|
|
Term
| 30yo homosexual M with skin eruption on upper limbs, trunk, anogenital areas. |
|
Definition
| molluscum contagiousum. Poxvirus. Opportunistic AIDS infection. Painless, pearly-white, dome-shaped, waxy, umbilicated nodules, 2-5mm, palms and soles not affected. |
|
|
Term
| 16yo M with headache, fever, and rash on the palms and soles. Recent camping in North Carolina. UA demonstrates proteinuria and hematuria. |
|
Definition
| RMSF. Rash periph. to central, palms/soles, petechial, thrombocytopenia, + Hess' test = Rumpel-Leede phenomena, + Proteus OX19 / OX2 Weil-Felix rxn. Rickettsia rickettsii. Rx tetracycline. Dermacentor wood tick. East coast of US. |
|
|
Term
| 24yo F with extensive denuding of skin and recent skin infection. |
|
Definition
| Scalded skin syndrome. Vesicle fluid is sterile. S. aureus on blood culture. Rx IV methicillin or oxacillin. Phage group 2 staph exotoxin. |
|
|
Term
| 30yo M with bilateral circular red eruption in the groin. |
|
Definition
| tinea corporis = ringworm. Circular papulosquamous eruption. Hyphae on KOH skin scrapings. Rx clotrimazole, miconazole, ketoconazole cream. Also systemic griseofulvin, keto/itraconazole prn. Tinea capitis = children. |
|
|
Term
| 28yo M treated for UTI develops raised, red, pruritic rash over trunk and limbs. |
|
Definition
| urticaria. wheal and flare rxn, "hives". Rx: stop causative agent, H1/2 blockers, calamine lotion, corticosteroids. |
|
|
Term
| 11yo M with jaundice, dark urine, and recent shellfish ingestion. |
|
Definition
| Hep A. Hyperbilirubinemia, ALT>AST, +/- AP, incr PT, incr. urine urobilinogen and bili, + IgM Ab to HepA. No infectivity in 3wks. Fecal/oral, bad water. Not chronic. HAV = naked, ssRNA, picorna. Prevent with killed vaccine and immune globulins. |
|
|
Term
| 25yo M with jaundice following needle stick two months ago. |
|
Definition
| HBV. Hyperbili, ALT>AST, +/- AP, HBsAg +, IgM anti-HBc + (window period). Liver biopsy = Councilman bodies. 5% progress to chronic c risk cirrhosis and HCC. Long incubation = 3 months. Enveloped DNA hepadna. HBsAg = chronicity. |
|
|
Term
| 30yo M intermittent jaundice for two years following a motorcycle accident. |
|
Definition
| HCV. Percutaneous transmission = 90% of cases. >50% progress to chronic, leading to cirrhosis in 20%. PCR test. |
|
|
Term
| 50yo alcoholic with fever, abdominal pain, and progressive distention of abdomen. |
|
Definition
| SBP. Ascites fluid leukocyte count >500/cc; PMNs >250 = diagnostic, low protein and glucose, ascites culture may be negative. Rx empirically, then organism-specific if possible. E. coli = most common. |
|
|
Term
| 56yo M with diarrhea for 2 months, arthritis, and weight loss. |
|
Definition
| Whipple's disease. Increased fecal fat. Macrocytic, hypochromic anemia. Small bowel biopsy c PAS + macrophages. Gram + actinomycete bacilli in macs. Rx with bactrim or ceftriaxone for 1 year. Tropheryma whippellii. Vitamin malabsorption. |
|
|
Term
| 19yo F with recurrent episodes of periorbital swelling and dyspnea lasting up to 24hrs. |
|
Definition
| C1 esterase inhibitor deficiency. Autosomal dominant. Decreased C4= best screening test. Decreased C1 inhibitor (confirmatory test). Decr. C2, but normalC3, normal IgE. Also called hereditary angioedema. |
|
|
Term
| 3yo M with albinism and recurrent infections with recurrent staph and strep infections. |
|
Definition
| Chediak-Higashi. Also nystagmus, photophobia. Decreased neutrophil count. Normal platelet count. Large cytoplasmic granules (Giant Lysosomes) in WBCs. Autosomal recessive, defect in microtubule polymerization in leukocytes. Defective chemotaxis. |
|
|
Term
| 2yo M with recurrent fungal and staph furunculosis and neutrophilic leukocytosis. |
|
Definition
| Chronic granulomatous disease. X-linked disorder of neutrophils, deficient NADPH oxidase . Normal chemotaxis, degranulation, and phagocytosis. Deficient killing d/t myeloperoxidase system. Recurrent staph infections. Rx SMP-TMP prophy. |
|
|
Term
| 25yo F with recurrent sinusitis, multiple allergies, watery diarrhea, and hypopigmented skin lesions. |
|
Definition
| IgA deficiency. No blood or plasma transfusions! #1 congenital immunodeficiency. Diarrhea usually G. lamblia, sinopulmonary infection with S. pneumo, H. flu, or S. aureus. Assoc with allergies/autoimmune dx. May be d/t isotype switching defect. |
|
|
Term
| 7 month M recurrent URIs, skin infections, and asymetric arthritis of the kness. No tonsillar tissue on exam. |
|
Definition
| X-linked hypogammaglobulinemia. Selective B-cell defect. Recurrent bacterial infections. a.k.a. Bruton's disease. Tyrosine kinase receptor defect, impaired maturation of antibodies. Labs = panhypoglobulinemia: very low IgG; IgA and IgM not detectable. |
|
|
Term
| 15yo M with thick yellow discharge that prevents eye-opening in the morning. |
|
Definition
| Conjunctivitis. Rx topical AB drops. Usually viral = adenovirus. Self-limiting. Secondary staph/strep may result. |
|
|
Term
| 8yo F with rash, diffuse joint pain, fever, and sore throat two weeks ago. |
|
Definition
| Acute rheumatic fever. Erythema marginatum = blanching ring-shaped over trunk and extremities. Elevated ASO titer, incr ESR, incr C-reactive protein. Blood culture negative. Endo/myo/pericarditis. Rx aspirin/corticosteroids, pcn/erythromycin. |
|
|
Term
| 35yo F with pain in upper teeth and face, nasal congestion and discharge. |
|
Definition
| sinusitis. boggy nasal mucosa. Common pathogens = S. pneumo, other streptococci, H. flu, Moraxella. Rx amoxicillin or TMP-SMX, decongestants. |
|
|
Term
| 48yo missionary returns from West Africa with lethargy, nuchal rigidity, HA, drowsiness. |
|
Definition
| African trypanosomiasis. Tsetse fly. Painless lymphadenopathy in posterior neck & supraclavicular = Winterbottom's sign. Does not respond to antibiotic rx. Chancre with induration at bite site. AKA African sleeping sickness. Rx suramin / pentamidine. |
|
|
Term
| 45yo M Peace Corps in Mexico with spiking fever, RUQ pain, and bloody diarrhea with mucus. Tender hepatomegaly on exam. |
|
Definition
| Amebic liver disease. Entamoeba histolytica. Cavitating liver lesion with chocolate-colored pus that is sterile, ameba obtained from periphery of lesion. Rx includes metronidazole and abscess drainage. |
|
|
Term
| 30yo sheep farmer with dyspnea, nonproductive cough, and black skin lesions. |
|
Definition
| Anthrax. CXR c mediastinal widening = hemorrhagic mediastinits. Vesicular papules covered by "black eschar". Bacillus anthracis. Rx IV penicillin G. Isolation precautions. Cell-free anthrax vaccine for high risk groups. |
|
|
Term
| 38yo M on chemotherapy with pleuritic chest pain, fever, and productive cough. |
|
Definition
| Aspergillosis. Multiple nodular infiltrates. Branched hyphae c silver stain, vascular invasion --> thrombi. Rx Amphotericin B c flucytosine. Lobectomy for fungus ball. Invasive dx: AIDS, neutropenia, chronic granulomatous dx, steroid rx, transplant pts. |
|
|
Term
| 25yo M c sudden onset double vision, dry mouth, weakness, dysarthria, and dysphagia. Ate some home-canned peaches the night before. |
|
Definition
| Botulism. Flaccid paralysis. Rx antitoxin, resp. support. Botox cleaves synaptic docking/fusion machinery. Disease d/t ingestion of toxin produced by C. botulinum. Often seen in infants after honey. |
|
|
Term
| 28yo M with hip pain, undulating fever for two months, and pain in testicle. Drinks unpasteurized milk. |
|
Definition
| Brucellosis. Blood culture demonstrates B. abortus, transmitted from milk or direct contact with animal tissues. Rx combination of doxycycline/SMX-TMP plus rifampin/streptomycin. |
|
|
Term
| 49yo obese, diabetic F with pruritus underneath her breasts. |
|
Definition
| candidiasis. Denuded, beefy red areas with whitish curd-like material. Budding cells with short hyphae on KOH prep. Rx clotrimazole, keep area dry. |
|
|
Term
| 24yo F with fever and swelling over eye after trip to Brazil. |
|
Definition
| Chagas dx. Eye swollen shut = Romana's sign. Encapsulated, nodular area at bite site = Chagoma. Ipsilateral retroauricular & cervical nodes. Trypanosoma cruzi, reduviid bug injects feces. Complications = dilated cardiomyopathy, megaesophagus/colon. |
|
|
Term
| 30yo M with profuse watery diarrhea, vomiting, and abdominal pain following trip to India. |
|
Definition
| Cholera. Vibrio cholerae. Severe dehydration, rice-water stools gram - rods c darting motility, O1 antigen, decreased serum chloride with increased serum sodium. Heat-labile exotoxin, stimulates Gs via ADP ribosylation incr cAMP --> secretory diarrhea. |
|
|
Term
| 19yo Arizona migrant worker with cough, pleuritic CP, fever and tender nodules over the both shins. |
|
Definition
| Coccidioidomycosis. Erythematous skin rash, erythema nodosum, positive skin test with coccidioidin, dimorhphic fungi, eosinophilia, caseating granulomas. Rx amphotericin B. Endemic in southwestern US. Inhalation of spores. |
|
|
Term
| 30yo M with AIDS presents with profuse, nonbloody diarrhea. |
|
Definition
| Cryptosporidium parvum. Dehydration. Acid-fast stain --> oocyts in fresh stool. Rx is supportive only. Self-limiting in immunocompetent pts. |
|
|
Term
| 13yo F s/p BMT on immunosuppresion now with fever, dyspnea, dry cough. |
|
Definition
| CMV pneumonitis. Insterstitial pneumonitis, intranuclear inclusions with surrounding halo (owl's eye). Rx ganciclovi ). #1 pneumonia and death in BMT patients. Common in AIDS. Enveloped dsDNA herpesvirus. |
|
|
Term
| 5yo M with fever, cervical lymphadenopathy, and grey membrane on tonsils. |
|
Definition
| Diptheria. Cornybacterium diphtheriae growth on Loffler's blood agar. Heat-labile exotoxin --> myocarditis and neuritis (blocks EF-2 via ADP ribosylation --> decr ribosomal fnctn & protein synth. Rx: PCN or erythromycin, antitoxin. |
|
|
Term
| 56yo veterinarian with sudden high fever, jaundice, and RUQ pain. |
|
Definition
| Echinococcosis. Hepatomegaly, + immunoblot test : echinococcal antigens, large septated liver cysts. +/- lungs/kidneys/bone/brain. Scoleces c inner germinal & outer laminated layer, fibrotic rxn. Rx: surgical cyst removal, albendazole. |
|
|
Term
| 36yo woman with AIDS and pneumonia develops spiking fever, chills, and delirium. |
|
Definition
| Endotoxic shock/gram neg. sepsis. E. coli on urine & blood culture. CXR with fluffy infiltrates (ARDS). Sequelae: ATN, DIC, multiorgan failure. Rx: fluid, IV ABs, manage ARDS c O2 and PEEP. Usually d/t gram negative endotoxins &gram positive exotoxins. |
|
|
Term
| 28yo Guatamalan refugee with severe headache, fever, and rash on trunk and extremities; palms and soles spared. Spent time in refugee camp. |
|
Definition
