Kathynotes PDF

UNSORTE D RANDOME NOTES RELATED TO STEP 2CK Credit goes to Dr.
Katherine and
Dr. Isaac
Some mnomonics from FA and review of UW:

Mnemonics
Management of A-Fib
Anticoagulate
B-blockers
Cardiovert/CCBs
Digoxin
Acute CHF Management
Lasix
Morphine
Nitrates
Oxygen
Position (upright)
Immediate tx for MI
Morphine
Oxygen
Nitroglycerine
Aspirin
Indications for CABG
Unable to perform PCI (diffuse dx)
Left main coronary A dx
Triple-vessel dx
Depressed ventricular func'n
Tx for HTN
ACEIs/ARBs (best for diabetics)
B-blockers (avoid if depression and beware in diabetics)
CCBs (best if hx of headaches)
Diuretics (first-line)
Causes of 2ndary Htn
Cushing's syndrome and CAH
Hyperaldosteronism (Conn's Syndrome) - hypokalemic
Aortic coarctation (BP of UE> LE)
Pheochromocytoma (episodic, flushing, palpitations)
Stenosis of renal arteries (+bruits)
OCPs
Causes of Pericarditis
CARDIAC RIND
Collagen vascular dx
Aortic dissection
Radiation
Drugs
Infections
Acute renal failure
Cardiac (MI)
Rheumatic fever
Injury
Neoplasms
Dressler's syndrome
DDx for Pleuritic Chest Pain
PE, Pneumonia, Pericarditis, Pneumothorax, Pleuritis
Beck's Triad for Cardiac Tamponade
JVD, Hypotension, Distant heart sounds
Virchow's Triad
Hemostasis, endothelial damage, hypercoagulability
Acute Ischemia
Pain
Pallor
Paralysis
Pulselessness
Paresthesias
Poikilothermia
Drugs that cause Stevens-Johnson Synd
Penicillin, Sulfa, Allopurinol, Rifampin, Lamotrigine
Lichen planus
Planar, Purple, Pruritic, Persistent, Pokygonal, Penile, Perioral, Puzzling, Koebner's Phenomenon
Melanoma
Asymmetric, irreg Borders, irreg Color, Diameter >6 mm, Evolution
Thyroid Neoplasms
the most Popular is Papillary
Papillae (branching), Palpable LNs, "Pupil" (orphan annie) nuclei, Psammoma bodies, Positive prognosis
Pheochromocytoma rule of 10s
10% extra-adrenal
10% bilateral
10% malignant
10% in children
10% familial
Adrenal crisis management
Saline 0.9%
Steroids (IV hydrocortisone 100 mg q 8h)

Support
Search for underlying dx
Pheochromocytoma
Pressure (episodic high BP), Pain (h/a), Perspiration, Palpitations, Pallor
MEN-1
Pancreas (gastrinomas, insulinomas, VIPomas), Pituitary adenoma, Parathyroid hyperplasia
MEN-2A
Medullary ca of thyroid, Pheochromocytoma, Parathyroid Hyperplasia
MEN-2B
Medullary ca, Pheochromocytoma, mucosal neuromas, marfinoid habitus
Pellagra
Diarrhea, Dementia, Dermatitis, Death
Charcot's Triad
RUQ pain, Jaundice, Fever/chills
Reynold's Pentad
RUQ pain, Jaundice, Fever/chills, Shock, Alt mental status; present in suppurative cholangitis, suggests
sepsis
Thrombocytopenia DDx
HIT SHOC
HIT or HUS
ITP
TTP or treatment
Splenomegaly
Hereditary (ie: Wiskott-Aldrich)
Other (ie: malignancy)
Chemotherapy
TB Tx
Rifampin, INH (+B6), Pyrazinamide, Ethambutol
Zidovudine AE
anemia
Protease Inhibitors AE
hyperglycemia, hyperlipidemia
Stavudine, Didanosine AE
peripheral neuropathy
Indinavir AE
nephrolithiasis
Lamivudine AE
NONE
Ganciclovir
Leukopenia
Foscarnet
nephrotoxicity
The Major Pathogens Concerning Complete T-cell Collapse
Toxoplasma gondii, MAC, PCP, Candida albicans, Cryptococcus neoformans, TB, CMV, Cryptosporidium
parvum
UTI Bugs
SEEKS PP
Serratia, E coli, Enterobacter, Klebsiella pneumoniae, Staph saprophyticus, Pseudomonas, Proteus
mirabilis
Fever & Rash
Tiny GERMS
Typhoid fever, Gonococcemia, Endocarditis, RMSF, Sepsis
Endocarditis
JR = NO FAME
Janeway lesions (painless), Roth's spots, Splinter hemorrhage, Osler's nodes (painful), Fever, Anemia,
Emboli
CREST Syndrome
Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodaxtyly, Telangiectasias
SLE Criteria
DOPAMINE RASH
Discoid rash, Oral ulcers, Photosensitivity, Arthritis (non-erosive), Malar rash, Immunologic, Neurologic
(cerebritis, seizures), Elevated ESR, Renal dx, ANA+, Serositis, Hemolytic anemia
Pediatric Limp DDx
STARTSS HOTT
Septic joint, tumor, avascular necrosis (Legg-Calve-P erthes), RA/JIA, TB, Sickle cell dx, SCFE (obese pt),
HSP, Osteomyelitis, Trauma, Toxic synovitis
Posterior Circulation Strokes
Diplopia, Dizziness, Dysphagia, Dysarthria
MCA Stroke
Contralateral paresis and sensory loss in face and arm
Homonymous hemianopsia
Aphasia (dominant)
Neglect (non-dominant)
Gaze preference toward side of lesion
Contraindications to tPA
SAMPLE STAGES
Stroke or head trauma w/in last 3mo, Anticoag (INR > 1.7 or prolonged PTT), MI recently, Prior
intracranial hem, Low platelets, Elevate BP (>185/110), Surgery <2wks ago, TIA, Age <18, GI or urinary
bleed in last 3 wks, Elevated or low glucose, Seizures at onset of stroke
Conditions a/w Berry aneurysms that can MAKE SAH more likely
Marfan's syndrome, Aortic coarctation, Kidney dx (ADPKD), Ehlers -Danlos, Sickle cell anemia,
Atherosclerosis, Hx (familial)
Etiology of Seizures
VITAMINS
Vascular, Infection, Trauma, Autoimmune, Metabolic (hyponatremia, hypomagnesemia, hypoglycemia,
hypoxia, drug OD/WD), Idiopathic (epilepsy), Neoplasm, pSychiatric
BPPV
Benign otolith, Paroxysmal <1 min, Positional, Vertigo
Symptomatic therapy for MS
Baclofen (spasticity), Oxybutinin (hyperactive bladder), Bethanechol (urinary retention), Fluoxetine
(fatigue/depression), Sildenafil (ED)
Dementia DDX
neuroDegenerative dx, Endocrine (hypothyroid), Metabolic, Exogenous, Neoplasm, Trauma, Infection
(encephalitis, syphillis), Affective disorders, Stroke/Structural
Normal Pressure Hydrocephalus
Wet (incontinence), Wacky (dementia), Wobbly (apraxia)
Parkinson's dx
4 PaRTS
Postural instability, Rigidity (cogwheel), Tremor (pill rolling), Slowed mov't (bradykinesia)
Vaccines NOT safe in Pregnancy
MMR, Polio, Yellow fever, Varicella
(if not immunized against Rubella, give vaccine AFTER delivery)
TORCHeS
Toxoplasmosis, Other (parvovirus, VZV, Listeria, TB, malaria, fungi), Rubella, CMV, HS V, HIV, Syphilis
BPP
Test the Baby, MAN!
fetal Tone, Breathing, Mov't, Amniotic fluid volume, NST
Preeclampsia
HyPE
Htn, Proteinuria, Edema
HELLP Syndrome
Hemolysis, Elevated LFTs, Low Platelets (<100,000) - increased risk of abruptio placenta
Ectopic pregnancy
Pain, Amenorrhea, Vaginal bleeding, Ectopic
Postpartum Fever Day 0
Wind
atelectasis, pneumonia
+ve rales, s/p C-section
Postpartum Fever Day 1-2

Water
UTI
+ve fever, CVAT, UA & CS, catheters
Womb
Endomyonetritis
early ROM/labor, emergency C-S
Wound
cellulitis, abscess if incision or episiotomy
Walk
DVT, PE
Postpartum Fever Day 7+
Weaning (breast engorgement, abscess, mastitis)
Wonder drugs
Severe PCOS
HAIR-AN Syndrome
HyperAndrogenism, Insulin Resistence, Acanthosis Nigricans
Acute Pelvic Pain DDx
A ROPE
Appendicitis, Ruptured ovarian cyst, PID, Ectopic pregnancy
Causes of Urinary Incontinence
DIAPPERS
Delirium/confused state, Infection, Atrophic urethritis/vaginitis, Pharmaceutical, Psychiatric, Excessive
output (hyperglycemia, hypercalcemia, CHF), Restricted mobility, Stool impaction
Cyanotic heart defects
Truncus arteriosus (1 arterial vessel overriding ventricles), Transposition of great vessels (2 arteries
switched), TRIcuspid atresia, TETRAlogy of Fallot, Total anomalous pulmonary venous return
Non-cyanotic heart defects
VSD, ASD, PDA
DiGeorge Syndrome
CATCH 22
Cardiac (transposition), Abnormal facies, Thymic aplasia, Cleft palate, Hypocalcemia, 22q11 deletion
Tetralogy of Fallot
PROVe
Pulmonary stenosis, RVH, Overriding aorta, VSD
Meckel's Diverticulum
under 2yo, 2x more common in males, 2 types of tissue, 2" long, w/in 2' of ileocecal valve, 2% of
population
Kawasaki Dx
CRASH and BURN
Conjunctivitis, Rash, Adenopathy (unilateral), Strawberry tongue, Hands and feet (red, swollen, flaky),
BURN (fever >104 for 5+ days)
APGAR
Appearance (blue/pale, pink trunk, all pink)
Pulse (0, <100, >100)
Grimace with stimulation (0, grimace, +cough)
Activity (limp, some, active)
Respiratory effort (0, irregular, regular)
Sx of Depressive Episode
SIG E CAPS
Sleep, loss of Interest, Guilt, Energy low/fatigue, low Concentration, Appetite changes, Psychomotor
agitation/retardation, Suicidal ideation
TCA toxicity
Convulsions, Coma, Cardiac arrhythmias
Causes of Delirium
I WATCH DEATH
Infection, Withdrawal, Acute metabolic/substance abuse, Trauma, CNS pathology, Hypoxia, Deficiencies,
Endocrine, Acute vascular/MI, Toxins/drugs, Heavy metals
Sx of Mania
DIG FAST
Distractibility, Insomnia, Grandiosity, Flight of ideas, Activities/Psychomotor agitation, Sexual
indeiscretions, Talkativeness/pressured speech
Characteristics of Personality Disorders
MEDIC
Maladaptive, Enduring, Deviate from cultural norms, Inflexible, Cause impairment in social/occupational
functioning
Evolution of EPS
4 hrs: Acute dystonia
4 days: Akinesia
4 weeks: Akathisia
4 months: Tardive dyskinesia
Risk for Suicide
SAD PERSONS
Sex (male), Age, Depressed, Previous attempt, Ethanol/substance abuse, Rational thought, Sickness,
Organized plan, No spouse, lack Social support
Obstructive Pulmonary Dx
Asthma, Bronchiectasis, CF, COPD, Tracheal or bronchial obstruction
Asthma Exacerbation Tx
Albuterol
Steroids
Theophylline (rare)
Humidified O2
Magnesium (severe)
Anticholinergics (better for COPD)
COPD Tx
Corticosteroids
Oxygen
Prevention (stop smoking)
Dilators (b-agonists, anticholinergics)
Restrictive Lung Dx
If the lungs AIN'T compliant...
Alveolar (edema, hemorrhage, pus)
Interstitial lung dx, Inflammatory, Idiopathic
Neuromuscular (myasthenia, phrenic palsy, myopathy)
Thoracic wall (kyphoscoliosis, obesity, ascites, pregnancy, ankylosing spondylitis)
Features of Sarcoidosis
GRUELING
Granulomas, aRthritis, Uveitis, Erythema nodosum, Lymphadenopathy, Interstitial fibrosis, Neg TB test,
Gammaglobulinemia
ARDS
Acute onset
Ratio PaO2/FiO2 <200
Diffuse infiltration
Swan-Ganz wedge pressure <18 mmHg
Sx of Pneumothorax
Pleuritic pain
Tracheal deviation away from lesion
Hyperresonance
Onset sudden
Reduced breath sounds & dyspnea
Absent fremitus
Xray shows collapse
Causes of Hypernatremia
Diuresis, Dehydration, Diabetes insipidus, Docs (iatrogenic), Diarrhea, Disease (ie: kidney, sickle cell)
Hyperkalemia Tx
C BIG K
Calcium, Bicarbonate/B-agonists, Insulin, Glucose, Kayexalate
Causes of hypercalcemia
CHIMPANZEES
Ca supplements, Hyperparathyroid/Hypert hyroidism, Iatrogenic (ie: thiazides, TPN)/Immobility, Milk -alkali
syndrome, Paget's dx, Adrenal insufficiency/Acromegaly, Neoplasm, ZE syndrom (MEN-1), Excess Vit A,
Excess Vit D, Sarcoidosis
Anion Gap Metabolic Acidosis
Methanol (tx: ethanol)
Uremia (tx: dialysis)
DKA (tx: insulin, IVF)
Paraldehyde/Phenformin
INH/Iron (tx: Charcoal/GI lavage)
Lactic acidosis
Ethylene glycol (tx: Fomepizole)
Salicylates (tx: alkalinize urine)
Indications for Urgent Dialysis
Acidosis
Electrolyte abnormalities (hyperK)
Ingestions (salicylates, theophylline, methanol, barbiturates, lithium, ethylene glycol)
Overload (fluid)
Uremic sx (pericarditis, encephalopathy, bleeding, nausea, pruritis, myoclonus)
Sx of Nephritic Syndrome
PHAROH
Proteinuria, Hematuria, Azotemia, RBC casts, Oliguria, Hypertension
Hematuria DDx
I PEE RBCS
Infection, PKD, Execise, External trauma, Renal glomerular dx, BPH, Cancer, Stones
Possible causes of Pulseless Electrical Activity
Hypovolemia, Hypoxia, H+ (acidosis), Hyper/Hypo-K, Hypothermia, Tablets (OD), Tamponade, Tension
PTX, Thrombosis (coronary & PE)
Body Surface Area
Head 9%
Arms 9% each
Chest 18%
Back 18%
Legs 18% each
Perineum 1%
Postop Fever
Wind: atelectasis, pneumonia
Water: UTI
Wounds: infection, abscess
Walking: DVT
Wonder drugs: drug rxn

Womb: endometritis
306 terms
T wave inversion differential
MI, myocarditis, old pericarditis, myocardial contusion, digitalis toxicity
Muddy brown granular casts
Acute tubular necrosis (see QID 3955)
RBC casts
Glomerulonephritis
WBC casts
Interstitial nephritis and pyleonephritis
Fatty casts
nephrotic syndrome
Braoad and waxy casts
chronic renal failure
Boy with gout
Lesh Nyhan syndrome (HPRT deficiency)
PAS positive macrophages on intestinal biopsy (diarrhea, arthritis, lymphadenopathy)
Whipple disease
double bubble sign on abdominal x-ray
Duodenal atresia, a/w Down syndrome
male infant with recurrent otitis media and pneumonia around 6 months of age with reduced Igs and B cells
Brutons agammaglobulinemia
dullness to percussion, egophony and bronchial (INCREASED) breath sounds, INCREASED tactile
fremitus
consolidation
dullness to percussion and DECREASED breath sounds
pleural effusion
medical treatment for HPV anal warts
Podophyllin (topical antimitotic)
OCD neurotransmitter and Rx
serotonin--> SSRIs
workup for suspected liver cancer
AFP, CT/MRI, then biopsy
hypertrophic cardiomyopathy pathophysiology
hypertrophied ventricular septum obstructs left outflow tract
mitral stenosis murmur
disastolic rumble at apex and/or opening snap
anascara
generalized edema (pulmonary, ascites, peripheral)
type 1 vs. type 2 Mobitz
Type 1 PR interval increases then a beat is dropped, in type 2, no change in the PR interval before a beat
is dropped
diffuse ST elevation with PR depression
acute pericarditis
12 causes of pulseless electrical activity
6Hs: hypovolemia, hypoxia, hydrogen ions (acidosis), hypothermia, hypoglycemia, hypo/hyperkalemia;
6Ts: tamponade, tension pneumothorax, thrombosis (MI, PE), trauma, tablets, toxins.
high output heart failure signs/symptoms
wide pulse pressure, brisk carotid upstroke, tachycardia, LVH. Basically, preload is increased by
connection b/w arteries and veins.
high output heart failure differential
congenital vs. aquired arteriovenous fistula (ie: PDA, angiomas, pulmonary or CNS AVF, trauma to
arteries, athrosclelrotic fistula, etc.) ("wet" beri beri (thiamine deficiency), Paget disease, thyrotoxicosis,
and anemia also)
Prinzmetal's angina Rx considerations
treat with nitrites or Ca channel blockers to vasodialate. Do NOT use B-blockers or aspirin which may
cause vasospasm
mitral regurgitation murmur
pansystolic murmur, loudest at the apex with radiation to the axilla
ventricular septal rupture murmur
pansystolic murmur, loudest at the left sternal border, often with an accompanying thrill, unlikely to radiate
to axilla
which drug to treat MI are contraindicated in cocaine related MI/angina?
B-blockers (will aggrevate cocaine induced vasospasm)
BNP >100 suggests
CHF (BNP is secreted in response to ventricular stretch and wall tension, I.e. volume overload)
how and when do you treat PVCs
only treat if symptomatic, B-blockers are 1st line, Amiodarone 2nd line
presentation of myocarditis in children
flu like illness --> heart failure and respiratory distress from CHF
normal changes of heart with aging
decreased CO, decreased max HR, slower contraction and relaxation of the muscle, decreased diastolic
compliance, decreased baroreceptor responsiveness, pigment accumulation
positive hepatojugular reflex in setting of edema
suggests cardiac etiology of edema
chest pain that radiates to back with normal EKG
dissection
which new heart sound is classic for an acute MI?

