Neat pathognomonics and cool stuff
What is associated with EBV?
1. oral hairy leukoplakia 2. Burkitt's lymphoma 3. hemophagocytic lymphohistiocystosis
What is the cut-off age for a solitary lung nodule for use of CT initially?
<35 years old
What volume of blood is associated with escalating intracranial pressure to > 30 mm Hg?
>5 mL
What is the Epley maneuver?
AKA particle repositioning - rotating the patient through a series of 4 positions and staying in each for 30 sec in attempt to relocate debris in the semicircular canal in to the vestibule of the labyrinth. May cause weakness, numbness, vision changes but is 90% successful if performed correctly. Expulsion of an OTOLITH from the Semicircular canal
What is a quinsy abscess?
AKA peritonsillar abscess
What are some causes of idiopathic intracranial HTN?
AKA pseudotumor cerebri; Vit A toxicity Phenytoin, corticosteroids, nitrofurantoin, oral contraceptives, tetracyclines and sulfanamides
Myelodysplastic syndrome will most likely convert to what cancer?
AML
What is a Bankart lesion?
ANTERIOR shoulder dislocation associated w/ an avulsion fx (labrum tear) that starts at 3:00, labrum/glenoid separation at the inferior glenohumeral ligament
What is leukocoria and what does it indicate?
Absence of red-light reflex; possible Ependymoma
If a COPD patient presents with fever and productive cough with relatively normal oxygen levels, what should be the FIRST initial treatment?
Abx
What neurotransmitter is required for memory?
Acetylcholine
What is bird beak sign?
Achalasia on X-ray
What is the Thompson test used for?
Achilles tendon rupture
What are the treatments for both forms of Glaucoma?
Acute Narrow Angle Closure Glaucoma IV Acetazolamide: first line agent - decrease IOP by decreasing aqueous humor production Topical beta blocker (ex. timolol) reduces IOP without affecting visual acuity Miotics/cholinergics (ex. Pilocarpine, Carbachol) Peripheral iridotomy (punches a hole in the iris) is the definitive treatment Chronic Open Angle Glaucoma Prostaglandin analogs are 1st line (ex. latanoprost) - increase outflow of aqueous humor Topical beta blocker (Timolol) - decrease production of aqueous humor Trabeculoplasty - opens trabecular meshwork
What are the four different endocarditis and the organism that affect each one?
Acute bacterial endocarditis: Infection of normal valves with a virulent organism (S. aureus) Subacute bacterial endocarditis: Indolent infection of abnormal valves with less virulent organisms (S. viridans) Endocarditis with intravenous drug users - Staphylococcus aureus Prosthetic valve endocarditis - Staphylococcus epidermidis
Cool facts about local anesthesia
Amides: lidocaine, bupivacaine (2 Is) Esters: tetracaine, benzocaine (1 I) Esters: allergenic 2º to (PABA) Benzocaine: methemoglobinemia Lidocaine: seizures, hypotension Bupivicaine: cardiotoxicity Concentration 1% = 1g/100mL = 10 mg/mL Toxicity Rx: lipid emulsion
What class of antibiotics are contraindicated for botulism?
Aminoglycosides
What is seen with Adenocarcinoma of the lung?
Amylase production in the lymph tissue and gynecomastia
What is Dyskeratosis Congenita?
An x-linked (can be autosomal recessive or dominant too...) inherited telomere shortening disorder, leads to aplastic anemia. If you have gray hair before 18 years old, you probably have dyskeratosis congenita. Symptoms: Bone marrow failure, mottled hyperpigmentation (looks like you have "dirty" skin, but it's a bunch of small darker pigments), abnormal nails (nail dystrophy) on toes and fingers, white growth on tongue (oral leukoplakia). Increased risk of acute leukemias. Diagnose by looking at family history for bone marrow failure. Run tests on telomere length. Treatment: you'll have to treat with a stem cell transplant, but watch out! With shortened telomeres, these patients are at increased risk of bad side effects from chemotherapy, so reduce intensity of pre-transplant treatment.
What are the different mass on the wrist?
Aneurysms (A), especially of the distal radial artery, can be confused with wrist ganglia. However, aneurysms will pulsate, and ganglia typically do not. Solid tumors, like lipomas (C), typically do not transilluminate when a penlight is placed at its side. Neuromas (D) are exquisitely tender, and typically produce radiating sensory symptoms when struck or compressed.
Which mosquito is the major vector of Malaria?
Anopheles gambiae
What test differentiates between fetal and maternal blood?
Apt test
What are the two different eye issues that develop from high triglycerides?
Arcus cornealis - annular lipid deposit in around the cornea Lipemia retinalis - the vasculature inside the eyes are white instead of red during fundoscopic exam
What is Jeune syndrome?
Asphyxiating thoracic dystrophy, also known as Jeune syndrome, is an inherited disorder of bone growth characterized by a narrow chest, short ribs, shortened bones in the arms and legs, short stature, and extra fingers and toes (polydactyly).
What is von Hippel-Lindau disease?
Autosomal dominant disorder associated with inactivation of the VHL gene Multiple hemangiomas in various organs including cranial hemangiomas
What are Axis I conditions?
Axis I provided information about clinical disorders. Any mental health conditions, other than personality disorders or mental retardation, would have been included here. Disorders which would have fallen under this axis include: Disorders Usually Diagnosed in Infancy, Childhood or Adolescence Delirium, Dementia and Amnestic and Other Cognitive Disorders Mental Disorders Due to a General Medical Condition Substance-Related Disorders Schizophrenia and Other Psychotic Disorders Mood Disorders Anxiety Disorders Somatoform Disorders Factitious Disorders Dissociative Disorders Sexual and Gender Identity Disorders Eating Disorders Sleep Disorders Impulse-Control Disorders Not Else Classified Adjustment Disorders Other Conditions That May Be a Focus of Clinical attention
What are Axis II disorders?
Axis II provided information about personality disorders and mental retardation. Disorders which would have fallen under this axis include: Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder Antisocial Personality Disorder Borderline Personality Disorder Histrionic Personality Disorder Narcissistic Personality Disorder Avoidant Personality Disorder Dependent Personality Disorder Obsessive-Compulsive Personality Disorder Personality Disorder Not Otherwise Specified Mental Retardation
What are the water soluble vitamins?
B vitamins and vitamin C
In regards to nephrotic syndrome why does proteinuria occur?
Because the glomeruli are damaged, they become more permeable, thus plasma proteins cross to nephron then urine why you have proteinuria
What are inflammatory processes causing retinopathy?
Bechet's, Sarcoidosis, SLE, Giant cell arteritis, Polyarteritis nodosa
What do you NOT give initially for pheochromocytoma?