| Epidemic typhus. Rickettsia prowazekii. Cerebral edema/myocarditis/pneumonia, peripheral spreading rash. + Weil-Felix rxn. Path: Zencker's degeneration of striated musc. Rx: tetracycline, chloramphenicol. Intracellular. Lice vector. war/famine/crowding. |
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|
Term
| 21 yo F with low-grade fever, pain and swelling over left knee, and dysuria. |
|
Definition
| gonnococcal arthritis. Intracellular diplococci bean-shaped. Migratory polyarthralgias. Incr WBCs c urethral smear & synovial fluid. Rx: IV ceftriaxone. Rapidly destroys cartilage. Associated with skin rash over affected joint, complement deficiencies. |
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|
Term
| 19yo M with burning urination and greenish-yellow purulent discharge. |
|
Definition
| gonorrhea. Intracellular gram negative diplococci, confirmed c Thayer-Martin medium culture. Rx: Ceftriaxone + doxycycline/erythromycin for Chlamydia coverage. Gonorrhea can involve throat, anus, rectum, epididymis, cervix, fallopian, prostate, joints. |
|
|
Term
| 25yo M with painful skin rash in the perianal area. |
|
Definition
| Herpes simplex 2. Vesicular in clusters with clear fluid over erythematous base. Giant cells on Pap-stained scraping. Rx: acyclovir. dsDNA virus. Transmitted to fetus through birth canal. |
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|
Term
| 27yo F with two months fever, mouth ulcers, fatigue, and weight loss. Started new job on farm in Ohio. |
|
Definition
| histoplasmosis. Histoplasma capsulatum.Rx: itraconazole or amphotericin B. Intracellular budding fungus in reticuloendothelial cells. Hilar adenopathy. Associated with bird or bat feces. Transmitted by inhalation of mold spores. |
|
|
Term
| 37yo M black male from the Caribbean with swollen glands in armpits and groin, feeling of heavyness in abdomen. |
|
Definition
| Human T-cell leukemia virus type 1 (HTLV-1). Lymphadenopathy & splenomegaly. Skin biopsy --> leukemic CD4+. Type C is assoc. c adult T-cell leukemia/lymphoma --> high incidence blacks in Carribean/SE US, Subsaharan Africa/Japan. |
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|
Term
| 20yo M with sore throat, lymphadenopathy, and malaise. |
|
Definition
| IM (EBV). Lymphocytosis c atypical lymphs. Incr ALT/AST/bili. Positive heterophil Ab test (Monospot / Paul-Bunnell test). IgM antibodies to viral capsid = monospot positive. |
|
|
Term
| 40yo M smoker with high fever, nonproductive cough, pleuritic CP, and coworkers with similar symptoms. |
|
Definition
| Legionella pneumonia. Gram stain shows no organisms. Direct immunofluorescence confirms indirect fluorescent antibody titer. CXR: ill-defined nodules. Rx: erythromycin. Outbreaks d/t drinking water, humidifiers. |
|
|
Term
| 30yo Pakistani immigrant with history of red papule on arm following insect bite; now with chronic fever, skin darkening, and massive splenomegaly. |
|
Definition
| Leishmaniasis / "kala azar". Leshmania donovani zoonosis. Transmitted by Phlebotomussandfly. Labs = anemia, leukopenia, thrombocytopenia. Amastigotesin buffy layer. Rx: pentavalent antimony = Na stibogluconate; amph. B, or pentamidine. |
|
|
Term
| 26yo M from India with hypopigmented anesthetic skin patch on face and swelling in elbow in area of ulner nerve. |
|
Definition
| Leprosy: Mycobacterium leprae. Acid-fast bacillus. Thermolabile, divides slowly --> long course. Tuberculoid = skin with limited nerve /involvement (ulner/peroneal). Lepromatous = diffuse skin involvement/eyes/nerves/disfigurement (leonine facies). |
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|
Term
| 12yo M with fatigue, joint pain, and rash. |
|
Definition
| Lyme. Borrelia burgdorferii, spirochete. IgM ELISA, confirm c WB. Rx: doxy or amox. 3 stages; 1= erythema chronicum migrans + constitutional si/sx. 2= cardiac & neuro. 3= persistent migratory arthritis/synovitis/acrodermatitis chronicum atrophicans. |
|
|
Term
| 25yo with tender masses and painful groin ulcers after unprotected sex. |
|
Definition
| Lymphogranuloma venerum. Inguinal adenitis, buboes. + complement fixation and IF tests. Ulcerated nodule --> secondary = inguinal bubo (enlarged node +/- fistula/balanitis/phimosis/rectal involvement. Rx: doxycycline. An STD d/t C. trachomatis (L1/2/3). |
|
|
Term
| 30yo missionary with high fever, chills, and severe HA after returning from Africa 1 wk ago. |
|
Definition
| Malaria. peripheral smear = plasmodia in erythrocytes. Rx: chloroquine, quinine for cerebral malaria, tetracycline for resistant areas. Anophelesmosquito. Plasmodium falciparum may be lethal --> cerebral malaria. |
|
|
Term
| 12yo F with fever, severe HA, and stiff neck who fainted at school. |
|
Definition
| Meningococcemia. +/- petechial rash. Kernig's / Brudzinski's. CSF = incr prot, low gluc. Hypoglycemia, hypo-Na, hyper-K = Waterhouse-Friedrichsen's = adrenal necrosis --> death. Rx: steroids, IV fluid, DA, PCN-G. Prophylactic rifampin for contacts. |
|
|
Term
| 24yo F in hospital for DKA develops periorbital swelling and purulent postnasal discharge that fails to respond to ABs. PE reveals black ulceration of nasal mucosa. |
|
Definition
| Mucormycosis. Irregular nonseptate hyphae branching at wide angles. Mucor and Rhizopus molds. Conjunctival swelling = chemosis, black ulceration of nasal mucosa, CNIII palsy, necrotic destruction. !Suspect if AB-resistant sinusitis in DM/lymph/leukemia! |
|
|
Term
| 20yo M college student with productive cough, malaise, and fever. Cough started out nonproductive. |
|
Definition
| Mycoplasma pneumonia. CBC: normal leukocyte count. Elevated cold agglutinin titer >1:128. CXR: patchy infiltrates appear worse than clinical picture. Rx: erythromycin. #1 atypical pneumonia. Rapid spread in close quarters. |
|
|
Term
| 45yo M undergoing chemotherapy for Hodgkin's now with SOB/cyanosis; has had greenish sputum for 3 months. |
|
Definition
| Nocardiosis. Gram + filamentous, partially acid-fast bacteria. Nocardia asteroides. Chronic infection: DM/leukemia/lymphoma/IC'd pts. Usually lungs, +/- brain/SC tissue. Rx: SMX-TMP 6mo. |
|
|
Term
| 56yo F with visual acuity change, generalized itching after showering, and recent travel to tropics. |
|
Definition
| River blindness. Hypopigmentation, nodules, keratitis, chorioretinal lesions.Diethylcarbamazapine --> pruritus, rash, fever, conjuctivitis = Massotti reaction. Rx: ivermectin. Blackfly --> Onchocerca volvulus. Larvae in SC tx and lymphatics. |
|
|
Term
| 28yo diabetic with immobility of knee, swelling, tenderness, and elevated ESR. |
|
Definition
| Osteomyelitis. Periosteal thickening. New bone = involucrum traps necrotic bone = sequestrum. Rx IV ABs, surg. #1 =Staph > strep > enterobacteria. SC = E. coli > Salmonella. DM/puncture = Pseudomonas. IC'd = Sporothrix.Human bite = anaerobes. |
|
|
Term
| 18 month F with irritability and ear discharge. Recurrent URIs. |
|
Definition
| Otitis media. E. coli,staph, Klebsiella (neonates); S. pneumo, H. flu, Morexella, group A strep (kids). Rx amoxicillin-clavulanate. Complications = ingrowth of epithelium of middle ear = cholesteatoma. Hearing loss, mastoiditis, CNS abscess. |
|
|
Term
| 25yo M bitten by a cat with shiny, edematous tender hand draining purulent fluid. |
|
Definition
| Pasturella multicoda. Gram neg rod with bipolar staining. Catalase and oxidase positive. Rx: Incision and drainage + amoxicillin/clavulanate, tetracycline, or penicillin. Can progress to osteomyelitis. |
|
|
Term
| 14yo M bitten by younger sister with shiny, edematous, tender hand draining fluid. |
|
Definition
| Eikenella corrodens. Rx: PCN + I&D. |
|
|
Term
| 44yo archaeologist returns from dig site in Arizona with high fever, severe myalgia, and painful inguinal swelling. |
|
Definition
| Plague. Yersinia pestis. Enlarged inguinal nodes = buboes. No genital lesions. Gram negative bacilli c safety pin appearance in aspirates from buboes. Rx: streptomycin / tetracycline. Rodents and fleas in Southwestern US. Death rapid if untreated. |
|
|
Term
| 11yo M with blood-tinged, mucoid sputum and pleuritic chest pain. |
|
Definition
| Pneumococcal pneumonia. Incr fremitus & dullness over afffected lobe. Gram positive diplococci in sputum, alpha-hemolytic colonies. CXR = homogenous opacification of affected lobe +/- pleural effusion. Rx: IV PCN. #1 community acquired pneumonia. |
|
|
Term
| 32yo HIV + M with progressive dyspnea over 3 wks. |
|
Definition
| PCP. dry cough, fatigue, hypoxemia out of proportion to clinical findings. Rx: SMX-TMP. Interstitial pneumonia in IC'd pts. Bactrim prophylaxis for HIV pts if CD4 <200. Labs: serum LDH elevated. |
|
|
Term
| 14yo M Russian immigrant with weight loss, fever, night sweats and bloody sputum. |
|
Definition
| TB. Primary = lower lobes / subpleural. Secondary = cavity lesions in upper lobes. Rx: RIPE therapy = rifampin, isoniazid, pyrazinamide, ethambucil. |
|
|
Term
| 28yo M with numbness of R arm following bat bite. Refuses to drink water. |
|
Definition
| Rabies. Hydrophobia, neuropathy. Long incubation period 3-8wks, prevent occurrence with vaccine. Negri bodies = cytoplasmic inclusions in Ammon's horn. Positive rabies antigen on corneal scraping. |
|
|
Term
| 27yo Peace Corps volunteer in Africa with fever, sweats, abdominal pain. Had an itchy rash after swimming several weeks ago. |
|
Definition
| Schistosomiasis. CBC: eosinophilia. Rx: praziquantel. Snail-infested ponds/lakes. Hepatosplenomegaly d/t portal hypertension d/t granulomas = periportal fibrosis. |
|
|
Term
| 36yo M executive with sudden nausea, vomiting, and diarrhea with blood and mucus after business trip to South America. |
|
Definition
| Shigellosis. + fecal leukocytes. Shigella on stool culture. Not motile. Outbreaks c overcrowding, fecal-oral. Can be complicated by Reiter's syndrome = arthritis, conjunctivitis, urethritis (HLA-B27 individuals). Rx: ampicillin or SMX-TMP. |
|
|
Term
| 37yo with ulcerated nodule on hand after trauma while doing yardwork. |
|
Definition
| Sporotrichosis. Sporothrix schenckii. Nonpainful, soft, ulcerated nodule at inoculation site = sporotrichotic chancre. Rx: itraconazole. (Sporothrix is a dimorphic fungus = cigar shaped budding cells). May cause bone/joint infection. |
|
|
Term
| 9yo M with odynophagia and erythematous tonsils with white exudate. |
|
Definition
| Strep pharyngitis. Rx: oral penicillin V. Streptococcus pyogenes. Complications include glomerulonephritis and rheumatic fever. |
|
|
Term
| 38yo diplomat in Nigeria with diarrhea, fever, dry cough, and dyspnea. Frequently walks barefoot through his neighborhood. |
|
Definition
| Strongyloidiasis. Eosinophilia with motile rhabditiform larvae. Rx: thiabendazole or ivermectin. Results from poor hygeine in tropics. CXR: bilateral transient migratory infiltrates. |