S4 from diastolic dysfunction and a consequently stiffened left ventricle
what is the inheritence of hypertrophic cardiomyopathy?
autosomal dominant
what is the classic murmur a/w hypertrophic cardiomyopathy?
systolic ejection murmur along left sternal border that decreases with squatting (incerased preload
distends the obstructed outflow tract)
digoxin toxicity symptoms
nausea, vomiting, diarrhea, vision changes, arrythmias
classic cause of diastolic dysfunction and Rx
chronic hypertension. treat with diuretics and BP control
first line diagnostic tests for aortic dissection
TEE or CT scan
dipyridamole mechanism and utility
coronary artery vasodilation (used as a "coronary steal" mechanism during non-excersice stress testing to
identify ischemia)
electric alterans =
pericardial effusion/cardiac tamponade
first line Rx for hypertrophic cardiomyopathy
B-blockers or cardioselective Ca channel blockers (diltiazem)
recent URI + distant heart sounds
pericardial effusion
"curtain falling down"
Classically RETINAL DETATCHMENT but also Amarouxis fugax (retinal emboli from ipsilateral carotid
artery)
proptosis, opthalmoplegia, diploplia and fever
orbital cellulitis (bacterial sinusitis most common cause)
progressive bilateral loss of central vision
macular degeneration
progressive bilateral loss of peripheral vision
open angle glaucoma
acute onset eye pain and vision loss
closed angle glaucoma
central retinal artery occlusion presentation
sudden painless unilateral blindness, sluggish pupil, chery red spot on FOVEA
central retinal vein occlusion presentation
rapid painless vision loss of variable severity. A/w HTN. SWOLLEN OPTIC DISC
yellow-white opacifications and retinal hemmorhages in AIDS patient with CD4 count <50
CMV retinitis
dacrocystitis
infection of the lacrimal sac of the eye (p/w unilateral redness and pus from medial corner of eye) usually
due to Staph or Strep
straight lines appear "wavy" on eye exam
most common cause of blindness in developed world
who are most commonly affected by viterous hemmorhage?
diabetics with diabetic retinopathy
main causes of death from burns
#1: hypovolemic shock; #2: sepsis
Graft vs. host disease mechanism
donor T-cell activation against host HLA antigens. CELL mediated immune response
what is a cystic hygroma
a lymphangioma: dialated lymphatic spaces lined by epithelium that usually appear on the neck.
Compressible and transilluminate
what is an acrochordon
a skin tag
what is the best way to protect yourself against melanoma?
protective clothing
Staph Scalded Skin Syndrome
seen mostly in kids. Caused by an exfoliative toxin which targets desmoglein 1 (similar to pemphigus
vulgaris). Large blisters, positive Nikolsy sign, fever, generalized rash
what type of hypersensitivity is caused by poison ivy?
contact dermatitis, a type IV hypersensitivity, which is CELL mediated (prior exposure required)
Type 1 hypersensitivity reaction, mechanism and examples
Antigen cross-links IgE on presensitized mast cells. Antibody mediated. Anaphylaxis, urticarial drug
reactions (a new rash in the hospital).
IgM and IgG bind to antigen on "enemy cell" leading to MAC. Cy -2-toxic. Autoimmune hemolytic anemia,
erythroblastalis fetalis, Goodpasture syndrome, rheumatic fever
Immune complex (3 things stuck together). Examples include many of the glomerulopathies and
vasculitities.... Most things rheumatological: SLE, RA, Polyarteritis nodosa, etc. Also includes SERUM
sickness (drug reaction) and ARTHUS reaction (post vaccine)
Sensitized T lymphocytes... cell mediated (not transferrable by serum). POISON IVY, contact dermatitis,
transplant rejection, TB skin tests
Raised sharply demarcated advancing margins on cheek, raised borders... sounds a little bit like
cellulitis... sometimes following pharyngitis or minor trauma
Eryspielas, a Group A Strep infection (usually)
Toxic Epidermal Necrolysis vs. Steven Johnson
>30% vs. <10% skin involvement respectively
pink or brown scaly plaque with central clearing followed by a maculopapular rash along skin tension
lines
Pityriasis rosea
which vitamin can help in the treatment of measles?
Vitamin A (for ALL better now)
malabsorbtion plus papulovesicular rash on extensor surfaces
dermatitis herpetiformis
scabies presentation and treatment
pruritic papules over penis/breasts. Treat with 5% permethrin cream overnight
tinea versicolor
areas of body does not tan, spagetthi and meatball appearance on KOH, treat with antifungal
creams/shampoo
vittiligo
areas of complete depigmentation (like Sanja) usually around mouth caused by autoimmune destruction
of melanocytes
tinea corporis
ring worm. Advancing ring shaped lesions with scaly border and central clearing
which drug can precipitate acute renal failure in patients with bilateral renal artery stenosis?
ACE inhibitors
in a patient with deficient C1 esterase inhibitor which products build up to cause angioedema?
C2b and bradykinin
"lizard skin" that gets worse in winter
Ichyosis vulgaris
eczema herpeticum
a complication of atopic dermatitis where there is a HSV infection (vesicles) overlying previous areas of
atopic dermatitis. CAN BE LIFE THREATENING. START ACYCLOVIR!!!
xanthelesma (what is it and what disease is it associated with)
cholesterol filled yellow plaques that appear in the corner of the eye. Can be idiopathic but are also
associated with PRIMARY BILIARY CIRRHOSIS (anti-mithochondrial antibodies)
lesions on palms and soles differential and Rx
1) secondary syphilis: non-pruritic, symmetric, STD, BEGINS ON TRUNK and spreads to palms and
soles, generalized LYMPHADENOPATHY--treat with Penicillin
2) Rocky Mountain Spotted Fever: HEADACHE, fever, rash starts on WRISTS --treat with doxycycline (or
chloramphenicol for pregnant women)
3) Hand Foot and Mouth disease: coxsackie A virus, in children, involves oral mucosa--supportive care
only.
4) Kawasaki disease: young asian children, prolonged HIGH fever, CONJUNCTIVITIS, strawberry
tounge, UNILATERAL lymphadenopathy, desquimation of fingertips, hepatitis, arthralgias;
5) Bacterial endocarditis
6) disseminated N. gonorrhea (painful pustules and joint pain)
treatment for dermatitis herpetiformis
gluten free diet and DAPSONE
phototoxic drug eruption in teen with acne would be caused by which drug?
doxycycline
porphyria cutanea tarda presentation
painless blisters and increased skin fragility of back of hands and facial hyperpigmentation and
hypertrcihosis. Can be precipitated by estrogen and alcohol and is often associated with Hep C
herpetic whitlow
HSV 1 or 2 infection of the hand/finger. Self limited. P/w throbbing pain in finger with vesicles
chalazion
a chronic granulomatous lesion of the eye lid due to obstruction of the meibomian gland. Initially painfull
swelling progresses to painless, rubbery, nodular lesion. If recurrent, biopsy is required to rule out
malignancy (meibomian sebaceous carcinoma vs. basal cell carcinoma)
Henoch Schonlein Purpura tetrad
1) lower extremity purpura 2) abdominal pain 3) renal disease 4) arthritis/arthralgias (HSP is the most
common form of systemic vasculitis in children)
pain bullas and skin necrosis over breast, buttocks and thighs in a patient recently diagnosed with Afib
Warfarin induced skin necrosis
Rosacea: presentation and Rx
telangectasias and redness/flushing of face, especially with hot drinks or emotions. Treat with topical
antibiotics (metronidazole)
Paget's disease Rx
if asymptomatic with minor elevations in Alk Phos and no involvement of weight bearing bones, NO
treatment. If symptomatic, treat with bisphosphonates.
untreated hyperthyroidism can cause (2)
1) rapid bone loss; 2) arrythmias
what is the most common form of congenital adrenal hyperplasia and how does it present?
21-hydroxylase deficiency (increased ACTH, +/- salt wastig, hyperandrogenism (virilization)
androgen producing adrenal tumors will show an elevation in the serum levels of?
DHEA-S
Hypokalemia, alkalosis and normotension differential (4)
1) Surreptitious vomiting 2) Diuretic abuse 3) Gittleman syndrome (like thiazide abuse) 4) Barter
syndrome (like loop diuretic abuse)
chloride sensitive vs. chloride resistant metabolic alkalosis

chloride sensitive: (Urine Cl <20) basically due to volume contraction (diuretics or vomiting); chloride
resistant: (Urine Cl >20) basically due to volume expansion (hyperaldo, Gittleman, Bartter)
which metabolic abnormality can cause refractory hypokalemia?
hypomagnesemia
which meds cause hyperkalemia? (7)
1) **ACEi, ARBs and spironolactone 2) Propranolol 3) Digitalis 4) *Succinylcholine 5) NSAIDs 6) Heparin
7) **Trimethoprim (TMP-SMX)
what percentage of results lie within 1, 2 and 3 standard deviations of the mean?
1 standard deviation=68%
2 standard deviations=95%
3 standard deviations=99.7%
mean, median, mode definitions
mean=the average number
median=the middle number
mode=the most common number
in a normal distribution they are all equal!
which live vaccine can be given to HIV patients?
MMR can be given to HIV patients with a CD4 count >200 who do not have an AIDS defining illness.
what drugs can cause pancreatitis (6)
1. Anti-seizure drugs (Valproic acid)
2. Diuretics
3. Inflammatory Bowel drugs (sulfasalazine, 5-ASA)
4. Immunosupressants (azathioprine, L-asparginase)
5. HAART drugs (didanosine, pentamidine)
6. Antibiotics (metronidazole, tetracycline)
(these drugs cause a jIIHAAD on the pancreas)
Another (descriptive) name for Reyes syndrome
Fatty liver encephalopathy, associated with Aspirin use in children <15
"Balloon degeneration with polymorphic cellular infiltrates" in liver
acute alcoholic hepatitis
"Panlobular mononuclear infiltration with hepatocyte necrosis and bridging necrosis" in liver
acute viral hepatitis
"Portal necrosis +/- bridging fibrosis" in liver
chronic active hepatitis
"inflammatory destruction of small intrahepatic biliary ducts"
primary biliary cirrhosis
"macrovesicular steatosis with PMN infiltrates and necrosis" in liver
alcoholic or non-alcoholic steatohepatitis (fatty liver)
how do chronic Hep B and Hep C differ in their symptomatic manifestations?

HepC classically presents with waxing and waning transaminase levels, but few symptoms. Patients may
complain of arthralgias or myalgias. Extrahepatic sequela are cryoglobulinemia, Porphyria cutanea t arda
and glomerulonephritis.
HepB are less likely to have the above sxs.
what annual preventative screening should be done in ulcerative colitis patients?
colonoscopy to detect colon cancer beginning 8-10 years after diagnosis.
pregnant female with pruritus +/- jaundice and elevated bile acids and liver enzymes in the third trimester
Intrahepatic cholestasis of pregnancy
acute fatty liver of pregnancy
often asymptomatic, but may have nausea, malaise, headache abdominal pain. 50% also have
PREECLAMPSIA and 60% will develop acute RENAL FAILURE. Biopsy will show microvesicular fat
deposition in hepatocytes, but NO NECROSIS. Labs can show elevated PT and LFTs
what are the most common complications of MUMPS?
orchitis
aseptic meningitis
encephalitis
pancreatitis
rare: myocarditis, arthritis
what is the treatment for Lyme disease in adults and children
Doxycycline for adults. Amoxicillin in pts. <8 and in pregnant and lactating women
boy with frequent nosebleeds and a mass in the nose and bony erosions has:
angiofibroma -> needs specialist evaluation and possibly surgery.... can be deeply invasive because it is
unencapsulated
Hemolytic Uremic Syndrome causes this kind of hemolysis
microangiopathic hemolytic anemia (schiztocytes and giant platelets.... looks li ke DIC)
anisocytosis
high RDW (different cell sizes)
neurological sxs + anemia + renal sxs.
lead poisoning
elevated leukocyte alkaline phosphatase score in setting of extreme WBC elevation
Leukemoid reaction
HIV medication which causes PANCREATITIS
DIDANOSINE (an RTI)
HIV medication which causes life threatening hypersensitivity reaction
ABACAVIR (an NRTI)
HIV medication class which causes LACTIC ACIDOSIS
NRTIs
HIV medication class which causes Stevens-Johnson Syndrome
NNRTIs
HIV medication which causes LIVER FAILURE

NEVIRAPINE (an NNRTI)
HIV medication which causes CRYSTAL INDUCED NEPHROPATHY
INDINAVIR (a protease inhibitor)
most common leukemia in kids
ALL (All Little ones)
Multiple Myeloma presentation:
CRAB
Calcium (hyper)
Renal insufficiency -> decreased EPO
Anemia
Bone pain/lytic lesions
Prussian blue stain is used to detect
Iron
what drugs can be used to treat the flu?
amantadine/rimantadine
neuramidase inhibitors: oseltamivir/zanamivir (tamiflu)
neutropenia definition
ANC count of less than 1,500/mm3 (multiply neutrophils + bands in differential with WBC count). Less
than 500 is severe neutropenia
what commonly causes a folate deficiency?
1) alcoholism, poor nutrition
2) TMP-SMX, methotrexate
3) anti-seizure medications (phenytoin)
Anterior mediastinal mass differential:
"the 4 Ts"
Thymoma
Teratoma (and other germ cell tumors)
Thyroid cancer
Terrible lymphoma
Serum B-HCG and AFP in Seminoma vs. other germ cell tumor
Seminoma: AFP always normal, B-HCG may be elevated
Other germ cell tumors: both are often elevated
which viruses commonly cause viral meningitis in kids?
echovirus and coxsackievirus
Fanconi anemia
Short stature, incidence of tumors/ leukemia, aplastic anemia (genetically inherited; often progresses to
AML)
Due to DNA cross-link repair deficiency
Babesiosis
fever and hemolytic anemia in NE US; Ixodes tick; maltese cross on blood smear; treat with quinine and
clindamycin
CMV vs. HSV ulcers in HIV esophagitis
CMV: shallow, large, irregular, linear with intranuclear and intracytoplasmic inclusions
HSV: small, deep, well circumscribed with intranuclear inclusions
what entity that is not infective endocarditis can give you splinter hemorrhages?
Trichinellosis. Orbital edema, myositis, eosinophillia (parasitic infection from uncooked pork)
Rx for bacterial sinusitis
augmentin (amoxicillin + clavulinic acid)
drug for hairy cell leukemia
CLADribine (put clothes on the hair...)
what oral medicine is active against MSSA?
dicloxacillin, cephalexin or clindamycin
new onset DM with joint pain +/- hepatomegaly
hemochromatosis
anemia, renal failure, hypercalcemia in elderly patient
multiple myeloma
these substances can increase the effect of Warfarin
alcohol
vitamin E
garlic
ginko
ginseng
St. John's wort
several antibiotics (by decreasing vit. K absorption)
hyperglycemia, red itchy skin rash, +/- blisters, diarrhea, weight loss, +/- DVT
glucagonoma
absence of urine erythropoetin
polycythemia vera
thrombocytopenia, prolonged PTT and positive VRDL
anti-phospholipid antibody (SLE), actually prothrombotic state.
cutaneous and visceral nodular angioma-like blood vessel growths in immunocompromised patient
sounds a bit like Kaposi's but is actually Bartonella (bacillary angiomatosis)
mucormycosis treatment
i.e horrible facial infection seen in diabetics
treat with surgical debriedment and amphotoericin B
post influenza pneumonia (species)
Staph aureus
Latent TB treatment
Isoniazid + pyridoxine (to prevent neuropathy) for 9 mos.
Check LFTs periodically
dry cough, dyspnea and fever in HIV pt
PCP pneumonia
treat with TMP-SMX
add steroids if PaO2 <70 or Aa gradient >35
empiric antibiotic used for animal bites (and human bites)
Augmentin (amoxicillin/clavulinic acid)
transplant patient with fever, dry cough (atypical pneumonia like findings) and diarrhea. Not Legionella
CMV pneumonitis with GI involvement
actinomyces vs. nocardia (location and treatment)
actinomyces: cervicofacial--penicillin G
noocardia: pulmonary/disseminated--TMP-SMX
what infection sounds like TB but isn't
Noocardia
tick bite, fever, HA/N/V, no rash but leukopenia/thrombocytopenia. Dx and Rx
Dx: Erlichosis.
Rx: Doxycycline
malaria prophylaxis
chloroquine
unless going to India or Africa (chloroquine resistant P. falciparum), when Mefloquine (meflyin' to India) is
used
Diarrhea in AIDS patient (3)
1) Cryptosporidium: profuse, watery, non bloody. cysts on acid fast staining of stool. Treat with
Nitazoxanide and HAART
2) CMV: bloody diarrhea, negative stool culture, large cells with inclusions on biopsy. Treat with
Ganciclovir or Foscarnet and HAART
3) MAC: non-bloody, major systemic sxs, elevated ALK PHOS and LDH. Treat with clarithromycin,
prevent with azithromycin, and HAART
halo sign on CXR in immunocompromised pt
aspergillosis
Tick bite differential: Lyme vs. Erlichosis vs. Rocky Mountain Spotted Fever vs. Babesiosis vs. Colorado
tick fever vs. Tularemia vs. Q fever
1) Lyme: erythema migricans, arthritis, AV block, Bells Palsy --doxycycline or Erythromycin if <8 or
pregnant
2) Erlichosis: no rash, HA, leukopenia/thrombocytopenia--Doxycycline
3) RMSF: HEADACHE, fever, wrist rash--Doxy or chloramphenicol (if preggers)
4) Babesiosis: NE United States, fever, hemolysis, jaundice--quinine+clinda or atovaquone+azithro
5) Colorado tick fever: western US and Canada, just a fever... supportive care only
6) Tularemia: fever, conjunctivitis, lymphadenopathy, myalgias and ULCER AT SITE OF
INNOCULATION. No rash. --supportive care only
7) Q fever: cattle, goats, sheep. flu like syndrome, hepatitis or pneumonia (Q=query for diffic ult to
diagnose). Can rarely become chronic and affect the heart as culture negative endocarditis --doxycycline
smooth round big cyst with daughter cysts is most likely found in the liver of a.....
sheep farmer
these cysts can also be called "hytadid cysts" and appear anywhere in the body.... liver is most common
though
Caused by:
--Echinococcus granulosus (a parasite)
A pig farmer contract this parasitic disease:
Neurocysticercosis: A condition characterized by brain cysts resulting from parasitic infecti on by the pork
tapeworm, T. solium
A midwest HIV positive patient develops fever, weight loss, dry cough, palatal ulcers and
hepatosplenomegaly. CXR shows a cavitary lesion and hilar lymphadenopathy. Dx and Rx
Histoplasmosis--> Amphotericin B followed by itraconazole
elevated Alk Phos and LDH in AIDS pt with fever and diarrhea
Disseminated MAC
Ring enhancing brain lesion in AIDS pt differential (4)
1) toxoplasmosis: multiple small lesions in basal ganglia (not on TMP -SMX)
-most common CNS lesion in AIDS pts
vs.
2) CNS lymphoma: solitary and periventricular (usually), EBV PCR positive.
3) bacterial abscess... much rarer
4) TB... with positive PPD.... also rare
MAC prophylaxis
Prevent MAC with a MACrolide: azithromycin when CD4 < 50
septic arthritis in sexually active person
N. gonorrhea
painful genital lesion differential and Rx
1) HSV: vesicles, small--Acyclovir
2) Chancroid (H. ducreyi): large, necrotic--Azithromycin or ceftriaxone
non-painful genital lesion differential and Rx
1) HPV: warts, small, itchy--cryotherapy
2) primary syphilis: single lesion, 1cm, regional lymphadenopathy --penicillin
3) Granuloma inguinale (Klebsiella): beefy red ulcer, rolled edge, white border, granulation tissue,
DONOVAN BODIES on biopsy--doxycycline or azithromycin
Anorexia nervosa complications (7)

1) Osteoporosis *****
2) elevated cholesterol and carotene
3) prolonged QT interval
4) Euthyroid sick syndrome (a/w starvation, severe illness)
5) anovulation, amenorrhea, estrogen deficiency
6) hyponatremia
7) Pregnancy: prematurity, small for gestational age
post traumatic CXR with mediastinal deviation to the right, and an opacity in LLL with decreased breath
sounds to match
suspect a ruptured diaphragm with herniation of abdominal content into thoracic cavity
migratory thrombophlebitis
think about pancreatic cancer
how is prolactin regulated?
secretion from anterior pituitary tonically inhibited by dopamine from hypothalamus
inhibits own secretion by increasing dopamine synthesis
*dopamine agonists (bromocriptine) inhibit prolactin secretion and can be used in Tx of prolactinoma;
dopamine antagonists (mostly antipsychotics) and estrogens (OCPs, pregnancy) stimulate prolactin
secretion
TRH and Serotonin prolactin secretion, i.e. HYPOTHYROIDISM
this type of ovarian tumor secretes estrogen
granulosa cell tumor
this type of ovarian tumor secretes androgens
Sertoli-Leydig cell tumor
condyloma lata vs. condyloma acuminata
condyloma lata: flat, velvety lesions caused by secondary syphilis
condyloma acuminata: genital warts
what happens to LH and FSH in PCOS?
there is an increased LH/FSH ratio (>2:1)
what is the use for leuprolide
GnRH analog: synthetic peptide used in pulse therapy to stimulate gonadal steroid synthesis (infertility);
used in continuous or depot therapy to shut off steroid synthesis, especially in prostate carcinoma, and
also in central precocious puberty.
what is mccune-albright syndrome
MCA: Think PPP
Precocious puberty
Pigmentation (cafe au lait spots, unilateral)
Polyosteotic fibrous dysplasia (bone defects)
Lab findings in breast milk jaundice vs. biliary atresia
breast milk jaundice: unconjugated (indirect) hyperbilirubinemia
biliary atresia: conjucated (direct) hyperbilirubinemia

what is the Rx for local impetigo?
topical mupirocin or oral erythromycin
problems of an infant of a diabetic mother
1) caudal regression syndrome (sacral agenesis)
2) transposition
3) duodenal atresia
4) anencephaly and neural tube defects
Beckwith-Widemann syndrome
"WIDTH AND WIDE, MAN" everything is too big
-macrosomia
-macroglossia
-visceromegaly
-neonatal hypoglycemia
-OMPHALOCELE
-due to up regulation of IGF2
WAGR syndrome
Wilms tumor
Aniridia (absence of iris)
Genital/gonadal tumors
Retardation (mental and motor)
Denys-Drash syndrome
-Wilms' tumor
-male pseudohermaphrodism
-early onset renal failure characterized by mesangial sclerosis
congenital hypothyroidism
-UMBILLICAL HERNIA
-LARGE TONGUE
-weakness, sluggishness, poor feeding
-hypotonia
-bloating
UNIVERSALLY SCREENED FOR IN UNITED STATES
Marfan syndrome (features and genetics)
tall stature
long fingers
hypermobility of joints
hyperelastic skin
Fibrillin-1 gene (FBN1)
most common type of childhood tumor
benign astrocytoma (can be infratentorial or supratentorial)
Ehlers-Danlos syndrome
similar to Marfan
hyperflexible joints
hyperelastic skin
-easy bruising
-poor wound healing
NOT TALL AND NO LONG FINGERS
-a COLLAGEN structure problem
Gram positive diplococci
Strep pneumo
Gram positive cocci in clusters
Staph
Gram negative cocci
Neisseria
Gram positive rods
Listeria and Bacillus
Gram negative rods
Pseudomonas
Haemophilus
Klebsiella
Legionella
chronic diarrhea and recurrent sinopulmonary infections in young child
Cystic fibrosis
marfan features + mental retardation + thromboembolic events + downward dislocation of the lens =
homocystineuria (recall that elevated homocystine causes endothelial damage and athrosclerosis)
mental retardation + musty odor
PKU
Gonococcal vs. Chlamydial conjunctivitis in neonates
Gonococcal much more purulent. EARLY onset (first few days). Treat with ceftriaxone
Chlamydial more indolent with LATER onset (after a week or two) but a/w pneumonia. treat with ORAL
erythromycin
incontinence differential:
1) urge incontinence (detrussor hyperactivity): feels urge to go to the bathroom, but doesn't make it in
time. Nocturia and frequency are common. Can also be a/w bladder cancer or infection/inflammation.
Oxybutynin (anticholinergic), TCAs
2) overflow incontinence: large post void residual. a/w diabetic neuropathy.
3) stress incontinence (pelvic floor muscle weakness): incontinent with coughing/sneezing. Kegel
excersices. Surgery. Alpha-agonists.
SIADH
this results from an excess of ADH (Antidiuretic Hormone) which causes the kidneys to reabsorb excess
water, which decreases urine output & increases fluid volume.

