Term
| Abnormal Uterine Bleeding |
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Definition
- Ddx: fibroids, adenomyosis, polyps, coagulopathy, infection, prolactinoma, PCOS, thyroid dx, eating disorder,
- Indications for EMB: any risk factor for cancer, family hx, all post-menopausal. |
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Term
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Definition
| - SE – suicidal ideations, anemia, thrombocytopenia, hypertriglyceridemia, hypercholesterolemia, increased LFTs |
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Term
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Definition
- Time is very important. If w/in 4 hours give charcoal. At 4 hours, obtain acetaminophen levels and determine if you need to administer NAC but it must be given w/in 8 hours.
-Dont forget to check a salicylate level too |
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Term
| Acute Hemolytic Transfusion Reaction |
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Definition
Most often caused by ABO imcompatibility from clerical error.
Sxs – fever, flank pain, hemoglobinuria, renal failure, DIC. W/in 1 hour of transfusion. + direct coombs test, pink plasma (indicating hemolysis) |
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Term
| Acute Myelogenous Leukemia |
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Definition
40-65. Malaise, infections, bleeding. Caused by reduced differentiation of myeloid precursor cells leading to decreased RBCs, platelets, and granulocytes. Auer rods are classic finding (described as elongated clumps of granular material). Need bone marrow biopsy
Tx – Vit A do cause proper differentiation of myelocytes. |
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Term
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Definition
| Very nephrotoxic. Precipitates in renal tubules to form obstructing crystals. See acute renal failure: oliguria, elevated BUN and creatinine. Must maintain adequate hydration |
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Term
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Definition
Autoimmune destruction of the adrenal glands. Patients are prone to developing other autoimmune conditions including vitiligo.
Sxs – fatigue, hyperpigmentation, low BP, eosinophilia, hyperkalemia, Hyponatremia.
Tests – morning cortisol and ACTH w/ a cosyntropin (ACTH analog) stimulating test. If rise in cortisol w/ test r/o addisons |
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Term
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Definition
| Always bilateral. Watery discharge. Diffuse injection with bumpy or follicular conjunctival appearance with edema. Look for h/o allergies, asthma |
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Term
| Alpha-1 Antitrypsin deficiency |
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Definition
Lung and liver involvement. Panacinar emphysema is MC killer followed by cirrhosis.
Liver biopsy shows hepatocytes with PAS staining inclusions that are resistant to diastase degradation. |
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Term
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Definition
| Covers listeria monocytogenes |
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Term
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Definition
Can cause a nephrotic syndrome. See apple-green birefringence on polarized light. Can affect any organ
Risk factors – RA |
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Term
| Anaphylactic Transfusion Reaction |
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Definition
| Occurs immediately upon transfusion. Caused by IgA deficiency in patient receiving transfusion. See all the typical anaphylaxis symptoms |
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Term
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Definition
| Nasal obstruction, visible nasal mass, frequent epistaxis. Typically found in back of nose in young boys. It is a benign growth but can be locally invasive. |
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Term
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Definition
Electrolyte disturbancers: hypokalemia, hypomagnesmia, hypophosphatemia
EKG findings from hypokalemia: QT prologation, U waves, ST flattening, T wave inversion. Can lead to bradycardia or torsades |
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Term
| Anterior Shoulder Dislocation |
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Definition
| Think about how it can happen. Basketball player blocking a shot. The arm will rest slightly externally rotated and will not want to internally rotate. Look for axillary nerve injury. |
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Term
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Definition
| Blowing diastolic murmur heart at L sternal border. Possible mid-diastolic rumble d/t backflowing blood hitting anterior leaflet of the mitral valve is called an Austin-flint murmur. + duroziez's Sign. Acute type flash pulmonary edema, cardiogenic shock, dyspnea. Chronic dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea |
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Term
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Definition
| Hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hatter |
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Term
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Definition
Develops in the setting of sepsis, severe bleeding, severe infection, burns, and toxin ingestions. Results in increased capillary leakage pulmonary edema dyspnea, cough, tachypnea, hypoxemia, and b/l “fluffy” infiltrates on CXR.
Tx – ventilate patient. Often needs up to 15 mmHg PEEP and low tidal volumes. This improves the hypoxemia. |
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Term
| Aspirin Sensitivity Syndrome |
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Definition
| Causes a pseudo-allergic reaction persistent nasal blockage and bronchoconstriction episodes. Caused by an imbalance between prostogladins and leukotrienes. Tx – discontinue aspirin and start singular (montelukast) or zileuton. |
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Term
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Definition
| Common post op. the VC can reduce up to 50% and the FRC up to 30%. Supine head elevated increases FEC 20-30% to prevent it. |
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Term
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Definition
| Most commonly caused by ectopic foci located at the base of the pulmonary veins called “myocardial sleeves” |
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Term
Attributable Risk Percent
Aka etiologic fraction |
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Definition
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Term
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Definition
| 1st line choice in animal and human bite wounds for coverage of pasturella (a gram neg coccobacillus). |
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Term
| Avascular Femoral Head Necrosis |
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Definition
| MC risk factors: chronic steroids, alcoholism, and hemoglobinapathies. |
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Term
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Definition
| Once it reaches 1500-2000 an ultrasound can detect an intrauterine pregrancy |
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Term
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Definition
Bright red, firm, friable, exophytic lesions commonly seen in HIV patients. Caused by bartonella.
Tx – oral erythromycin. |
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Term
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Definition
| Used for MRSA skin infections, UTIs, and PCP pneumonias |
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Term
| Beckwith-Wiedemann Syndrome |
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Definition
Overgrowth disorder seen in newborns caused by mutation in chromosome 11p15 which encodes IGF-2.