Beta Blockers, will cause unopposed alpha constriction during catecholamine release triggered by surgery, could lead to life threatening HTN.
What is the batwing appearance on CXR?
Bilateral interstitial infiltrates (PCP)
Why should bismuth be avoided in children with viral infection?
Bismuth contains salycilates which will lead to reyes syndrome
What is Battle's sign?
Bluish discoloration on the area behind the ears (mastoid process).
What is Cushing's triad?
Bradycardia, hypertension, and irregular breathing secondary to increased intracranial pressure.
What is the test used for hearing loss i.e. loud sounds in an infant?
Brainstem auditory-evoked potentials evaluate the sensory pathway and identify the site of any anatomical disruption. The test does not require any active response from the patient and is useful in the evaluation of suspected hearing loss in an infant.
Porcelain gallbladder
CA of gallbladder
HSV-5
CMV
Retinitis, cotton-wool spots in HIV?
CMV
What does an up or downbeat nystagmus usually indicate?
CNS dysfunction
H. Influenza PNA
COPD gram-negative pleomorphic rods
How do you treat prolactinoma?
Cabergoline Bromocriptine Both are dopamine agonists
Which medication can be considered to halt lactation in women with poorly controlled infection, severe symptoms, instability or wide spread nipple excoriation?
Cabergoline; dopamine agonism antagonizes the release of prolactin
What grows on skirrow agar?
Campylobacter Jejuni Comma or S-shaped bacteria with polar flagella and Oxidase positive
What is Quinke's sign? What does it indicate?
Capillary pulsation in the nail bed Manifests as alternating flushing and blanching of the nail bed due to pulsations in the subpapillary arteriolar and venous plexuses Seen in aortic insufficiency aka AORTIC REGURG
How does carotid massage affect second degree type I and type II heart block?
Carotid massage will typically worsen second degree type I block and improve second degree type II block.
What is associated with Pasteurella multocida?
Cat bites; treat with ampicillin-sulbactam (Unisyn)
Oculoglandular syndrome is synomonous with what?
Cat scratch disease Preauricular, unilateral, watery discharge, LAD
What is the most common cause for alkaline burns?
Cement
What is marasmus?
1. "to waste away" (chronic condition) [body's adaptation to starvation] 2. Inadequate food intake (protein and calories deficiency) over a long period of time 3. Common in children 6-18 months; impairs brain development and learning 4. Muscles, including heart, waste and weaken (no edema) skin and bones 5. Poor growth if any POOR INTAKE OF ANY! ENERGY
What is Amsel criteria?
1. A thin, white homogenous discharge 2. Presence of clue cells in microscopic exam 3. pH of vaginal fluid >4.5 A fishy odor to vaginal discharge before or after addition of 10% KOH (whiff test) 3/4 positive for Bacterial Vaginosis
What disorders does vitiligo associate with?
1. Addison's disease 2. Hyperthyroidism 3. Pernicious anemia
What are some causative agents for paralysis?
1. Botulism 2. MG 3. GBS 4. Poliomyelitis 5. Stroke 6. Tick paralysis 7. Curare 8. Belladonna alkaloids
Triad for intussusception
1. Colicky abdominal pain 2. Abdominal mass (sausage) 3. Currant jelly stools
What is seen with small cell of the lung?
1. Ectopic ACTH 2. SIADH 3. Lambert-Eaton-Syndrome
How many positions of romberg are there and describe each of them?
1. Patient has hands out in front with feet close together 2. Patient performs #1 but tilts head back 3. Patient performs #2 but closes eyes and the provider taps her in her chest to see if she falls
Biphosphonates adverse effects
1. gastric upset and esophagitis 2. ocular inflammation 3. OSTEONECROSIS of jaw 4. hypomagnesemia 5. hypocalcemia
What are the three helminth infections?
1. nematodes - pinworms, roundworms, hookworm 2. cestodes - tapeworms 3. Trematodes - flukes
What is the acronym for hypercoagulable states?
PVC's Platelets: too many (usually more than 1 million/μL) or overactive (TTP, Heparin-induced thrombocytopenia (HIT), HUS, and HELLP). Vascular injury: from plaques, trauma, or burns. Clotting factors: anticlotting factors protein C, protein S, or antithrombin III deficient or not working. Stasis and Surgery.
What should you think if a patient has chronic eczematous itchy, scaling rash on the nipples and areola
Paget's disease
What should you think if a women has an itchy nipple with a breast mass?
Paget's disease (infiltrating ductal carcinoma with spread to the nipple)
What is courvoisier sign?
Palpable non-tender gallbladder on PE
What is WDHA syndrome?
Pancreatic VIPoma (Vasoactive Intestinal Polypeptide tumor) Also known as Verner-Morrison syndrome Tumor secretes VIP, which causes: - Watery - Diarrhea - Hypokalemia - Achlorhydria (inhibits gastric acid secretion)
Kussmals sign?
Paradoxical RISE in central venous pressure with inspiration aka increase in JVD. Seen in cardiac tamponade.
What is Ogilvie syndrome
Paralytic ileus of the colon seen in elderly patients who have been immobilized XR shows massively dilated colon
What are tet spells?
Paroxysmal cyanosis, older children respond by squatting in tetralogy of fallot
Irremovable white lesions on lateral tongue in HIV?
hairy leukoplakia (EBV)
What is at the level of T12?
halfway b/t inf angle of scapula and sup iliac crest
What has a popcorn configuration on x-ray?
harmatoma (calcified)
What is De Musset's sign?
head bob with each heart beat; AORTIC REGURG
What is the most common finding in a patient with a brain abscess?
headache
What is ortner syndrome?
hoarse voice caused by "mitral stenosis"
What helminth infection can cause a (+) FOBT?
hookworm because it's sucking the blood from the intestinal tract leading to RBC presenting i the stool
What is defined as a posterior MI on EKG?
horizontal ST depression with tall, broad R waves and upright T waves in leads V1-3
What is seen with squamous cell carcinoma of the lung?
hypercalcemia
What is the most common electrolyte abnormality with Legionella
hyponatremia
What is the Monro-Kellie doctrine?
idea that the head is a closed shell and the three major components (brain, blood, and CSF) are in a state of dynamic equilibrium - as the volume of one goes up, the volume of another must go down
What is the treatment for DDH or developmental dysplasia of the hip?
Pavlik harness
What can Vit B12 deficiency lead to?
Pernicious anemia --AI disorder that destroys parietal cells in stomach --> loss of IF needed for Vit12 absorp --most common deficiency worldwide BUT also GASTRITIS A -> gastric Ca; if this flares up, use STEROIDS
HSV-7
Pityriasis Rosea - Xmas Tree Rash
What is Stein-Leventhal syndrome?