Causes hyponatremia, water retention, weight gain, concentrated urine, muscle cramps & weakness.
The low osmolality of blood allows fluid to leak out of vessels & causes brain swelling.
Hyponatremia-->confusion
dysgerminoma
Malignant germ cell tumor, rare, identical to male testicular seminoma, women under 30, solid mass,
hyperechoic, most common neoplasm seen in pregnancy along with serous cystadenoma
endometrioma
benign cyst that 80% of the time results from endometriosis. mass may be large and filled with old blood.
also called chocolate cyst. wall is usually thick with bright reflectors. results in extreme pain.
granulosa cell tumor
secretes estrogen
--precocious puberty in kids.
--endometrial hyperplasia (vaginal bleeding) post-menopausal women
Sertoli-leydig cell tumor
Ovarian tumor that secretes testosterone
Rapid onset of hirsutism
Dx - Marked increase of testosterone, increase in LH/FSH
Tx - removal of involved ovary
mucinous cystadenoma
benign tumor of the ovary that contains thin-walled MULTILOCULA R cysts
atypical pneumonia with negative sputum gram stain and a polymorphic rash
mycoplasma pneumonia
atypical pneumonia with diarrhea +/- neurological sxs
Legionella pneumonia
"sausage digit" dx. and rx
dx: psoriatic arthritis
rx: NSAIDs, Methotrexate.
STEROIDS ARE CONTRAINDICA TED
joint pains, painless skin lesions, tendon tenderness and new sexual partner in 24 year old female
disseminated gonococcal infection
before ordering a CT scan for suspected PE (or anything else) you should establish that:
1) no contrast allergy
2) adequate renal function (creatinine <2.0)
Causes of priapism (4)
1) trazoDONE or PRazosin
2) Sickle Cell Disease and leukemia
3) Neurologic (spinal cord)
4) Trauma to cavernous artery
Pts. with severe proteinuria are at increased risk for: (4)

1) infections (nephrotic syndrome pts. should get pneumococcus vaccine)
2) hypercoaguability (renal vein thrombosis most common, but PE, DVT possible)
3) anemia (looks like Fe deficiency but doesn't respond to Fe)
4) Vit. D deficiency
what nephropathy is associated with cancer? (plus an exception)
Membranous glomerulonephritis
BUT... Hodkin's Lymphoma is a/w Minimal Change Disease
numerous small hemorrhages and blurring of gray-white matter junction following head trauma
diffuse axonal injury
purulent arthritis in sexually active individual
gonococcal arthritis until proven otherwise
central vs. peripheral precocious puberty
central:
--pubertal (high) levels of LH
--LH increases with GnRH stimulation
--IMAGING OF BRAIN IS MANDATORY
--treat with continuous GnRH for IDIOPATHIC CENTRAL PUBERTY, surgery to resect tumor.
peripheral:
--low levels of LH
--LH does not change with GnRH stimulation
--look for estrogen secreting source
pruritus and atrophied and whitish appearance of vagina in post menopausal woman. Dx and Rx
-lichen sclerosis
-punch biopsy to r/o SCC and establish dx, steroid cream to treat
which type of arrythmia goes along with a wide QRS?
bradyarrythmia
which type of arrythmia goes along with a prolonged QT?
tachyarrythmia
what maneuver will increase the murmur heard in hypertrophic cardiomyopathy? (i.e. young athlete about
to drop dead)
Valsalva maneuver (increased intrathoracic pressure causes compression of heart, making the outflow
obstruction by the septum more prominent.... and it also decreases preload)
painless loss of vision with pallor of optic disc, cherry red fovea, boxcar segmentation of retinal arteries
and veins
Central retinal artery occlusion
painless loss of vision with optic disc swelling, retinal hemorrhages, cotton wool spots
Central vein occlusion
painless loss of vision with whitened edematous retina along the arterioles
Retinal emboli
what test is done to confirm a diagnosis of acromegaly (GH hypersecretion)

administer a glucose load then measure GH, it should drop in normal individuals, but stay the same or
increase in disease
what additional testing needs to be done if you suspect a migraine?
none
Testing is required only if:
1) focal neurological sxs.
2) fever
what electrolyte abnormality can be seen following a subarachnoid hemorrhage?
hypoNATREMIA
what is the treatment of acute kidney transplant rejection?
IV steroids
pronator drift test for what kind of lesion?
Upper motor neuron
Pruritus plus maloderous vaginal discharge, pH of 5.0
Trich
Kawasaki disease dx.
High fever for >5 days
-conjunctivitis
-oral lesions, strawberry tongue
-rash
--risk of Coronary Artery ANERURISM
how do you differentiate between post streptococcal glomerulonephritis and IgA nephropathy in a patient
with hematuria and recent URI
Strep: normal complement levels, later onset >10 days
IgA: low complement, onset after 5 days
herceptin (breast cancer) toxicity
cardiac
abdominal trauma with pain radiating to the shoulder suggests?
chemical peritonitis due to spillage of blood, urine, or bowel contents irritating the phrenic nerve on the
diaphragm
what is a logical way that acute pre-renal renal failure would cause acidosis?
by making the patient uremic (i.e. not excreting the inorganic acids produced by the body)
What is the antidote for TCA toxicity and how does it work?
Sodium bicarbonate
-works by unblocking cardiac Na channels and thus narrowing the QRS complex
malignant otitis externa is caused in 95% of the time by:
Pseudomonas (wet in the ear!... like hot tub folliculitis... swimmer's ear.
Treat with Ciprofloxacin
what is the most common form of thyroid cancer?

papillary
(medullary secretes calcitonin but is uncommon and a/w MEN 2a/b)
Fixed split S2
ASD
Pulsus parvus et tardus
slow and late carotid upstroke
--Aortic stenosis
opening snap
mitral stenosis
early diastolic murmur
aortic regurgitation
late diastolic murmur
Mitral or Tricuspid stenosis
holosystolic murmur
VSD, tricuspid regurgitation, mitral regurgitation
what complication of RA can sometimes imitate a DVT
a ruptured Baker's cyst in the popliteal fossa
what happens to plasma Calcium levels with changes in pH?
increasing pH causes increased affinity for Ca by albumin, thus reducing the free Ca and causing an
effective hypocalcemia
when the kidneys retain HCO3 they will sacrifice which other electrolyte?
Chloride
what types of masses will be found in the three mediastinal compartments (anterior, middle, posterior)
anterior: thymus, thyroid
middle: bronchial, tracheal, lymphatics, aortic arch
posterior: spinal, esophageal, aortic root, hernias, lymphatics
tacrolimus toxicity
NEPHROTOXICITY
hyperkalemia
hypertension
tremor
cyclosporine toxicity
NEPHROTOXICITY
hyperkalemia
hypertension
tremor
HIRSUTISM
GUM HYPERTROPHY
azathioprene toxicity
Dose related diarrhea
liver toxicity
leukopenia
mycophenolate toxicity
bone Marrow toxicity
what are the risk factors that would make an endometrial biopsy necessary in the face of heavy
menses/intramenstural bleeding
>35 years old
--obese
--HTN
--DM
extrahepatic complications of Hep C (8)
1) membranoproliferative glomerulonephritis
2) cryoglobulinemia
3) B-Cell lymphomas
4) autoimmune disease
5) lichen planus
6) porphyria cutanea tarda
7) ITP
8) plasmacytomas
what do you do if you suspect that a kid has minimal change disease?
start them on empiric steroids.
do not start with biopsy in nephrotic syndrome in kids
what are the indications for renal biopsy in kids?
>8 years old at onset
--resistant to steroids
--present at birth
--significant hematuria
--frequent relapses
renal biopsy contraindications
Absolute:
--bleeding disorders
--single kidney
--uncontrolled hypertension.
Relative contraindications:
--suspected renal infection
--hydronephrosis
--possible vascular lesions.
what happens to the ABG in atelectasis, PE, pleural effusion, pulmonary edema?
PCO2 is low from hyperventilation
PO2 is low from inadequate oxygenation
what needs to be checked before starting someone on Lithium?

creatinine and TFTs (can cause hypothyroidism)
hepatic adenoma should be associated with (and the dreaded complications are):
young women on OCPs with solitary mass in Right Lobe of liver
complications: intra-tumor hemorrhage, malignant transformation
Pulseless electrical activity should be treated with:
chest compressions and epinepherine. NOT cardioversion
what lab findings are indications for ordering TFTs?
Hyperlipidemia
Hyponatremia
elevated CK
anemia
what is the etiology of most ASCENDING aortic aneurism vs. DESCENDING aortic aneuris ms?
Ascending: cystic medial fibrosis (Marfan or connective tissue disease of aging)
Descending: athrosclerosis
what is the treatment for a prolactinoma
medical management first with bromocriptine or cabergoline
surgery for cases that are refractory to medical treatment
a fixed, solid breast mass with calcifications. needle biopsy shows foamy macrophages with fat globules
fat necrosis of the breast. Not cancer
fever and sore throat in patient on antithyroid drugs suggests:
agranulocytosis
--stop offending agent and start IV broad spectrum antibiotics.
how do you calculate the corrected Ca? what are the normal values that pertain to this?
Corrected Ca= 0.8(4-serum albumin)+serum Ca
normal value for albumin is 4
normal value for Ca is 8.4 to 10.2
acute heart failure treatment
"LMNOP" Lasix, Morphine, Nitrates, Oxygen, Positioning and pressors
NOT BETA BLOCKERS IN ACUTE EXACERBATION
when do you anticoagulate someone for afib? when do you do a Heparin bridge?
CHADS2 score >2: anticoagulate
If hx of prior stroke, Heparin bridge
absolute indications for dialysis: (4)
1) fluid overload unresponsive to medication
2) hyperkalemia unresponsive to medication
3) uremic pericarditis
4) refractory metabolic acidosis
relative indications for dialysis: (3)

1) GFR <10
2) Cr >8
3) severe uremic sxs
contraindications for dialysis: (2)
1) debilitating chronic disease
2) severe irreversible dementia
what are the indications for surgical correction of a pediatric umbillical hernia? (4)
1) persists past the age of 3-4
2) >2cm
3) becomes strangulated
4) progressively enlarges
fingernail clubbing in COPD patient suggests:
malignancy (COPD is not usually a/w clubbing)
elevated JVP, peripheral edema and hyperinflated lungs without infiltrates in a COPD patient suggests:
cor pulmonale (pulmonary htn)
lithium toxicity presents with:
ataxia
tremor
seizures
hyperreflexia
nephrotic syndrome common causes/epidemiology
Children: minimal change disease
AA adults/HIV/heroin/obesity: FSGS
post viral: IgA
Hep C: membranoproliferative
when evaluating a woman with hirsutism, DHEAS levels and testosterone levels are significant in this
way:
DHEAS: specific for ADRENAL androgen producing tumors
Testosterone: produced by both ADRENAL and OVARIAN tumors
Thus:
--low DHEAS + high testosterone = ovarian tumor
--high DHEAS +/- normal testosterone = adrenal tumor
MEN 2a/2b both have pheochromocytoma and medullary thyroid CA (calcitonin), how do they differ?
2a: primary parathyroidism (not a tumor)
2b: mucosal neuromas and marfanoid habitus. Mucosal neuromas are present on the tongue, lips,
eyelids, GI tract
other than polycystic ovaries on ultrasound, how does PCOS present?
1) hirsutism or signs of testosterone excess
2) amenorrhea or oligomenorrhea
3) obesity, in 50% of patients
4) infertility
5) glucose intolerance
what is the most common cause of nephrotic syndrome in adults?
membranous glomerulonephritis
a chi square test compares what types of data?
compares proportions
a "two sample" test compares what types of data?
compares two MEANS. Only the two sample T test is useful. It is used to calculate the P value of a study
ANOVA test compares what types of data
THREE or more variables
rheumatic fever major signs and symptoms:
"no Rheum for SPECCulation"
Subqutaneous nodules
Polyarthrits
Erythema marginatum
Chorea
Carditis
proximal muscle weakness and lupus like rash on face or possibly overlying knuckles
dermatomyositis
increased risk for cancer
anti-Mi-2 antibodies against helicase
rapidly progressive skin lesions that develops into non-tender nodules with central necrosis in an
immunocompromised patient with a fever suggests infection with:
pseudomonas
(this is ecthyma gangreneosum)
CSF findings in HSV encephalitis
lymphocytic, increased protein, lots of RBCs, normal glucose
exudates from tuberculosis are characterized by:
high LYMPHOCYTE count
high protein
slightly low glucose
SLE manifestations
"I'M DAMN SHARP" for figuring out that this person has SLE
--immunoglobulins: anti-dsDNA, anti-Smith
--malar rash
--discoid rash
--ANA
--mucous membranes (oral ulcers)
--neurological (seizures, psychosis)
--serositis (pleuritis, pericarditis)
--hematological (anemia, cytopenias)
--arthritis
--renal (membranous)
--photosensitivity (sunburns)
mallory weiss vs boerhave's tear
mallory weiss is partial thickness
boerhave's is full thickness
how is calcium regulated?
PTH increases the number and activity of osteoclasts. The result is elevated bone resportion which
releases ionic calcium (Ca2+) and phosphates into the blood. PTH also acts on the kidneys. First, it slows
the rate at which Ca2+ and Mg2+ are lost from blood into the urine. 2nd it increases loss of HPO4 from
blood into the urine. B/c more HpO4 is lost in the urine than is gained from the bones, PTH decreases
blood HPO4 level and increases blood Ca2+ and Mg2+ levels. Third effect of PTH on the kidneys is to
promote formation fo the hormone cacitrol, the active form of vitamin D. Calcitrol increases the rate of
Ca2+, HPO4, and Mg2+ absorption from the gastrointestinal tract into the blood
what happens to blood pH in septic shock?
increased anaerobic metabolism causes lactic acidosis
young healthy patient who presents with heart failure, arrythmias or chest pain following a URI should be
suspected of having:
myocarditis... most likely Coxsackie
how is infertility in PCOS treated?
weight loss.... then clomiphene and metformin
exudative pleural effusion w/o signs of infection
think cancer (breast or lung cancer)
pruritus plus thick white discharge, pH of 4.0
vaginal candidiasis
how do you remember normal heart chamber pressures?
nickle, dime, quarter, dollar
RA: 5
LA: 10
RV: 25
LV: 100
roughly....
testicular pain that improves with elevating the testicles
epididymitis
testicular pain that does not improve with elevating the testicles and with an absent cremasteric reflex
testicular torsion
how do the EKG findings of hyperkalemia progress?
1) peaked T waves
2) flattening of P waves
3) PR prolongation
4) widened QRS with "sine wave" pattern