|
|
Term
| 54yo F with spiking fever, loss of appetite, and RUQ pain who underwent emergency cholecystectomy 10d ago. |
|
Definition
| Subdiaphragmatic abscess. Rx: percutaneous drainage. Findings include pain on percussion, left-shift, fluid collection below diaphragm. Occurs typically >1wk after abdominal surgery. |
|
|
Term
| 18yo M with painless ulcer on penis. |
|
Definition
| Syphillis. Dark-field exam of exudate = treponemes. VDRL and FTA-ABS positive. Rx: Benzathine PCN IM, 2.4U single dose. STD d/t Treponema pallidum. |
|
|
Term
| 23yo F with nonpruritic skin rash, hair loss, and copper-colored maculopapular rash on palms and soles. |
|
Definition
| Secondary syphilis = generalized tender lymphadenopathy, rash on palms/soles, coalescent papules/plaques in groin = condyloma lata, hair loss = alopecia. Rx: IV benzathine PCN. |
|
|
Term
| 12yo M with dysphagia. Stepped on a nail about a week ago. |
|
Definition
| Tetanus. Clostridium tetani. Trismus = jaw m rigid, Risus sardonicus = facial m spasm; dysphagia, neck rigidity, painful facial spasms, opisthotonos. Rx: debride wound, tetanus immune globulin IM or intrathecally, diazepam; tetanus toxoid; IV PCN. |
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|
Term
| 40yo HIV + M with severe HA. Has 2 cats at home. |
|
Definition
| Toxoplasmosis. Toxoplasma gondii. Host = cats. Rx: pyrimethamine or sulfadiazine. PE reveals generalized lymphadenopathy, papilledema. CT/MRI-head reveals mass lesions with ring or nodular enhancement. Compl include seizure, brain abscess. |
|
|
Term
| 50yo M with generalized myalgia and low-grade fever. Had severe abdominal pain and diarrhea several weeks ago after eating at a pigroast. |
|
Definition
| Trichinosis. Labs: elevated CPK, LDH, and AST. Normal ESR. Eosinophilia. Raw/undercooked pork. Trichinella spiralis. Affects facial, neck, lower back, and diaphragm. Biopsy of SCM reveals organism. |
|
|
Term
| 20yo M with ulcer on wrist, lymphadenopthy in ispilateral axilla with suppuration. Recently trapped and disposed of rabbit on his property. |
|
Definition
| Tularemia. Francisella tularensis. Rabbits, squirrels, rodents, ticks. E levated ESR. Lymph nodes with suppuration + necrosis. Direct fluorescentantibody staining. May be tonsillar, oculoglandular, pneumonitic, typhoidal. Rx: streptomycin + tetracycline. |
|
|
Term
| 27yo M with increasing fever, constipation, and faint erythematous macules over the trunk. Visited Southeast Asia three weeks ago. |
|
Definition
| Typhoid fever. Salmonella typhi. Rx: ciprofloxacin. Infection of Peyer's patches c subsequent mucosal necrosis. Fever c stepladder pattern. Macules = "Rose spots" Infection from contaminated food or water. Typhoid vaccine available. |
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|
Term
| 5yo M with pruritic rash on scalp, face and trunk. |
|
Definition
| Varicella zoster. Lesions appear in crops q3-5d. Macules, papules, vesicles, pustules, and scabs all present at same time. Leukopenia. Tzank smear = inclusion bodies (Lipschutz bodies) + MNG cells. DNA herpesvirus. |
|
|
Term
| 45yo HIV+ M with painful, burning skin rash on left side of chest. |
|
Definition
| Zoster (shingles). Vesicular rash on erythematous base. Dermatomal distribution. Exquisitely tender. Acantholytic cells on Tzanck smear from base of vesicles. Cowdry A = intranuclear eosinophilic inclusions surrounded by clear halo. Rx: acyclovir. |
|
|
Term
| 24yo South American male develops high fever. He develops yellow eyes, and coffee-ground emesis four days later. |
|
Definition
| Yellow fever. Flavivirus transmitted by Aedes mosquito. Affects liver and kidneys: liver midzonal lobular necrosis, severe renal tubular damage. Rx: symptomatic only. Preventable by vaccine. 5-10% mortality, most cases mild. |
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|
Term
| 50yo M with sudden fever, chills, neck stiffness. |
|
Definition
| Bacterial meningitis. S. pneumoniae = most common adult. Photophobia, obtundation. Tap = high pressure, cloudy, high protein, very low glucose, high cells mostly WBCs. |
|
|
Term
| 33yo HIV+ M with persistent HA. |
|
Definition
| Cryptococcal meningitis. Encapsulated spherical fungi on India ink prep. CT/MRI-brain multiple ring-enhancing lesions. Rx: amphotericin B + 5-flucytosine. Acquired from pigeon droppings, usually seenin IC'd pts. |
|
|
Term
| 30yo HIV+ M with rapidly progressive visual loss. |
|
Definition
| CMV retinitis. Cotton-wool exudates, necrotizing retinitis, perivascular hemorrhages. Rx: ganciclovir; foscarnet. Occurs in 20% of AIDS pts. Blindness in HIV = toxoplasmosis, PML, and CMV. |
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|
Term
| 45yo hog farmer with visual loss, severe HA, and projectile vomiting. |
|
Definition
| Neurocysticercosis. Taenia solium. Papilledema, free-floating cysts in vitreous body of right eye. Ingestion of ova is fecal-oral. CT/MRI-brain: intracranial cysts or calcifications. Eosinophilia. |
|
|
Term
| 54yo man with ataxia, MS changes, deformed ankles, and shooting pain in extremities. |
|
Definition
| Tertiary syphillis. Gummas = subcutaneous nodules. Dorsal column --> reduced position/vibration sense. Charcot's neuropathic arthropathy. Broad-based gait. Romberg's sign. Light reflex lost with retained accomadation = Argyll Robertson. "Tree-bark" aorta. |
|
|
Term
| 25yo F with dysuria, frequency, and hematuria after her honeymoon. |
|
Definition
| Acute cystitis. E. coli > Proteus, Klebsiella, Staph. saprophyticus, and Enterococcus. Hemorrhagic cystitis may also result from adenovirusinfection. |
|
|
Term
| 28yo F in 27th week of pregnancy with R flank pain, fever, and dysuria. |
|
Definition
| Acute pyelonephritis. UA: proteinuria, WBC casts, >100,000 cfu E. coli. Rx by sensitivity, ampicillin empirically. E. coli, Klebsiella, Proteus, and Enterobacter. |
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|
Term
| 19yo M with painful urination and yellow-green urethral discharge. No bacteria seen on Gram stain. |
|
Definition
| Nongonnococcal urethritis. Rx: doxycycline. Most common = C. trachomatis, also Ureaplasma urealyticum. Frequentl coinfection c gonnococcal urethritis. Direct immunofluorescence using monoclonal Ab to Chlamydia. No growth on culture. |
|
|
Term
| 15yo M with painful bilateral parotid swelling and left-sided scrotal pain. |
|
Definition
| Orchitis. Mumps, E.coli, enterobacteria, chlamydia, gonnorhea, mycobacterium tuberculosis. May cause sterility if bilateral. Rx: scrotal support, ice packs, steroids. CBC: lymphocytosis, hyperamylasemia. |
|
|
Term
| 25yo F with burning on urination. |
|
Definition
| UTI. E. coli, staph saprophyticus = #1 and 2 causes. Others include proteus, klebsiella, enterobacter, serratia, psuedomonas, enterococcus, chlamydia, neisseria. Risk = females, sex, pregnancy, obstruction, bladder dysfunction, reflux, catheters. |
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|
Term
| 34yo M with multiple myeloma develops reticular skin infarction, necrosis, and ulceration. |
|
Definition
| Cryoglobulinaemia. Associated with paraproteinemias, RA, SLE, mononucleosis, lymphoma, PBC, and HCV. Small vessel vasculitis that may involve kidneys = renal failure. Rx: plasmapheresis. |
|
|
Term
| 54yo F with RA develops Bence Jones proteinuria. |
|
Definition
| Monoclonal gammopathy of uncertain significance (MGUS). Monoclonal paraprotein without B-cell tumor. Assoc c hepatitis, leptospirosis, autoimmune dx. Follow closely 10-20% develop myeloma. Rx: None necessary. Close f/u. |
|
|
Term
| 78yo M with fever, anemia, fatigue, petechiae and recent lacunar stroke. |
|
Definition
| Waldenstrom's macroglobulinemia. Old men 2:1. Normochromic normocytic anemia. Rouleaux RBCs. ESR elevated. Serum M protein, cryoglobulin, and cold-reacting Abs. Hyperviscosity --> stroke, MI, Raynaud's, pyoderma gangrenosum. |
|
|
Term
| 55yo M with anemia, leukopenia, thrombocytopenia and bone pain. |
|
Definition
| Multiple myeloma. Infections (70%), renal failure (50%), bone pain (100% with progression), bleeding (10%). Very high ESR, rouleaux RBCs. Diagnosis = 2 of following: Bence Jones, bone marrow plasma cells, punched-out bone lesions. |
|
|
Term
| 19yo M with recurrent DVTs for one year. |
|
Definition
| Antithrombin III deficiency. Diagnosis = antithrombin level. Rx: coumadin. AT-III activity enhanced by binding heparin (don't use heparin to treat AT-III deficiency). Inherited disorder, screen family. Onset in late teens typical. |
|
|
Term
| 24yo M with recurrent DVTs. Family history of DVTs affecting mother and sister. |
|
Definition
| Factor V Leiden. #1 thrombophilia. 20-40% of pts c DVTs esp. young ages. Auto dom: homoz's with 80x risk, hetero 7x risk. Incr risk in pregnancy & contraceptive use. Mutation eliminates protein C cut site. Rx: coumadin for homos, prophy for hetero's. |
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|
Term
| 23yo M bitten by snake now with purpuric skin lesions. |
|
Definition
| DIC. Causes include meningococcal, snakebite, staph septicemia, obstetric, malignancy (bronchus, pancreas, ovary, prostate, leukemias), shock, massive transfusion, vasculitis (HUS/TTP), bypass, cavernous hemangiomas. |
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|
Term
| 16yo M with massive hematomas and no history of trauma. |
|
Definition
| Differential includes: Christmas dx, von Willebrand's, hemophilia, or uncontrolled anticoagulation. |
|
|
Term
| 15yo M with acute hot, red, swollen knee and easy bruising. |
|
Definition
| Hemophilia. Prolonged aPTT, normal PT. Rx: factor VIII replacement. X-linked recessive. |
|
|
Term
| 13yo M with recurrent bleeding episodes and normal factor VIII levels and activity assay. |
|
Definition
| Christmas disease. Factor IX deficiency. Complications of both include: chronic degenerative joint dx, compression neuropathy, renal pelvic / ureteral obstruction, intestinal obstruction. |
|
|
Term
| 53yo homeless man with bleeding gums, purpura, and perifollicular bleeding. |
|
Definition
| Scurvy = vitamin C deficiency. |
|
|
Term
| 6yo F with generalized skin rash following mild URI. Rash became purpuric after one day. |
|
Definition
| HSP. Drugs, food, insect bites, infections. Purpura +/- glomerulonephritis. Immune complex deposition. Children > adults. Glomerulonephritis in 33%. |
|
|
Term
| 14yo with recurrent epistaxis and multiple small red lesions on lips, mouth, tongue. Mother and uncle have similar condition. |
|
Definition
| Hereditary hemorrhagic telangiectasias = Osler-Weber-Rendu. Autosomal dominant. Mucosal bleeding. Association with pulmonary AV fistula. |
|
|