Polycystic ovary disease, also called hyperandrogenic anovulation
What is associated with Anti-Jo-1
Polymyositis
What is alkaline phosphatase?
Present in liver and bone and increases when there are bone or liver mets (i.e.Paget's disease) Normal is 44 to 147 a hydrolase enzyme responsible for removing phosphate groups from many types of molecules, including nucleotides, proteins, and alkaloids. The process of removing the phosphate group is called dephosphorylation and occurs in an alkaline environment. High ALP levels can occur if the bile ducts are obstructed. A rise in ALP activity occurs with all forms of cholestasis, particularly with obstructive jaundice. The response of the liver to any form of biliary tree obstruction is to synthesize more ALP. The main site of new enzyme synthesis is the hepatocytes adjacent to the biliary canaliculi.
Ring-enhancing intracranial lesions + AMS in HIV?
Primary CNS lymphoma
Describe protein C
Protein C is activated on the endothelial cell membrane, where it is anchored by the endothelial protein C receptor. Activated protein C and protein S assemble on the platelet membrane. Protein S acts as a cofactor for protein C in proteolytically cleaving activated factors V and VIII (factors Va and VIIIa). The main function of protein C is its anticoagulant property as an inhibitor of coagulation factors V and VIII. A deficiency results in a loss of the normal cleaving of Factors Va and VIIIa.
Describe protein S
Protein S is a vitamin K-dependent glycoprotein, but it is not a zymogen of a serine protease enzyme. It serves as a cofactor for activated protein C, which inactivates procoagulant factors Va and VIIIa, reducing thrombin generation.
What does increase intake of protein cause regarding stones?
Protein also increases calcium, oxalate and uric acid excretion. All these factors can lead to stone formation.
HA-PNA
Pseudomonas MRSA
What is "peripheral pruning" of the large pulmonary arteries suggestive or pathognomonic for?
Pulmonary HTN
What are the mechanisms of pulmonary bleeding?
Pulmonary HTN, erosion into a blood vessels, coagulopathy
What is the Graham-Steell murmur?
Pulmonary valve regurge causing an early diastolic murmur
What is Mueller's sign?
Pulsation of the Uvula; AORTIC REGURG
What are the 4 P's of lichen planus?
Purple, polygonal, pruritic, papule
What do macrolides do on EKG?
QT prolongation
What is "shawl sign"?
Rash on face, neck, shoulders, upper chest, and back; DERMATOMYOSITIS
What are Gottron's papules?
Red papules on the elbows, knuckles, and knees seen in DERMATOMYOSITIS.
What is TORCH syndrome?
Refers to infection of a developing fetus or newborn by: (T)oxoplasmosis (O)ther Agents (R)ubella (A.K.A. German Measles) (C)ytomegalovirus (H)erpes Simplex.
What is associated with Anti-SS-A?
SJOGREN syndrome and SLE
What is associated with Anti-DsDNA (anti-double stranded DNA)?
SLE
What is seen with circumflex artery occlusion on EKG?
ST segment elevation in I and AVL with reciprocal ST changes in III and AVF
What is the acronym for hypovolemic hypernatremic?
STAR SIADH THYROID (hypo) ADDISONS RENAL TUBULAR ACIDOSIS
Lofgren's syndrome
Sarcoid - Bernie Mac made you Grin (lofGREN as opposed to Loeffler) Loaf around and you'll FAILE F-fever A-arthritis I-Iritis L-LAD of hilum E-EN
What is Schumms test?
Schumm's test is a blood test that uses spectrophotometer to determine the blood level of methemalbumin.
What is associated with Anti-SCL-70?
Scleroderma
What are the 6 causes of reversible neurocognitive diseases
Secondary to an infection of the CNS (neurosyphilis) Metabolic and nutritional dementias (vitamin B12 deficiency) Inflammatory dementias (vasculitis involving cerebral blood vessels) Dementia caused by a structural defect impinging on the brain (a subdural hematoma or tumor) NPH Endocrine-related dementia (hypothyroidism)
Q-waves/ST elevations V1 and V2 area of infarction and artery involved?
Septal wall, Proximal LAD
What is serous retinal detachment?
Serous retinal detachment is characterized by a dome shaped retina and subretinal fluid that shifts position with posture changes. Serous retinal detachment results from subretinal fluid accumulation which can occur in exudative age-related macular degeneration.
Difference between sialadenitis and sialolithiasis?
Sialadenitis is a bacterial infection of a salivary gland usually caused by sialolithiasis which is an obstructing stone in the salivary gland
What is a coffee bean sign?
Sigmoid volvulus on X-ray
What is an autoimmune disorder that can cause sialadenitis?
Sjogren
What are Burr cells?
Spiculated RBC or tentacle-like of similar size and with regularly spaced projectioins. Seen in uremia or with preparation artifacts.
What are the four clinical stages of HIV/AIDS?
Stage 1 - Clinical stage 1 could be asymptomatic or there could be persistent generalized lymphadenopathy Stage 2 - Characterized by papular pruritic eruptions, Recurrent oral ulcerations etc. Stage 3 - Characterized by Oral hairy leukoplakia, unexplained persistent diarrhea etc. Stage 4 - Characterized by Kaposi sarcoma, CMV retinitis, esophageal candidiasis, HIV encephalopathy etc.
What are the different stages of birth?
Stage 1: Onset contractions to full dilation (primi- 6-20 hours ) (multi- 2-14 hours) Stage 2: Full dilation to baby delivery (primi- 30 mins-3 hours) (multi- 5-6 minutes) Stage 3: After baby delivery to expulsion of placenta (0-30 mins) Placenta should have 2 arteries and 1 vein
Bacterial endocarditis but GI malignancy?
Staph Bovis
What is the organism in Group B strep?
Streptococcus agalactiae
Dental caries are caused by which of the following organisms?
Streptococcus mutans
What is associated with ADAMTS13 deficiency?
TTP
What do you transport in Hanks solution?
Teeth; milk is next best solution
What is a "Boot-shaped" heart on x-ray?
Tetralogy of Fallot (due to RVH)
What is hydrostatic pressure?
The FORCE EXERTED ON THE CAPILLARY WALLS by the volume of fluid within the intravascular space. Think of transudative pleural eff
What is the cerebellum?
The cerebellum is the part of the brain associated with voluntary responses. At the back, responsible for muscle contraction & balance
Ring-enhancing intracranial lesions + focal neurologic deficits in HIV?
Toxoplasma gondii
What is egg-on-a-string sign?
Transposition of great arteries on X-ray
What is a fracture of a tooth?
Trauma to the teeth may cause fractures of the teeth and/or damage to the supporting alveolar bone and periodontium.
What is Lofgren's syndrome?