6) cardiac arrest
what is lid lag and what is it associated with?
lid lag=visible sclera on downward gaze
associated with hyperthyroidism (but different from proptosis)
cataracts vs. open angle vs. closed angle glaucoma
cataracts: vision problems at night, glare
open angle: loss of peripheral vision then central vision
closed angle: painful
steroids should be given in preterm labor if the fetus is:
24-34 weeks
QT prolongation on EKG, what do you do?
give Mag Sulfate to avoid torsades de pointes
pulsus paradoxus
decrease in systolic BP of more than 10mmHg with normal inspiration; palpated as weakened pulse with
inspiration.
--cardiac tamponade
CHADS2 score
C-CHF
H-HTN
A- Age >75
D-Diabetes
S- prior stroke/TIA
RAPID REVIEW
Classic ECG finding in atrial flutter. "Sawtooth" P waves
Definition of unstable angina. Angina is new, is worsening, or occurs at rest
Antihypertensive for a diabetic patient with proteinuria. ACEI
Beck's triad for cardiac tamponade. Hypotension, distant heart sounds, and JVD
Drugs that slow AV node transmission. -blockers, digoxin, calcium channel blockers
Hypercholesterolemia treatment that flushing and pruritus. Niacin
Treatment for atrial fibrillation. Anticoagulation, rate control, cardioversion
Treatment for ventricular fibrillation. Immediate cardioversion
Autoimmune complication occurring 2-4 weeks post-MI. Dressler's syndrome: fever, pericarditis, ESR
IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment? Treat existing heart
failure and replace the tricuspid valve
Diagnostic test for hypertrophic cardiomyopathy. Echocardiogram (showing thickened left ventricular wall
and outflow obstruction)
A fall in systolic BP of > 10 mmHg with inspiration. Pulsus paradoxus (seen in cardiac tamponade)
Classic ECG findings in pericarditis. Low-voltage, diffuse ST-segment elevation
Definition of hypertension. BP > 140/90 on three separate occasions two weeks apart
Eight surgically correctable causes of hypertension. Renal artery stenosis, coarctation of the aorta,
pheochromocytoma, Conn's syndrome, Cushing's syndrome, unilateral renal parenchymal disease,
hyperthyroidism, hyperparathyroidism
Evaluation of a pulsatile abdominal mass and bruit. Abdominal ultrasound and CT
Indications for surgical repair of abdominal aortic aneurysm. > 5.5 cm, rapidly enlarging, symptomatic, or
ruptured
Treatment for acute coronary syndrome. Morphine, O2, sublingual nitroglycerin, ASA, IV -blockers,
heparin
What is the metabolic syndrome? Abdominal obesity, high triglycerides, low HDL, hypertension, insulin
resistance, prothrombotic or proinflammatory states
Appropriate diagnostic test? A 50-year-old male with angina can exercise to 85% of maximum predicted
heart rate. Exercise stress treadmill with ECG
Appropriate diagnostic test? A 65-year-old woman with left bundle branch block and severe
osteoarthritis has unstable angina. Pharmacologic stress test (e.g., dobutamine echo)
Signs of active ischemia during stress testing. Angina, ST-segment changes on ECG, or BP
ECG findings suggesting MI. ST-segment elevation (depression means ischemia), flattened T waves, and
Q waves
A young patient has angina at rest with ST-segment elevation. Cardiac enzymes are normal. Prinzmetal's
angina
Common symptoms associated with silent MIs. CHF, shock, and altered mental status
The diagnostic test for pulmonary embolism. V/Q scan
An agent that reverses the effects of heparin. Protamine
The coagulation parameter affected by warfarin. PT
A young patient with a family history of sudden death collapses and dies while exercising. Hypertrophic
cardiomyopathy
Endocarditis prophylaxis regimens. Oral surgeryamoxicillin; GI or GU proceduresampicillin and
gentamicin before and amoxicillin after
The 6 P's of ischemia due to peripheral vascular disease. Pain, pallor, pulselessness, paralysis,
paresthesia, poikilothermia
Virchow's triad. Stasis, hypercoagulability, endothelial damage
The most common cause of hypertension in young women. OCPs
The most common cause of hypertension in young men. Excessive EtOH
"Stuck-on" appearance. Seborrheic keratosis
Red plaques with silvery-white scales and sharp margins. Psoriasis
The most common type of skin cancer; the lesion is a pearly -colored papule with a translucent surface
and telangiectasias. Basal cell carcinoma
Honey-crusted lesions. Impetigo
A febrile patient with a history of diabetes presents with a red, swollen, painful lower extremity. Cellulitis
+ Nikolsky's sign. Pemphigus vulgaris
- Nikolsky's sign. Bullous pemphigoid
A 55-year-old obese patient presents with dirty, velvety patches on the back of the neck. Acanthosis
nigricans. Check fasting blood sugar to rule out diabetes
Dermatomal distribution. Varicella zoster
Flat-topped papules. Lichen planus
Iris-like target lesions. Erythema multiforme
A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with
clothing or jewelry. Contact dermatitis
Presents with a herald patch, Christmas-tree pattern. Pityriasis rosea
A 16-year-old presents with an annular patch of alopecia with broken-off, stubby hairs. Alopecia areata
(autoimmune process)
Pinkish, scaling, flat lesions on the chest and back. KOH prep has a "spaghetti-and-meatballs"
appearance. Pityriasis versicolor
Four characteristics of a nevus suggestive of melanoma. Asymmetry, border irregularity, color variation,
large diameter
Premalignant lesion from sun exposure that can squamous cell carcinoma. Actinic keratosis
"Dewdrop on a rose petal." Lesions of 1 varicella
"Cradle cap." Seborrheic dermatitis. Treat with antifungals
Associated with Propionibacterium acnes and changes in androgen levels. Acne vulgaris
A painful, recurrent vesicular eruption of mucocutaneous surfaces. Herpes simplex
Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women.
Lichen sclerosus
Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common
type of skin cancer. Squamous cell carcinoma
The most common cause of hypothyroidism. Hashimoto's thyroiditis
Lab findings in Hashimoto's thyroiditis. High TSH, low T4, antimicrosomal antibodies
Exophthalmos, pretibial myxedema, and TSH. Graves' disease
The most common cause of Cushing's syndrome. Iatrogenic steroid administration. The second most
common cause is Cushing's disease
A patient presents with signs of hypocalcemia, high phosphorus, and low PTH. Hypoparathyroidism
"Stones, bones, groans, psychiatric overtones." Signs and symptoms of hypercalcemia
A patient complains of headache, weakness, and polyuria; exam reveals hypertension and tetany. Labs
reveals hypernatremia, hypokalemia, and metabolic alkalosis. 1 hyperaldosteronism (due to Conn's
syndrome or bilateral adrenal hyperplasia)
A patient presents with tachycardia, wild swings in BP, headache, diaphoresis, altered mental status, and
a sense of panic. Pheochromocytoma
Should - or -antagonists be used first in treating pheochromocytoma? -antagonists (phentolamine and
phenoxybenzamine)
A patient with a history of lithium use presents with copious amounts of dilute urine. Nephrogenic
diabetes insipidus (DI)
Treatment of central DI. Administration of DDAVP serum osmolality and free water restriction
A postoperative patient with significant pain presents with hyponatremia and normal volume status.
SIADH due to stress
An antidiabetic agent associated with lactic acidosis. Metformin
A patient presents with weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show
hyponatremia and hyperkalemia. Treatment? 1 adrenal insufficiency (Addison's disease). Treat with
replacement glucocorticoids, mineralocorticoids, and IV fluids
Goal hemoglobin A1c for a patient with DM. < 7.0
Treatment of DKA. Fluids, insulin, and aggressive replacement of electrolytes (e.g., K+)
Why are -blockers contraindicated in diabetics? They can mask symptoms of hypoglycemia
Bias introduced into a study when a clinician is aware of the patient's treatment type. Observational bias
Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to
death. Lead-time bias
If you want to know if race affects infant mortality rate but most of the variation in infant mortality is
predicted by socioeconomic status, then socioeconomic status is a _____. Confounding variable
The number of true positives divided by the number of patients with the disease is _____. Sensitivity
Sensitive tests have few false negatives and are used to rule _____ a disease. Out
PPD reactivity is used as a screening test because most people with TB (except those who are anergic)
will have a +PPD. Highly sensitive or specific? Highly sensitive for TB
Chronic diseases such as SLEhigher prevalence or incidence? Higher prevalence
Epidemics such as influenzahigher prevalence or incidence? Higher incidence
Cross-sectional surveyincidence or prevalence? Prevalence
Cohort studyincidence or prevalence? Incidence and prevalence
Case-control studyincidence or prevalence? Neither
Describe a test that consistently gives identical results, but the res ults are wrong. High reliability, low
validity
Difference between a cohort and a case-control study. Cohort studies can be used to calculate relative
risk (RR), incidence, and/or odds ratio (OR). Case-control studies can be used to calculate an OR
Attributable risk? The incidence rate (IR) of a disease in exposed the IR of a disease in unexposed
Relative risk? The IR of a disease in a population exposed to a particular factor the IR of those not
exposed
Odds ratio? The likelihood of a disease among individuals exposed to a risk factor compared to those
who have not been exposed
Number needed to treat? 1 (rate in untreated group rate in treated group)
In which patients do you initiate colorectal cancer screening early? Patients with IBD; those with familial
adenomatous polyposis (FAP)/hereditary nonpolyposis colorectal cancer (HNPCC); and those who have
first-degree relatives with adenomatous polyps (< 60 years of age) or colorectal cancer
The most common cancer in men and the most common cause of deat h from cancer in men. Prostate
cancer is the most common cancer in men, but lung cancer causes more deaths
The percentage of cases within one SD of the mean? Two SDs? Three SDs? 68%, 95.5%, 99.7%
Birth rate? Number of live births per 1000 population
Fertility rate? Number of live births per 1000 women 15-44 years of age
Mortality rate? Number of deaths per 1000 population
Neonatal mortality? Number of deaths from birth to 28 days per 1000 live births
Postnatal mortality? Number of deaths from 28 days to one year per 1000 live births
Infant mortality? Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal
mortality)
Fetal mortality? Number of deaths from 20 weeks' gestation to birth per 1000 total births
Perinatal mortality? Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Maternal mortality? Number of deaths during pregnancy to 90 days postpartum per 100,000 live births
True or false: Once patients sign a statement giving consent, they mus t continue treatment. False.
Patients may change their minds at any time. Exceptions to the requirement of informed consent include
emergency situations and patients without decision-making capacity
A 15-year-old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
No. Parental consent is not necessary for the medical treatment of pregnant minors
A doctor refers a patient for an MRI at a facility he/she owns. Conflict of interest
Involuntary psychiatric hospitalization can be undertaken for which three reasons? The patient is a
danger to self, a danger to others, or gravely disabled (unable to provide for basic needs)
True or false: Withdrawing life-sustaining care is ethically distinct from withholding sustaining care. False.
Withdrawing and withholding life are the same from an ethical standpoint
When can a physician refuse to continue treating a patient on the grounds of futility? When there is no
rationale for treatment, maximal intervention is failing, a given intervention has already failed, and
treatment will not achieve the goals of care
An eight-year-old child is in a serious accident. She requires emergent transfusion, but her parents are
not present. Treat immediately. Consent is implied in emergency situations
Conditions in which confidentiality must be overridden. Real threat of harm to third parties; suicidal
intentions; certain contagious diseases; elder and child abuse
Involuntary commitment or isolation for medical treatment may be undertaken for what reason? When
treatment noncompliance represents a serious danger to public health (e.g., active TB)
A 10-year-old child presents in status epilepticus, but her parents refuse treatment on religious grounds.
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
A son asks that his mother not be told about her recently discovered cancer. A patient's family cannot
require that a doctor withhold information from the patient
Patient presents with sudden onset of severe, diffuse abdominal pain. Exam reveals peritoneal signs and
AXR reveals free air under the diaphragm. Management? Emergent laparotomy to repair perforated
viscus, likely stomach
The most likely cause of acute lower GI bleed in patients > 40 years old. Diverticulosis
Diagnostic modality used when ultrasound is equivocal for cholecystitis. HIDA scan
Sentinel loop on AXR. Acute pancreatitis
Risk factors for cholelithiasis. Fat, female, fertile, forty, flatulent
Inspiratory arrest during palpation of the RUQ. Murphy's sign, seen in acute cholecystitis
Identify key organisms causing diarrhea: Most common organism Campylobacter
Identify key organisms causing diarrhea: Recent antibiotic use Clostridium difficile
Identify key organisms causing diarrhea: Camping Giardia
Identify key organisms causing diarrhea: Traveler's diarrhea ETEC
Identify key organisms causing diarrhea: Church picnics/mayonnaise S. aureus
Identify key organisms causing diarrhea: Uncooked hamburgers E. coli O157:H7
Identify key organisms causing diarrhea: Fried rice Bacillus cereus
Identify key organisms causing diarrhea: Poultry/eggs Salmonella
Identify key organisms causing diarrhea: Raw seafood Vibrio, HAV
Identify key organisms causing diarrhea: AIDS Isospora, Cryptosporidium, Mycobacterium avium
complex (MAC)
Identify key organisms causing diarrhea: Pseudoappendicitis Yersinia
A 25-year-old Jewish male presents with pain and watery diarrhea after meals. Exam shows fistulas
between the bowel and skin and nodular lesions on his tibias. Crohn's disease
Inflammatory disease of the colon with risk of colon cancer. Ulcerative colitis
Extraintestinal manifestations of IBD. Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema
nodosum, 1 sclerosing cholangitis
Medical treatment for IBD. 5-aminosalicylic acid +/ sulfasalazine and steroids during acute
exacerbations
Difference between Mallory-Weiss and Boerhaave tears. Mallory-Weisssuperficial tear in the

esophageal mucosa Boerhaavefull-t hickness esophageal rupture
Charcot's triad. RUQ pain, jaundice, and fever/chills in the setting of ascending cholangitis
Reynolds' pentad. Charcot's triad plus shock and mental status changes, with suppurative ascending
cholangitis
Medical treatment for hepatic encephalopathy. protein intake, lactulose, neomycin
First step in the management of a patient with acute GI bleed. Establish the ABCs
A four-year-old child presents with oliguria, petechiae, and jaundice following an illness with bloody
diarrhea. Most likely diagnosis and cause? Hemolytic -uremic syndrome (HUS) due to E. coli O157:H7
Post-HBV exposure treatment. HBV immunoglobulin
Classic causes of drug-induced hepatitis. TB medications (INH, rifampin, pyrazinamide), acetaminophen,
and tetracycline
A 40-year-old obese female with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine,
and clay-colored stools. Biliary tract obstruction
Hernia with highest risk of incarcerationindirect, direct, or femoral? Femoral hernia
A 50-year-old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the
back and is relieved by sitting forward. Management? Confirm the diagnosis of acute pancreatitis with
elevated amylase and lipase. Make patient NPO and give IV fluids, O2, analgesia, and "tincture of time"
Four causes of microcytic anemia. TICSThalassemia, Iron deficiency, anemia of Chronic disease, and
Sideroblastic anemia
An elderly male with hypochromic, microcytic anemia is asymptomatic. Diagnostic tests? Fecal occult
blood test and sigmoidoscopy; suspect colorectal cancer
Precipitants of hemolytic crisis in patients with G6PD deficiency. Sulfonamides, antimalarial drugs, fava
beans
The most common inherited cause of hypercoagulability. Factor V Leiden mutation
The most common inherited hemolytic anemia. Hereditary spherocytosis
Diagnostic test for hereditary spherocytosis. Osmotic fragility test
Pure RBC aplasia. Diamond-Blackfan anemia
Anemia associated with absent radii and thumbs, diffuse hyperpigmentation, caf-au-lait spots,
microcephaly, and pancytopenia. Fanconi's anemia
Medications and viruses that aplastic anemia. Chloramphenicol, sulfonamides, radiation, HIV,
chemotherapeutic agents, hepatitis, parvovirus B19, EBV
How to distinguish polycythemia vera from 2 polycythemia. Both have hematocrit and RBC mass, but
polycythemia vera should have normal O2 saturation and low erythropoietin levels
Thrombotic thrombocytopenic purpura (TTP) pentad? Pentad of TTP"FAT RN": Fever, Anemia,
Thrombocytopenia, Renal dysfunction, Neurologic abnormalities
HUS triad? Anemia, thrombocytopenia, and acute renal failure
Treatment for TTP. Emergent large-volume plasmapheresis, corticosteroids, antiplatelet drugs

Treatment for idiopathic thrombocytopenic purpura (ITP) in children. Usually resolves spontaneously; may
require IVIG and/or corticosteroids
Which of the following are in DIC: fibrin split products, D-dimer, fibrinogen, platelets, and hematocrit.
Fibrin split products and D-dimer are elevated; platelets, fibrinogen, and hematocrit are .
An eight-year-old boy presents with hemarthrosis and PTT with normal PT and bleeding time.
Diagnosis? Treatment? Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX
supplements
A 14-year-old girl presents with prolonged bleeding after dental surgery and with menses, normal PT,
normal or PTT, and bleeding time. Diagnosis? Treatment? von Willebrand's disease; treat with
desmopressin, FFP, or cryoprecipitate
A 60-year-old African-American male presents with bone pain. Workup for multiple myeloma might
reveal? Monoclonal gammopathy, Bence Jones proteinuria, "punched-out" lesions on x-ray of the skull
and long bones
Reed-Sternberg cells Hodgkin's lymphoma
A 10-year-old boy presents with fever, weight loss, and night sweats. Examination shows anterior
mediastinal mass. Suspected diagnosis? Non-Hodgkin's lymphoma
Microcytic anemia with serum iron, total iron-binding capacity (TIBC), and normal or ferritin. Anemia
of chronic disease
Microcytic anemia with serum iron, ferritin, and TIBC. Iron deficiency anemia
An 80-year-old man presents with fatigue, lymphadenopathy, splenomegaly, and isolated lymphocytosis.
Suspected diagnosis? Chronic lymphocytic leukemia (CLL)
A late, life-threatening complication of chronic myelogenous leukemia (CML). Blast crisis (fever, bone
pain, splenomegaly, pancytopenia)
Auer rods on blood smear. Acute myelogenous leukemia (AML)
AML subtype associated with DIC. M3
Electrolyte changes in tumor lysis syndrome. Ca2+ , K , phosphate, uric acid
Treatment for AML M3. Retinoic acid
A 50-year-old male presents with early satiety, splenomegaly, and bleeding. Cytogenetics show t(9,22).
Diagnosis? CML
Heinz bodies? Intracellular inclusions seen in thalassemia, G6PD deficiency, and postsplenectomy
An autosomal-recessive disorder with a defect in the GPIIbIIIa platelet receptor and platelet
aggregation. Glanzmann's thrombasthenia
Virus associated with aplastic anemia in patients with sickle cell anemia. Parvovirus B19
A 25-year-old African-American male with sickle cell anemia has sudden onset of bone pain.
Management of pain crisis? O2, analgesia, hydration, and, if severe, transfusion
A significant cause of morbidity in thalassemia patients. Treatment? Iron overload; use deferoxamine
The three most common causes of fever of unknown origin (FUO). Infection, cancer, and autoimmune
disease
Four signs and symptoms of streptococcal pharyngitis. Fever, pharyngeal erythema, t onsillar exudate,
lack of cough
A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1 infection.
Postinfectious glomerulonephritis
Asplenic patients are particularly susceptible to these organisms. Encapsulated organisms-pneumococcus, meningococcus, Haemophilus influenzae, Klebsiella
The number of bacterial culture on a clean-catch specimen to diagnose a UTI. 105 bacteria/mL
Which healthy population is susceptible to UTIs? Pregnant women. Treat this group aggressively
because of potential complications
A patient from California or Arizona presents with fever, malaise, cough, and night sweats. Diagnosis?
Treatment? Coccidioidomycosis. Amphotericin B
Nonpainful chancre. 1 syphilis
A "blueberry muffin" rash is characteristic of what congenital infection? Rubella
Meningitis in neonates. Causes? Treatment? Group B strep, E. coli, Listeria. Treat with gentamicin and
ampicillin
Meningitis in infants. Causes? Treatment? Pneumococcus, meningococcus, H. influenzae. Treat with
cefotaxime and vancomycin
What should always be done prior to LP? Check for ICP; look for papilledema
CSF findings: Low glucose, PMN predominance Bacterial meningitis
CSF findings: Normal glucose, lymphocytic predominance Aseptic (viral) meningitis
CSF findings: Numerous RBCs in serial CSF samples Subarachnoid hemorrhage (SAH)
CSF findings: gamma globulins MS
Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar
after 7-10 days. Treatment? Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Findings in 3 syphilis. Tabes dorsalis, general paresis, gummas, Argyll Robertson pupil, aortitis, aortic
root aneurysms
Characteristics of 2 Lyme disease. Arthralgias, migratory polyarthropathies, B ell's palsy, myocarditis
Cold agglutinins. Mycoplasma
A 24-year-old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis?
Workup? Treatment? Candidal thrush. Workup should include an HIV test. Treat with nystatin oral
suspension
Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV -positive patient at what CD4 count?
Mycobacterium avium-intracellulare (MAI) prophylaxis? 200 for PCP (with TMP); 50-100 for MAI (with
clarithromycin/azithromycin)
Risk factors for pyelonephritis. Pregnancy, vesicoureteral reflux, anatomic anomalies, indwelling
catheters, kidney stones
Neutropenic nadir postchemotherapy. 7-10 days
Erythema migrans. Lesion of 1 Lyme disease
Classic physical findings for endocarditis. Fever, heart murmur, Osler's nodes, splinter hemorrhages,
Janeway lesions, Roth's spots
Aplastic crisis in sickle cell disease. Parvovirus B19
Ring-enhancing brain lesion on CT with seizures Taenia solium (cysticercosis)
Name the organism: Branching rods in oral infection. Actinomyces israelii
Name the organism: Painful chancroid. Haemophilus ducreyi
Name the organism: Dog or cat bite. Pasteurella multocida
Name the organism: Gardener. Sporothrix schenckii
Name the organism: Pregnant women with pets. Toxoplasma gondii
Name the organism: Meningitis in adults. Neisseria meningitidis
Name the organism: Meningitis in elderly. Streptococcus pneumoniae
Name the organism: Alcoholic with pneumonia. Klebsiella
Name the organism: "Currant jelly" sputum. Klebsiella
Name the organism: Infection in burn victims. Pseudomonas
Name the organism: Osteomyelitis from foot wound puncture. Pseudomonas
Name the organism: Osteomyelitis in a sickle cell patient. Salmonella
A 55-year-old man who is a smoker and a heavy drinker presents with a new cough and flulike
symptoms. Gram stain shows no organisms; silver stain of sputum shows gram -negative rods. What is
the diagnosis? Legionella pneumonia
A middle-aged man presents with acute-onset monoarticular joint pain and bilateral Bell's palsy. What is
the likely diagnosis, and how did he get it? Treatment? Lyme disease, Ixodes tick, doxycycline
A patient develops endocarditis three weeks after receiving a prosthetic heart valve. W hat organism is
suspected? S. aureus or S. epidermidis.
A patient presents with pain on passive movement, pallor, poikilothermia, paresthesias, paralysis, and
pulselessness. Treatment? All-compartment fasciotomy for suspected compartment syndrome
Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the
hips. Spinal stenosis
Joints in the hand affected in rheumatoid arthritis. MCP and PIP joints; DIP joints are spared
Joint pain and stiffness that worsen over the course of the day and are relieved by rest. Osteoarthritis
Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Osteogenesis imperfecta
Hip and back pain along with stiffness that improves with activity over the course of the day and worsens
at rest. Diagnostic test? Suspect ankylosing spondylitis. Check HLA -B27
Arthritis, conjunctivitis, and urethritis in young men. Associated organisms? Reactive (Reiter's) arthritis.
Associated with Campylobacter, Shigella, Salmonella, Chlamydia, and Ureaplasma
A 55-year-old man has sudden, excruciating first MTP joint pain after a night of drinking red wine.
Diagnosis, workup, and chronic treatment? Gout. Needle-shaped, negatively birefringent crystals are
seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Rhomboid-shaped, positively birefringent crystals on joint fluid aspirate. Pseudogout
An elderly female presents with pain and stiffness of the shoulders and hips; she cannot lift her arms
above her head. Labs show anemia and ESR. Polymyalgia rheumatica
An active 13-year-old boy has anterior knee pain. Diagnosis? Osgood-Schlatter disease
Bone is fractured in fall on outstretched hand. Distal radius (Colles' fracture)
Complication of scaphoid fracture. Avascular necrosis
Signs suggesting radial nerve damage with humeral fracture. Wrist drop, loss of thumb abduction
A young child presents with proximal muscle weakness, waddling gait, and pronounced calf muscles.
Duchenne muscular dystrophy
A first-born female who was born in breech position is found to have asymmetric skin folds on her
newborn exam. Diagnosis? Treatment? Developmental dysplasia of the hip. If severe, consider a Pavlik
harness to maintain abduction
An 11-year-old obese, African-American boy presents with sudden onset of limp. Diagnosis? Workup?
Slipped capital femoral epiphyses. AP and frog-leg lateral view
The most common 1 malignant tumor of bone. Multiple myeloma
Unilateral, severe periorbital headache with tearing and conjunctival erythema. Cluster headache
Prophylactic treatment for migraine. -blockers, Ca2+ channel blockers, TCAs
The most common pituitary tumor. Treatment? Prolactinoma. Dopamine agonists (e.g., bromocriptine)
A 55-year-old patient presents with acute "broken speech." What type of aphasia? What lobe and
vascular distribution? Broca's aphasia. Frontal lobe, left MCA distribution
The most common cause of SAH. Trauma; the second most common is berry aneurysm
A crescent-shaped hyperdensity on CT that does not cross the midline. Subdural hematomabridging
veins torn
A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most
likely etiology? Treatment? Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
CSF findings with SAH. Elevated ICP, RBCs, xanthochromia
Albuminocytologic dissociation. Guillain-Barr ( protein in CSF with only a modest in cell count)
Cold water is flushed into a patient's ear, and the fast phase of the nystagmus is toward the opposite side.
Normal or pathological? Normal
The most common 1 sources of metastases to the brain. Lung, breast, skin (melanoma), kidney, GI tract
May be seen in children who are accused of inattention in class and confused with ADHD. Absence
seizures
The most frequent presentation of intracranial neoplasm. Headache
The most common cause of seizures in children (2-10 years). Infection, febrile seizures, trauma,
idiopathic
The most common cause of seizures in young adults (18-35 years). Trauma, alcohol withdrawal, brain
tumor
First-line medication for status epilepticus. IV benzodiazepine
Confusion, confabulation, ophthalmoplegia, ataxia. Wernicke's encephalopathy due to a deficiency of
thiamine
What % lesion is an indication for carotid endarterectomy? Seventy percent if the stenosis is sy mptomatic
The most common causes of dementia. Alzheimer's and multi-infarct
Combined UMN and LMN disorder. ALS
Rigidity and stiffness with resting tremor and masked facies. Parkinson's disease
The mainstay of Parkinson's therapy. Levodopa/carbidopa
Treatment for Guillain-Barr syndrome. IVIG or plasmapheresis
Rigidity and stiffness that progress to choreiform movements, accompanied by moodiness and altered
behavior. Huntington's disease
A six-year-old girl presents with a port-wine stain in the V2 distribution as well as with mental retardation,
seizures, and leptomeningeal angioma. Sturge-Weber syndrome. Treat symptomatically. Possible focal
cerebral resection of affected lobe
Caf-au-lait spots on skin. Neurofibromatosis 1
Hyperphagia, hypersexuality, hyperorality, and hyperdocility. Klver-Bucy syndrome (amygdala)
Administer to a symptomatic patient to diagnose myasthenia gravis. Edrophonium
1 causes of third-trimester bleeding. Placental abruption and placenta previa
Classic ultrasound and gross appearance of complete hydatidiform mole. Snowstorm on ultrasound.
"Cluster-of-grapes" appearance on gross examination
Chromosomal pattern of a complete mole. 46,XX
Molar pregnancy containing fetal tissue. Partial mole
Symptoms of placental abruption. Continuous, painful vaginal bleeding
Symptoms of placenta previa. Self-limited, painless vaginal bleeding
When should a vaginal exam be performed with suspected placenta previa? Never
Antibiotics with teratogenic effects. Tetracycline, fluoroquinolones, aminoglycosides, sulfonamides
Shortest AP diameter of the pelvis. Obstetric conjugate: between the sacral promontory and the midpoint
of the symphysis pubis
Medication given to accelerate fetal lung maturity. Betamethasone or dexamethasone 48 hours
The most common cause of postpartum hemorrhage. Uterine atony