Term
| 9yo F with recurrent URIs, diarrhea, and failure to thrive.` |
|
Definition
| CF. High Cl sweat test.CXR: brochiectasis. Pseudomonasand staph infections of the lung. Mucous plugging, small bowel obstruction = meconium ileus. Rx: pulmozyme (DNAse breaks up airway). Azithromycin. Inhaled tobramycin (Tobi). Male sterility. |
|
|
Term
| 23yo M with chronic productive cough and wife with difficulty becoming pregnant. Apical impulse not present on L side. |
|
Definition
| Kartagener's syndrome. Sperm immotility, bronchiectasis. Dynein defect leads to immotile cilia. Autosomal recessive. Dextrocardia. |
|
|
Term
| 23yo M goes to family doctor for evaluation of sterility. Found to have height greater than arm span, crown-pubis length greater than pubis-floor. |
|
Definition
| Klinefelter's. 47XXY. Male hypogonadism. High incidence of breast CA, COPD, DM, mild mental retardation. PE: small testes, gynecomastia, "eunuchoid" body proportions. Increased gonadotropin with reduced testosterone. |
|
|
Term
| 26yo M with flat nose, and single palmar crease. Had silver spots on iris at birth. |
|
Definition
| Down's. Epicanthal folds, Brushfield spots, Simian crease. Double bubble on KUB: dilated stomach proximal duodenum d/t duodenal atresia. Hypoplastic phalanges in 5th digits (acromicria). Usually nondisjunction; Robertsonian translocation or mosaicism. |
|
|
Term
| 7yo boy with diminished visual acuity and long arms, legs, and fingers. |
|
Definition
| Marfan's syndrome. Arm span > height, arachnodactyly, ectopia lentis, severe myopia, high-arched palate, flat feet = pes planus, aortic insufficiency, pectus excavatum. Rx: beta-blockers, endocarditis prophy. Auto-dom. fibrillin = elastin scaffold. |
|
|
Term
| 17yo F with amenorrhea, lack of breast development, and harsh systolic murmur. |
|
Definition
| Turner's. Short stature, webbed neck, shield-like chest with wide-spaced nipples. High serum FSH/LH; no Barr bodies on buccal smear. Get US pelvis --> streak ovaries. Karyotype 45, XO; sometimes mosaicism --> skeletal, CV, horshoe kidney. |
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|
Term
| 5yo Asian F with sudden eye pain and loss of vision after watching a film. Reports seeing halos around lights at night. |
|
Definition
| Acute glaucoma (angle closure). Hazy cornea, elevated intraocular pressure. Rock-hard eye. Rx: analgesics, IV acetazolamide, topical beta-blocker, steroids, pilocarpine, laser iridotomy. Precip'd by mydriatics and switch from dark to well lit areas. |
|
|
Term
| 49yo M with progressive weakness, difficulty speaking, and fasciculations. |
|
Definition
| ALS. Bilateral hand wasting, DTRs absent in upper limbs, muscle weakness, + Babinski sign (upgoing great toe) = upper motor neuron sign. Involves both upper and lower motor neurons. CSF normal. CT/MRI-brain normal. |
|
|
Term
| 40yo M, now unresponsive, found in bathroom at work projectile vomiting. Said he was "seeing double". |
|
Definition
| Cerebral aneurysm. Papilledema, CNIII palsy. Congenital Berry aneurysms associated with polycystic kidney disease, AV malformation. Cause subarachnoid hemmorhage. ACOMM > PCOMM > POST CEREBRAL. |
|
|
Term
| 14yo M with short stature, history of polyuria, and peripheral vision loss. |
|
Definition
| Craniopharyngioma. #1 supratentorial tumor in kids. Derived from Rathke's pouch remnants. Common cause of growth retardation, diabetes insipidus, bitemporal hemianopia, and headache d/t obstructive hydrocephalus. Bimodal with peak in fifth decade. |
|
|
Term
| 62yo M with rapidly progressing decline in cognitive function, somnolence, and clonus on exam. |
|
Definition
| Creutzfeld-Jakob. Subacute spongiform encephalopathy. Risk = dura mater, corneal transplants, cadaveric growth hormone, neurosurgical contamination. Lithium OD may mimic presentation. |
|
|
Term
| 19yo F horseback rider was thrown off horse. Lost consciousness then recovered. Now with HA, confusion, and weakness of left side with projectile vomiting. |
|
Definition
| Epidural hematoma. "Lucid interval" is classic. Signs = bradycardia, papilledema, mydriasis and CNIII palsy on ipsilateral,extensor plantar response and weakness on contralateral. CT --> lens-shaped, convex extra-axial fluid collection btwn dura & skull. |
|
|
Term
| 19yo M with wide-based gait, clubfoot, and lateral curvature of spine. |
|
Definition
| Friedreich's ataxia. #1 hereditary ataxia. Auto-dom, chromosome 9. Degeneration of doral root ganglia --> prorioceptive loss, areflexia, ataxia, Babinski's. Also causes visual loss, hypertrophic cardiomyopathy. |
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|
Term
| 60yo M with HA worse in morning, nausea, and vomiting for six weeks. |
|
Definition
| Glioblastoma multiforme. CT = irregular enhancing left-sided mass with necrotic center; mass effect and surrounding edema. |
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Term
| 38yo M with symmetric muscle weakness started in feet, now involving legs and shoulders. Had diarrhea and fever. |
|
Definition
| Guillain-Barre. Symmetrical proximalweakness / flaccidity. Increased CSF protein concentration without cellular increase. VDRL negative. Decreased nerve conduction velocity. Preceeded by GI/respiratory/EBV/Campylobacter/CMV +/- respiratory paralysis. |
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|
Term
| 65yo M with sudden severe HA and hemiplegia. Now incontinent. |
|
Definition
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|
Term
| 59yo F with retro-orbital HA and diplopia. Diagnosed with lung cancer. |
|
Definition
| Metastatic dx. Intracranial mets from lung, breast, GI, GU, CA, and melanoma. |
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|
Term
| 25yo with weakness, droopy eyelids, double vision, and dysphonia. |
|
Definition
| Myastenia gravis. Autoimmune c Abs to acetylcholine receptor subunits. Thymoma is present in 20% of cases. |
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Term
| 46yo M with HAs in the morning, seizures, and CT showing nodular calcifications in a frontal lobe mass. |
|
Definition
| Oligodendroglioma. Usually low grade, but may be anaplastic. More sensitive to chemo than astrocytomas. Calcification in 90% of cases. |
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|
Term
| 30yo M with anesthesia and weakness in both arms, occipital HAs, and stiff gait. |
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Definition
| Syringomyelia. MR/CT --> cystic dilatation within central cervical cord. Hydromelia is lined by ependymal tissue, syringomyelia is not. |
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|
Term
| 18yo M with wide-based gait and headaches. Father died of renal cell carcinoma at young age. |
|
Definition
| von Hippel-Lindau. Auto-dom, renal cell CA + renal, hepatic, pancreatic cysts + cerebellar ataxia. |
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|
Term
| 49yo alcoholic with confusion, stupor, and nystagmus following 5% dextrose infusion. |
|
Definition
| Wernicke's encephalopathy. Due to thiamine deficiency. |
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|
Term
| 22yo F with abnormal Pap smear and no history of irregular menstrual, postcoital bleeding, or vaginal discharge. |
|
Definition
| Cervical carcinoma in situ. |
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|
Term
| 29yo Vietnames F with nausea, vaginal bleeding, dyspnea, and hemoptysis. |
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Definition
| Choriocarcinoma. Can develop during normal pregnancy, s/p hydatidiform mole, or previous spontaneous abortion. Elevated hCG. |
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|
Term
| 45yo F with gross difference in size of her breasts with sensation of fullness but no pain. Exam reveals large, firm mass. |
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Definition
| Cystosarcoma phyllodes. Less common benign tumor of breast. Mass tends to be mobile and is well circumscribed. Path = cystic spaces on cut section, producing recesses and longitudinal openings with 'leaflike' (phyllodes) appearance. |
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|
Term
| 25yo W with amenorrhea for 6 weeks and development of pelvic pain for 1 day. |
|
Definition
| Ectopic pregnancy. Risk factors = previous tubal surgery, tubal ligation, endometriosis, previous ectopic pregnancy, ovulation induction, pelvic inflammatory disease. Test of choice = hCG and ultrasound (can get transvaginal US if needed). |
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|
Term
| 60yo F with obesity presents with intermittent vaginal bleeding for three months. Has never had children. |
|
Definition
| Endometrial CA. Estrogen-dependent cancer. Rx: hysterectomy, radiation. Important to include in differential of postmenopausal bleeding. |
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|
Term
| 27yo with inability to conceive, painful intercourse, and painful menses. |
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Definition
| Endometriosis = extrauterine endometrial tissue. Can be located in various locations with unique symptoms , most frequently bilateral ovaries = chocolate cysts. |
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|
Term
| 27yo F marathon runner with painful lump breast. Mammography reveals irregular mass with focal areas of calcification. |
|
Definition
| Fat necrosis. Indurated lesion with retraction of overylying skin. Unilateral localized process associated with trauma, breast biopsy, and radiation. Easy to confuse with CA… pain is the key distinguishing feature. |
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|
Term
| 25yo F with right breast lump that is small, encapsulated, and freely moveable. |
|
Definition
| Fibroadenoma. #1 benign breast tumor in young women; sometimes enlarges during pregnancy or normal menstrual cycles. Mammogram = "popcorn calcifications". |
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|
Term
| 20yo F with chronic left lower quadrant pain and left adnexal mass on exam. |
|
Definition
| Follicular ovarian cyst. #1 cause of ovarian enlargement. Test = US to look for cyst. Rx: Follow-up ultrasound (many disappear spontaneously); laparoscopic removal if persistent. |
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|
Term
| 52yo nulliparous F with painles lump in breast. PE reveals fixed, hard, nontender mass with retraction of overlying skin and palpable ispilateral nodes. |
|
Definition
| Infiltrating ductal CA = #1 breast cancer. Risk = family hx, estrogen "exposure", atypical hyperplasia, previous breast cancer. Fibrosis with induration = desmoplastic reaction. Rx = surgery, tamoxifen if E receptor positive. |