Triad: 1) erythem nodosum 2)polyarthralgias 3) Bilateral Hilar LAD 20-50% of sarcoid pts. w/ acute presentation
What is carvallos sign?
Tricuspid regurgitation murmur becoming louder during inspiration
Does smoking help UC or crohn's?
UC
What is pANCA positive?
UC
What causes anion gap acidosis <12?
USED CRAP U-ureter-enterostomy S-small bowel fistula E-extra chloride D-diarrhea C-carbonic anhydrase inhibitors R-renal tubular acidosis A-adrenal insufficiency P-pancreatic fistula
What is the treatment for intrahepatic cholestasis in pregnancy?
Ursodiol or Ursodeoxycholic acid Induce pregnancy at 36-37 weeks
What is McRobert's Maneuver?
Used to manage shoulder dystocia during delivery of the infant. Maternal legs are removed from stirrups and sharply flexed upon the abdomen.
What is Bence Jones protein?
Very small globulin protein found in the urine, Detection of Bence-Jones protein may be suggestive of MULTIPLE MYELOMA or Waldenström's macroglobulinemia. They are present in 2/3 of multiple myeloma cases
What is Lhermitte's sign?
Vibratory/ electrical sensations traveling up or down the neck and back with flexion, generally suggesting the presence of cervical myelitis MULTIPLE SCLEROSIS
The most common organism to cause deep neck infections is?
Viridans streptococci
Which of the following supplementations has been associated with reductions in morbidity and mortality in patients with measles?
Vit A
What are the fat soluble vitamins?
Vitamins A, D, E, K
Which duct is most common for sialolithiasis?
Wharton's duct (submandibular gland)
What is Alice in Wonderland Syndrome aka Todd's paralysis?
When MICROPSIA (small vision) and MACROPSIA (big vision) alternates. Occurs in migraine, EBV ("mono") infection, and commonly in children. There is a problem with V5!!!!
What is Hutchinson's sign?
When a zoster infection has a trigeminal eruption including the tip of the nose that risks corneal involvement
What is WAGR syndrome?
Wilms tumor Aniridia Genital abnormality Retardation
What antibiotic is best known for causing aplastic anemia?
Chloramphenicol
What is second line treatment for RMSF?
Chloramphenicol
What is the triad for toxoplasmosis?
Chorioretinitis, hydrocephalus, and intracranial calcifications
What is vulvar lichen sclerosus et atrophicus?
Chronic inflammatory dermatosis characterized by ivory-white plaques or patches with glistening surface commonly affecting the vulva and anus.
What are smudge cells associated with?
Chronic lymphocytic leukaemia (CLL) due to fragile leukaemia cells being crushed by coverslip
What is apple core sign?
Colon cancer on X-ray
How can you differentiate between absence and complex partial seizure?
Complex partial seizure will have a POST-ICTAL state (confusion and loss of memory)
Klebsiella PNA
Currant jelly sputum ETOH RUL bulging fissures cavitations
Pseudomonas PNA
Cystic fibrosis Nursing home resident Cyanosis
What is the difference between wet and dry macular degeneration?
Dry = retinal pigment changes and atrophy Wet = neovascularization or serous retinal pigment hemorrhage and detachment
Which physical exam is most sensitive for carpal tunnel syndrome?
Durkan's test: pressing of median nerve for 30 seconds worsens symptoms
What commonly causes transient brachial plexus palsy and whats the other names for brachial plexus palsy?
Dystocia; Erb's palsy or Walter's tip deformity
What is nonproliferative diabetic retinopathy?
EARLY NORMAL visual acuity microaneurysms, hemorrhages, hard/soft exudates
What is Waterhouse-Friderichsen syndrome?
EPIDEMIOLOGY young children PATHOGENESIS Neisseria meningitidis infection --> DIC, endotoxic shock, adrenal hemorrhagic necrosis --> acute PRIMARY adrenal insufficiency --> lack of cortisol --> exacerbation of hypotension --> death Bilateral adrenal hemorrhage+meningococcemia
What is a hydatid cyst?
Echinoccoal Infection aka tape worm diameter >5 cm nodule on x-ray
What is referred to as the "ring of fire" on U/S?
Ectopic pregnancy (hypervascular lesion with peripheral vascularity on Doppler)
What does a decrease in AFP, hCG, and estriol indicate in quad screen during pregnancy?
Edwards syndrome
What helminth is responsible for lymphatic filariasis (elephantiasis)?
Filarial worms
Facts about thermal burns and burn surface
Fire: obtain CO levels Industrial fire: suspect CN toxicity Superficial: similar to sunburn Superficial partial: red, painful, blisters Deep partial: white, leathery, painless Full-thickness: charred, insensate ABCs and consider intubating early Rule of 9s Parkland formula: 4 mL/kg % total BSA burned (pediatrics give 3 mL/kg); 50% given in first 8 hours, remainder over 16 hours Target urine output: 0.5 - 1 mL/kg/h in adults; 1 - 2 mL/kg/h in children Consider escharotomy for circumferential and full-thickness burns
What is ciguatera poisoning?
Fish poisoning; HOT-COLD REVERSAL (temperature-related dysesthesias); GAMBIERDISCUS TOXICUS; Tx is supportive (IV saline), atropine (hypotension), MANNITOL(increased ICP)
How many stages are there for vesicoureteral reflex and what are they?
Five I: Reflux only fills ureter, no dilation. II: Reflux fills ureter and collecting duct system, no dilation. III: Reflux fills ureter and collecting system with mild blunting of calices with mild dilation. IV: Reflux fills ureter and collecting system with blunting of calyces and some tortuosity of the ureter. Is present with gross dilation. V: Massive reflux with complete blunting of calices, loss of papillary presences on imaging and significant dilation
What is condyloma lata
Flat fleshy white warts, ulcerate, 2° Syphilis
Vitamin B6 association?
anemia, weakness, alcoholism
What is Traube's sign?
aortic regurgitation - systolic and diastolic "pistol-shot" sounds over the femoral artery
What is a cancer is associated with acanthosis nigracans?
Gastric carcinoma
What is Brugada syndrome?
Genetic disorder that causes syncope, v.fib, and sudden death often during sleep Characterized by RBBB, J point elevation, saddle shaped or sloped ST segment; Coved ST segment elevation > 2 mm followed by a negative T wave in leads V1-3 (B)
What is scleral buckling indicative of?
Globe rupture
What is podagra?
Gout of the great toe
Which hepatitis is a hepatovirus?
HAV
Which hepatitis virus is a hepadnavirus?
HCB
Which hepatitis virus is a flavivirus,
HCV
Which hepatitis is deltaviridae?
HDV
Which hepatitis is hepeviridae?
HEV
Which coagulopathies cause thrombocytopenia?