Treatment for postpartum hemorrhage. Uterine massage; if that fails, give oxytocin
Typical antibiotics for group B streptococcus (GBS) prophylaxis. IV penicillin or ampicillin
A patient fails to lactate after an emergency C-section with marked blood loss. Sheehan's syndrome
(postpartum pituitary necrosis)
Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
Inevitable abortion
Uterine bleeding at 18 weeks' gestation; no products expelled; cervical os closed. Threatened abortion
The first test to perform when a woman presents with amenorrhea. -hCG; the most common cause of
amenorrhea is pregnancy
Term for heavy bleeding during and between menstrual periods. Menometrorrhagia
Cause of amenorrhea with normal prolactin, no response to estrogen-progesterone challenge, and a
history of D&C. Asherman's syndrome
Therapy for polycystic ovarian syndrome. Weight loss and OCPs
Medication used to induce ovulation. Clomiphene citrate
Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding. Endometrial
biopsy
Indications for medical treatment of ectopic pregnancy. Stable, unruptured ectopic pregnancy of < 3.5
cm at < 6 weeks' gestation
Medical options for endometriosis. OCPs, danazol, GnRH agonists
Laparoscopic findings in endometriosis. "Chocolate cysts," powder burns
The most common location for an ectopic pregnancy. Ampulla of the oviduct
How to diagnose and follow a leiomyoma. Ultrasound
Natural history of a leiomyoma. Regresses after menopause
A patient has vaginal discharge and petechial patches in the upper vagina and cervix. Trichomonas
vaginitis
Treatment for bacterial vaginosis. Oral or topical metronidazole
The most common cause of bloody nipple discharge. Intraductal papilloma
Contraceptive methods that protect against PID. OCP and barrier contraception
Unopposed estrogen is contraindicated in which cancers? Endometrial or estrogen receptorcancer
breast
A patient presents with recent PID with RUQ pain. Consider Fitz -Hugh-Curtis syndrome
Breast malignancy presenting as itching, burning, and erosion of the nipple. Paget's disease
Annual screening for women with a strong family history of ovarian cancer. CA -125 and transvaginal
ultrasound
A 50-year-old woman leaks urine when laughing or coughing. Nonsurgical options? Kegel exercises,
estrogen, pessaries for stress incontinence
A 30-year-old woman has unpredictable urine loss. Examination is normal. Medical options?
Anticholinergics (oxybutynin) or -adrenergics (metaproterenol) for urge incontinence.
Lab values suggestive of menopause. serum FSH
The most common cause of female infertility. Endometriosis
Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap
smear. Follow-up evaluation? Colposcopy and endocervical curettage
Breast cancer type that the future risk of invasive carcinoma in both breasts. Lobular carcinoma in situ
Nontender abdominal mass associated with elevated VMA and HVA. Neuroblastoma
The most common type of tracheoesophageal fistula (TEF). Diagnosis? Esophageal atresia with distal
TEF (85%). Unable to pass NG tube
Not contraindications to vaccination. Mild illness and/or low-grade fever, current antibiotic therapy, and
prematurity
Tests to rule out shaken baby syndrome. Ophthalmologic exam, CT, and MRI
A neonate has meconium ileus. CF or Hirschsprung's disease
Bilious emesis within hours after the first feeding. Duodenal atresia
A two-month-old presents with nonbilious projectile emesis. What are the appropriate steps in
management? Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
The most common 1 immunodeficiency. Selective IgA deficiency
An infant has a high fever and onset of rash as fever breaks. What is he at risk for? Febrile seizures
(roseola infantum)
Acute-phase treatment for Kawasaki disease. High-dose aspirin for inflammation and fever; IVIG to
prevent coronary artery aneurysms
Treatment for mild and severe unconjugated hyperbilirubinemia. Phototherapy (mild) or exchange
transfusion (severe)
Sudden onset of mental status changes, emesis, and liver dysfunction after taking aspirin. Reye's
syndrome
A child has loss of red light reflex. Diagnosis? Suspect retinoblastoma
Vaccinations at a six-month well-child visit. HBV, DTaP, Hib, IPV, PCV
Tanner stage 3 in a six-year-old female. Precocious puberty
Infection of small airways with epidemics in winter and spring. RSV bronchiolitis
Cause of neonatal RDS. Surfactant deficiency
What is the immunodeficiency? A boy has chronic respiratory infections. Nitroblue tetrazolium test is +.
Chronic granulomatous disease
What is the immunodeficiency? A child has eczema, thrombocytopenia, and high levels of IgA. Wiskott Aldrich syndrome
What is the immunodeficiency? A four-month-old boy has life-threatening Pseudomonas infection.

Bruton's X-linked agammaglobulinemia
A condition associated with red "currant-jelly" stools. Intussusception
A congenital heart disease that cause 2 hypertension. Coarctation of the aorta
First-line treatment for otitis media. Amoxicillin 10 days
The most common pathogen causing croup. Parainfluenza virus type 1
A homeless child is small for his age and has peeling skin and a swollen belly. Kwashiorkor (protein
malnutrition)
Defect in an X-linked syndrome with mental retardation, Lesch-Nyhan syndrome (purine salvage problem
with
gout, self-mutilation, and choreoathetosis. HGPRTase deficiency)
A newborn female has continuous "machinery murmur." Patent ductus arteriosus (PDA)
First-line pharmacotherapy for depression. SSRIs
Antidepressants associated with hypertensive crisis. MAOIs
Galactorrhea, impotence, menstrual dysfunction, and libido. Patient on dopamine antagonist
A 17-year-old female has left arm paralysis after her boyfriend dies in a car crash. No medical cause is
found. Conversion disorder
Name the defense mechanism: A mother who is angry at her husband yells at her child. Displacement
Name the defense mechanism: A pedophile enters a monastery. Reaction formation
Name the defense mechanism: A woman calmly describes a grisly murder. Isolation
Name the defense mechanism: A hospitalized 10-year-old begins to wet his bed. Regression
Life-threatening muscle rigidity, fever, and rhabdomyolysis. Neuroleptic malignant syndrome
Amenorrhea, bradycardia, and abnormal body image in a young female. Anorexia
A 35-year-old male has recurrent episodes of palpitations, diaphoresis, and fear of going crazy. Panic
disorder
The most serious side effect of clozapine. Agranulocytosis
A 21-year-old male has three months of social withdrawal, worsening grades, flattened affect, and
concrete thinking. Schizophreniform disorder (diagnosis of schizophrenia requires 6 months of
symptoms)
Key side effects of atypical antipsychotics. Weight gain, t ype 2 DM, QT prolongation
A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways.
Diagnosis? Treatment? Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Medication to avoid in patients with a history of alcohol withdrawal seizures. Neuroleptics
A 13-year-old male has a history of theft, vandalism, and violence toward family pets. Conduct disorder
A five-month-old girl has head growth, truncal dyscoordination, and social interaction. Rett's disorder
A patient hasn't slept for days, lost $20,000 gambling, is agitated, and has pressured speech. Diagnosis?
Treatment? Acute mania. Start a mood stabilizer (e.g., lithium)
After a minor fender bender, a man wears a neck brace and requests permanent disability. Malingering
A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C peptide. Factitious
disorder (Munchausen syndrome)
A patient continues to use cocaine after being in jail, losing his job, and not paying child support.
Substance abuse
A violent patient has vertical and horizontal nystagmus. Phencyclidine hydrochloride (PCP) intoxication
A woman who was abused as a child frequently feels outside of or detached from her body.
Depersonalization disorder
A man has repeated, intense urges to rub his body against unsuspecting passengers on a bus.
Frotteurism (a paraphilia)
A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements.
Diagnosis? Treatment? Tardive dyskinesia. or discontinue haloperidol and consider another
antipsychotic (e.g., risperidone, clozapine)
A man unexpectedly flies across the country, takes a new name, and has no memory of his prior life.
Dissociative fugue
Risk factors for DVT. Stasis, endothelial injury and hypercoagulability (Virchow's triad)
Criteria for exudative effusion. Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Causes of exudative effusion. Think of leaky capillaries. Malignancy, TB, bacterial or viral infection,
pulmonary embolism with infarct, and pancreatitis
Causes of transudative effusion. Think of intact capillaries. CHF, liver or kidney disease, and proteinlosing enteropathy
Normalizing PCO2 in a patient having an asthma exacerbation may indicate? Fatigue and impending
respiratory failure
Dyspnea, lateral hilar lymphodenopathy on CXR, noncaseating granulomas, increased ACE, and
hypercalcemia. Sarcoidosis
PFT showing FEV1/FVC. Obstructive pulmonary disease (e.g., asthma)
PFT showing FEV1/FVC. Restrictive pulmonary disease
Honeycomb pattern on CXR. Diagnosis? Treatment? Diffuse interstitial pulmonary fibrosis. Supportive
care. Steroids may help
Treatment for SVC syndrome. Radiation
Treatment for mild, persistent asthma. Inhaled -agonists and inhaled corticosteroids
Acid-base disorder in pulmonary embolism. Hypoxia and hypocarbia
Non-small cell lung cancer (NSCLC) associated with hypercalcemia. Squamous cell carcinoma
Lung cancer associated with SIADH. Small cell lung cancer (SCLC)
Lung cancer highly related to cigarette exposure. SCLC
A tall white male presents with acute shortness of breath. Diagnosis? Treatment? Spontaneous
pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Treatment of tension pneumothorax. Immediate needle thoracostomy
Characteristics favoring carcinoma in an isolated pulmonary nodule. Age > 45-50 years; lesions new or
larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular
margins
Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure. ARDS
risk of what infection with silicosis? Mycobacterium tuberculosis
Causes of hypoxemia. Right-to-left shunt, hypoventilation, low inspired O2 tension, diffusion defect, V/Q
mismatch
Classic CXR findings for pulmonary edema. Cardiomegaly, prominent pulmonary vessels, Kerley B lines,
"bat's-wing" appearance of hilar shadows, and perivascular and peribronchial cuffing
Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis. Type I (distal)
RTA
RTA associated with abnormal HCO3 and rickets. Type II (proximal) RTA
RTA associated with aldosterone defect. Type IV (distal) RTA
"Doughy skin." Hypernatremia
Differential of hypervolemic hyponatremia. Cirrhosis, CHF, nephritic syndrome
Chvostek's and Trousseau's signs. Hypocalcemia
The most common causes of hypercalcemia. Malignancy and hyperparathyroidism
T-wave flattening and U waves. Hypokalemia
Peaked T waves and widened QRS. Hyperkalemia
First-line treatment for moderate hypercalcemia. IV hydration and loop diuretics (furosemide)
Type of ARF in a patient with FeNa < 1%. Prerenal
A 49-year-old male presents with acute-onset flank pain and hematuria. Nephrolithiasis
The most common type of nephrolithiasis. Calcium oxalate
A 20-year-old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral
enlarged kidneys with cysts. Associated brain anomaly? Cerebral berry aneurysms (AD PCKD)
Hematuria, hypertension, and oliguria. Nephritic syndrome
Proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, edema. Nephrot ic syndrome
The most common form of nephritic syndrome. Membranous glomerulonephritis
The most common form of glomerulonephritis. IgA nephropathy (Berger's disease)
Glomerulonephritis with deafness. Alport's syndrome
Glomerulonephritis with hemoptysis. Wegener's granulomatosis and Goodpasture's syndrome
Presence of red cell casts in urine sediment. Glomerulonephritis/nephritic syndrome
Eosinophils in urine sediment. Allergic interstitial nephritis
Waxy casts in urine sediment and Maltese crosses (seen with lipiduria). Nephrotic syndrome
Drowsiness, asterixis, nausea, and a pericardial friction rub. Uremic syndrome seen in patients with renal
failure
A 55-year-old man is diagnosed with prostate cancer. Treatment options? Wait, surgical resection,
radiation and/or androgen suppression
Low urine specific gravity in the presence of high serum osmolality. DI
Treatment of SIADH? Fluid restriction, demeclocycline
Hematuria, flank pain, and palpable flank mass. Renal cell carcinoma (RCC)
Testicular cancer associated with -hCG, AFP. Choriocarcinoma
The most common type of testicular cancer. Seminomaa type of germ cell tumor
The most common histology of bladder cancer. Transitional cell carcinoma
Complication of overly rapid correction of hyponatremia. Central pontine myelinolysis
Salicylate ingestion in what type of acid-base disorder? Anion gap acidosis and 1 respiratory alkalosis
due to central respiratory stimulation
Acid-base disturbance commonly seen in pregnant women. Respiratory alkalosis
Three systemic diseases nephrotic syndrome. DM, SLE, and amyloidosis
Elevated erythropoietin level, elevated hematocrit, and normal O2 saturation suggest? RCC or other
erythropoietin-producing tumor; evaluate with CT scan
A 55-year-old man presents with irritative and obstructive urinary symptoms. Treatment options? Likely
BPH. Options include no treatment, terazosin, finasteride, or surgical intervention (TURP)
Class of drugs that may cause syndrome of muscle rigidity, hyperthermia, autonomic instability, and
extrapyramidal symptoms. Antipsychotics (neuroleptic malignant syndrome)
Side effects of corticosteroids. Acute mania, immunosuppression, thin skin, osteoporosis, easy bruising,
myopathies
Treatment for DTs. Benzodiazepines
Treatment for acetaminophen overdose. N-acetylcysteine
Treatment for opioid overdose. Naloxone
Treatment for benzodiazepine overdose. Flumazenil
Treatment for neuroleptic malignant syndrome. Dantrolene or bromocriptine
Treatment for malignant hypertension. Nitroprusside
Treatment of AF. Rate control, rhythm conversion, and anticoagulation
Treatment of supraventricular tachycardia (SVT). Rate control with carotid massasge or other vagal
stimulation
Causes of drug-induced SLE. INH, penicillamine, hydralazine, procainamide
Macrocytic, megaloblastic anemia with neurologic symptoms. B12 deficiency
Macrocytic, megaloblastic anemia without neurologic symptoms. Folate deficiency
A burn patient presents with cherry-red flushed skin and coma. SaO2 is normal, but carboxyhemoglobin
is elevated. Treatment? Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or
pregnant
Blood in the urethral meatus or high-riding prostate. Bladder rupture or urethral injury
Test to rule out urethral injury. Retrograde cystourethrogram
Radiographic evidence of aortic disruption or dissection. Widened mediastinum (> 8 cm), loss of aortic
knob, pleural cap, tracheal deviation to the right, depression of left main stem bronchus
Radiographic indications for surgery in patients with acute abdomen. Free air under the di aphragm,
extravasation of contrast, severe bowl distention, space-occupying lesion (CT), mesenteric occlusion
(angiography)
The most common organism in burn-related infections. Pseudomonas
Method of calculating fluid repletion in burn patients. Parkland formula
Acceptable urine output in a trauma patient. 50 cc/hour
Acceptable urine output in a stable patient. 30 cc/hour
Cannon "a" waves. Third-degree heart block
Signs of neurogenic shock. Hypotension and bradycardia
Signs of ICP (Cushing's triad). Hypertension, bradycardia, and abnormal respirations
CO, pulmonary capillary wedge pressure (PCWP), peripheral vascular resistance (PVR).
Hypovolemic shock
CO, PCWP, PVR. Cardiogenic shock
CO, PCWP, PVR. Septic or anaphylactic shock
Treatment of septic shock. Fluids and antibiotics
Treatment of cardiogenic shock. Identify cause; pressors (e.g., dobutamine)
Treatment of hypovolemic shock. Identify cause; fluid and blood repletion
Treatment of anaphylactic shock. Diphenhydramine or epinephrine 1:1000
Supportive treatment for ARDS. Continuous positive airway pressure
Signs of air embolism. A patient with chest trauma who was previously stable suddenly dies
Trauma series. AP chest, AP/lateral C-spine, AP pelvis
RAPID REVIEW PART 2:

The most common cause of hypothyroidism. Hashimoto's thyroiditis
Lab findings in Hashimoto's thyroiditis. High TSH, low T4, antimicrosomal antibodies
Exophthalmos, pretibial myxedema, and TSH. Graves' disease
The most common cause of Cushing's syndrome. Iatrogenic steroid administration. The second most
common cause is Cushing's disease
A patient presents with signs of hypocalcemia, high phosphorus, and low PTH. Hypoparathyroidism
"Stones, bones, groans, psychiatric overtones." Signs and symptoms of hypercalcemia