Sxs – hemihyperplasia, macrosomia, macroglossia, and midline abdominal wall defects. Hypoglycemia, tumors (MC are wilms and hepatoblasomas). Screen with AFP levels and abdominal ultrasounds. |
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Term
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Definition
| A peripheral neuropathy of CN VII which originates BELOW the pons. Causes upper and lower facial paralysis. Presentation is rapid onset of paralytic symptoms (<2days) with maximal paralysis at 3 weeks and partial to complete recovery over 6 months. |
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Term
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Definition
| 1% population lifetime risk. 10% risk if 1st degree family member has it. 60% if both parents have it. |
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Term
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Definition
In the great lakes, Mississippi and ohio river areas. Most common in Wisconsin.
Sxs – low grade fever, night sweats, cough (pulmonary sxs), weight loss, ulcerated skin rashes, lytic bone lesions. In a lot of ways it resembles TB or histoplasmosis.
Tx – itraconazole or amphotericin B. |
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Term
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Definition
| If severe and see an elevation in creatinine, it may be progressing to urinary obstruction and renal failure. Need to assess for hydronephosis with ultrasound. |
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Term
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Definition
| Treats Neisseria meningitis, H. influenzae, and strep pneumo meningitis |
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Term
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Definition
Most often caused by hyperextension of cervical spine in patients w/ previous cervical spondylosis. Can also be caused by Syringomyelia or tumors.
Characterized by loss of upper extremity strength > lower extremeity. May also have loss of pain/temp in UE if it gets spinothalamic tract |
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Term
Cerebral Palsy
Types?
sxs?
PE?
Pathogenesis?
Risk factors? |
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Definition
| Characterized by non-progressive motor dysfunction. MC form is spastic diplegia. Others include dyskinetic and ataxic. Other sxs include hearing, speech, vision and intellectual disability. Exam shows clasp knife reflexes and resistance to passive flexion. Hypertonia and hyperreflexia. Caused by some disturbance in brain development. Risk factors prematurity (#1), IUGR, antepartum hemorrhage, twins, alcohol and tobacco use |
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Term
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Definition
| Meibomian cyst. Presents originally as a painful swelling progressing to rubbery nodular lesion. If persistentsebaceous carcinoma. Can also look like a basal cell carcinoma of the eyelid so you must rule that out first w/ biopsy and histopathologic exam. |
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Term
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Definition
| Look for clues to what caused it. Such as recent cardiac cath or anything else that will disturb stable plaques. Signs include blue discolorations of toes and feet. Can embolize anywhere: kidney, legs, GI, pancreas. May see increased eosinophils in blood or urine (clue). |
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Term
| Chronic Lymphocytic Leukemia |
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Definition
MC leukemia. Typically in adults avg age 65. Clonal proliferation of well differentiated lymphocytes
Sxs – fever, malaise, LAD, splenomegaly, infections. Dx – clinical or with CD5 present on CD20/21 T-Cells. SMUDGE CELLS. Marrow infiltration granulocytopenia, anemia, thrombocytopenia and hypogammaglobulinemia.
Rai staging system – 0 = lympocytosis >15,000. 1 = lymphocytosis + LAD. 2 = lymphocytosis + splenomegaly. 3 = lymphocytosis + anemia. 4 = lymphocytosis + thrombocytopenia.
Tx – Held until symptomatic. palliative. No cure. Long disease-free intervals can be achieved. |
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Term
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Definition
Deletion of 5p
Hypotonia, short stature, microcephaly w/ large metopic suture, hypotelorism, epicanthal folds, flat nasal bridge, retardation. |
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Term
| Chronic Myelogenous Leukemia |
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Definition
Characterized by the philidelphia chromosome t(9;22) (BCR-ABL gene).
Affects middle aged adults and produces insidiously increasing sxs of fatigue and frequent infections. Can cause a blast crisis where WBC counts are extremely elevated. (most are neutrophils) Radiation is a risk factor.
Tx – imatinib. Monoclonal antibody that targets aberrant protein. |
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Term
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Definition
Good gram positive (staph and strep) and anaerobe coverage.
common cause of C Diff. |
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Term
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Definition
| Typically seen in HIV affected patients CD4 <50. Sxs – chronic bloody diarrhea, neg stool exam, abd pain. Owl’s eye cells on biopsy. Tx w/ Ganciclovir or foscarnet for resistant strains. |
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Term
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Definition
2nd gen flouroquinolone w/ activity against mainly gram neg cocci and rods
Good for pseudomonas (hot tub for ex) |
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Term
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Definition
Need to determine if it is compensated or decompensated to determine level of care and exam. MCC are alcohol, hepatitis, and NAFLD (often in the overweight).