HIT, HUS, DIC, TTP, and HELLP
What is bilateral perihilar infiltrates/diffuse interstitial infiltrates on X-ray in a patient who does not improve despite O2 supplementation pathognomonic for?
HIV-related PNA (PCP)
What causes Bell's Palsy infective agent wise?
HSV
Silver wiring and copper wiring can be seen on fundoscopic exam for what disease process?
HTN retinopathy
What is commonly seen in a uremic patient?
HTN, pruritis, and xerosis
What lab values are you looking for in dehydration?
Hematocrit and serum albumin may be increased in volume-depleted patients Urinary sodium decreases Urea increases (secondary to urine stasis in the nephron), but there is little change in serum creatinine Serum bicarbonate is the most useful laboratory test to assess the degree of dehydration in children. A value below 17 mEq/L differentiates children with moderate and severe hypovolemia from those with mild hypovolemia
What is Christmas disease?
Hemophilia B; Factor IX deficiency
Which hepatitis is DNA?
Hep B
Which hepatitis is the only one that has DNA?
Hep B
What is pathognomonic with acidophilic intranuclear inclusion bodies?
Herpes Zoster
What is paraneoplastic phenomena?
High CA+, SIADH, Anemia, DVT, Cushing's
What is the difference between hip fracture versus hip dislocation?
Hip fracture = A displaced femoral neck fracture will cause external rotation and shortening. Hip dislocation = leg is shortened and internally rotated with flexion and adduction at the hip
What are the 4 H's of polycythemia vera?
Histaminemia Hypervolemia Hyperviscosity Hyperuricemia
What are borborygmi?
Hyperactive high-pitched bowel sounds.
What is a tombstone comedone?
In reference to hidradenitis suppurativa; a double comedone
How do you differentiate between stroke and bell's palsy?
In stroke, the eyebrow raise is preserved because it's usually a central process
What are the physical exam findings of Iritis?
In the dark, Constriction of pupils d/t light will cause pain and may also cause pain in the consensual eye
What is a cerebellopontine angle tumor?
are the most common neoplasms in the posterior fossa, accounting for 5-10% of intracranial tumors. Most CPA tumors are benign, with over 85% being vestibular schwannomas (acoustic neuromas), lipomas, vascular malformations, and hemangiomas.
What is the sensory cortex?
area at the front of the parietal lobes that registers and processes body touch and movement sensations
What can help iron therapy without causing abnormal gut issues?
ascorbic acid (juice)
What is black water fever?
associated with P. falciparum (malaria)
What are S100 proteins?
associated with Schwannomas
What are crowe signs?
axillary freckling associated with NEUROFIBROMATOSIS type 1
Where is the location of the lesion if patient demonstrates with bradykinesia, akinesia, and loss of postural reflexes?
basal ganglia
What positions does atrial myxoma cause syncope?
bending, lying down from a seated position, turning over in bed
What is condyloma acuminatum?
benign warty growth on genital skin due to HPV type 6 or 11 characterized by koliocytic change
What is Ludwig's angina?
bilateral cellulitis of submaxillary/sublingual spaces that usually results from an infected tooth symptoms: poor dentition, "woody" edema in the sublingual area and neck, tongue displaced posteriorly, and drooling
Vitamin K association?
bleeding
What are auspitz's signs?
bleeding when psoriasis scales are pulled off
What does increase intake of sodium cause regarding stones?
Increased sodium intake will increase sodium and calcium excretion and increase monosodium urate saturation.
How does thiazides affect Ca?
Increases resorption
Prominent P-waves in leads II, III aVf, V1, V2 equate to what?
Indicative of R atrial enlargement
R-waves in lead in V1 and V2 + S-waves in I, V4, V5, V6 equate to what?
Indicative of R ventricular hypertrophy
What meds keep open and close PDA
Indomethacin CLOSES; Prostaglandin E1 OPENS
Q-waves/ST elevations II, III, aVF area of infarction and artery involved?
Inferior, right coronary artery (RCA)
What are the different fractures of teeth?
Infraction - Infracted teeth are intact but display surface cracks on the enamel, which are best appreciated by shining a bright light onto the crown of the tooth. Uncomplicated crown fracture - Uncomplicated crown fractures consist of two types: Enamel only - The affected tooth is chipped. Pain is typically absent but may be elicited with manipulation. Enamel and dentin - The chipped tooth has exposed dentin. The tooth is sensitive to touch and temperature. Complicated crown fracture - Complicated crown fractures have associated exposure of the pulp. These injuries have an increased risk of infection. Root fracture - Fractures of the root may or may not also involve the crown (crown-root fracture). If the crown is not involved, a root fracture is suggested by mobility of the crown. Dental radiographs are necessary to confirm a root fracture. Root fractures may be horizontal, vertical, or oblique. Alveolar fracture - Fracture of the alveolus causes dislocation of multiple teeth that move together with palpation.
What type of regional nerve block will provide anesthesia to the upper central incisor?
Infraorbital nerve block. An inferior alveolar nerve block will provide anesthesia to the lower central incisors.
What does inspiration reflexively do with vagal tone? What does expiration reflexively do with vagal tone?
Inspiration: reflexively inhibits vagal tone, thereby increasing the sinus rate Expiration: vagal tone rises to its previous state and the rate declines
What is the histopathology on herpes zoster?
Intraepidermal vesicles, acantholysis, and reticular degeneration
What is associated with coiled spring or target lesion on US?
Intussusception
What are the symptoms of Brown-sequard syndrome
Ipsilateral loss of motor strength, vibratory sensation, and proprioception with contralateral loss of pain and temperature sensation below the level of injury
What is the Rumack-Matthew Nomogram?
It is a chart used to assist in the degree of toxicity after an acute, single ingestion of APAP; Above TREAT, below NO treatment
What should happen when a patient's blood is mixed in with normal blood who has hemophilia? What if it doesn't happen?
It should normalize, it's called a mixed study. If it doesn't, then look for lupus anticoagulant or factor inhibitor (C/S, antithrombin III)
What is the hurley staging system for?
It's for staging hidradenitis suppurativa Stage 1: single or multiple abscesses, but no sinus tract or scaring Stage 2: sinus tracts and scarring Stage 3: multiple interconnected sinus tracts and abscesses across entire area
Dark purple skin/mouth nodules in HIV?
Kaposi Sarcoma
HSV-8
Kaposi's sarcoma
What does a straight leg pain test for?
L5 or S1 radiculopathy from HERNIATED DISC
What is proliferative diabetic neuropathy?
LATE or ADVANCED Neovascularization
What do you need to monitor with oral terbinafine?
LFT levels or aminotransaminases
What does a vestibular (horizontal) nystagmus indicate?
Labyrinth or vestibular nerve dysfunction
What is Dysarthria-Clumsy hand syndrome?