A patient complains of headache, weakness, and polyuria; exam reveals hypertension and tetany. Labs
reveals hypernatremia, hypokalemia, and metabolic alkalosis. 1 hyperaldosteronism (due to Conn's
syndrome or bilateral adrenal hyperplasia)
A patient presents with tachycardia, wild swings in BP, headache, diaphoresis, altered mental status, and
a sense of panic. Pheochromocytoma
Should - or -antagonists be used first in treating pheochromocytoma? -antagonists (phentolamine and
phenoxybenzamine)
A patient with a history of lithium use presents with copious amounts of dilute urine. Nephrogenic
diabetes insipidus (DI)
Treatment of central DI. Administration of DDAVP serum osmolality and free water restriction
A postoperative patient with significant pain presents with hyponatremia and normal volume status.
SIADH due to stress
An antidiabetic agent associated with lactic acidosis. Metformin
A patient presents with weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show
hyponatremia and hyperkalemia. Treatment? 1 adrenal insufficiency (Addison's disease). Treat with
replacement glucocorticoids, mineralocorticoids, and IV fluids
Goal hemoglobin A1c for a patient with DM. < 7.0
Treatment of DKA. Fluids, insulin, and aggressive replacement of elect rolytes (e.g., K+)
Why are -blockers contraindicated in diabetics? They can mask symptoms of hypoglycemia
Bias introduced into a study when a clinician is aware of the patient's treatment type. Observational bias
Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to
death. Lead-time bias
If you want to know if race affects infant mortality rate but most of the variation in infant mortality is
predicted by socioeconomic status, then socioeconomic status is a _____. Confounding variable
The number of true positives divided by the number of patients with the disease is _____. Sensitivity
Sensitive tests have few false negatives and are used to rule _____ a disease. Out
PPD reactivity is used as a screening test because most people with TB (except those who are anergic)
will have a +PPD. Highly sensitive or specific? Highly sensitive for TB
Chronic diseases such as SLEhigher prevalence or incidence? Higher prevalence
Epidemics such as influenzahigher prevalence or incidence? Higher incidence
Cross-sectional surveyincidence or prevalence? Prevalence
Cohort studyincidence or prevalence? Incidence and prevalence
Case-control studyincidence or prevalence? Neither
Describe a test that consistently gives identical results, but the results are wrong. High reliability, low
validity
Difference between a cohort and a case-control study. Cohort studies can be used to calculate relative
risk (RR), incidence, and/or odds ratio (OR). Case-control studies can be used to calculate an OR
Attributable risk? The incidence rate (IR) of a disease in exposed the IR of a disease in unexposed
Relative risk? The IR of a disease in a population exposed to a particular factor the IR of those not
exposed
Odds ratio? The likelihood of a disease among individuals exposed to a risk factor compared to those
who have not been exposed
Number needed to treat? 1 (rate in untreated group rate in treated group)
In which patients do you initiate colorectal cancer screening early? Patients with IBD; those with familial
adenomatous polyposis (FAP)/hereditary nonpolyposis colorectal cancer (HNPCC); and those who have
first-degree relatives with adenomatous polyps (< 60 years of age) or colorectal cancer
The most common cancer in men and the most common cause of death from cancer in men. Prostate
cancer is the most common cancer in men, but lung cancer causes more deaths
The percentage of cases within one SD of the mean? Two SDs? Three SDs? 68%, 95.5%, 99.7%
Birth rate? Number of live births per 1000 population
Fertility rate? Number of live births per 1000 women 15-44 years of age
Mortality rate? Number of deaths per 1000 population
Neonatal mortality? Number of deaths from birth to 28 days per 1000 live births
Postnatal mortality? Number of deaths from 28 days to one year per 1000 live births
Infant mortality? Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal
mortality)
Fetal mortality? Number of deaths from 20 weeks' gestation to birth per 1000 total births
Perinatal mortality? Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Maternal mortality? Number of deaths during pregnancy to 90 days postpartum per 100,000 live births
True or false: Once patients sign a statement giving consent, they must continue treatment. False.
Patients may change their minds at any time. Exceptions to the requirement of informed consent include
emergency situations and patients without decision-making capacity
A 15-year-old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
No. Parental consent is not necessary for the medical treatment of pregnant minors
A doctor refers a patient for an MRI at a facility he/she owns. Conflict of interest
Involuntary psychiatric hospitalization can be undertaken for which three reasons? The patient is a
danger to self, a danger to others, or gravely disabled (unable to provide for basic needs)
True or false: Withdrawing life-sustaining care is ethically distinct from withholding sustaining care. False.
Withdrawing and withholding life are the same from an ethical standpoint
When can a physician refuse to continue treating a patient on the grounds of futility? When there is no
rationale for treatment, maximal intervention is failing, a given intervention has already failed, and
treatment will not achieve the goals of care
An eight-year-old child is in a serious accident. She requires emergent transfusion, but her parents are
not present. Treat immediately. Consent is implied in emergency situations
Conditions in which confidentiality must be overridden. Real threat of harm to third parties; suicidal
intentions; certain contagious diseases; elder and child abuse
Involuntary commitment or isolation for medical treatment may be undertaken for what reason? When
treatment noncompliance represents a serious danger to public health (e.g., active TB)
A 10-year-old child presents in status epilepticus, but her parents refuse treatment on religious grounds.
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
A son asks that his mother not be told about her recently discovered cancer. A patient's family cannot
require that a doctor withhold information from the patient
Night blindness, dry skin Vitamin A deficiency
Beriberi, Wernicke Korsakoff syndrome Vitamin B1 (thiamine) deficiency
Poly neuritis, dilated cardiomyopathy, high output congestive heart failure, edema Beriberi
Angular stomatitis, cheilosis, corneal vascularization Vitamin B 2 (riboflavin) defic iency
Dermatitis, enteritis, alopecia, adrenal insufficiency Vitamin B 5 deficiency
Convulsions, hyper irritability Vitamin B6 (PYRIDOXINE) deficiency
Required during INH administration Pyridoxine
Macrocytic, megaloblastic anemia; neurologic symptoms, glos sitis Vitamin B 12 deficiency
Scurrvy, poor wound healing, swollen gums, bruising Vitamin C deficiency
Rickets in children, osteomalacia, hypercalcemic tetany Vitamin D deficiency
Increased fragility of red blood cells Vitamin D deficiency
Neonatal hemorrhage, increased PT, aPTT Vitamin K deficiency
Dermatitis, enteritis, can be caused by the ingestion of raw eggs Biotin deficiency
Most common vitamin deficiency in the United States Fully casted deficiency
Weakness, muscle cramps, exacerbation of hypocalcemia tetany, tremors, dyskinesias Magnesium
deficiency
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Keshan disease, Cardiomyopathy Selenium deficiency
dermatitis. dementia, diarrhoea >> niacin deficiency
common in carcinoid syndrome and harnup disease
increased red cell fragility is vit A deficiency. called acanthocytes.(spiculated RBCs.) associated with
abetalipoproteinemia >> fat soluble vitamin deficiency.
hallmark of vit C deficiency is perifollicular hemarrhage. common with tea and toast diet.
IMPORTANT SIGNS:
contralateral pelvic droop/hip drop, waddling gait.
What nerve to gluteus medius,minimus Trendelenburg sign; superior gluteal n
Distal tingling upon tapping n (at wrist) Tinel sign; for carpel tunnel synd
excruciating pain of 2nd and 3rd branch of trigeminal lower face Tic douloureux (trigeminal neuralgiacompression)
signs for hemorrhagic pancreatitis Grey Turner sign or Cullen sign
pain w passive overhead reach of arm Neer sign= rotator cuff impingement
JVD during inspiration suggests what dz? Kussmaul;s sign= R Ventricular failure (constrictive pericarditis,
RV infarct)
signs of pancreatic cancer = Courvier's sign = palpable gb in juandiced pt
Virchow's nodes = supraclavicular LN
BP decr 10 w inspiration/ distal pulses disappear w inspiration = pulses paradoxus = cardiac tamponade
(cardiac filling only occurs when inspiration cause neg press in thoracic cavity)
late diastolic murmur; pt present w pulm edema and a fib mitral stenosis
gradual, late peak of pulse @carotids; pt present w syncope pulses parvus et tardus; Aortic stenosis;
capillary pulsations in fingers and lips; water hammer pulse; early diastolic murmur Bounding
(waterhammer) pulses= Aortic regurg.
L sided pelvic pain in pt w reg cycles (LMP = 2wks ago) if not on OCP, unilateral b/c lateralize to ovary
about to ovulate= midcycle pain (mittelshermrz);
if abnl (no pain) then check mid-luteal progesterone levels.
borborygmus noted on PE, what dz do you think of? = bowel gurgling sounds - think celiac, colitis,
diverticulitis, IBS
DDx Rash on palms/soles = 1. 2ndary Syphilis (trunk to palms)
2. Rocky Mtn Spot fever
3. Reyes synd (aspirin, varicella)
4. infective endocarditis
5. Erythema Multiforme
6. Kawasaki Dz (>5day fever)
7. Toxic Shock Synd (S Aureus)
8. Coxsackie A (hand-foot-mouth dz-vesicles)
9. Dyshidrotic eczema (form of dermatitis)
acute febrile rxn w headache/myalgia after 1st dose of syphilis tx called what? Jarish-Herxheimer rxn after
1st 24hr of benzathine penicillin
migratory thrombophlebitis is? what dz? Trousseau's sign; look for courvoisier's sign in Pancreatic ca
1-2 wk alternating high fevers/no fever and alcohol induced pain at nodes Pel-Ebstein fevers of Hodgkin's
dz
referred shoulder pain due to diaphragmatic irritation classically on left side= kehr's sign
signs of Aortic Regurg Blowing diastolic murmur @ L sternal, Austin Flint murmur (mid-diastolic rumble)
Musset's (headbob w heartbeat)
Corrigan's (water-hammer pulse)
Duroziez's (femoral bruit)
signs of rickets craniotabes (ping pong over occiput)
rachitic rosary (enlarged chostochondral junctions)
harrison groove (horizontal depression on lower border of chest)
large ant fontanelle
presentation of endocarditis JR = NO FAME
Janeway lesions, Roth spots, Nailbed hemorrhages, Osler's nodes , Fever, Anemia, Murmur, Emboli
signs of steroid toxicity PICACHO
Peptic ulcers, Immunosuppresion, Cushing's, Acne, Cataract, Hyperglycemia, Obesity (truncal)
also incr BUN due to catabolic effect, and antagonize insulin, HTN, demarginize PMNs, Tcell atrophy
signs of MCA stroke CHANG
Contralateral paresis/sensory loss, Homonymous hemianopia, Aphasia, Nondominant Neglect, Gaze
toward lesion
bulbar involvement tongue & Oropharyngeal mm (suggest pathology above foramen magnum)= ALS
Kussmaul's sign JVD w inspiration
decr capacity of RV
constrictive pericarditis>>tamponade
Pulsus paradoxus decr Systolic BP (>10) w inspiration
decr capacity of LV
cardiac tamponade >> pericarditis
saber shins, saddle nose, CNS defects, Hutchinson's triad: peg central incisors, deaf, interstitial keratitis
congenital syphilis: Darkfield, VDRL/RPR, FTA-ABS
Penicillin in pregnant woman
viral exanthem start on arms, worsens w fever/sun, aplastic crisis Erythema infectiosum (Parvo B19)
viral exantham, head to toe, small red spots w gray specks in oral mucosa, encephalitis Koplik spots of
measles (paramyxovirus)
Vit A
viral exantham head to toe, Jt. pain, lymphadenopathy, PDA do not appear ill rubella (rubella virus)
viral exantham w rash appears as fever breaks (on trunk to face), febrile sz roseola infantum (HHV6, 7)
viral exantham papular, vesicular & crusting, from face to body, Reye synd varicella (VZV), infectious from
24hr before eruption til crust over
posterior cervical lymphadenoapthy, sore throat, pharyngitis, rash develops after ampicillin given
Infectious mononucleosis
vision loss after shower, occasional dizziness and clumsiness optic neuritis from MS (vision loss
transient)
abd pressure reveals persistent distention of jugular veings + Hepato-jugular reflex =indicates cardiac
etiology
valsalva incr systolic ejection murmur on L sternal border, AND recumbency decr murmur dx
Valsalva/standing -> decr preload
leg raise-> incr preload
Hypertrophic cardiomyopathy
+succussion splash sign dx +stethoscope over upper abd & rocking pt back/forth =gastric outlet
obstruction cause by mechanical obstruction (PUD, Crohn's, malignancy, pyloric stricture)
cervical mucus stretched vertically to 6cm NL during ovulatory phase= spinnbarkeit
pH is 6.5(more basic) and ferning
Pain b/t 3rd & 4th toes on plantar surface w clicking sensation metatarsal jts= Mulder sign
Morton Neuroma (not true neuroma) for runners= mechanically induced neuropathic degeneration
Tx w support bar or insert to decr press on metatarsal head
sharp and localized pain over bone surface worse w palpation stress fracture
compression of tibial nerve as it passes ankle (fracture of ankle bones) Tarsal tunnel synd
white reflex on eye exam of 2 month old dx/tx Leukocoria= Retinoblastoma, intraocular tumor of childhood
Tx: Refer to Opthalmologist immediately! Failure to tx early may lead to death from liver/brain mets (CT
scan)
marcus gunn pupil dx seen in optic n pathology (MS or detachment). Affected eye pupil doesn't constrict
cherry red spot on retina ddx Tay Sachs, Neiman Pick, or CRAO
Kerley B lines ddx =subpleural interstitium (interlobar septum):
CHF (leftsided), mitral valve dz, lympahtic obstruction (lymphangitis carcinomatosis), asbestosis,
sarcoidosis
Valsalva incr the murmur in: decr the murmur in: incr murmur: HOCM (decr preload- septum blocks more
of LV/subaorta area)
decr murmur: aortic stenosis (decr preload)
#kathynotes
after trauma, how to differentitate mycardial contusion and pulmonary contusion.
myocardial contusion will hav PCWP higher than 20mmHg after fluid replacement. high cardiac enzymes.
ST T changes.
pulomary contusion will hav PCWP high but not more than 20 mmHG after fluid resusciitation, plus
alveloar opaciities
how to differentiate ARDS and pulmoary contusion?
ARDS develope after first 24 hours, bilateral infilitrates
Pul contusion develope within first 24 hours, unilateral mostly.
how to differentiate cardiac failure and ARDS?
cardiac failure improves on high flow O2,
ARDS doesnt improves with high flow O2 alone, it needs PEEP
how to differentiate contrast induced ATN and drug induced ATN

contrast induced ATN occurs next day after contrast exposure
drug induced ATN needs 5 to 10 days to develope.
how to differentiate urticaria (type 1 HS ) and rash due to EBV and serum sickness after amoxillicin
exposure?
type 1 HS >> occurs immediately, urticaria rash
EBV >> occurs 24 hours after exposure, maculopapular rash
serum sickness >> occurs after 5 days to weeks >> urticaria rash, accompanied by arthralgia fever
how to differentiate septal rupture and papillary rupture after MI?
septal rutpure has PSM at left sternal border, not radiate to axilla
papillary rupture causes MR , PSM at apex, radiate to axilla
how to differentiate HOCM and bicuspid aortic valve on normal yound patient with sudden syncopy?
HOCM >> harsh holosystolic murmur, no radiation
bicuspid aortic valve causes SA >> ejection systolic murmur, ( soft ) radiates to carotid.
To differentiate between ARDS and heart failure>>BNP>100 in heart failure,,,<100 in ARDS
contrast ATN as a matter of fact present with prerenal features
In pulmonary contusion hypoxia also worsens after fluid, There is another thing worsens with fluid
resuscutation____ uncal herniation (plz correct me if its not correct)
in septal rupture there will be step up of o2 saturation.
11-b-hydroxolase deficiency
Congenital Adrenal Hyperplasia
can't make final mineralocorticoid or glucocorticoid products (but 11-deoxycorticosterone can still ^BP)
Presentation:
- masculinization
- HTN
17-a-hydroxolase deficiency
all steroids synth shunted to mineralocorticoids
Presentation:
- feminization
- hypertension
21-a-hydroxolase deficiency
all steroids synth shunted towards sex hormones
Presentation:
- Masculinization
a-Thalasemia
Defect in a-globin production (you have 4 gene copies)
prevalent in africa
microcytic hypochromic
Three types:
1. Four deletions: Hg Barts, hydrops fetalis
2. Three deletions: HbH
3. Two or less: no significant disease
Abetalipoprotinemia
Deficient ApoB-100 and ApoB-48
Autosomal recessive
Presentation:
- FA accumulation in enterocytes on bx
- "Burr Cells": spiny RBCs
- steatorrhea, failure to thrive
- acanthosis
- ataxia
- night blindness
Acute Intermittent Porphyria
Deficient porphobiligen decarboxylase
Increased porphobiligen, delta-ALA, uroporphyrin
Caused by drugs like rifampin
Presentation:
- Abdominal pain
- Neuropathy
- Port wine urine
- Psych changes
Rx: glucose + heme (inhibit ALA synthesis)
Acute Lympocytic Leukemia
more common in children
B-cell is more common than T-cell
PAS(+)
Bone Pain
Good prognosis
Philadelphia chromosome sometimes seen (bad)
Associated with Down Syndrome (we ALL fall DOWN)
Alagille Syndrome
Autosomal Dominant: Bile duct paucity with cholestasis, pulmonary artery stenosis, butterfly vertebrae,
triangular shaped facies
Albanism
1. deficient tyrosinease => can't make melanin
2. abnormal tyrosine transport
Variable inheritance
Alkaptonurea
Deficient Homogentisic acid oxidase => can't degrade tyrosine
Mostly benign
Presentation:
- Dark connective tissue
- brown sclera
- urine turns brown in air
- arthralgias
Alport Syndrome
Defective Type IV collagen
Presentation: boys 5-20 years old
- nephritis (hematuria)
- deafness (sensorineural)
- eye disorders
--GBM splitting on EM
AML
Middle age distribution
"Auer Rods" characteristic
Usually CD13/33(+)
PAS(-)
Associated with Down Syndrome
Angelman Syndrome
puppet like gait, large mouth, small head, prominent jaw, ataxia, sudden bursts of inappropriate laughter.
Seizures, severe intellectual disability, paucity of speech, hyperactivity, fascination of water, hand
flapping, sleep disturbances, gorging
Apert Syndrome
Autosomal Dominant: Syndactyly, craniosynostosis, maxillary hypoplasia, narrow palate ("cathedral
ceiling"), broad thumbs, fusion of 2,3 and 4 fingers
Arsenic Poisoning
Inhibits lipoic acid
Presentation:
- emesis
- rice water stools
- garlic breath
Rx: Dimercaperol (chelating)
Ataxia-Telangectasia
DNA repair deficiency
IgA deficiency
Cerebellar ataxia
Telangectasias of face at 5years
Cancer risk: lymphomas, leukemias, radiation sensitivity
Increased AFP
b-Thalasemia
Point mutations in B-globin genes (two copies)
increased HbF
microcytic, hypochromic
Two types:
1. B-thal minor: heterozygote
- usually asymptomatic
2. B-thal major: homozygote
- sever anemia requiring transfusions
- 2' hemachromatosis
- skeltal deformaties ("crew cut" and "chipmunk")
Beckwith-Wiedemann Syndrome
Congenital disorder characterized by neonatal hypoglycemia, coarse facies, macroglossia, large size,
visceromegaly, omphalocele and characteristic earlobe crease
Bernard Soulier
defect in Gp1b
platelets cannot bind vWF on exposed collagen
Presentation:
- decreased PC (large platelets removed by spleen)
- increased BT
Bloom Syndrome
Hypersensitivity to sunlight, leukemias and lymphomas are common, average age of cancer onset is 25.
"Sun BLOOM"
Burkitt's Lymphoma
B-cell lymphoma of adolescents and young adults
t(8;14) moves c-myc near Ig
"starry sky" on bx
Assocated with EBV
Endemic: africa, jaw lesion
Sporadic: pelvis or abdomen
Burton Agammaglobulinemia
"Rule of Bs"
Boys: X-Linked
B-Cell deficiency: defective tyrosine kinase, low levels of all immunoglobulins
Bacteria: Recurrent bacterial infections after 6m
C3 Deficiency
Presentation:
- recurrent URIs (S. pneumo, H. flu)
- type III hypersensitivity reaction: glomerular nephritis
C5/6/7/8/9 Deficiency
Deficient MAC
Nisseria infections
Carnatine Deficiency
Can't tranport Actyl-CoA into mitochondria during FA degredation (CARnatine = CARnage of FA)
Toxic accumulation in cytosol

Presentation:
- weakness
- hypotonia
- hypoketotic hypoglycemia
Chediak-Higashi
Defective LYST gene
defective lysosomal transport => cytoplasmic granules in PMNs
Presentation:
1. Albinism
2. recurrent respiratory and skin infections
3. Neurologic disorders
Chiari Malformation
Type I: Sublinical
Type II-IV: herniation of cerebellar tonsils through the foramen magnum
Presentation:
- hydrocephalus
- syringomyelia: crossing spinothalamic => "capelike" loss of pain and temp, hand weakness
- meningiomyelocele
Chronic Granulomatous Disease
NADPH oxidase deficiency
Impotent phagocytes
Catalase + infections: S. aureus, E. coli, Klebsialla, Aspergillus, Candida
Dx: - NBT dye
Rx: Prophylactic TMP-SMZ, INF-y
Classic Galactosemia
Deficient Galactose-1-phosphate uridyltransferace (G1PUD)
Presentation:
- ^^Galacitol
- infantile cateracts
- hepatomegaly
- MR
- failure to thrive
CLL
Most common adult leukemia (typically over 50)
95% are B-cell
10% progess to ALL
"Smudge Cells" characteristic
Autoimmune hemolytic anemia (warm and cold)
Usually it is monitored (no therapy)
CML
Middle age distribution
80% progress to AML (blast crisis)

Hyperplasia of all 3 cell lines, but mostly granulocytes
Philidelphia chromosome t(9;22) is always present
BCR-ABL tyrosine kinase
Rx: imitanib
Cori's Disease
Type III Glycogen Storage Disorder
Deficient a-1,6-glucosiderase (debranching)
similar to Von Gierke's but much milder
Cornelia De Lange Syndrome
Autosomal Dominant: IUGR; microcephaly; hirutism; down-tunred mouth; heart defects; micrognathia; low
hairline; long eyelashes; thin upper lilp; 2,3 syndactyly of toes
Criggler Najar
Type I:
Absent UDP glucuronyl transferase
Presentation:
- jaundice
- kernicterus
- death
Type II:
mild from
Rx: phenobarbitol
Cystinurea
Defect of "COLA" transporter in kidney (PCT)
COLA: cys, ornathine, lys, arg
Presentation:
- cystine kidney stones
Rx: acetazolamide (alkalizes urine)
Dandy Walker Malformation
loss of cerebellar vermis
increased 4th ventricle
Diamond-Blackfan Syndrome
(aka. congenital pure red cell anemia) Autosomal Dominant: macrocytic anemia, low retic count, and
multiple congenital abnormalities such as Triphalangeal thumb, radial hypoplasia, hypoplastic anemia,
congenital heart defects
Diffuse Large B-Cell Lymphoma
Most common adult NHL
DiGeorge
3rd and 4th pharyngeal pouches fail to develop
90% have 22q11 deletion
No thymus: No T cells
No parathyroids: low Ca2+ => tetany
Congenital heart defects

Recurrent viral, fungal, and protozoal infections
Dubin Johnson
Defective bile excretion from liver
"Black Liver"
Conjugated Bili
Benign
Dubowitz Syndrome
Autosomal Recessive: IUGR, telecanthus, ptosis, eczema; hypotrichosis; behavioral and developmental
disorders
Edwards syndrome
aka trisomy 18, mental retardation, prominent occiput, micrognathia (small jaw), low::set ears,
rocker::bottom feet, finger deformities, congenital heart dx p51
Ehlers Danlos
Defective Type III collagen
Presentation:
- bruising
- barry aneurisms
- elastic skin and ears
- joint hypermobility
Essential Fructoseurea
Deficient Fructokinase
Benign fructoseurea +/- osmotic dieuresis
Familial Hypercholesterolemia
Absent or decreased LDL receptors
Autosomal dominant
Presentation:
- increased LDL and cholesterol
- atherosclerosis: stroke and MI
- tendon (achilles) xanthomas
- corneal pathology
Fanconi anemia
Autosomal Recessive: Pancytopenia, hypoplastic thumb and radius, hyperpigmentation, abnormal facial
features
Follicular Lymphoma
B-cell lymphoma
Adults
t(14;18) ^ bcl-2 expression, inhibits apoptosis
poor prognosis
Friedrich Ataxia AR trinucleotide repeat disorder (GAA) in gene that encodes frataxin; leads to impairment
in mitochondrial functioning; HYPERTROPHIC CARDIOMYOPATHY is the cause of death;
p/w SCOLIOSIS, "HAMMER TOES" and ATAXIA