Every cirrhotic patient gets EGD to assess for varices d/t #1 cause of death in these patients. If varices are present, indication for non-selective beta blocker |
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Term
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Definition
| Do not give beta blockers to patients on cocaine d/t unopposed alpha action causing vasospasm. Use CCB or an alpha blocker like phentolamine/phenoxybenzamine instead. Can also use a benzo |
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Term
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Definition
| Can be either prospective or retrospective. The study exams risk factors and compares disease incidence. |
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Term
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Definition
| Flat velvety lesions seen in secondary syphillis |
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Term
| Constrictive Pericarditis |
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Definition
| MCC are cardiac surgery, radiation therapy, and viral pericarditis. Look for Kussmaul’s sign (paradoxical increase in JVP w/ inspiration), elevated JVP. Can even result in ascites, hepatic congestions, and dyspnea. Tx – diuretics or pericardectomy |
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Term
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Definition
| The chronic hypoxemia causes the pulmonary arterial vasculature to constrict resulting in increased pulmonary artery pressure. Leads to pulmonary HTN, right ventricular hypertrophy and failure. |
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Term
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Definition
| Nontendet palpable gallbladder in a jaundiced patient pancreatic cancer |
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Term
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Definition
| Abd pain, bloody diarrhea, weight loss, fever, and possible obstruction signs. Affects all layers of GI tract cobblestoning and thickening of bowel wall. Complications include fistula formation, edema, and mesenteric LAD. See non-caseating granulomas. |
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Term
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Definition
Helminthic disease caused by Ancylystoma Braziliense. A dog and cat hookworm. Happens after contact with soil contaminated with dog or cat feces. Present in tropical and subtropical areas. Starts as severely pruritic erythematous papules and develops into serpiginous red/brown lesions that grow
tx - ivermectin or albendazole |
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Term
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Definition
| Increases cranial rhythm pulse. Performed by compression 4th ventricle in posterior cranial fossa with compression during flexion and exaggeration during extenstion. |
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Term
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Definition
| First line is SSRI. If that doesn’t work, try a different SSRI. |
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Term
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Definition
| Glomerular hyperfiltration is the earliest change in diabetic nephropathy. It is a result of glomular hypertension. ACE inhibitors treat the HTN. If continued, it leads to glomerular basement membrane thickening which is the first change that can be quantitated. |
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Term
| Diamond-Blackfan Syndrome |
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Definition
Aka congenital hypoplastic anemia. Defect in erythroid progenitor cells causing increased apoptosis. Presents before 1 yo.
Macrocytic (w/o hypersegmentation of neutrophils), low retic count, other congenital abnormalities. Electrophoresis elevated HbF.
Tx: steroids or transfusions. |
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Term
| Duchenne Muscular Dystrophy |
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Definition
| Most sensitive test is serum creatinine kinase levels |
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Term
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Definition
| Look for times that it bothers them. Usually at night or several hours after eating versus a gastric ulcer which is after meals. Duodenal ulcer patients gain weight while gastric ulcer patients avoid food and lose weight. Pain relieved by food or antacids. |
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Term
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Definition
| Femoral bruit heard in patients with severe aortic regurgitation |
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Term
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Definition
MC 2nd to strep pyogenes. Only involves the dermis, not integument. Commonly spreads via lymphatics.
Tx – uncomplicated infection treated with Penicillin VK. If allergic-> erythromycin |
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Term
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Definition
| Characteristic rash seen with Lyme disease. Erythematous macular rash that expands concentrically around the bite wound and develops central clearing bullseye appearance. |
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Term
| Erythema Toxicum Neonatorum |
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Definition
Neonatal rash characterized by asymptomatic scattered erythematous macules, papules, and pustules. Palms and soles not affected
Tx – none required |
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Term
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Definition
Fungal skin infection by corynebactirium minutissimum. Scaly plaques between toes or brown patches/plaques in the intertriginous areas. Mildy pruritic. Diabetics and immunocompromised patients are at risk. Gram stain shows Gram + rods. Woods lamp shows coral red fluorescence.
Tx – oral erythromycin |
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Term
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Definition
Characterized by the three D’s: dyspareunia, dysmenorrhea, and dyschezia (pain w/ defecation)
Dx: not done by US. Must be done with laparascopy or via clinical diagnosis. Early findings are speckled “powder burns” that are blue/black. Chocolate cysts occur if lesions implant w/in the ovarian capsule.
Tx: NSAIDs and OCPs to suppress ovulation |
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Term
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Definition
Common infection 2nd or 3rd day postpartum. Commonly caused by polymicrobial infection.
Tx: clindamycin and gentamicin. |
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Term
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Definition
Deltoid and infraspinatus (C5), biceps (C6), and wrist/finger extensors (C7)
Spontaneous resolution 80% of time as long as serious nerve injury has not occurred. Risk factor is Macrosomia. |
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Term
| Fitz-Hugh-Curtis Syndrome |
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Definition
| Infection of glissons capsule resulting from ascending infection from pelvic inflammatory disease. |
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Term
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Definition
Pediatrics: 4mL/hr/Kg for first 10 kg of body weight. 2mL/hr/Kg for the next 10 kg of body weight. Then 1mL/hr/kg for every 1 kg above 20 kg.
Electrolyte management is 2-5 mEq/kg of sodium and 2-3 mEq/kg of potassium |
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Term
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Definition
| DO NOT GIVE TO PATIENTS THAT TAKE BENZOS REGULARLY D/T SEVERE SEIZURE INDUCTIONS. Benzo overdose in general is not dangerous and can be handled supportively. |
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Term
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Definition
| Repetitive trauma causing osteonecrosis of the second metatarsal head seen in adolescents and young women. Initially normal radiographs with subsequent flattening of metatarsal heads. Tx w/ orthotics, NSAIDs, and possible surgery |
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Term
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Definition
| AR. MOST COMMON TYPE OF SPINOCEREBELLAR ATAXIA. Trinucleotide repeat disorder. Degeneration of Spinocerebellar tract, posterior columns and pyramidal tracts -> gait problems, frequent falls, and dysarthria, sensory abnormalities, absent lower extremity reflexes, . Non neuro sxs skeletal deformities (pes cavus, scoliosis), concentric hypertrophic cardiomyopathy (90% of patients) and diabetes |
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Term
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Definition
| Autosomal dominant mutations of APC on chromosome 5 Patients develop colonic polyposis, skull osteomas, fibromas, and epidermal inclusion cysts. |
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Term
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Definition
| Excellent gram negative coverage. |
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Term
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Definition
A variant of severe eclampsia
Hemolysis (anemia, elevated bilirubin), elevated liver enzymes (centrilobar necrosis, portal thrombi, hematoma formation), Low platelets
Sxs – RUQ or epigastric pain. Possible n/v. Due to swelling of liver and distention of liver capsule. May also develop pulmonary edema from vasospasm increased afterload and SVR pulmonary edema. |
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Term
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Definition
Common presentation is hematoma or bleeding after minor trauma seen in young boys (because it is x linked recessive). Common complication is hemarthrosis (80% of bleeding sites). Hemophilia A = factor VIII deficiency. Hemophilia B = Factor IX deficiency.