Lacunar stroke - can be silent, pure motor or sensory, or ataxic hemiparesis
Q-waves/ST elevations I, aVL, V5, V6 area of infarction and artery involved?
Lateral wall, circumflex (CFX)
What is the medical term for the manifestations of widow spider bites?
Latrodectism
In romberg, when patient has hands out with feet close and falls/stumbles what does this indicate?
Lesion in the
In romberg, when patient has hands, out with feet close, head tilted back and falls/stumbles what does this indicate?
Lesion in the
In romberg, when patient has hands out, with feet close, head tilted back with eyes closed and provider pushes them gently in the chest and patient falls/stumbles what does this indicate?
Lesion in the posterior column
When treating patients for toxoplasmosis, what do you give them if you are giving them Pyrimethamine?
Leucocorven
What is a virchows node?
Located in the Left supraclavicular fossa. Associated with lymphatic metastasis of abdominal, specifically GASTRIC or PANCREATIC cancer
What is loeffler's syndrome
Loeffler's Syndrome is a result of the massive infestation of larvae migrating through the lungs during the early phase of the infestation. Symptoms develop 1 - 2 weeks after the infection; they usually last 5 - 10 days. Can be caused by idiopathic eosinophilia and can cause "simple pulmonary eosinophilia" or loeffler endocarditis. They are accompanied by mild blood eosinophilia (5 - 20%) and sometimes with the elevated Immunoglobulin E (IgE) level. Treat with benzimidazole drug.
What is the most reliable sign of acute otitis media (AOM)?
Loss of tympanic membrane mobility during pneumoinsufflation is the most reliable sign for diagnosing acute otitis media.
What is the earliest sign of iron deficient anemia?
Low serum ferritin
What is a dilute Russell viper venom time?
Lupus anticoagulants (LA) are autoantibodies produced by the immune system that mistakenly attack certain components of the body's own cells. They specifically target phospholipids as well as the proteins associated with phospholipids that are found in the outer-most layer of cells (cell membranes). These autoantibodies interfere with the blood clotting process in a way that is not fully understood and increase a person's risk of...
What is associated with bilateral facial palsy?
Lymes disease (Bell's palsy)
What is Sipple syndrome?
MEN 2a "MPH" -Medullary thyroid cancer -Pheochromocytoma -Hyperparathyroid
What is Wermer's syndrome?
MEN type 1 "3 P's" -Pancreatic islet cell tumours -Parathyroid hyperplasia -Pituitary adenomas
What is the most sensitive indicator for cerebral herniation?
bradycardia
Where is the location of the lesion if patient demonstrates with a unilateral sensory or weakness finding on one side of the body and contralateral finding of weakness or sensory loss of the face?
brain stem
What is the Lund and Browder Chart?
burn tool for evaluating total body surface area according to age with specific calculations for each body part burned; RECOMMENDED for children who are burned
What do right sided cancers do?
cause bleeding
What do left sided cancers do?
cause obstruction
What is a positive romberg sign (test) indicated for?
central vertigo
Where is the location of the lesion if patient demonstrates with ataxia, intention tremor, and dysmetria.
cerebellum
Where is the location of the lesion if patient demonstrates with motor, sensory, visual or auditory findings depending on the lesion.
cerebral hemisphere
Aortic dissection when >50 years old?
chronic HTN
What is the triad for hemochromatosis?
cirrhosis, secondary diabetes mellitus, and bronze skin. Also find cardac arrhythmias and gonadal dysfunction.
What is a paraneoplastic syndrome?
combination of hypoglycemia, erythropoiesis, hypercholesterolemia & hypercalcemia; presentation of hepatocellular carcinoma
What is a Hill-Sachs lesion?
compression fracture of posterior humeral head during ANTERIOR shoulder dislocation
What are PE findings of Uncal transtentorial herniation?
compression of parasympathetic fibers running with the third cranial nerve resulting in a fixed and dilated pupil due to unopposed sympathetic tone.
Aortic dissection when <40 years old?
connective tissue disorders
Is calcified pericardium on x-ray suggestive of restrictive or constrictive cardiomyopathy?
constrictive
Which heart condition has a pericardial knock?
constrictive pericarditis
Upper motor neuron damage to CN VII (central facial palsy) in left hemisphere?
contralateral facial weakness of the lower face only, with preservation of the muscles of the upper face on both sides, due to the dual innervation of the upper face. Patients will have a weak smile, but will be able to close their eye tightly and wrinkle their forehead symmetrically
What is used for cold-induced urticaria?
cyproheptadine
PPI and Coronary artery disease patients?
decreases the effectiveness of clopidogrel
What is Shy-Drager syndrome?
degenerative multiple system atrophy *symptoms resemble Parkinson Parkinsonism predominantly with orthostasis
How does a spinal C5 present?
deltoid and biceps weakness and diminished biceps reflex
What is tophi?
deposits of urate compounds in and around the joint of the extremities.
How do you treat insulinoma?
diazoxide or somatostatin agonists (such as octreotide)
What is Gallavardin phenomenon?
difference of harsh quality (LUSB) versus musical quality in the apex. "Aortic stenosis" differentiates from mitral regurg because it doesn't radiate to L axilla
What is linitis plastica? What disease is it observed in?
diffuse thickening of the stomach wall due to cancer infiltration; gastric cancer
GAD-65 with C-peptide
expensive test for DM
If pleural effusion develops primarily on the left side, what should you think initially?
exudative
What is the most common causes of neonatal hemorrhaging?
failure to administer vitamin K in the immediate postpartum period (HOME-BIRTH)
How does sickle cell affect HgbA1C?
falsely low
Why should you make sure to r/o Vit B12 deficiency before administering folate for a macrocytic anemia?
folate supplementation can alleviate the anemia but does not reverse, and may even worsen, neurologic deficits
How long does the parachute reflex remain intact?
for life
HSV-2
genital herpes
What causes anion gap acidosis >12?
MUDPILES M-methanol U-uremia D-DKA P-paraldehyde I-INH/iron L-lactic acidosis E-ethylene glycol S-salicilates
Differentiate macular degeneration vs glaucoma vs cataract
Macular degneration = central vision -> peripheral Glaucoma = peripheral vision -> central and "cloudy" cornea Cataract = "cloudy" lens
What is claritin made with?
Milk
Which heart murmurs are only holosystolic or pansystolic?
Mitral regurg Tricusp regurg VSD
What can precipitate an acute asthma attack?
NSAIDS and aspirin
What are nagayama spots and what do they infer?
Nagayama spots: an exanthem of erythematous papules on the mucosa of the soft palate and the base of the uvula. It is seen in 2/3rd of patients with ROSEOLA.