(i.e three things: 1) neurological 2) skeletal 3) cardiac
"Friedreich is Fratastic (frataxin) He's your favorite frat brother always stumbling, staggering and falling,
with a big heart"
Fructose Intolerance
Deficient Aldolase B
buildup of fructose-1-phosphate => depletes phosphate => impairs gluconeogenisis and glycogenolysis
Presentation:
- Jaundice
- cirrosis
Rx: no fuctose or sucrose in diet
G6PD Deficiency
RBCs Cannot reduce glutathione
Susceptible to oxygen radicals
X-linked
Presentation:
- hemolytic anemia after ingesting fava beans, sulfonamides
- "Heinz Bodies" and "Bite Cells"on peripheral smear
Galactokinase Deficiency
buildup of galacitol in blood an urine
infantile cateracts
Gilbert Syndrome
"Philippe Gilbert turned yellow while riding in the TDF"
Autosomal Recessive, 5% of caucasians
Mildly decreased UDP-glucuronyl transferase
Unconjugated bilirubinemia in stress
Glanzman's Thrombocytopenia
defect in GpIIa/IIIb
platelets cannon crosslink to fibrin, or aggregate
Presentation:
- nL PC
- increased BT
Hartnup Disease
Defective neutral AA transporter on renal and intestinal cells
Decreased absorption and ^ excretion of tryptophan
Presentation:
- pellagra (diarrhea, dermatitis, dementia)
Hemochromatosis
Hemosiderine (iron) deposition in tissues
Autosomal recessive OR from transfusions
Associated with HLA-A3
Presentation:
- Cirrosis
- CHF
- "Bronze Diabetes"
- HCC
- Testicular Atrophy
Rx: Phlebotomy, deferoxamine
Hemolytic Uremic Syndrome
Caused by e. coli O157
Presentation:
- hemolysis
- uremia
- thrombocytopenia
Hemophilia A
Factor 8 "Aieght" deficiency
increased PTT (intrinsic)
macrohemorrhage
Hemophilia B
Factor 9 deficiency
increased PTT (intrinsic)
macrohemorrhage
Holt-Oram Syndrome
Autosomal Dominant: Triphalangeal thumb, ASD, congenital heart disease
Homocystineurea Three Mechanisms:
1. Cystathione synthase deficiency:
Rx: no met, high cys, B12 and folate
2. decreased cystathione synthase function:
Rx: high B6
3. Homocystine methyl transferase defciency
Rx: high B12
Presentation:
--Marfan syndrome + stroke
- homocystinurea
- MR
- osteoporosis + kyphosis
- lens subluxation (downward!)
- atherosclerosis
I-cell Disease
Defect in Golgi trafficking
Presentation:
- coarse facial features
- clouded corneas
- joint problems
- MR
- death in childhood
Idiopathic Thrombocytopenic Purpura
Autoimmune, ab against GpIIb/IIIa
Presentation:
- decreased PC
- increased megakariocytes (in marrow)
- increased BT
Rx: streroids, IVIG, splenectomy
IL-12 Receptor Deficiency
Mycobacterial infections
Job
Hyperimmunoglobulin E syndrome
Deficient INF-y => PMNs fail to respond to chemotactic stimuli (C5a, LTB4)
Elevated IgE and eos
Presentation:
1. Eczema
2. "cold" S. aureus abscesses (like Job's boils)
3. coarse facial features and "doughy" skin
Kallmann Syndrome
X-linked: Short stature, mental retardation, hypogonadotropic hypogonadism, anosmia
Kartaganers
Defective Dyenin
Immotile cillia
Presentation:
- infertility
- bronchectasis
- situs inversus
Lactose Intolerance
Deficient Lactase
Presentation:
- Osmotic diarrhea
- bloating
- acid stool and ^ breath H+
Rx: Lactase or dairy avoidance
Lead Poisoning Inhibition of delta-aminolevulinic acid and ferochelatase
Presentation:
- microcytic anemia w/ basophilic stippling
- headache
- memory loss
- demyelination w/ foot and wrist drop
- darkend gums
- metal in epiphysis (XR)

Rx: Adults: EDTA, dimercaperol
Children: succomer
Lesch-Nyhan Syndrome
Defect in purine salvage pathway
Defective HGPRT (IMP=>GMP)
X linked recessive
Presentation:
- MR
- self mutilation and aggression
- uricemia
- GOUT IN YOUNG BOY
Rx: allopurinol (for gout)
Leukocyte Adhesion Deficiency Syndrome
Abnormal integrins
Delayed separation of the umbilicus
Frequent infections
Mantle Cell Lymphoma
B-cell lymphoma
Older males
t(11;14) deactivation of cyclin D
poor prognosis
Maple Syrup Urine
Deficient a-ketoacid dehydrogenase
Increased serum and urine branched AAs (isoleucine, leucine, valine)
"I Love Vermont"
Presentation:
- CNS defects
- MR
- Death
Marfan Syndrome
Defective Fibrilin
Presentation:
- hyperelastic joints
- marfanoid features, upward lens dislocation
- aortic dissection
- arachnodactyly
McArdle's Disease
Type V Glycogen Storage Disorder
Deficient Skeletal Glycogen Phosphroylase
Presentation:
- increased glycogen in muscles => cramps
- myoglobinuria following stress

- benign
McCune-Albright Syndrome
Sporadic Inheritance: Multiple bony fibrous dysplasia, cafe-au-lait spots, sexual precocity
Meckel-Gruber Syndrome
Autosomal Recessive: Encephalocele (occipital), microcephaly, polycystic kidney, polydactyly, lethal
MEN1
3Ps (think diamond)
Parathyroid
Pituitary (prolactinoma or GHoma)
Pancreatic (ZE, insulinoma, VIPoma, glucagonoma)
MEN2a
2Ps (think square)
RET oncogene association
Parathyroid
Pheochromocytoma
Medullary Thyroid CA
MEN2b
(think triangle)
RET oncogene association
Pheochromocytoma
Oral/Intestinal ganglioneourotosis
Medullary Thyroid CA
Menkes Syndrome X-linked: Defect in an intestinal copper transport protein. Clinical features include pili
torti, short, brittle "steel-wool" hair, and spare eyelashes and sparse broken eyebrows. The skin is often
hypopigmented with a soft, "doughy" consistency and redundancy. metaphyseal widening with spurs in
the long bones
Mercury Poisoning
Present in shark, tuna and swordfish
Presentation:
- accumulation in brain
- acrodynia: peeling of skin on fingertips
- abdominal pain
Multiple Myeloma
Singel plasma cell line proliferates
Commonly IgG
"CRAB"
C: ^Ca2+, "clockface chromatin"
R: renal inssuficiency, Rouleaux formation
A: anemia, amyloidosis
B: Bone (lytic lesions), Bence Jones (UPEP)
M-spike (SPEP), "fried egg" plasma cells, may progress form MGUS
Neuroblastoma
Think "Adrenal Neuroblastoma"
Can occur anywhere on sympathetic chain
N-myc mutation
Bombesin (tumor marker)
Presentation:
- HTN
- ^ urine HVA
-"Homer-Wright" pseudorosette
- Neurofilament stain
Neurofibromatosis Type I
Autosomal Dominant: Macrocephaly, neurofibroma, learning disability, optic glioma, Lisch nodules
Noonan Syndrome
Autosomal dominant inherited condition characterized by wide set eyes, pulmonic stenosis, abnormally
shaped chest, webbed neck, undescended testicles, and delayed puberty
Ornathine Transcarbamoylase Deficiency
Cannot eliminate amonia
X-linked recessive
Presentaiton:
- orotic acid in blood
- decreased BUN
- hyperammonemia
Rx: phenylbutyrate, Lactulose
Orotic Acidurea
Deficient orotic acid phosphoribyltransferase OR orotidine 5'-phosphate decarboxylase
Cant make UMP (defect in uric acid cycle)
Autosomal recessive
Presentation:
- megaloblastic anemia (no response to VB12/ folate)
- ôrotic acid in urine
- no hyperuremia
Rx: oral uridine (UMP)
Ossler-Weber-Rendo Syndrome
Inherited Disorder of Blood Vessels
Presentation:
- telangectasias
- epistaxis (nose bleeds)
- skin discoloration
- AVMs
Osteogenisis Imperfecta
Type I:
Autosomal Dominant
Defective Type I collagen
Presentation:
- fractures
- blue sclera
- hearing loss
- dental abnormalaties
Type II:
Fatal
Patau syndrome
Trisomy 13 (P = puberty age), 1:15,000. Severe MR, rockerbottom feet, congenital heart disease.
Vs. Edwards': cleft lip / Palate, holoProsencephaly, Polydactyly (P's), micropthalmia, m icrocephaly. Death
w/in 1 yr
Phenylketonurea
Deficient phenylallanine hydroxolase or THB
Tyrosine becomes an essential FA
Presentation:
- phenylketones in urine
- MR, growth retardation
- fair skin
- "mousey" odor
- eczema
Rx: Diet (low phe, high tyr)
Maternal: microcephaly, MR, heart defects, growth retardation
Plummer Vinson Syndrome
Triad of:
1. Iron deficiency anemia
2. esophageal webs (dysphagia)
3. glossitis
Pompe's Disease
Type II Glycogen Storage Disorder
Deficient lysosomal-a-1,6-glucosidase
Infant: cardiomegaly => death
Adult: phrenic weakness => respiratory failure
Porphyria Cutanea Tarda
Deficient Uroporphyrin-1-synthetas e
Think "typical hobo"
assocation with HepC and EtOH
Presentation:
- Blistering +photosensitivity
- increased hair growth
- hyperpigmentation
- ÂST, ÂLT
Prader-Willi characterized by severe hypotonia at birth, uncontrolled eating, small hands and feet, short
stature, hypogonadism, mental retardation and behavior problems in adults, caused by deletion of
chromo 15 or maternal uniparental disomy for chromo 15, or a mutation involving imprinting
Pyruvate Dehydrogenase Deficiency
Backup of pyruvate and alanine
acquired or alcoholics (B1 deficiency)
Sx:
- lactic acidosis
- Wernike-Korsakov:
- confusion, ataxia, confabulation, memory loss
- damage to medial dorsal thalamus + mamillary bodies
Rett Syndrome Neurodevelopmental disorder of childhood characterized by normal early development
followed by loss of purposeful use of the hands, distinctive hand movements, slowed brain and head
growth, gait abnormalities, seizures, and mental retardation; affects females almost exclusively; included
in autism spectrum disorders.
Reye Syndrome
Rare, fatal hepatoencephalopat hy
decreased B-oxidation by mitochondrial enzymes
Triad:
1. child
2. Viral infection (VZV, influenza)
3. ASA
Selective Immunoglobulin Deficiency
IgA is the most common (1/600)
Mostly benign
Recurrent URIs
Possible anaphylaxis to blood transfusions
Severe Combined ImmunoDeficiency (SCID) Defect in stem cell differentiation
7 causal gene defects: adenosine deaminase deficiency
only NK cells still work
no thymic shadow on CXR
Presentation:
1. Severe recurrent infections: Chronic mucocutaneous candidiasis, recurrent viral (VZV, RSV, HSV,
measles, flu), PCP pneumonia
2. Chronic diarrhea
3. Failure to thrive
Sheehan Syndrome
Infarction of pituitary due to post partum hemorrhage
Sjogren's
Presentation:
- dry eyes (keratoconjunctivitis)

- dry mouth
- candida and cavities
Sturge-Weber Syndrome
Sporatic inheritance: Hemangioma in trigeminal nerve distribution, glaucoma, seizures, meningeal
hemangiomata
Thrombotic Thrombocytopenic Purpura Defective ADAMTS13 > decreased vWF polymer breakdown >
excessive plt activation > decreased survival
hemolytic uremic syndrome is a milder form
Presentation:
- Nasty: neuro (headache, seizures)
- Fever: fever
- Torched: thrombocytopenia
- His: hemolytic uremia
- Kidneys: kidney failure
- also ^ LDH
Treacher-Collins Syndrome
Autosomal dominant condition characterized by symmetrical external and middle ear, hearing loss,
mandibular hypoplasia, parrotbeaked nose, and absence of medial lower eyelashes.
Von Gierke's Disease
Type I Glycogen Storage Disorder
Deficient glucose-6-phosphatase (can't remove glucose form liver)
Presentation:
- Severe fasting hypoglycemia
- ^^ glycogen in liver => hepatomegaly
vonWillibrand's disease
Mild, most common inherited bleeding disorder
Intrinsic: normal of elevated PTT (vWF carries VIII)
Platelet: defect in plt-plt adheasion, increased BT
Waldenstroms Macroglobulinemia
Like MM, but IgM (not IgG) and no lytic lesions
Waterhouse Friedrichsen Syndrome
Adrenal hemorrhage 2' to N meningiditis
Presentation:
- petichial rash
- 1' adrenal insufficiency
Williams Syndrome
microdeletion of long arm of chromosome 7 characterized by: elfin face, mental retardation,
hypercalcemia, well-developed verbal skills, extreme friendliness with strangers, hypoplastic nails,
anteverted nares, supravalvular aortic stenosis
Wilson's Disease
Poor hepatic copper excretion
"Copper is Hella BAD"
C: decreased Ceruloplasmin, Cirrosis, Corneal deposits, HCC
H: Hemolytic anemia
B: Basal ganglia degeneration (parkinsonism)
A: Asterixsis
D: Dementia, Dyskinesis, Dysarthrium
Rx: Penicillamine
Wiskott Aldrich
WAITER
I: immunodeficiency
T: Thrombocytopenia and purpura
E: Eczema
R: Recurrent pyogenic infections: no IgM vs capular polysaccharides of bacteria, low IgM, high IgA,
X-Linked
Xeroderma Pigmentosum
Can't repair T-T dimers in DNA
hypersensitivity to light
massively increased risk of skin cancer
Zellweger Syndrome
Autosomal Recessive: Rare hereditary disorder affecting infants. Problems in prenatal development,
enlarged liver, high levels of iron and copper in the blood, hypotonia and vision abnormalities. Death by
age 6.
Felty syndrome
rheumatoid arthritis (hands and wrists especially)
neutropenia
splenomegaly
Still's disease
a form of juvenile idiopathic arthritis
-arthritis
-daily high spiking fevers
-salmon colored rash
-hepatosplenomegaly
may go away within 1 year
Lffler's syndrome
Simple pulmonary eosinophilia
Most common eosinophilic lung disorder
Frequently complicates helminth infection and drug reactions
Cough, wheeze, dyspnea
Peripheral blood eosinophilia
Transient infiltrates resolve spontaneously, does not recur

goodpastures syndrome -pulmonary/renal autoimmune disease
can present as ARF with RBC casts and bloody sputum
-antibody mediated injury to glomerular and pulmonary basement membranes
- autoantibody against collagen IV
- rapidly progressive glomerular nephritis
- necrotizing hemorrhagic interstitial pneumonia
deQuervain tenosynovitis Often seen in new mothers holding their infants with their thumbs extended
Inflammation of the tendon / tendon sheath of:
1. Abductor pollicis longus
2. Extensor Pollicis brevis
S/S:
- pain along radial styloid process when using thumb/wrist
Dx:
- Finkelstein's test
Tx:
1. Rest
2. Splinting
3. Ice
4. NSAID's
5. Steroid Injx
6. Surgery for severe cases
Behcet syndrome
RECURRENT ORAL ULCERS plus 2 of the following:
-genital ulcers
-skin lesions (erythema nodosum or other)
-eye lesions (anterior uveitis or other)--> blindness
May also have CNS involvement
Rx: corticosteroids are palleative, methotrexate for CNS/eye involvement
Picwickian syndrome
OSA/Obesity hypoventilation syndrome
-decreased lung complience
-hypoxia, hypercapnia--> chronic respiratory acidosis.... kidneys try to compensate by retaining HCO3,
but in so doing loose Chloride
Wegener's granulomatosis
-Glomerulonephritis (hematuria)
-Upper and lower granulomas (nasal stuff, hemoptysis)
-cutaneous lesions (pyoderma granulosum)
--C-ANCA
Minimal change disease
--proteinuria, edema in CHILDREN
-normal on light microscopy, fusion of foot processes on EM

-a/w NSAIDS, hematologic cancers
Membranous nephropathy
--most common nephrotic syndrome in white adults
--a/w solid tumors and HEPATITIS B, syphilis, malaria
--spike and dome on EM
--IgG and C3 on BM
Post infectious glomerulonephritis
--can follow Group A strep infection
--p/w oliguria, cola colored urine
--LOW C3, elevated ASO titer
--"lumpy bumpy" on IF
--Rx: diuretics
Membranoproliferative glomerulonephritis
--nephrotic or nephritic
--a/w HCV, SLE, bacterial endocarditis
--"tram track" on EM
Kawasaki disease
>5 days of high fever
-conjunctivitis
-oral lesions (cracked lips, strawberry tongue)
--risk for coronary artery aneurism
Kleinfelter syndrome
XXY
No apparent abnormality until puberty when testicles do not enlarge, gynecomastia becomes apparent
Tall, sterile, minimally reduced IQ
IS associated with maternal age
androgen insensitivity syndrome
XY male with faulty testosterone receptors
Develops female phenotype but fails to mensturate or develop pubic hair.
-No uterus, no fallopian tubes,
-blind vaginal pouch
-retained testicles need to be removed after puberty to prevent CA
Legg-Calve-Pert hes disease
idiopathic osteonecrosis of the femoral head, usually in boys 4-10 with an insidious onset limp. Limp can
be precipitated by vigorous exercise.
Asherman syndrome
-secondary amenorrhea due to loss of stratum basalis (regenerative layer-stem cells) of endometrium and
scarring
-result of overaggressive dilation and curettage (D&C)
Shy-Drager syndrome
1) Parkinsonism
2) Autonomic dysfunction (orthostatic hypotension, impotence, etc.
3) widespread neurological signs
Tx: not anti-parkinson drugs. Volume expansion with salty diet, fludrocortisone, alpha-agonists
WAGR syndrome
Wilms tumor
Aniridia
Genitourinary abnormality
Retardation (mental)
osgood-schlatter disease painful swelling of the tibial tubercle just below the knee, probably from
repeated stress on the patellar tendon. occurs most in puberty during rapid growth and most often in
males; pain increases with kicking, running, bike riding, stair climbing, or kneeling; condition is usually self
limited and symptoms resolve with rest
lennox-gastaut syndrome
Characterized by MULTIPLE SEIZURE TYPES - complex absences, tonic, atonic, myoclonic and tonic clonic.
There are associated learning difficulties and neuropsychiatric problems.
Prognosis is poor, onset between 3 and 5 years.
Cushings syndrome too much cortisol.
--muscle breakdown-->weakness
--androgen excess
--fat redistribution-->central obesity
--hypertension
--easy bruising
most common cause:
1) exogenous glucocorticoids
2) Cushings disease (pituitary ACTH tumor)
3) adrenal tumor
4) ectopic ACTH production
henoch schnlein purpura
- Most common form of childhood systemic vasculitis
-Skin Rash on buttocks and legs (palpable purpure)
-Arthralgia, Intestinal hemorrhage, abdominal pain, and melena
-Follows upper respiratory infection.
-Associated with IgA nephropathy
let's list age related changes of normal ppl. i keep seeing them in NBMEs and it is really annoying.
Urinary bladder >> urge incontinence.
eye >> macular degeneration.... central scotoma,
cataract ...... cant see clearly at night. glare.

loss of lens elasticity >> cant see near objects .. aka.. presbyopia
seeing straight lines as curved. >> grid test>> screening for AR MD
ear >> high tone deafness .. aka. presbycusis
CVS >> wide pulse pressure, calcified aortic valve.
reflex >> decreased deep tendon reflexes
>> postural hypotension
>> situational syncope while straining for urine
fine hand tremor.
decreased sensation of taste, smell
decreased upward gaze.
total sleep time decrese. rem percentage decrease. stage 3,4 of sleep vanish
calcification of bicuspid aortic valves
Skin elasticity lost. Due to decreased production & Increased Cross-linking of collagen fibrils & elastin
Loss of lense elasticity..Presbyopia , having difficulty in near vision, can't accommodate.
take longer to erect! has icreased refractory period. delayed ejaculation
lean body mass decrease so decrease need of calorie.
orthostatic hypotension due to decreased baroreceptor deficienc y
no acute transfusion reaction due to loss of IG's
Loss of DTRs..,Position&Vibration sense at ankle & knee
CVID >> normal B cell count,low Ig G A M
Bruton >> low b cell count, low Ig G A M
Transient hypoglobulinemia of infancy >> normal b cell count, low Ig G, normal Ig A (age 6 to 11 months)
hyper Ig M >> high Ig M, low Ig A G
hyper Ig E >> high Ig E
how to differentiate ABSENCE SEIZURES and COMPLEX PARTIAL SEIZURES without EEG
hyperventilation? Absence has.. No aura. no postictal state. Complex partial has bot h.
buzz words for absence : staring and eye rolling .. Buzz for complex : loss of consciousness that maybe
ass. With smell and lip smacking plus post ictal confusion. .
EEG in complex seizures will reveals sharp waves in temporal region
eye conditions and associations

retinitis pigmentosa >> refsum disease and abetalipoproteinemia
retinal harmatoma >> tuberous sclerosis
optic glioma, lisch nodules >> NF
Optic neuritis >> multiple sclerosis

and side effect of ethambutol
anterior uveitis >> autoimmune diseases like sarcodosis etc.
coloboma >> CHARGE assocition
almond eyes >> prader willi
different colour iris in two eyes >> waadenburg syndrome ( must b a really cute baby) associated with
white forelock of hair and hearing loss
aniridia >> WAGR syndrome (absence of iris)
brushfield spots >> down
kayser filscher rings >> wilson
blue eyes >> albino, phenyketouria, normal blondes too, of cos
cherry red macula >> Tay sach. Niemann pick, CRAO
retinal deposits >> side effect of CQ (antimalaria) and thioridazine (typical antipsychotic)
retinitis pigmentosa laurance moon biedl
ant uveitis behcet disease
red eye iridocyclitis conjuctivits keratitis
roth spot infective endocarditis
white red reflex corneal opacity cataract chemical injury
cobblestone appearance spring catarhh
retinitis pig:tioridazin
blue eye:osteogenesis imperfecta
orbital cellulitis-paranasal sinusitis-mc:h.influ non typal/dx:ct/tx:iv ab
also diplopia,proptosis,chemosis
periaucular adenopathy+adenovirus8+watry discharge:viral conjunctivitis
sup. and temporal lens dislocation:marfan
inf. and nasal dislocation:homocystinuria
sturge weber:glucoma(buphthalmus )
trachoma:follicular conj.+panus in cornea
painless mooocular visuall loss:amarusis fugax,CRAO,CRVO,vitrous hemorrhage
fluffy lesion:cmv
uveitis:psorisis,sarcoidosis,syphlis,reiter syn.,ibd
red eye:GO SUCK:glucoma,orbital dis,scleritis,uveitis,conjuctivitis,keratitis
white red reflex:RB,cataract,galactosemia
cataract:rubella
chorioretinitis:toxo,cmv,hsv(ped)
so let me get this straight. pls correct me if u see any error.