Tx – replace deficient factor. |
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Term
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Definition
Very fatal. Commonly occurs from stone disease such as after Cholecystitis, cholangitis, appendicitis, abdominal abscess. Most common agent is Klebsiella pneumoniae
Tx - percutaneous cather drainage + empiric Abx (zosyn, unasyn or Ceftriaxone/metro) |
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Term
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Definition
| Spread through fecal oral route. Vaccine is given to people travelling to endemic areas |
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Term
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Definition
Tx – Tenofovir or entecavir is preferred tx d/t low resistance rates along with emtricitabine (NRTI). Interferon used for younger patients w/ compensated liver disease. Lamivudine rarely used d/t resistance.
Uses a reverse transcriptase. Only Hep virus with a DNA genome |
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Term
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Definition
Tx w/ ribavirin and pegylated interferon. It is known to worsen psychiatric illness so patients should have psych eval before interferon is started
Coats itself in LDL to infect hepatocytes |
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Term
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Definition
| High infant mortality rate when it infects pregnant mothers. Spread fecal oral route. |
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Term
| Hereditary Hemorrhagic Telangectasia |
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Definition
Aka osler weber rendu syndrome. Autosomal dominant.
Common presentation is recurrent epistaxis. The AVMs can be anywhere. If in the lungs chronic hypoxemia clubbing. In brain can cause seizures, hemorrhages. If in stomach/esophagus sometimes fatal hemoptysis. Can see ruby colored papules in skin. |
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Term
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Definition
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Term
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Definition
| Good for lupus treatment when it affects isolated skin and joints. Major side effect is retinopathy. Thus eye exams every 6 months are required. |
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Term
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Definition
Water deficit in relation to sodium. Most often occurs in debilitated patients (commonly the elderly). Look for diseases that would cause the patient to have decreased access to drinking water.
Tx – start with NS and once volume status is replaced switch to ½ NS. |
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Term
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Definition
| The most effective lifestyle modifications for the treatment of HTN is either DASH diet or weight loss. |
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Term
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Definition
| Can look a lot like menopause in women around that age. In order to differentiate the cause, measure FSH and LH. They will be elevated if it is menopause causing the symptoms |
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Term
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Definition
| You know what it is. Tx – discuss emotional stressors on primary visit and follow up with psychotherapy. Often resolves. |
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Term
Hypothyroidism
other sequalae? |
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Definition
| Other sequelae include: hyperlipidemia (high cholesterol w/ or w/o high trigs), Hyponatremia, elevated creatinine kinase, elevated LFTs. Don’t give statins to decrease d/t increased risk of myopathy |
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Term
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Definition
| You know what it looks like. Just remember with the mild splenomegaly no contact sports and monospot test is negative early repeat |
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Term
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Definition
| Used to treat multiple sclerosis |
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Term
| Intracranial hypertension |
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Definition
| Sxs – diffuse headaches, n/v, vision changes, papilledema, CN deficits, somnolence, confusion, imbalance, cushings reflex |
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Term
| Intraparenchymal Hemorrage |
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Definition
MCC is uncontrolled HTN followed by amloid angiopathy. MC place is putamen, then thalamus, then cerebellum and pons. Clues that it isn’t subarachnoid is the focal motor/sensory deficits and eye deficiencies.
Sxs – cerebral bleeds cause deviation of eyes towards affected side. Thalamic and pontine cause deviation away from side with bleed. |
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Term
| Intrauterine Growth Restriction |
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Definition
| Also called fetal growth restriction. MCC is smoking during pregnancy. Other less important is maternal HTN and CMV |
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Term
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Definition
| Immune Thrombocytopenia Purpura. Usually occurs after an infection and lasts less than 2 weeks. Chronic cases often have no identifiable source. If unstable, give transfusions and IvIg. If stable, corticosteroids. |
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Term
| Jervell-Lange-Nielson Syndrome |
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Definition
AR Congenital long QT syndrome from defective ion channels. Also see congenital deafness
Manifestations: syncope, episodes of torsades, deafness
Tx: beta blocker if asymptomatic w/o syncope. W/ syncope BB and implanted defibrillator |
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Term
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Definition
| Fracture of the 5th metatarsal proximal diaphysis. A candidate for surgical correction. |
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Term
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Definition
Aka mucocutaneous lymph node syndrome
Clinical features required for diagnosis: bilateral conjunctivitis, at least one enlarged LN, mucositis, erythematous polymorphous rash, extremity changes.
Tx: HIGH dose aspirin and IV Ig’s |
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Term
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Definition
| AVN of the lunate from repetitive compression loading |
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Term
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Definition
| Osteochondrosis (aka apophysitis) of the tarsal navicular bone seen in childhood |
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Term
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Definition
First line agent used in the treatment of bipolar disorder SE – can induce SJS.
UpToDate says aripiprazole, risperidone, and Li are common as well. |
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Term
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Definition
Defined as laxity of the supraglottic structures. Sxs – inspiratory stridor worsening when supine/crying/feeding. Better prone.