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|
Term
| 59yo F with pain and swelling in breast with erythematous overlying skin with peau d'orange appearance. |
|
Definition
| Inflammatory carcinoma of breast. Highly malignant with early and widespread metastases. |
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|
Term
| 39yo F with heavy and frequent periods, occasionally painful. |
|
Definition
| Leiomyoma. #1 tumor of uterus, most common tumor in women. Estrogen-dependent. US reveals multiple heterogenous masses, 95% intramural myometrium location, round, firm, well circumscribed. |
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|
Term
| 60yo F with foul-smelling, blood-tinged, purulent vaginal discharge. Tumor projecting from cervical os on speculum exam. |
|
Definition
| Leiomyosarcoma. CT = large complex mass in uterus. Biopsy = spindle-shaped cells with many mitotic cells. Rx: adriamycin, progestins, combination therapy. Aggressive malignant tumor of the myometrium, can arise from leiomyoma or de novo. |
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|
Term
| 56yo F with history of breast CA with pelvic mass identified on routine physical exam. |
|
Definition
| Ovarian carcinoma. Serous type most common, often bilateral and advanced at diagnosis. Elevated CA-125, psammoma bodies. |
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|
Term
| 68yo F with itchy, painless scaling and oozing of erythematous nipple. |
|
Definition
| Paget's carcinoma. Characteristically a scally skin lesion of areola and nipple arising from ductal adenocarcinoma. |
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|
Term
| 35yo F with bloody nipple discharge originating from one of the duct openings. |
|
Definition
| Papilloma of the breast. Benign proliferation of ductal epithelial tissue. #1 cause of serous / bloody nipple discharge. |
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|
Term
| 88yo M with purpura over extensor aspect of both hands. CBC reveals not abnormality. |
|
Definition
| Senile purpura. Benign disease of elderly, characteristically extensor hand surfaces, forearms, and neck. Defect in collagen support of dermal cappillaries. No treatment available. Cosmetic consequence only. |
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|
Term
| 18yo M with small purple skin lesions following URI two weeks ago. |
|
Definition
| ITP. Abrupt onset. Viral illnesses, drugs = thiazides, gold, carbamazepine, phenothiazines, quinine, rifampicin, valproate, sulphonamides, penicillins. Drug binds pltlt or drug binds plasma protein, forms immune complex, binds pltlt. Rx: steroids. |
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|
Term
|
Definition
| Senile, Osler-Weber-Rendu (hereditary haemorrhagic telangiectasia), giant cavernous hemangioma (can cause DIC), Ehler's-Danlos, Marfan's, HSP, scurvy, Cushing's, steroid use, uremia, liver dx. |
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|
Term
| 64yo M with testicular swelling. |
|
Definition
| Lymphoma of testis. #1 testicular neoplasm in elderly. |
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|
Term
| 29yo M with painless lymph node in the axilla, normochromic, normocytic anemia, and elevated ESR. Next test? |
|
Definition
| Node biopsy. Hodgkin's --> Reed-Sternberg. Non-Hodgkins' --> spectrum small lymphocytic (low-grade) to large cell centroblastic (high grade). A2 staging; I=nodes 1 region II=2 regions, same side III=nodes both sides hemidiaphragm, IV=diffuse. |
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|
Term
| 45yo F with anemia, bone tenderness, and abdominal distension. Smear demonstrates blasts at all stages of maturation. Recent DVT. |
|
Definition
| CML. Philadelphia chromosome 22 bcr-abl translocation 9:22 (95% of cases). Complications = hyperviscosity (rx with leukophoresis). |
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|
Term
| 60yo F with diffuse lymph node enlargement and smear with increased lymphocytes, smudge cells. |
|
Definition
| CLL. Most common leukemia in US and Europe. Monoclonal transformation of B cells. Diagnosis = persistent lymphocytosis with increased lymphs. Warm antibody hemolytic anemia may result. No rx if asymptomatic. |
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|
Term
| Causes of asplenia (anatomic or functional). |
|
Definition
| SLE, sickle cell, celiac, lymphoma, post-surgical. Risk of infection with S. pneumo, H. flu, N. meningitidis, malaria. |
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|
Term
| 34yo M with facial plethora (redness), conjunctival suffusion, and splenomegaly. |
|
Definition
| Polycythemia. True or d/t excess EPO --> polycystic kidneys, renal CA / cysts, chronic glomerulonephritis, liver disease, hepatocellular CA, overian CA, bronchial CA. Hypoxia, lung disease, congenital heart disease, smoking. Enlarged retinal vessels. |
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|
Term
| Causes of warm antibody autoimmune hemolytic anemia. |
|
Definition
| Lymphoma, leukemia (CLL), SLE, HIV. Causes spherocytes (also seen in congenital spherocytosis). Rx: prednisolone may induce remission; consider splenectomy. |
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|
Term
| Causes of cold antibody autoimmune hemolytic anemia. |
|
Definition
| Infectious mononucleosis, mycoplasma pneumonia, malaria, idiopathic (IgM paraprotein). |
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|
Term
| Cigar shaped erythrocytes. |
|
Definition
| Hereditary elliptocytosis. Usually asymptomatic. |
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|
Term
| Spherocytes on peripheral smear. |
|
Definition
| Perform osmotic fragility test. Spectrin defect = hereditary spherocytosis. |
|
|
Term
| 2yo with frontal bossing and "hair-on-end" appearance on skull x-ray. Has painful swelling of the fingers. |
|
Definition
| Sickle cell. Salmon-patch retinal hemmorhages. Homozygotes affected, heterozygotes asymptomatic until exposed to low O2 tension. Test with Hb electrophoresis and sickling test. |
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|
Term
| 25yo black M develops painful joints and severe stomach pain one day into ski trip in the French Alps. |
|
Definition
| Sickle cell trait. Crisis at low O2 tensions. |
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|
Term
| Drug induced aplastic anemia. |
|
Definition
| Chloramphenicol, chlorpropamide, chlorpromazine, carbimazole, carbamazepine, gold salts, methotrexate, phenytoin. |
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|
Term
| Most common cause of iron deficiency anemia worldwide. |
|
Definition
|
|
Term
| 58yo F with recurrent episodes of thrombophlebitis in the legs and arms. |
|
Definition
| Pancreatic CA. Thrombophlebitis may preceed diagnosis by many months. |
|
|
Term
| 64yo peanut farmer with jaundice, weight loss, and right upper quadrant pain. |
|
Definition
| Hepatocellular CA. Test for alpha-fetoprotein. Ultrasound / CT to evaluate. |
|
|
Term
|
Definition
| Glycogen storage, Fanconi's, alpha-1-antitrypsin (neonatal hepatitis with cirrhosis in childhood), cardiac cirrhosis (late complication of R heart failure), methotrexate, hereditary hemorrhagic telangiectasias, ulcerative colitis and Crohn's. |
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|
Term
| 17yo M with tremor, athetoid movements, and elevated LFTs. |
|
Definition
| Wilson's disease. Low ceruloplasmin. Kayer-Fleischer ring in cornea. Rx: penicillammine chelation therapy. |
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|
Term
| 55yo F with pruritus and jaundice that progressed over 3 years. |
|
Definition
| Primary biliary cirrhosis. Anti-mitochondrial Abs. Assoc. c Sjogren's, Raynaud's, thyroid dx, Addison's, RA, fibrosing alveolitis, dermatomyositis, scleroderma. Women 9:1, age 40-60. ERCP reveals normal intra/extrahepatic bile ducts. Gallstones common. |
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|
Term
| 31yo M with jaundice, pruritus, and RUQ pain. Markedly elevated AP with slight elevation in AST and ALT. |
|
Definition
| Primary sclerosing cholangitis. ERCP shows patchy dilatation and stricturing of biliary tree. High risk of ulcerative colitis. Progresses to hepatic cirrhosis. Risk = ascending cholangitis. HLA B8, DR2, DR3. |
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|
Term
| 30yo F with hypothyroidism and rheumatoid arthritis develops jaundice. |
|
Definition
| Autoimmune hepatitis. Type I = history or family history of autoimmune disease. Type 2 = anti-liver and kidney microsomal autoantibodies, occurs in younger children. Type 3/4 = soluble liver antigen, type 4 ill-defined similar clinical as type 1. |
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|
Term
| 31yo F with morbilliform rash and jaundice. Recently seen by a neurolgist for epilepsy. |
|
Definition
| Drug-induced hepatitis. Phenytoin (anti-epilepsy). |
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|
Term
| 25yo with eosinophilia, chronic cough, and distal small bowel obstruction. |
|
Definition
| Ascaris lumbricoides. Larvae migrate to lung, small bowel obstruction are complications. |
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|
Term
| 29yo HIV + F with eosinophilia, liver, heart, and renal failure. |
|
Definition
| Strongyloidiasis. Can result in systemic invasion in IC'd pts. |
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|
Term
| 23yo M former aid worker in Guatemala has resolving bloody diarrhea nd develops stricturing and mucosal damage to colon. |
|
Definition
| Entamoeba histolytica. Don’t confuse with inflammatory bowel disease. |
|
|
Term
|
Definition
| Rotavirus, Norwalk, Adenovirus. |
|
|
Term
| Diarrhea: bacterial toxin |
|
Definition
| E. coli (enterotoxigenic), Vibrio cholerae, Staph aureus, Clostridium perfringens, Clostridium difficile, Clostridium botulinum, Bacillus cereus. |
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|
Term
| Diarrhea: bacterial invasive |
|
Definition
| E. coli (enteroinvasive), Shigella, Salmonella, Yersinia enterocolitica, Vibrio parahemolyticus, Campylobacter jejuni. |
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|
Term
|
Definition
| Giardia lamblia, Cryptosporidium parvum, Entamoeba histolytica. |
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|
Term
|
Definition
| laxatives, antacids with magnesium |
|
|
Term
|
Definition
| puffer-fish, ciguatoxin, scombroid |
|
|
Term
| Diarrhea: chronic GI disorders |
|
Definition
| Ischemic colitis, malabsorption, irritable bowel, inflammatory bowel disease |
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|
Term
|
Definition
| Vibrio cholera, campylobacter, E. coli, Salmonella. |