What is string sign?
Narrowed bowel lumen by Crohn's disease or pyloric stenosis
Which testicular cancer is radioresistant?
Nonseminomatous are radioresistant meaning they will not respond to radiation therapy
What can strep lead to other than the usual processes?
OCD and anxiety; thought to be because Aby attacks part of the brain
What is the tonic neck reflex?
Occurs when newborn's head is turned to the side, the arm on that side will extend while the opposite arm will contract - prepares the infant for voluntary reaching and may be a precursor to hand/eye coordination. DISAPPEARS at 6-7 months
Bitemporal hemianopsia is due to what?
Optic chiasm lesion
What is schistosomiasis?
Other names for schistosomiasis are bilharzia or "snail fever". It is caused by the parasite Schistosoma
What is the differential for gynecological pain?
Ovarian cyst, ovarian torsion, PID, mittelschmerz, tubo-ovarian abscess (TOA), uterine fibroid, necrotic fibroid, pregnancy, ectopic pregnancy, endometriosis, cancer of the cervix/ uterus/ovary, endometrioma, gynecologic tumor, torsion of cyst or fallopian tube
What are the cognitive domains?
PCELLS Perceptual motor ability Complex attention Executive function Language Learning and memory Social cognition
What is the classic triad for congenital rubella?
PDA, Cataract, and Sensorineural hearing loss.
What can cause an isolated pleural effusion and/or acute cor pulmonale?
PE
What is Rumpel-Leede phenomenon?
PETECHIAE formation after blood pressure cuff inflation. Associated with RMSF
Focal neurologic deficits, non-enhancing white matter lesions, CD4 < 200 in HIV?
PML (JC virus)
What is dysgeusia?
inability to taste or altered
What is an indicator iron therapy is working?
increasing retic count
What is at the level of T6?
inf. angle of scapula lying prone
What is chorioretinitis?
inflammation of the choroid and retina (Posterior uveitis)
What is the triad for acute closed angle glaucoma?
injected conjunctiva, cloudy cornea, and fixed dilated pupil
What is the triad for Iritis?
injected conjunctiva, cloudy cornea, and small constricted pupil
What is ciliary flush?
injection around the limbus (transition zone between the cornea and the sclera)
What is an "owl eye" inclusion body on tissue biopsy in reference to?
intro-cytoplasmic inclusions CMV
What is luxation of a tooth?
involve the supporting structures of the teeth, including the periodontal ligament and alveolar bone
What is Milian ear sign?
involvment of ear from erysipelas
What is responsible for central acuity?
macula
What is hairy cell leukemia?
malignant disorder of well-differentiated B lymphocytes w/ an unclear cause very rare disease that accounts for 2% of adult leukemia cases and most commonly affects older males TX=rituximab
What is an egg shaped heart on x-ray?
malposition of the great arteries
What is the most common location source for a pulmonary embolism?
proximal femoral veins
What is a side effect of bleomycin?
pulmonary fibrosis
What are PE findings of central transtentorial herniation?
pupils pinpoint and there is spasdic motor paresis
What is purpura fulminans associated with?
meningoccocal septicemia
What is the latest sign of iron deficient anemia?
microcytic/hypochromic changes in RBC
MRSASS
mitral regurgitation systolic, aortic stenosis systolic
MSDARD
mitral stenosis diastolic, aortic regurg diastolic
What is a target sign on US?
pyloric stenosis
What is olgivie sign?
pyloric stenosis
What is the Reid index?
ratio of submucosa thickness to epithelium thickness (DOES NOT INCLUDE CARTILAGE). This is in regards to CHRONIC BRONCHITIS! thickness of glandular layer/total thickness of bronchial wall (gland layer is >50% of total bronchial wall)
What is enophthalmos?
recession of the eyeball within the orbit "sunken eyeball"
HSV-1
oral lesions "cold sores"
What cancer is most associated with paget's disease?
osteosarcoma
What is the reverse straight leg test
pain with passive extension of the hip when proned. Indicative of L3 or L4 radiculopathy
What is Horner's syndrome?
partial ptosis miosis anhidrosis SUSPECT LUNG CANCER and GET A CHEST XRAY
What is responsible for peripheral vision?
peripheral retina
What are Auer rods?
peroxidase positive cytoplasmic inclusions in granulocytes and myeloblasts "AML"
What is the Gleason score?
scoring system in which architectural features of prostate cancer cells are graded, with 1 representing the most well-differentiated and 5 representing the least well-differentiated; the 2 scores represented by the 2 most prevelant differentiation patterns identified in a biopsy specimen are added together to derive a composite score; the most prevelant differentiation pattern is listed first
Vitamin C association?
scurvy, bruising, IMPAIRED WOUND HEALING, petechiae, and weakness
What is the Nikolsky sign?
separation of epidermis upon manual stroking of skin. Associated with STAPHYLOCOCCAL SCALDED SKIN SYNDROME (SSSS), but also SJS and TEN. PEMPHIGUS
triad for pheochromocytoma
severe headache tachycardia profuse sweating
What is Bornholm disease ?
severe pleurodynia epidemics
Pancoast syndrome?
shoulder pain horrner's syndrome (miosis, ptosis, anhydrosis) atrophy of hand/arm mm tumor at the apex of the lung -pain in shoulder -horner's syndrome due to involvement of cervical sympathetic ganglia Shoulder pain radiating to arm in ulnar distribution - tumor invasion of eight cervical and first thoracic nerves
What is a waterview x-ray indicated for?
sinusitis
What is the Koebner sign?
skin lesions on lines of trauma. It's associated with erythema multiforme
What is athetosis?
slow, writhing movements; generally seen in CEREBRAL PALSY patients
How do you treat glucagonoma and VIPoma?
somatostatin agonists
How do you treat a somatotroph adenoma?
somatostatin or dopamine agonists
Whatis the artery most associated with woodruff's plexus?
sphenopalatine artery
what is actinic keratosis a precursor to?
squamous cell carcinoma
What maneuvers increase preload?
squatting and hand grip
What is pleurodynia?
sudden occurrence of lancinating chest pain or abdominal pain attacks, commonly associated with fever, malaise, and headaches. Coxsackievirus B is an RNA Enterovirus, which usually causes an asymptomatic or brief upper respiratory tract or gastroenteric infection.
What medication is contraindicated for migraine relief if they have CAD?
sumatriptan
What is Wellen's syndrome?
t-wave changes w/hx of anginal CP w/caridac serum markers elevated; no Q waves and sig ST elevation assoc w/LAD stenosis *PAIN-FREE* but with angina biphasic T waves in leads V2-3 CRITICAL HIGH-GRADE occlusion of the proximal LAD
What is Basset's sign?
tenderness to palpation at distal pole of the patella in full extension and no tenderness to palpation at distal pole of the patella in full flexion.