Starts 4-8 mo and resolved by 18 mo w/ conservative treatment |
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Term
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Definition
| MC tumor of testicular sex cord stromal tumors. Occurs in all ages. Main source of testosterone. |
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Term
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Definition
| Slow taper off of it. Abrupt relapse. |
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Term
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Definition
| First sign is straight lines appearing wavy. Driving, and reading are classically affected first. Age and smoking are risk factors. Exam shows drusen spots in the macula |
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Term
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Definition
Ear discharge with severe ear pain is classic. Often radiates to the TMJ. May worsen despite topical antibiotic therapy. Exam shows granulation tissue formation in EAC. Diabetes and immunocompromised are at risk. Pseudomonas is MC etiology.
Tx – iv Ciprofloxacin |
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Term
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Definition
Anterior: thymomma, retrosternal thyroid, teratoma, terrible lymphoma (terrible Ts)
Middle: LAD, bronchogenic cysts, enteric cysts, pericardial cysts
Posterior: neurogenic cysts, esophageal leiomyomas. |
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Term
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Definition
Once confirmed with CBC with diff, get a peripheral smear to look for hypersegmented neutrophils. If +, then get folate and B12 level. If equivocal, order homocysteine and MMA levels.
Causes: folate/B12 deficit, alcoholism, liver disease, myelodysplastic syndromes, hypothyroidism, MTX, zidovudine (AZT), and hydroxyurea |
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Term
| Membranoproliferative Glomerulonephritis |
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Definition
Nephrotic syndrome. Hematuria.
Bx intramembranous deposits of C3 caused by auto-IgG antibodies against C3 convertase activation of alternate complement pathway and kidney damage. |
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Term
| Mixed Essential Cryoglobulinemia |
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Definition
| Suspect w/ triad of palpable purpura, hematuria (microscopic), and proteinuria. Other signs may include arthralgias, low complement levels (C4), and HSM. Most patients have underlying hepatitis C infection |
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Term
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Definition
Boys - 9-14
Girls 8-12
Shortly following menarche, the HP axis is still immature and may not produce enough gonadotropins to induce ovulation irregular menses |
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Term
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Definition
| Popping sensation, significant swelling or hemarthrosis, joint instability. |
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Term
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Definition
| Must stop when there is kindey injury occurring. |
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Term
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Definition
Causes initial disinhibition followed by headache, nausea, vomiting, and abd pain. Severe sxs are vision loss and coma
How to ddx from ethylene glycol ingestion, ethylene glycol damages kidneys and methanol damages the eyes. |
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Term
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Definition
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Term
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Definition
Seen in newborns at 2-8 weeks presenting with painless hematochezia, and severe reflux/vomiting. D/t non IgE mediated colonic inflammation. May be a/w eczema and have + FH.
Tx – switch to hydrolyzed formula or change maternal diet. |
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Term
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Definition
Commonly a benign finding in teenagers and young adults (mostly women). If heard, should do echo to check for regurg, if not present, no follow up or care needed.
MC symptom is non-anginal/atypical chest pain |
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Term
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Definition
| Look for neurological signs to differentiate this from simple Alzheimers. |
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Term
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Definition
CRAB nemonic. Calcium elevated, renal impairment, anemia, bone involvement. Also look for recurrent infections
Blood smear: fried egg appearance of lymphcytes and rouleaux formation |
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Term
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Definition
| After the diagnosis is established, my must RO a thymoma. Esp if patient is < 60. Removal of thymoma is treatment in 2-4 years. |
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Term
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Definition
| A cutaneous T-Cell Non-Hodgkins lymphoma characterized by a clonal expansion of CD4+ T cells. Hone to the skin via surface expression of CLA. Extravasate into skin and surrounded by Langerhans cells to form pautriers microabscesses. |
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Term
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Definition
RF – obesity, DM, hypertriglyceridemia, meds (steroids, diltiazem, amiodarone, tamoxifen, HAART), cushings syndrome, and TPN.
Caused by hepatocyte resistance to insulin. May progress to cirrhosis and hepatic fibrosis
Tx – underlying cause or usodeoxycholic acid |
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Term
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Definition
| MC extra-cranial tumor of children. Occurs in adults too though. Arises from NC cells and is MC in adrenal gland or paravertebral sympathetic ganglion. + calcifications and hemorrhages on xray/CT. Most have metastatic disease at Dx. Labs show elevated catecholamines and catecholamine precursors (HMA/VMA) w/o sxs of Pheochromocytoma. Expression of N-myc oncogene is poor prognostic factor |
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Term
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Definition
| Dihydropyridine CCB that can cross the BBB to stop cerebral vasospasm in subarachnoid hemorrhages. |
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Term
| Non-Ketotic Hyperosmolar State |
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Definition
| Main sxs is altered consciousness (confustion to coma). Other sxs include blurred vision from myopic increase in lens thickness and decreased intraocular pressure due to hyperosmolality of blood. |
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Term
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Definition
TCA that is also a mainstay of treatment for post-herpetic neuralgia.