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|
Term
| Diarrhea with systemic illness |
|
Definition
| Salmonella typi (enteric fever with diarrhea as late symptom) |
|
|
Term
| 64yo with CAD deficiency develops diarrhea, vomiting, and vague abdominal pain that rapidly progresses to hematochezia and severe abdominal pain. |
|
Definition
| Acute mesenteric ischemia. |
|
|
Term
| 48yo M with recurrent abdominal pain after eating. Also has hypercholesterolemia. |
|
Definition
| Chronic mesenteric ischemia (intestinal angina). |
|
|
Term
| 53yo M with abdominal pain and diarrhea with blood. Plain abdominal film reveals "thumbprinting" pattern in the descending colon and narrowing of the colonic lumen. |
|
Definition
| Colonic ischemia. More common than mesenteric ischemia, typically affects splenic flexure and other watershed areas. |
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|
Term
| 55yo F previously treated for carcinoma of cervix, now with nausea, vomiting, and rectal bleeding. |
|
Definition
| Radiation colitis. Intestinal ischemia may develop due to endarteritis obliterans. Sometimes pseudo-obstruction. Barium study = thickening of mucosal folds, narrowing of lumen. Symptoms due to rapid transit time and malabsorption. |
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|
Term
| 38yo F with celiac disease with chronic diarrhea and weight loss. Has been strictly adhering to gluten-free diet. |
|
Definition
| Intestinal lymphoma. Increased risk in celiac disease. |
|
|
Term
| 19yo F with diarrhea and bullous skin eruption. |
|
Definition
| Dermatitis herpetiformis. Gluten senstive enteropathy (celiac disease) + bullous skin eruption. Both may respond to gluten-free diet. |
|
|
Term
| 8yo M with chronic diarrhea, steatorrhea, abdominal distention, and failure to thrive. |
|
Definition
| Celiac disease (Gluten-sensitive enteropathy). Adult presentation more vague with megaloblastic anemia, diarrhea, vague abdominal symptoms. Abs include endomysial, gliadin, and reticulin. IgA endomysial Ab with high sensitivity and specificity. |
|
|
Term
| Diagnosis of celiac disease? |
|
Definition
| Biopsy! Flattening of vili. Definative diagnosis requires trial of gluten-free diet. |
|
|
Term
|
Definition
| Stomach: post-gastrectomy dumping, ZE, pernicious anemia. Hepatic/biliary: bil. obstr. / cholestasis. Pancreas: CF, pancreatitis, CA. Sm. bowel: celiac, crohn's, removal of sm. bowel, fistulae/blind loops, infection, radiation, lymphoma, drugs, whipple's. |
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|
Term
| Approach to malabsorption? |
|
Definition
| 1. confirm impaired absorption (fecal fat, Schilling test) 2. Identify specific deficiencies (CBC, Fe, iron, folate, B12, PT/PTT, vit D 3. establish cause. |
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|
Term
| 34yo M with severe recurrent peptic ulcer, diarrhea, and weight loss. |
|
Definition
| Zollinger-Ellison. Gastrin producing tumor associated with MENI (usually pancreatic). Diagnosis = high gastrin level and high basal secretion of acid. |
|
|
Term
|
Definition
| GUMBLEEDING = Gastritis, Ulcer, Mallory-Weiss, B, L, Esophagitis, Esophageal varices, angioDysplasia, Infection, N, GERD. |
|
|
Term
| Common causes of lower GI bleeding? |
|
Definition
| hemorrhoids, anal fissure, inflammatory bowel, diverticulitis, carcinoma, intussusception. |
|
|
Term
| Test for bacterial overgrowth? |
|
Definition
| glycochocolate breath test, based on deconjugation of radiolabeled bile acid and exhalation of labeled CO2. |
|
|
Term
|
Definition
| Liver, pancreas, and biliary tract. |
|
|
Term
| GI utility of plain film? |
|
Definition
| Demonstrate dilatation (toxic megacolon), obstruction. |
|
|
Term
| GI utility of angiography? |
|
Definition
| GI bleeding of obscure cause or suspected mesenteric ischemia. |
|
|
Term
| Unusual causes of lower GI bleeding? |
|
Definition
| AV fistulae, hereditary-hemorrhagic-telangiectasias (Osler-Weber-Rendu), angiodysplasia, vasculitis, amyloidosis. Meckel's, blood disorders (hemophilia, thrombocytopenia), rupture of AAA into bowel. |
|
|
Term
| Common causes of upper GI bleeding? |
|
Definition
| Duodenal ulcer > stomach erosions / gastritis > GERD > gastric ulcer > Mallory-Weiss > duodenal erosions > esophageal/gastric varices > stomach CA |
|
|
Term
|
Definition
| Systemic: folate/B12/Fe deficiency, collagen-vascular dx, diabetes. Local: smoking, fractured tooth/dentures/crowns, candidiasis, dry mouth. |
|
|
Term
|
Definition
| Blue line at tooth/gum margin = lead; gingivae swollen and purplish = scurvy; hyperplastic gingivitis = phenytoin, cyclosporin, and calcium antagonists; yellow staining = tetracycline. |
|
|
Term
|
Definition
| poor dental hygeine, gluten enteropathy, inflammatory bowel dx, Behcet's. |
|
|
Term
|
Definition
| Acromegaly, myxoedema, amyloidosis, motor neuron disease. |
|
|
Term
| 71yo M smoker with progressive dysphagia. |
|
Definition
|
|
Term
| 25yo M with progressive dysphagia and no past medical history. |
|
Definition
| Esophageal ring. Occur at or near GE junction. Cause unknown. |
|
|
Term
| 31yo M with HIV and odynophagia. |
|
Definition
| Esophagitis due to candidia, herpes, or CMV. |
|
|
Term
|
Definition
| Association with duodenal ulcer (100%) > gastric (80%) > duodenitis/gastritis. Increased risk of gastric cancer and MALT lymphoma. Test: serology or urease breath test. |
|
|
Term
|
Definition
| Infectious = rotavirus, norwalk, E. coli, H. pylori. Drug/chemicals = aspirin and other NSAIDs, alcohol. Asymptomatic chronic = elderly persons often with H. pylori. Atrophic = autoimmune (positive parietal cell Abs) with pernicious anemia. |
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|
Term
| 38yo F presents with melena and epigastric pain. Barium study revealed rugal hypertrophy. |
|
Definition
| Menetrier's disease (giant hypertrophic gastritis). Assoc. with protein-losing enteropathy. |
|
|
Term
| GI disease with finger clubbing? |
|
Definition
| malabsorption, small intestinal disease, and cirrhosis. |
|
|
Term
|
Definition
| Stimulation test and markers: |
|
|
Term
|
Definition
| Insulin hypoglycemia test: GH, cortisol, blood glucose |
|
|
Term
|
Definition
| Glucacon: GH, blood glucose |
|
|
Term
|
Definition
| Thyrotropin releasing hormone: TSH, T3, T4, prolactin, GH |
|
|
Term
|
Definition
| Gonadotropin releasing hormone: FSH, LH, spermatogenesis, ovulation |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| 11yo M with with color blindness, midline facial deformity, and anosmia. |
|
Definition
| Isolated gonadotropin deficiency = Kallman's syndrome. Prepubertal onset, hypogonadal hypogonadism. |
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|
Term
| 28yo F with resolving meningitis develops polyuria. |
|
Definition
| Central diabetes insipidus. Most frequently associated with craniopharyngioma. Rarely with anterior pituitary disease. Test = water deprivation and measure urine osmolality. |
|
|
Term
| 43yo M with thick skin, broad nose, and prominent supraorbital and nuchal ridges. |
|
Definition
| Acromegaly. Uncommon. May occur in MEN1. Large spade-like hands. Enlargement of the tongue. Hoarse voice. Cardiomegaly, heart failure, and malignancy causes death. Tufting of terminal phalanges on x-ray. |
|
|
Term
| Elevation of prolactin level due to physiolgic cause? |
|
Definition
| Sleep, stress, nipple stimulation, coitus, pregnancy, suckling. |
|
|
Term
| Most common cause of Cushing's syndrome? |
|
Definition
| ACTH overproduction by pituitary 60% > ectopic ACTH (15%) > adrenal adenoma (15%) > adrenal carcinoma (10%). Cushing's disease usually pituitary microadenoma (90%) more frequently in women. |
|
|
Term
| 48yo F with develops increasing pigmentation following bilateral adrenalectomy for Cushing's disease. |
|
Definition
| Nelson's syndrome. May follow adrenalectomy if ACTH production continues in excess. |
|
|
Term
| Diagnosis of Cushing's syndrome. |
|
Definition
| Low dose 48hr dex suppression. Screening with overnight dex suppresion test or 24hr urinary free cortisol. If plasma ACTH is undetectable, usually adrenal tumor. Pituitary-dependent disease suppresses, whereas adrenal tumors and ectopic ACTH does not. |
|
|
Term
|
Definition
| Bronchial carcinoma, carcinoid. |
|
|
Term
| 29yo F with SLE and history of DVTs develops increased skin pigmentation and profound hypekalemia. |
|
Definition
| Primary adrenal insufficiency. Antiphospholipid syndrome can destroy adrenal glands. |
|
|
Term
| 31yo M with fatigue, weight loss, GI disturbances, and dark spots on the inside of his cheeks. |
|
Definition
| Addison's disease. Autoimmmune or rarely TB, granulomatous disease, metastases. Other causes of adrenal insufficiency include withdrawal of steroid therapy, Waterhouse-Friderichsen, anticoagulant therapy. Hyponatremia, hyperkalemia, vitiligo. |
|
|
Term
|
Definition
| Rare congenital syndromes, nutritional/emotionald deprivation, GH deficiency (fat with immature facies and genitals), hypothyroidism, Cushing's. "Fat and short" likely endocrine. Turner's 45XO, and Noonan's (45XO/XY mosaic). |
|
|
Term
| 34yo F with short stature, large head, prominent forehead and disproportion of body and limbs. |
|
Definition
| Achondroplasia. Autosomal dominant. #1 short stature with abnormal proportions. |
|
|
Term
| 15yo F found on pelvic exam to have bilateral masses in the labia. LH levels is high. |
|
Definition
| Testicular feminization syndrome. XY male with X-linked deficiency of androgen receptors. |
|
|
Term
| Newborn with ambiguous genitalia, clitoral hypertrophy, and partial fusion of labioscrotal folds. |
|
Definition
| Congenital adrenal hyperplasia. 21-hydroxylase defiency. Excess androgenic cortisol precursors. |
|
|
Term
| 18yo M with small firm testes, gynecomastia, and female distribution of body hair. |
|
Definition
| Klinefelter's. Infertile, may be unusually tall, 47XXY. |
|
|
Term
| Common causes of amenorrhea? |
|
Definition
| Hyperprolactinemia, weight loss, anorexia nervosa, autoimmune associated ovarian failure (Addison's or other). |
|
|
Term
| 24yo obese F with menstrual irregularity, hirsutism, and acne. |
|
Definition
| Polycystic ovarian syndrome. Stein-Leventhal syndrome = obesity, amenorrhea, and hirsutism. DM2 develops in 40% by age 40. Labs = incr LH, +/- incr T, normal FSH, prolactin and TSH. Pelvic |
|
|
Term
| 61yo M with new onset atrial fibrillation, heart failure, and 20lb weight loss over 12 months. |
|
Definition
| "Masked" hyperthyroidism. Commonly due to toxic multinodular goiter. Lacks typical Grave's features. |
|
|
Term
| 44yo F with diffuse goiter, pretibial myxoedema, and tachycardia. |
|
Definition