herpes zoster opthalmicus
characteristic skin rash in trigerminal distribution followed by keratitis, dendriform ulcers on cornea
Tx -acylcovir
herpes simplex keratitis
dendritic ulcers and vesicles on cornea then may progress to herpes retinitis
tx-acyclovir
CMV retinitis
retinitis only, no keratitis involved.
seen in CD4 < 50.
tx - ganciclovir
if cant b used then foscarnet. then cidofovir
fungal keratitis
stromal abscesses
contact lens keratitis
pseudomonas
for cmv retinitis, it is ganciclovir. if not, then foscarnet. if not then cidofovir.
If you are talking about eye conditions in HIV, one important thing CMV is painless. Herpes is painful.
And another condition we are missing here is Candida Endophthalmitis.
Candida endophthalmitis: Presentation: eye pain,photosensitivity, white lesions seen on fundoscopic
exam, vitreous haze
Risks: HIV pts, IV drug users, Neutropenia, central venous catheters, TPN, broad spectrum ABx.
Rx. Vitrectomy & Amphotericin B (NOT ketoconazole b/c it does not concentrate in the eye)
HIV association with these diseases has specific fundoscopy findings
in HSV or VZV...painful and fundoscopy show pale retinal necrosis
in CMV...painless and on fundoscopy fluffy and granular lesions around retinal vessels,and no keratitis
and conjunctivitis
fundoscopy in aids+CMV....yellow white patches of retinal opacification and retinal hemorrhages.. .
PPD positive and CXR negative
standard >> isoniazide and B6 for 9 months
alternatives >> pyrizinamide + rifampicin for 2 months
or rifampicin alone 4 months
black necrotic eschar like things

in nasal turbinates >> mucor infection >> rhizopus species
associated with DKA or leukemia
tx - surgical debridement and IV amphotericin
in external ear >> maligant otitis externa >> pseudomonas
also seen granulation tissue, aka swimmer's ear
in skin >> ecthyma gangranosum >> pseudomonas
in skin >> cutaenous anthrax >> bacillus anthracis
gram positive bacilli, spore forming, polypeptide capsule, postal worker, or sheep breeder
Tx-cipro, doxy, penicillin
in skin >> necrolytic migratory erythema >> glucagonoma
mild DM, wellcontrolled with OHAs
Dx >> serum glucagon more than 1000 pg/ml
Tx >> osterotide or surgical resection
in skin >> necrobiosis lipoidica diabetacorum >> associated with DM
nausea vomitting after eating food,

onset within six hours >> preformed toxins >> staph aureus or bacillus cereus
staph aureus contains in myonoisee containing food
bacillus cereus contains in fried rice, chinese restruant. (reheated rice sydrome)
listeriosis....neonatal granulormatosis from unpasteurised milk products during pregnanc y
sea food diarrhea.... vibrio parahemolyticus
travellers diarrhea...... ETEC.
mountain trip... drinking water from the stream... long episode of diarrhea+ malabsorption+ bloating... do
giardia lamblia antigen... RX; metronidazole
small child diarrhea: Rota virus
Iron overload is more associated with vibrio vulnificus, yersinia enterocolitica, and listeria.
so are vibrio parahemolyticus patients more susceptible in patients with liver disease.
EHEC = is uncooked meat
primary adrenal insufficiency causes hypovolemic hyponatremia
secondary adrenal insufficiency and hypothyroid casues euvolemic hyponatremia.
difference between amurosis fugax and central retinal artery occlusion? Both condition cause unilateral
painless visual loss.
CRAO has clues like cherry red fovea and pallor of optic disc while Amaurosis Fugax describes
something about edematous retinal arterioles. Hollenhorst cholesterol particle depositied at carotid
bifurcation. amaurosis fugax (next step -- check carotid artery Doppler) or CRAO (next step: give 100%
oxygen and actetazolamide)
differentiate epiglottis, retrophargeal abscess and pertonsillar abscess? all that i know is that all come in
with fever, throat pain, unable to swallow and moffled voice. anyone can help?
Uvula deviated in quinsy (peritonsillar)

there will be a unilateral posterior pharyngeal bulge in retro pharyngeal abscess. lateral neck xray or
ct scan will usually differentiate them.
epiglottitis will show a enlarged swollen epiglottis (thumb sign ) along with thickened aryepiglottic
folds and obliteration of vallecula
Epiglotitis with drolling saliva ..retropharyngeal abcess with torticollis
Most distinguishing features :
Peritonsillar abscess : muffled voice , deviation of uvula to opposite side , unilateral cervical
lymphadenopathy .
Retropharyngeal abscess : limited neck mobility 2ry to pain , trismus (inability to open the mouth normally)
, limited cervical extension , radiology may show lordosis of cervical spine with gas and swelling in the
rteropharyngeal space .
Epiglottitis : muffled voice , drooling , stridor , radiology may show thumb-print sign .
In exanthoma subitum rashes appear after fever subsided....Herpangina caused by coxsachie virus A16
in which pt have high fever , severe throat pain makes completely unable to swallow , on exam u find
ulcerative lesions on tonsils, palate & pharynx, it may progress to involve hands & feet....Hand foot mouth
disease.
what about ethanem? It is similar to exanthoma sabitum ,caused by HHV7 , usually present during
first 2years of life median age 26months older than exanthum( median age 9months)
schizoaffective disorder is mood symtoms with psychotic features at a time, and after that, psychotic
features for at least 2 weeks in the absence of mood symtoms
bipolar with psychotic features is mood symtoms occuring at the same time with psychotic feat ures
most common nephrotic syndrome associated with

underlying Carcinoma >>MEMBRANOUS
hogkin lymohoma >>MINIMAL CHANGE DISEASE.
HIV, heroin>>FSGS
HBV >>Membranous
HCV >> Membranoproliferative
drugs, NSAIDS, SLE>> Membranous
renal vein thrombosis>> Membranous
WHO classification of lupus nephritis
=========================================================================
I: normal or minimal abnormality; no abnormalities identified by H& E, immunofluorescence or EM;
asymptomatic; may not actually represent renal diseas e
II (10-20% of cases): pure mesangial lesions; mesangial expansion but mostly patent capillaries;
mesangial immune deposits; mild proteinuria with variable hematuria, but normal renal function
IIA: minimal light microscopy changes, but immune deposits present in mesangium by
immunofluorescence and EM
IB: glomerular mesangial hypercellularity present by light microscopy, involving center of lobules away
from vascular pole; immune deposits only in mesangial region; no significant tubular, interstitial or
vascular changes; good prognosis (5 year renal survival > 90% )
III (30-40% of cases): focal proliferative glomerulonephritis; focal and segmental proliferative intra- or
extracapillary necrotizing or sclerosing lesions in < 50% of glomeruli; predominantly mesangial and
subendothelial immune deposits (Ig, complement); nephritic urinary sediment; variable proteinuria but
usually non-nephrotic
IV (40-60%): diffuse proliferative glomerulonephritis; predominantly global proliferative lesions, necrosis,
crescents in > 50% of glomeruli, variable sclerosis, prominent inflammatory interstitial infiltrate, often wire
loop lesions in thickened capillary walls; predominantly mesangial and subendothelial immune deposits of
IgG, often IgM and IgA (all three is called a full house); also C3 and C1q, fibrin and fibrinogen; nephritic
and nephrotic syndromes, hypertension, variable renal insufficiency; rapidly progresses to renal failure
without treatment
V (10-15%): membranous glomerulonephritis; diffuse thickening of capillary walls, subepithelial and
mesangial immune deposits (spike and dome pattern with silver stain); nephrotic syndrome or severe
proteinuria
VI: advanced sclerosing glomerulonephritis; glomerular obsolescence and segmental
glomerulosclerosis, tubular atrophy, interstitial fibrosis; few immune deposits; chronic renal failure that is
unlikely to respond to therapy

Overlap common in classes III and V, IV and V
Nice piece of information i read:
In thyroid storm,dont use aspirin to lower temperature cuz it diplaces thyroid hormone from albumin and
worsen the condition,,use acetaminophen instead.
Dont give iodide compounds until at least one hour after giving antithyroid medications,,cuz before that it
will be used to form more thyroid hormones and worsen the condition
missisipi, ohio and wincousin >> blastomyces and histoplasma

BlaSTomycosis has
Bone > osteomyelitis
Lung > pneumonia (BL)
Skin > warT like verrucous Lesion (ST)
broad based budding yeast
tx itraconazole or amphotericin B
histoplasmosis
bilateral interstitial inflitrates and hilar adenopathy
when disseminated >>hepatosplenomegaly. lymadenopathy, palatal ulcers
Histoplamasis, blastmyces and TB has similar Xray presentations
southwestern US, arizona, california >> Coccidioidomycosis >> skin (erythema multiforme, erythema
nodosum) , skeleton, meninges in addition to lungs
DM and immunocompromised >> mucor
necrotic nasal turbinates
tx- surgical debridement + amphotericin B
GI Complaint plus interstiatial pneumonia
normal ppl >> legionellla (also has hyponatremia)
immunocompromised >> CMV pneumonitis
AIHA plus interstial pneumonia >>mycoplasma
sidenote>> drug of choice for invasive asperigillosis is variconazle. not amphotericin.
1. Most common cause of septic arthritis with rash (and tenosinovitis) in a person less than 40 years old =
Gonococcus
2. Most common cause of osteomyelitis in general population = S. aureus
3. Most common cause of osteomyelitis in Sickle Cell patients = staph aureus (Salmonella has high
incidence)
4. Most common cause of osteomyelitis due to nail-puncture wounds = Pseudomonas (V.Imp!)
5. Most common parasitic infection of the brain = Neurocysticercosis
6. Most common cause of Encephalitis in USA = Herpes Simplex Virus (HSV )

7. Most common cause of dysentry in the USA = C. jejuni (undercooked poultry )
8. Second most cause of dysentry in the USA = Shigella (daycare centers )
9. Most common cause of pneumonia in nursing home residents = S. pneumoniae
10. Most common cause of malignant otitis externa = P. aeruginos a
11. Most common risk for contracting HIV in USA= Intravenous Drug Us e
12. Most common presenting Manifestation of AIDs = P. carinii pneumonia
13. Most common cause of Menigitis in adolescents = N. meningitidis
14. Most common cause of Meningitis in the USA = Streptococcus pneumoniae
15. Most common Neurological Manifestation of Lyme Disease = Facial Nerve palsy !
16. Most common Cardiac manifestation of Lyme Disease = AV Heart Bloc k
17. Most Common viral STD in the USA = HPV !
18. Most Common Complication of Mumps in Pre-pubertal Children = Encephalitis
19. Most Common Complication of Mumps in Pubertal and Post -Pubertal Adults (and Males) = Orchitis
most common cause of septic arthritis in normal = staph aureus
most common cause of septic arthritis in sickle disease = still staph aureus, second most common is
salmonella
Most common organism causing HUS- E.coli
Second most common organism causing HUS- shigella
most common cause of spontaneous bacterial peritonitis -- E coli /strep pneumo
ring enhancing lesions on Ct
hiv -ve tumor or abscess
hiv +ve toxo or lymphoma
I remember it for treatment of acne as follows: With increasing severity, go with the following sequence1. Topical retinoid 2. Topical Abx 3. Oral Abx and 4. Oral Isotretinoin ..............1 is for blackhead and
whitehead comedones i.e. mild disease. 2 is for mild-moderate. 3 is for moderate to severe. 4 is for
recalcitrant, resistant or severe cases of nodulocystic acne + patients with scars.................BASICALLY,
no satisfactory response to 1 indicates treatment with 2, no response with 2 indicates treatment with 3,
and so on....................
type 1 morbiz block worsens with vagal manuveurs and improves with atropine
type 2 morbiz block improves with vagal manuveurs and worsens with atroine,
In type 1 morbiz block the disease located in AV node ,and most often due to a parasympathetic
hypertonia ,and knowing that the NAV has a rich parasympathetic innervation explains that vagal
maneuvers inhibit AV node and makes it more refractory ,and atropine which is a parasympatholytic
therefore interrupts the block.
In type 2 mobitz block the disease located in his-purking system ,the parasympathetic system has no
effect on this part so vagal maneuver too , for atropine it has no effect in infranodal but it increases
the blocking because it increses the atrial rate therefore we have increas number of pulses atriales
blocked explaining why type 2 mobitz bloch worsen with atropin.
Sampling bias= not getting the right people into the study, Selection bias: HAving different people in the
two groups being compared, Measurement bias: the fact of measurement changes what is measured,
ascertainment bias= more likely to see the sickest cases (and so characterize the disease (the opposite
of late look bias where we are more likely to see the healthiest).
alternative names
osteoporosis >> normal bone mineralization and reduced bone mass
osteomalacia >> reduced bone mineralization
paget's disease >> defective bone remodelling, osteoclastic hyperactivity
paget's disease >> osteiitis deformans
hyperparathyroidism that includes bone >> osteitis fibrosa cystica , brown tumor of the bone,von
recklinghausen disease of the bone
osteopetrosis >> marble bone disease
bisphosphate side effect >> osteonecrosis of jaw
albright's osteodystrophy >> pseuohypoparathyroidism
McCune Albright's syndrome >> polyostic fibrosa cystica
legg's perthe's disease >> avascular necrosis of capitial femoral epiphysis
osgood schlatter >> osteochondrosis of tibial tubercle
ankylosing spondylitis >> apophyseal joint arthritis , associated wit h ethesis
reiter's sydrome >> reactive arthritis , associated with ethesis
osteoarthritis >> degenerative joint disease
nursemaid elbow >. radial head subluxation
tennis elbow >> lateral epicondylitis
NF type 1 >> von recking hausen disease >> c/r 17 RAS GTPase actiivating protein
NF type 2 >> c/r 22
MEN 1 >> warmer's syndrome >> c/r 11 MENIN gene
MEN 2A >> sipple's syndrome >> c;/r 10 RET protooncogene
benign intracranial hypertension >> pseudotumor cerebri
wilson >> hepatolenticular degeneration
mytonic dystrophy >> steinert disease
muliple system atrophy >> shy dragger disease
obesity hypoventilation syndorme >> pickwickian syndrome
kawaski disease >> mucocutaneous lymph node syndrome

infectious mononuclesis >> kissing disease, gladular fever
klebsiela pneumia >> friedlander 's pneumonia
HSP >> Leuocytoclastic vasculitis
eczema herpeticum >> kaposi varicilliform eruption
Morbix type 1 block >> wenckebach block
lateral medullary stroke >> wallenberg syndrome >> occulsion of a branch of vertebral artery (PICA)
herediitary haemarrhagic telengectasia >> osler rendu weber syndrome
both TSH and RAIU low in
subacute thyroiditis >> dequavian thyroiditis
silent thyroidistis
huntinton >> hereditary dementia
alzeihmer >> temporoparietal atrophy
pick's disease >> frontotemporal atrophy
crubeck jacob disease >> prion disease > spongioform encephalopathy
progressive mulitfocal leukoencephalopathy >> JCvirus encephalopahty in AIDS
cafe au lait spots seen in >> Neurofirbromatoiss type 1
>> faconi anemia
> > McCune albright syndrome
Ig A nephro - BERGER ds
Golfer elbow - medial epicondylitis
Obesity hypovent $ (pickwickian) not hyper*
MVP - Barlow $
drug of choice for rheumato
Hypertension + gout >> losartan cos losartan lowers uric acid
hypertension + Acute renal failure due to scleroderma >> ACEI
Hypertension + Ig A nephropathy >> ACEI
most common cause of death in
SLE >> long term >>Atherosclerosis
>> acute >> infection
RA >> Atherosclerosis
scleroderma >> pulomonary fibrosis
most feared complication of sjogren >> non-hogkin lymphoma
cystic fibrosis >> respiratory disease
acromegaly >> heart disease
warniff hoffman >> respiratory failure
friedrich ataxi >> cardiomyopathy
xray findings
OA narrowing of joint space +osteophytes+bone cysts
RA narrowing of joint space + juxtaarticular erosions+
periarticularosteopenia
GOUT punched out erosions with rim of cortical bone
scans
HIDA scan >> for gall bladder
MUGA scan>> for heart failure ejection fraction measurement
RAIU scan/ I 123 scintigraphy >> for thryoid nodules
MIBG scan >>to find extra adrenal phaeochromocytoma
DEXA scan >> osteoporosis
sestomibi scan >> parathyroid adenoma
serotonin receptor sctnigraphy >> extra pancreatic ZE syndrome
T99 pertechnetate scan >> meckle's diverticulum (it detects gastric mucosa)
Gallium scan, indian scan >> to find site of infection or tumor in pyrexia of unkown origin
techium pyrophosphate scan, thallium scan >> exercise tes t in myocardial infarct
bone survery for multiple myeloma
somebody pls check those biopsy of choice with me and correct me and add more.
lymphoma >> excisional biopsy
melanoma >> full thickness skin biopsy (excisional biopsy with narrow margins),punch biopsy, >> never
to do shave biopsy
SCC of skin >> punch out biopsy
BCC skin >>punch biopsy or shave biopsy
metastasis suspected lymph nodes and parotid tumors >> FNAB
breast ducts>> excisional biopsy
breast mass >> core biopsy
inflammatory CA of breast >> core biopsy
ductal insitu of breast >> steotactic biopsy
cervix >> colposcopy directed wedge biopsy ( or is it which one?? someone pls remind me) then if above
biposy is indeterminate then cone biopsy
what else? thanks.
NO NO biopsy things are
testicular tumor >> go straight to orchinectomy then send the whole thing to excisional biopsy
highly vascular leisons like hepatic adenoma, hemangioma,
follicular thyroid CA >> FNA u can do but it cant differentiate between follicular adenoma and follicular
CA, u gotta do frozen section again.
ovarian Ca > we dont do FNAB too.
Lichen sclerosis (precancerous) >> Punch biopsy

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UNSORTE D RANDOME NOTES RELATED TO STEP 2CK Credit goes to Dr.

Some mnomonics from FA and review of UW:

Steroids (IV hydrocortisone 100 mg q 8h)

Postpartum Fever Day 1-2

Wonder drugs: drug rxn

which new heart sound is classic for an acute MI?

chloride sensitive vs. chloride resistant metabolic alkalosis

how do chronic Hep B and Hep C differ in their symptomatic manifestations?

HIV medication which causes LIVER FAILURE

Anorexia nervosa complications (7)

biliary atresia: conjucated (direct) hyperbilirubinemia

water, which decreases urine output & increases fluid volume.

Pts. with severe proteinuria are at increased risk for: (4)

what test is done to confirm a diagnosis of acromegaly (GH hypersecretion)

what is the most common form of thyroid cancer?

what needs to be checked before starting someone on Lithium?

relative indications for dialysis: (3)

4) widened QRS with "sine wave" pattern

Difference between Mallory-Weiss and Boerhaave tears. Mallory-Weisssuperficial tear in the

Treatment for TTP. Emergent large-volume plasmapheresis, corticosteroids, antiplatelet drugs

The most common cause of postpartum hemorrhage. Uterine atony

What is the immunodeficiency? A four-month-old boy has life-threatening Pseudomonas infection.

RAPID REVIEW PART 2:

"Stones, bones, groans, psychiatric overtones." Signs and symptoms of hypercalcemia

how to differentiate contrast induced ATN and drug induced ATN

Toxic accumulation in cytosol

80% progress to AML (blast crisis)

Congenital heart defects

p/w SCOLIOSIS, "HAMMER TOES" and ATAXIA

- metal in epiphysis (XR)

- myoglobinuria following stress

- dry eyes (keratoconjunctivitis)

Transient infiltrates resolve spontaneously, does not recur

-normal on light microscopy, fusion of foot processes on EM

cataract ...... cant see clearly at night. glare.

eye conditions and associations

Optic neuritis >> multiple sclerosis

so let me get this straight. pls correct me if u see any error.

black necrotic eschar like things

in skin >> necrobiosis lipoidica diabetacorum >> associated with DM

nausea vomitting after eating food,

Uvula deviated in quinsy (peritonsillar)

most common nephrotic syndrome associated with

unlikely to respond to therapy

missisipi, ohio and wincousin >> blastomyces and histoplasma

6. Most common cause of Encephalitis in USA = Herpes Simplex Virus (HSV )

kawaski disease >> mucocutaneous lymph node syndrome

friedrich ataxi >> cardiomyopathy

Lichen sclerosis (precancerous) >> Punch biopsy

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