Has significant anti-cholinergic effects. |
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Term
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Definition
| More common in African americans, people w/ family hx, and diabetes. Sxs gradual peripheral vision loss over years leading to tunnel vision. Exam disc cupping. Tx timolol eye drops |
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Term
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Definition
| Characteristic finding in NF1. Causes unilateral vision loss and decrease brightness sensation (dyschromatopsia) |
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Term
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Definition
| Sclerotic cortical bone lesion with a central nidus of lucency. Pain is worse at night, unrelated to activity, and is rapidly relieved with NSAIDs |
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Term
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Definition
| Aminoglycosides, chemo drugs, aspirin, loop diuretics |
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Term
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Definition
| Often follows surgery or even a vertebral body fracture w/ retroperitoneal hemorrhage. |
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Term
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Definition
| Pleural effusions after pneumonias. Get sample of fluid pH <7.2 or glucose <60 risk of empyema and insert chest tube. |
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Term
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Definition
| Used to calculate the amount of fluids needed in first 24 hours for burn victim resuscitation. Only calculated off of 2nd and 3rd degree burns 4mL x %TBSA x Kg. Half of the calculated amount is given in first 8 hours and remainder given over next 16. This is given in addition to maintenance fluids. |
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Term
| Paroxysmal Nocturnal hemoglobinuria |
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Definition
| Defect in CD55/59 which causes RBC to be more sensitive to complement during an acidodic state. Thus when you sleep and hypoventilate, you become more acidotic and lyse RBCs. MCC of death is thrombosis of hepatic or mesenteric veins. |
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Term
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Definition
| Not an automatic indication for cesarean if the patient is at term and mom and baby are stable. |
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Term
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Definition
Defined as a central venous hematocrit >65%.
In infants MCC is delayed clamping of umbilical cord.i
Sxs – plethora, CNS disturbances, poor feeding and respiratory distress are most common |
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Term
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Definition
Good clue is onset of pruritis after hot shower. also transient visual changes and burning/tingling of hands/feet
Major complications are thrombotic events and mylefibrosis
Median age is over 60 |
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Term
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Definition
Affects patients after 50 yo. Can be brought on by malignancies. Sxs include proximal muscle weakness, myocarditis, cardiac conduction abnormalities. Patients will complain of stiffness and weakness. Increased CK, aldolase and positive anti-Jo-1
Tx – high dose corticosteroids, azathioprine and methotrexate are backups for diabetics. |
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Term
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Definition
| Appearance of axillary hair before the age of 6. Benign condition that needs no treatment. If pubic hair develops before age 8, large concern for a CNS disorder. |
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Term
| Primary Biliary Cirrhosis |
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Definition
+ anti-mito antibodies. Sxs – pruritis, fatigue, hepatosplenomegaly, xanthasmas. Jaundice develops later. Elevated risk of hepatic malignancy.
Tx – Ursodeoxycholic acid. Sometimes methotrexate and colchicine are backups. Definitive tx is liver transplant. |
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Term
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Definition
| Pain just before the onset of menses. Often radiates to thighs and lower back. D/t prostaglandin release from endometrial breakdown. Tx w/ NSAIDS |
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Term
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Definition
| Effective in the use of benign essential tremor |
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Term
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Definition
< 3 mo s aureus, gram – rods, and anaerobes. >3mo coag neg staph (epidermidis), proprionobacterium, enterococci.
In both cases, need revision |
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Term
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Definition
Psychological disorder where women present with signs and symptoms of pregnancy but are not pregnant. A type of conversion disorder
US will show normal endometrial stripe and neg pregnancy test in office. |
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Term
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Definition
| Tx: acetazolamide w/ or w/o furosemide. Acetazolamide decreases CSF production by inhibition of choroid plexus carbonic anhydrase |
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Term
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Definition
| Make sure before you treat them that they are stable and have good electrolytes. If not, hydrate with potassium replacement. |
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Term
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Definition
| Estrogen antagonist in breast and agonist in bone. Does not affect ovarian or endometrial cancer. Used for osteoporosis if bisphosphonates are not effective or CI’d. Can increase risk of thromboembolic events though. |
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Term
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Definition
Can present as failure to thrive. Labs show low bicarb, high chloride and a non-gapped metabolic acidosis.
Can be caused by fanconi’s syndrome via decreased bicarb reabsorption |
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Term
| Respiratory Distress Syndrome |
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Definition
Aka Hyaline Membrane Disease.
Biggest risk factor is prematurity but also: maternal diabetes, males, cesarean w/o labor, perinatal asphyxia. |
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Term
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Definition
Aka fatty liver w/ encephalopathy. Caused by diffuse mitochondrial injury. Biopsy shows fatty vacuolization w/o inflammatory changes.
Tx – glucose w/ ffp and mannitol to prevent cerebral edema. |
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Term
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Definition
| If the mom is Rh negative give rhogam. If her titers are low (< 1:4) give rhogam. If they are >1:6, must watch carefully and rhogam is not helpful |
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Term
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Definition
| Monoclonal antibody that binds to CD20 and treats B cell predominant CLL and rheumatoid arthritis |
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Term
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Definition
| Congenital decrease in liver ability to store conjugated bilirubin. Spills over into blood. Clue: benign picture with + urine dipstick bilirubin |
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Term
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Definition
Congenital infection sensineural hearing loss, cataracts, heart malformation (PDA), glaucoma. Infection is worse when it occurs in the first trimester
Child/Adult infection fever, conjunctivitis, coryza, cervical LAD, cephalocaudal spreading of maculopapular rash.
Dx – PCR and serology for rubella IgM/IgG |
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Term
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Definition
Rule #1: If L5 is sidebent, the oblique axis is on the same side of the sidebending.
Rule #2: If L5 is rotated, the sacrum will rotate opposite of the L5.
Rule #3: a positive seated flexion test indicates an oblique axis on the other side. |
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Term
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Definition
| Nemonic SALTeR. Class 1 – Slipped epiphysis and thus through growth plate. Class 2 – Away from joint. Fracture through metaphysis and towards diaphysis. Class 3 – Lower and towards the joint. Class 4 – Te is through everything. Class 5 – Rammed or crushed |
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Term
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Definition
Lungs, erythema nodosum, anterior uveitis, and acute polyarthritis.