| Grave's. IgG antibodies against TSH receptor = thyroid stimulating Abs (TSAb). Exopthalmos, lid lag, periorbital puffiness, increased lacrimation, conjunctival edema, ophthalmoplegia, loss of visual acuity. |
|
|
Term
| 53yo F with hyperlipidemia, puffy face, and coarse hair, and hair loss. |
|
Definition
| Hypothyroidism: Spontaneous atrophic, postsurgical, radioactive I, Hashimoto's (thyroid peroxidase and thyroglobulin Abs in 90%). Dry skin, coarse hair, facial edema, effusion, ascites, cardiac dilatation. Assoc c pernicious anemia and carpal tunnel. |
|
|
Term
| Most common goitrous hypothyroidism? |
|
Definition
| Hashimoto's. Women >> Men. Older women > younger. |
|
|
Term
| 58yo F from central Africa with large goiter. |
|
Definition
| Endemic goiter. Can be euthyroid. Due to iodine deficiency. |
|
|
Term
| 73yo F with hypothermia and altered mental status and history of hypothyroidism. |
|
Definition
| Myxedema coma. marked by hypothermia, cardiac failure, altered MS, convulsion. Mortality 50%. |
|
|
Term
| 46yo M with painful itchy ear following family vacation to lake. Experiences pain when tragus is pressed during exam. |
|
Definition
| Otitis externa. Symptoms inlcude pain, pruritus, hearing loss, and fullness. Tragus = semicircular cartilage in front of ear canal. Staph and pseudomonas. |
|
|
Term
| 51yo diabetic M with painful itchy ear. Physical exam reveals inflammation and swelling of the pinna. |
|
Definition
| Cellulitis. Differentiate from otitis externa. |
|
|
Term
| 47yo HIV positive M with "boring" ear pain and long-standing ear infection that has not responded well to treatment. |
|
Definition
| Necrotizing external otitis. Occurs in ICd pts. Refer to otolaryngology. |
|
|
Term
| 28yo F with diffusely swollen and tender pinna. |
|
Definition
| Perichondirits. IV antibiotics, serious condition. |
|
|
Term
| 31yo M with circumscribed swellings in the external canal with tenderness on exam. |
|
Definition
| Furunculosis. Rx with topical ABs. |
|
|
Term
| 82yo M with pruritus of the external canal. Whitish exudate with black spots on exam. |
|
Definition
| External mycotica (otomycosis). Aspergillus niger causes black spots over white. |
|
|
Term
| 44yo construction worker with dizziness, tinitus, and conductive hearing loss in the right ear. |
|
Definition
|
|
Term
| Complications of sinusitis? |
|
Definition
| Osteomyelitis, periorbital infections (pain with eye motion, ptosis, proptosis), cavernous sinus thrombophlebitis (CN III, IV, VI palsies), brain abscess, meningitis. |
|
|
Term
|
Definition
| Consider Wegener's granulomatosis, cystic fibrosis, Kartagener's, and TMJ syndrome. Need CT scan to rule out obstruction. |
|
|
Term
| 25yo F develops high fever, myalgias, rhinorrhea, and sore throat. |
|
Definition
| Common cold, due to: influenza virus, rhinovirus, coronavirus, adenovirus, parainfluenza. Rule out bacterial sinusitis, pharyngitis, and allergic rhinitis (history of itchy eyes, nose, and throat). |
|
|
Term
| 25yo F develops high fever, myalgias, and palpable tender neck nodes. |
|
Definition
| Bacterial pharyngitis. No cough or rhinorrhea. Tonsillar exudate may be present. Viral pharyngitis much more common (90%). Group A strep >> other strep, mycoplasma, chlamydia, and neisseria gonorrhea. Diptheria with grey-white pseudomembrane. |
|
|
Term
| 25yo F with itchy eyes, nose, and throat. Pale edematous nasal mucosa. |
|
Definition
| Allergic rhinitis. Seasonal or allergic pattern. Tearing. Mucosa is not erythematous. |
|
|
Term
| 25yo F with purulent nasal discharge, tender face, and toothache. |
|
Definition
| Bacterial sinusitis. Treat with amoxicillin. |
|
|
Term
| Findings suggestive of Group A strep pharyngitis. |
|
Definition
| Recent exposure, history of infection in past yr, absence of cough, hoarseness, or rhinorrhea, temp > 101, tonsillar exudate, anterior cervical lymphadenopathy. |
|
|
Term
| Causes of secondary hypertension (5% of all HTN, primary/essential HTN 95%) |
|
Definition
| Aortic coarctation, intrinsic renal dx, renal artery stenosis (young = fibromuscular, old = athero), primary hyperaldosteronism (suspect if hypokalemic and not on diuretic), Cushing's, Pheo, |
|
|
Term
| 1 anatomic, two renal, three adrenal, and four CENTs cause HTN. |
|
Definition
| CENTs = hyperCalcemia, Ethanol or Estrogen (oral contraceptives) most common causes, Neurologic disease = increased ICP, Thyrotoxicosis. |
|
|
Term
| 21yo F develops dramatic increase in creatinine after starting ACE inhibitor therapy for hypertension. |
|
Definition
| Consider renal artery stenosis! |
|
|
Term
| 31yo M with mental status changes and blood pressure of 225/124 |
|
Definition
| Hypertensive emergency. Hypertensive urgency = systolic BP > 220. Hypertensive emergency = Urgency + End-organ damage: encephalopathy (ms changes), intracranial hemorrhage, aortic dissection, MI, unstable angina, hypertensive nephropathy. |
|
|
Term
| HTN treatment: uncomplicated, DM1, CHF systolic, CHF diastolic, isolated systolic HTN, CAD or MI, BPH, pregnancy. |
|
Definition
| beta blocker or diuretic; ACE or diuretic; beta blocker, diuretic, or CCB; diuretic; beta blocker; prazosin; methyyldopa. |
|
|
Term
| 18yo M with painful swollen knee and ipsilateral leg lower leg edema. |
|
Definition
|
|
Term
| 54yo F with inguinal lymphadenopathy, pelvic symptoms, weight loss and bilateral lower extremity edema. Dry and scaly skin on feet. |
|
Definition
|
|
Term
| 43yo F with painless edema worse at the end of the day. Varicose veins present. Improves with elevation. |
|
Definition
| Chronic venous insufficiency. |
|
|
Term
| 54yo F with painful thighs and bilateral lower extremity edema following knee replacement surgery. |
|
Definition
|
|
Term
| 45yo F with tachycardia, bilateral lower extremity edema, and tremor. |
|
Definition
| Pretibial myxedema (Grave's disease) |
|
|
Term
| 12yo M with leg length discrepancy since childhood and ipsilateral lower extremity edema. |
|
Definition
| Congenital venous malformation. |
|
|
Term
| 24yo F with SLE presents with bilateral lower extremity edema. |
|
Definition
|
|
Term
| 28yo M with taut, shiny skin and extreme sensitivity to touch of right leg. Edema in the right leg on exam. |
|
Definition
| Reflex sympathetic dystrophy. |
|
|
Term
| 43yo M with lots of tatoos develops peripheral edema and necrotic skin lesions. |
|
Definition
| HCV is associated with cryoglobulins and membranoproliferative glomerulonephropathy. |
|
|
Term
| 45yo F with recurrent infections, nonhealing leg ulcers, history of RA, and splenomegaly on examination. |
|
Definition
|
|
Term
| Calcinosis, Raynaud's, Esophageal dysmotility, Sclerodactyly, Telangiectasias. |
|
Definition
|
|
Term
| 45yo F with history of PBC with skin thickening of the fingers and difficulty swallowing. |
|
Definition
| CREST. Associated with PBC and primary pulmonary hypertension. |
|
|
Term
|
Definition
| Postnasal drip > GERD > asthma. Also cigarette use +/- COPD. Less common causes include bronchiectasis, CHF, ACE-I, post-pertussis cough, malignancy, chronic infection usually c systemic symptoms, and psychogenic cough. |
|
|
Term
| Headache and jaw claudication. |
|
Definition
| Giant cell arteritis. Diagnosis with biopsy, start steroid rx immediately. Large vessel vasculitis. |
|
|
Term
| 26yo Asian F with finger ischemia and arm claudication. |
|
Definition
| Takayasu's arteritis. "Pulseless disease". Diagnosis with aortic arch angiogram. |
|
|
Term
| 32yo M with skin ulceration, hematuria, abdominal pain after eating, joint pain, and right hand weakness. |
|
Definition
| Polyarteritis nodosa (PAN). Necrotizing vasculitis of small and medium muscular arteries. 1/3 associated with HBV, also with HCV. No pulmonary findings! |
|
|
Term
| 35yo M with shortness of breath, fever, maculopapular rash, palpable purpura, and cutaneous nodules. CBC reveals eosinophilia. |
|
Definition
| Churg-Strauss. Granulomatous reaction in medium sized vessels. |
|
|
Term
| 28yo M with recurrent sinusitis, hematuria, and hemoptysis. Has had recurrent fevers, weight loss and arthralgias. |
|
Definition
| Waegener's granulomatosis. C-ANCA positive vasculitis of small arteries. Upper and lower respiratory infections. |
|
|
Term
| Drug causing palpable purpura. |
|
Definition
| Hypersensitivity vasculitis. |
|
|
Term
| 45yo M with abdominal pain, swollen joints, purpuric rash, and hematuria following URI four days ago. |
|
Definition
| Henoch Schonlein Purpura. Definition = IgA nephropathy plus abdominal pain, join pain, and purpura. |
|
|
Term
| 24yo F with history microscopic hematuria and microalbuminuria, now with gross hematuria following URI. |
|
Definition
|
|
Term
| 34yo M with hemoptysis and hematuria. |
|
Definition
| Goodpasture's syndrome. Anti-glomerular basement membrane antibody. (Anti-GBM). |
|
|
Term
| 50yo M with CLL presents with blurry vision, finger ischemia, headache, and lethargy. |
|
Definition
| Monoclonal cryoglobulinemia. Rx with plasmapheresis. |
|
|
Term
| 60yo M with history of IVDA now with arthralgia, purpura, glomerulonephritis, and neuropathy. |
|
Definition
| Mixed cryoglobulinemia. Result of immune complex deposition. Associated with HCV, lupus, and RA. |
|
|
Term
| 35yo M with one year progressive dyspnea. Oxygen saturation drops with ambulation. |
|
Definition
| Idiopathic pulmonary fibrosis or PCP pneumonia. Hallmark of interstitial lung disease. |
|
|
Term
| Dermatomyositis patients have increased risk of what? |
|
Definition
| Malignancy: colon, lung, breast, and prostate. |
|
|
Term
|
Definition
| CARES: Cardiac asthma (CHF), Churg-Strauss, Allergic bronchopulmonary aspergillosis, Reflux esophagitis (GERD), Exposures (irritants, meds), Embolism, Sinusitis, Strongyloides. |
|
|
Term
| Causes of obstructive lung disease? |
|
Definition
| Asthma, COPD, bronchiectasis, cystic fibrosis. |
|
|
Term
| Causes of restrictive lung disease? |
|
Definition
| Pleural fibrosis, Interstitial (idiopathic, fungal infection: histoplasmosis, sarcoid), neuromuscular (myasthenia gravis, myopathy, Guillain-Barre), alveolar edema or inflammation, BOOP, pleural effusion, kyphoscoliosis, pregnancy, obesity. |
|
|
Term
| What causes most cases of acute bronchitis? |
|
Definition
| Viral > atypical bacteria (Mycopl, Chlamydia, Legionella) > typical bacteria rarely (s. pneumo, h. flu, morexella) > allergic. Acute onset of cough and sputum production s hx of chronic pulm dx and no evidence of pneumonia or sinusitis. No Abs needed. |
|
|
Term
| Most common immunodeficiency? |
|
Definition
| Selective IgA deficiency. Caused by anti-IgA IgG. Recurrent sinopulmonary infections. |
|
|
Term
| Low IgA, IgG, and IgM. Normal numbers of B cells. Pts 15-30yrs old. |