Tx w/ glucocorticoids if symptomatic. Otherwise most patients spontaneously resolve. |
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Term
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Definition
Need to first rule out adrenal insufficiency and hypothyroidism.
Measure plasma and urine osmolality. If serum is low (<280) and urine is concentrated (>100), then suspect SIADH. You will also see decreased plasma uric acid levels.
Can be caused by chronic NSAID use, antidepressants, Paraneoplastic syndromes, brain tumors, pneumonias, sarcoidosis
Tx – mainstay is water restriction and fixing underlying cause. Tolvaptan (vasopressin antagonist) is backup |
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Term
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Definition
| Variant of sjogrens syndrome w/o the arthritis. Have anti-SSa and SSb antibodies (anti-ribonucleoprotein). MC in women between 40-60. |
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Term
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Definition
| Watch out for dysfunction of this causing a gallstone/Cholecystitis picture. |
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Term
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Definition
| Important to give high dose corticosteroids as the initial treatment to decrease inflammation to spare motor function, improve pain, and prevent further neurological impairment. |
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Term
| Spontaneous Bacterial Peritonitis |
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Definition
Cirrhosis and ascities complicated by fever, lethargy, and subtle changes in mental status. Tricky part is that abdominal pain is less of a problem than in other causes of peritonitis. Diagnose with paracentesis with PMN > 250.
Tx – cover e coli and Klebsiella with 3rd gen cephalosporin. |
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Term
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Definition
| Common cause of nosocomial pneumonia because it is a gram neg aerobic rod. Tx – 4th gen cephalosporin (cefipime), aztreonam (for pcn allergy), piperacillin/tazobactam, Imipenem/cilastin, cipro, levo, imipenem, meropenem. |
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Term
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Definition
| Autosomal recessive. Howell-Jolly bodies (eosinophilic inclusions in RBCs). After splenic sequestration get encapsulated organism infections including: S. pneumo, Hib, Neisseria, and salmonella (typically osteomyelitis) |
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Term
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Definition
| Tx depends on if they have strictly performance anxiety of if it is a baseline anxiety. For consistently anxious patients, use SSRI/SNRI and CBT. For performance anxiety, use benzo or propranolol. |
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Term
| Squamous Cell Carcinoma of the Vagina |
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Definition
Often presents as a friable bleeding mass w/ malodorous discharge. Common in elderly.
Tx – surgical excision is preferred but if poor surgical candidate radiation therapy. |
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Term
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Definition
Immune complex mediated hypersensitivity reaction of skin and mucous membranes.
Sxs – starts as upper resp infection non-pruritic burning rash of face, neck and torso. Common etiological agents: sulfonamides, allopurinol, LAMOTRIGINE (black box warning), phenytoin, carbamezapine, and NSAIDS |
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Term
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Definition
Bovis (gut), sanguis (mouth), and mutans (mouth)
Mostly susceptible to penicillin. Use IV penicillin-G or IV ceftriaxone. |
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Term
| Supraventricular Tachycardia |
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Definition
| Tx – carotid massage or Valsalva maneuver to slow conductin through AV node. Second line is IV adenosine. This pattern originates from hypersympathetic activity on the left. The right innervates the R heart and SA node. |
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Term
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Definition
Sxs – seizure, hypotension, prolonged QRS (over 120).
Tx – sodium bicarb to correct acidosis and narrow the QRS. Can use physostigmine in mild cases |
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Term
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Definition
| Only give immuneglobin to patients who have had <3 vaccinations or an uncertain hx. |
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Term
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Definition
| Fatigue, peripheral and perioral cyanosis, systolic murmur at left sternal border. Squatting increases the murmur because it forces more blood past the right ventricular outflow obstruction and relieves cyanosis because it puts blood into the right heart circulation. |
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Term
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Definition
| Aka Dejeine-Rousy Syndrome. A stroke of the ventral posterior lateral thalamus. It transmits sensory information to the contralateral side of the body contralateral hemianesthesia, paresis, athetosis, ballistic movements, and hypersensitivity (thalamic pain syndrome) |
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Term
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Definition
| 3rd world Ocular infection by Chlamydia trachomatis causing follicles on conjunctiva and pannus formation on the bulbar conjunctiva. Can spread to sinuses nasal discharge. Dx with giemsa stain of scrapings and tx with topical tetracycline or oral azithro. |
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Term
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Definition
Used for parkinsons and drug-induced EPS. Benztropine also in this class. Very anti-cholingergic.
Red as a beet, mad as a hatter, dry as a bone, hot as a hare, blind as a bat (glaucoma) |
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Term
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Definition
Pentad: microangiopathic hemolytic anemia (schistocytes, high LDH, indirect bilirubinemia), thrombocytopenia, neuro sxs, fever, and renal dysfunction
should prompt urgent plasma exhchange therapy |
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Term
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Definition
| Tx for latent TB is isoniazid for 9 mo. Positive if healthcare worker PPD >10mm of if direct contact, immunosuppressed, AIDS/HIV, or have irregular findings on CXR >5mm. |
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Term
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Definition
Enterocolitis caused by Salmonella typhi or paratyphi (gram neg bacillus).
Sxs – flu like illness, bloody diarrhea, rose spots, splenomegaly, possible confusion and delirium.
Tx – ciprofloxacin, oxafloxacin, or ceftriaxone/cefixime. |
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Term
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Definition
| Used to compare two means. Need the means, the variances, and the sample sizes. Produces a p value. If <0.05, null hypothesis is rejected. |
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Term
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Definition
Commonly from epidural hematoma from middle meningeal artery rupture.