|
Definition
| Common variable immunodeficiency. Associated with autoimmune disease and lymphoid malignancies. |
|
|
Term
| Recurrent pyogenic infections of skin and lower respiratory tract. Pruritus, coarse facies, keratotic nails. |
|
Definition
| Job's syndrome. Hyper-IgE. Autosomal recessive. Abscess, empyema, staph. aureus. |
|
|
Term
| Thrombocytopenia, eczema, and recurrent infections. |
|
Definition
| Wiscott-Aldrich. Depressed cell-mediated immunity, high IgA. |
|
|
Term
| Low set ears, opportunistic and viral infections, severly sick after live viral vaccine, hypokalemia and hypocalcemia. |
|
Definition
| DiGeorge syndrome. Congenital immunodeficiency with no thyroid or parathyroid. 3rd and 4th pharyngeal pouch. |
|
|
Term
| 5yo M without tonsils, recurrent URIs and skin infections, and asymmetric arthritis. |
|
Definition
| Bruton's congenital agammaglobulinemia. |
|
|
Term
| Recurrent staph and strep infections in albino child. |
|
Definition
|
|
Term
| 34yo M with slow onset of cough and pleuritic chest pain several days following resolution of URI. |
|
Definition
| Pneumococcal pneumonia. Usually abrupt presentation occurs insidiously following viral respiratory tract infection. |
|
|
Term
| 57yo M with COPD develops pleuritic CP and worsening cough. |
|
Definition
|
|
Term
| 88yo F develops cough, fever, and pleuritic CP. |
|
Definition
| S. aureus pneumonia. Seen in ICd and nursing home pts. |
|
|
Term
| 54yo alcoholic presents with productive cough, fever, and lobar consolidation on CXR. |
|
Definition
|
|
Term
| 19yo F with mild pneumonia and hemolytic anemia. |
|
Definition
| Mycoplasma. Prominent extrapulmonary symptoms including: erythema multiforme, myocarditis, erythema nodosum, bullous myringitis, neurological abnormalities. |
|
|
Term
| 23yo M with mild pneumonia and hoarseness with severe pharyngitis. |
|
Definition
| C. pneumoniae. Distinguishing feature = hoarseness with severe pharyngitis. |
|
|
Term
|
Definition
| Legionella, Moraxella, Chlamydia, Mycoplasma. |
|
|
Term
| Pneumonia requiring hospital admission? |
|
Definition
| Two or more lobes, increased A-a gradient or tachypnea, mental status changes, vulnerable patient, homeless patient, very high/low white count. |
|
|
Term
| 45yo M with pedal edema, nocturia, and morning headache. |
|
Definition
| Sleep apnea. Symptoms include snoring, daytime hypersomnolence, morning headache, impotence, nocturia or enuresis, pedal edema, exercise fatigue. Exclude hypothyroidism and acromegaly. |
|
|
Term
| Abdominal Pain due to metabolic / systemic disorders: Puking My Very BAD LUNCH |
|
Definition
| Porphyria, Mediterranean fever, Vasculitis, Black widow, Addison's / Angioedema, DKA, Lead, Uremia, Neurogenic (diabetes, syphillis, spinal nerve impingement), hyperCalcemia, Herpes zoster. |
|
|
Term
|
Definition
|
|
Term
| Abdominal pain: Epigastric |
|
Definition
| stomach, pancreas, duodenum, abdominal aorta |
|
|
Term
|
Definition
|
|
Term
| Abdominal pain: lower quadrants |
|
Definition
| appendix, intestine, ovary, fallopian tubes, testes, kidney, ureters |
|
|
Term
| Abdominal pain: periumbilical |
|
Definition
| small intestine, appendix, abdominal aorta |
|
|
Term
| Abdominal pain: suprapubic |
|
Definition
| bladder, uterus, ovaries, fallopian tubes |
|
|
Term
| Causes of secretory diarrhea that persists despite fasting? |
|
Definition
| Thyrotoxicosis, carcinoid syndrome, colon cancer, colonic polyps, durgs. |
|
|
Term
|
Definition
| Colchicine, Mg-containing antacids, antibiotics, theophylline, lactulose, laxatives. |
|
|
Term
| Causes of osmotic diarrhea? |
|
Definition
| Drugs, pancreatic insufficiency, celiac disease, lactose/fructose intolerance, laxatives. |
|
|
Term
| Causes of exudative diarrhea? |
|
Definition
| (Protein, blood, mucus) Stools with leukocytes and blood. Causes include: Lymphoma, Whipple's disease, collagenous colitis, IBD, ischemic colitis. |
|
|
Term
| Intestinal motility disorders associated with? |
|
Definition
| IBS, DM, narcotic use, systemic sclerosis, fecal impaction, surgery (post-gastrectomy dumping, post-vagotomy syndrome). |
|
|
Term
|
Definition
| Radiation enteritis, bacterial overgrowth, enteric fistula, ileal resection, short bowel syndrome. |
|
|
Term
| Diarrheas associated with immunodeficiency? |
|
Definition
| Isospora belli, Microsporidia, Cryptosporidium parvum, Giardia lamblia, Strongyloides stercoralis, Entameba histolytica, Mycobacterium-avium-intracellulare complex, Clostridium difficile, CMV. |
|
|
Term
| What accounts for 50% of cases of diarrhea referred to gastroenterologists? |
|
Definition
| Functional diarrhea. No organic cause. |
|
|
Term
| 34yo M presents with low back pain worse with rest and bloody diarrhea. |
|
Definition
|
|
Term
| 67yo M with CAD and familial hypercholesterolemia presents with bloody diarrhea. |
|
Definition
|
|
Term
| 31yo F with diarrhea, weight loss, and skin rash. |
|
Definition
| Celiac disease with dermatitis herpetiformis. |
|
|
Term
|
Definition
| Neoplasia, strictures, adhesion/rectoceles, drugs (tricyclics, opiates, neuroleptics, antihistamines, CCBs, iron supplements, antacids without Mg), DM, hypothyroid, hypokalemia, hypomagnesemia, uremia, neurologic disorders, IBS, amyloid, scleroderma. |
|
|
Term
|
Definition
| H secretion. Low K. pH > 5.3. Rx: HCO2 + K. Hereditary, amphotericin, collagen vascular disease, cirrhosis, nephrocalcinosis. |
|
|
Term
|
Definition
| Bicarb reabsorption. Low K. pH < 5.3. Rx: HCO3 + K + thiazide. Hereditary, sulfonamides, carbonic anhydrase inhibitors, Fanconi syndromes. |
|
|
Term
|
Definition
| Aldosterone defiency. High K. pH < 5.3. Rx: Fludrocortisone, K restriction, HCO3. Hyporeninemic with diabetes, HTN, or chronic interstitial nephritis; aldosterone resistance. |
|
|
Term
| Anion gap metabolic acidosis? |
|
Definition
| MUDPILES: Methanol, Uremia, Diabetic ketoacidosis, Paraldehyde, Iron/INH, Lactic acidosis, Ethylene glycol, Salicylates. |
|
|
Term
| Hyperchloremic metabolic acidosis (no anion gap)? |
|
Definition
| Diarrhea, RTA, spironolactone/acetazolamide, TPN |
|
|
Term
|
Definition
| Foreign body, pneumothorax, flail chest, hypoventilation d/t sedatives/narcs, obstructive/restrictive pulmonary disease, pleural effusion. |
|
|
Term
|
Definition
| NaCl responsive = vomiting, villous adenoma, contraction alkalosis, diuretics. Rx IVF + K. Not NaCl responsive = Conn's & Cushing's, adrenal hyperplasia, licorice, Bartter's syndrome. Rx: KCl and spironolactone or acetazolimide (enhance HCO3 excretion) |
|
|
Term
|
Definition
| Hyperventilation (anxiety/pain), CVA, head trauma, asthma, PE, CHF, pneumonia, pregnancy, hepatic insufficiency, ASA toxicity, thyrotoxicosis, mechanical ventilation. Rx = treat underlying cause. |
|
|
Term
|
Definition
| High osmolality = hyperglycemia or hypertonic infusion. Normal osmolality = Pseudohyponatremia, hyperlipidema, hyperproteinemia. Low osmolality = hypotonic hyponatremia. |
|
|
Term
|
Definition
|
|
Term
| Hypotonic hyponatremia with FeNa >1%. |
|
Definition
| Hypervolemic = renal failure; Euvolemic = SIADH, hypothyroidism, renal failure, drugs; Hypovolemic = diuretics, RTA, adrenal insufficiency, ACE inhibitors. |
|
|
Term
| Hypotonic hyponatremia with FeNa <1%. |
|
Definition
| Hypervolemia = nephrosis, CHF, cirrhosis; Euvolemic = polydipsia; Hypovolemic = vomiting, diarrhea, third spacing, dehydration. |
|
|
Term
| Treatment fo hypotonic hyponatremia? |
|
Definition
| Hypervolemic = salt & water restrict; Euvolemic = salt & water restrict; Hypovolemic = normal saline. |
|
|
Term
| Hyperkalemia signs and symptoms? |
|
Definition
| Intestinal colic, areflexia, weakness, peaked T wave, prolonged QRS and PR, low P. |
|
|
Term
|
Definition
| Cellular shifts: (tissue injury, acidosis, insulin deficiency, drugs including succinylcholine, digitalis, beta-agonists, arginine); |
|
|
Term
| Treatment of hyperkalemia? |
|
Definition
| C BIG K = Calcium gluconate (cardiac membrane stabilization); Bicarb, Insulin, Glucose; Kayexalate and loop diuretics (furosemide). |
|
|
Term
|
Definition
| muscle weakness, cramps, ileus, hyporeflexia, parasthesias, flaccid paralysis. |
|
|
Term
| Linear calcification on x-ray of the knee? |
|
Definition
| Pseudogout. Positive birefringent crystals. Associated with hemachromatosis. |
|
|
Term
| 58yo F with long history of RA develops splenomegaly and leukopenia. |
|
Definition
|
|
Term
|
Definition
| septic shock, pustules, organisms on gram stain |
|
|
Term
|
Definition
| prositutes, urethritis, joint pain with effusion |
|
|
Term
|
Definition
| poor sanitation, prolonged fever, constipation, bradycardia, rose spots |
|
|
Term
|
Definition
| vesicles and bullae, IVDA |
|
|
Term
|
Definition
| raw seafood, lesions on legs > arms, cirrhotics most susceptible |
|
|
Term
|
Definition
| hot tubs: pseudomonas; swimmer's itch: schistosomes |
|
|
Term
|
Definition
| scarlet fever: sandpaper texture of rash, cellulitis, palms peeling |
|
|
Term
|
Definition
| Toxic shock = palmar desquamation |
|
|
Term
| rocky mountain spotted fever |
|
Definition
| ascending purpuritic rash on palms and soles |
|
|
Term
|
Definition
| maculopapular rash, viral syndrome |
|
|
Term
| Diagnosis of amyloidosis? |
|
Definition
| Biopsy of abdominal fat pat or rectal biopsy. |
|
|
Term
|
Definition
| Serum Ca and Mg. Serum PTH, 25 and 1,25-D, phosphate, Cl, creatinine, amylase & lipase. Obtain EKG to look for prolonged QT. |
|
|
Term
|
Definition
| HIPOCAL: Hypo-PTH, Infection, Pancreatitis, Overload (rapid IV volume expansion), Chronic renal failure, Absorption abnormality, Loop diuretics. |
|
|
Term
|
Definition
| MISHAP-F: Meds/malignancy, Intox (vit D or A) or Immobilization, Sarcoidosis, Hyper-PTH or Hyperthyroid, Addison's or milk-Alkali, Paget's or Pheochromctoma. Familial hypocalciuric hypercalcemia (benign autosomal dominant condition) |
|
|
Term
| Symptoms of hypercalcemia? |
|
Definition
| abdominal moan, psychiatric groan, kidney stone, and urination zone. |
|
|
Term
| Most common cause of hypercalcemia? |
|
Definition
| malignancy or hyperparathyroidism. |
|
|
Term
|
Definition
| Hyperparathyroidism: alters setpoint for PTH secretion. |
|
|
Term
| Thiazide diuretic sideffect? |
|
Definition
| hypercalcemia d/t increased renal reabsorption. |
|
|
Term
| PTH-related peptide secreting tumors? |
|
Definition
|
|
Term
| Why does sarcoid and other granulomatous disease cause hypercalcemia? |
|
Definition
| increased conversion of 25-hydroxyvitamin D to 1,25 in macrophages. Occurs in TB, berylliosis, and lymphoma. |
|
|
Term
| Most common hyperparathyroidism? |
|
Definition
| Solitary adenoma > 80% of cases. Four-gland hyperplasia 10%, multiple adenomas 5%, MENI or II. |
|
|