Structures affected: contralateral crus cerebri ipsilateral hemiparesis. Ipsilateral occulomotor nerve mydriasis and down and out gaze. Ipsilateral posterior cerebral artery contralateral homonymous hemianopsia. Reticular Formation altered mental status and coma |
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Term
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Definition
| 4mm or less have 80% chance of passage. >4mm have 20% chance of passage |
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Term
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Definition
| First line tx is oxytocin |
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Term
| Waldenstroms Macroglobulinemia |
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Definition
| Plasma cell neoplasm invades spleen, bone marrow, and LN with excess Ig made hyperviscosity Sxs – spleno/hepato/lymphomegaly, tiredness (anemia), easy bleed/bruises (typically gums), night sweats, headaches, dizziness, vision issues, extremity pain/numbness. Two big clues: IgM spike and hyperviscosity. |
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Term
Warfarin
agents that alter metabolism |
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Definition
Increase effects of warfarin: acetaminophen, antibiotics, amiodarone, ginko balboa, omeprazole, phenytoin
Decrease effects of warfarin: rifampin, carbamazepine, greens, OCPs, st. johns wort, ginseng |
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Term
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Definition
| Test for thoracic outlet syndrome. Hyperabduct the patients arm over their head w/ external rotation. Positive if sxs reproduce or pulse diminishes |
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Term
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Definition
| Know what it looks like on ECG. Shockable rhythm. Common after heart attacks. DUMBASS |
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Term
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Definition
| Rings of blood vessels around the trachea and esophagus from the developing double aortic arch of fetal life. Presents with difficulty breathing (stridor, wheezing not relieved by meds) and esophageal swallowing difficulty. |
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Term
| Volkmann Ischemic Contracture |
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Definition
| Final sequelae of compartment syndrome. |
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Term
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Definition
Autosomal dominant. vWF also carries factor 8.
Sx – nose bleeds, oral bleeding, easing bruising, menorrhagia, or post-coital bleeding. Not severe enough to produce petechiae. Worse w/ aspirin ingestion.
Labs – PTT prolonged and bleeding time prolonged. Rest is normal. Ristocetin assay determines diagnosis.
Tx – desmopressin, aspirin avoidance, and lifestyle modifications. |
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Term
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Definition
Piperacillin-Tazobactam
Uses – Gram positives, gram-negs, pseudomonas (esp ventilator associated pneumonias) |
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Term
| hydroxyurea Mechanism and uses |
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Definition
| DNA synthesis inhibitor Increases HBf in sickle cell, CML blast crisis, AML, PCV, essential thrombocytosis, radiation therapy for head and neck cancers. |
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Term
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Definition
aka Obesity Hypoventilation syndrome
See a respiratory acidosis w/ metabolic compensation (5mEq rise in HCO3 per 10mmHg rise in CO2).
10% of pickwickian pts have OSA too |
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Term
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Definition
multisystem heterogenous inflammatory condition. Hallmark is recurrent skin and mucocutaneous ulcers of all mucosal surfaces. Oral, genital, ocular, cutaneous, neurologic. MC in 20-40 yo but can be seen in children
Dx criteria: oral ulcers plus at least two of the following:
recurrent genital ulcers
eye lesions
skin lesions
+ pathergy test (similar to koebner) |
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Term
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Definition
> 55 yo
Commonly found on routine blood screening w/ WBC >50k. R/o occult infection. Signs progress as follows: LAD, splenomegaly, Hepatomegaly, anemia, recurrent infections |
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Term
| Leukemia age differential |
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Definition
ALL = children
AML = 20-40 (middle aged)
CML = 40-60
CLL = >65 |
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Term
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Definition
prevalance increases with age. Can be seen from the young to the middle/older age. Notched nuclei and Auer rods (M3 form) are diagnostic. + myeloid proliferation -> pancytopenia. Presents with signs of pancytopenia. Lymphocytes not affected
BMB -> blasts stain + for myeloperoxidase
Median age - 65 |
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Term
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Definition
philidelphia chromosome (9,22)
40-60 yo. More common w/ h/o radiation exposure.
Can develop blast crisis |
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Term
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Definition
MC cancer in kids.
Sxs - fatigue, bone pain, pallor, fever, neutropenia, possible anemia and thrombocytopenia. Need BMB.
Rarely presenting sign can be unilateral painless testicular enlargement. |
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Term
| Monckeberg arteriosclerosis |
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Definition
| calcification of tunica media in the extremity arteries. usually diagnosed incidentally. Shows up on plain films. Only seen in elderly. Requires no treatment |
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Term
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Definition
hypothermia is classic finding. dry brittle hair, desquamation of skin, cool extremities, non-pitting edema of face/hands.
Must check TSH, Free T4, and CORTISOL level. Common to have hypothyroidism and low cortisol. Appropriate to give cortisol after getting baseline draws done. If labs return normal, can stop steroids w/o tapering |
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Term
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Definition
| Rubeola 4 C's!!! (conjunctivitis, coryza, cough, Koplik spots) blanching erythematous rash cephalocaudal spreading sparing palms soles. Important: rash forms as fever peaks! Vs roseola where rash and fever peak together Complications: OM, PNA, encephalitis (early and late), gastroenteritis. Tx: supportive or Vit A for hospitalized pts. |
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Term
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Definition
Congenital -> . blueberry muffin baby, Hearing loss, mental retardation, congenital heart defects (PDA or PAS), ocular symptoms
Post-natlal -> aka German Measles think of it as a mild measles. Typically lasts only 3 days. Rash doesn't darken as much as measles and appears 2-3 days after fever or LAD. No koplik spots or conjunctivitis |
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