What is penalization therapy?
the sound eye is blurred with glasses or drops (amblyopia)
What is the sag sign and when is it seen?
tibia sagging posteriorly PCL tear
What is the ankle mortise formed by?
tibia, fibula, and syndesmotic ligaments
What is TAH-BSO?
total abdominal hysterectomy with bilateral salpingo-oophorectomy
What is Uhthoff's phenomenon?
transient worsening of vision with increased body temperature associated with Optic Neuritis in MS
If pleural effusion develops primarily on the right side, what should you think initially?
transudative
How does a spinal C7 present?
triceps weakness and paresthesias in the middle finger and diminished brachioradialis reflex.
Which cranial nerve is activated during a migraine?
trigeminal
What is aniscoria?
unequal pupil size
How long does the grasp reflex remain intact?
until 2-3 months
How long does the moro reflex remain intact?
until 3-6 months
How long does the tonic neck reflex remain intact?
until 6-7 months
What is adenomyosis?
uterine thickening that occurs when endometrial tissue moves into the muscular walls of the uterus (rather than just lining the uterus). implantation of endometrial tissue in the myometrium. tender, symmetric, enlarged "boggy" uterus.
What maneuvers decrease preload?
valsalva and standing
HSV-3
varicella zoster chicken pox
What is lupus pernio?
violaceous, raised discoloration of nose/ear/cheek/chin. Rresembles frostbite. pathognomonic for SARCOIDOSIS
What is poliomyelitis characterized?
viral destruction of anterior horn cells in the spinal cord
Lower motor neuron damage to CN VII (Bell's palsy) on the left?
weakness involving the mouth, eye and forehead. Specific clinical features include: weakness raising the eyebrow and furrowing the brow; difficulty or inability to close the eye; weakness in grimacing and smiling; and flattening of the nasolabial fold IT'S ON THE SAME SIDE
Lower motor neuron damage to CN VII (Bell's palsy) on the right?
weakness involving the mouth, eye and forehead. Specific clinical features include: weakness raising the eyebrow and furrowing the brow; difficulty or inability to close the eye; weakness in grimacing and smiling; and flattening of the nasolabial fold IT'S ON THE SAME SIDE
What is the Drehmann sign?
while in the supine position, hip externally rotates and abducts with passive hip flexion.
What are three disease processes that should be thought of when hilar lymphadenopathy is seen on CXR?
young (black) female in 30's = sarcoidosis Young kid with a fever, from Ohio, zoo keeper = histoplasmosis Old guy in his 60's works on ceramics = Berylliosis"
What alternative medicine can you give cocaine toxicity besides benzo's?
phentolamine
What are common medications that cause gingival hyperplasia?
phenytoin, CCB, and cyclosporine
What causes a + boas sign?
phrenic nerve irritation during biliary colic and acute cholecystitis
What are PE findings of upward transtentorial herniation?
pinpoint pupils and downward gaze without vertical eye movements
What are PE findings of Tonsillar herniation?
pinpoint pupils and flaccid motor paresis
What is Enterobius vermicularis?
pinworm
What brain structure is responsible for vibratory sensation and proprioception?
posterior column
What is Sleeping beauty syndrome aka Klein-levine syndrome?
is a rare sleep disorder characterized by persistent episodic hypersomnia and cognitive or mood changes. Many patients also experience hyperphagia, hypersexuality and other symptoms.
What is Myerson sign? What disease does it indicate?
is reflexive, sustained eye blinking in response to repetitive tapping just above the nasal bridge between the eyes. AKA Glabellar reflex. It may indicate PARKINSON's
What is a clue cell?
it's associated with bacterial vaginosis
How is a positive galeazzi test defined?
limb-length discrepancy
What is Darier's sign?
localized uticaria appearing where the skin is rubbed (Histamine induced)
What is the double ring and alternate name?
AKA double decidual sign. Helps confirms pregnancy on US, it's the stalk and the yolk
Why use exophthalmos verus proptosis?
Exophthalmos is used in endocrine related Proptosis is used when it's non-endocrine related
What dermatome is the umbilicus?
T10
What dermatome is the nipple?
T4
What is the most known side effect of haloperidol (or psychotropic drugs)?
TARDIVE DYSKINESIA
What is a Ghon complex?
TB granulomas (Ghon focus + lobar and perihilary lymph node involvment) - primary infection or exposure (Calcified lymph+lesion)
What is Pott's disease?
TB of the spine
what is the Marcus Gunn pupil?
afferent pupillary defect, so decreased bilateral constriction when light is shone in affected eye
What is risus sardonicus?
"Evil grin" A common first clinical sign of TETANUS; the jaw becomes locked and results in an 'evil smile' presentation
Vitamin B2 association?
"Riboflavin" glossitis and seborrheic dermatitis
What is POP-Q?
(pelvic organ prolapse quantification): quantifies the extent and location of defects
What is the Zavanelli maneuver?
*maneuver of LAST RESORT for shoulder dystocia -cephalic replacement into pelvis and then C section - fetal head is rotated into a direct occiput anterior position, then vertex is flexed and pushed back into the birth canal, while holding continuous upward pressure until C section is complete
What are the osmotic laxatives?
- Increase fecal water content, bowel distention, increased peristalsis, and evacuation: Mg2+, Na+, and K+ salt preparations can cause substantial loss of water - Contraindicated in kidney disease, may be problematic in heart failure, hypertension, oedema - Polyethylene glycol (GoLYTELY), sorbitol, glycerin, lactulose (Chronulac), Mg hydroxide (Milk of Magnesia), sodium phosphate (Fleet Phospho-Soda)
What is Poland syndrome?
- Ipsilateral breast and nipple hypoplasia and/or aplasia, - deficiency of subcutaneous fat and axillary hair, - absence of the sternal head of the pectoralis major muscle, - hypoplasia of the rib cage, and - hypoplasia of the upper extremity
What are the classic bacterial PNA symptoms associations?
- S. Pneumoniae: Rust colored sputum, common in patients with splenectomy - S. Aureus: Salmon colored sputum, lobar, after influenza, MRSA treat with vancomycin - Pseudomonas: Ventilators, Cystic fibrosis, patients become sick fast - treat with 2 antibiotics - Legionella: Air conditioning, aerosolized water, low NA+ (hyponatremia), GI symptoms (diarrhea) and high fever - Mycoplasma: Young people living in dorms, (+) cold agglutinins, bullous myringitis, walking pneumonia, low temp - Klebsiella: Alcohol abuse, currant jelly sputum, aspiration - Pneumocystis jiroveci HIV CD4 <200, immunosuppressed - Haemophilus influenzae: COPD, smokers, postsplenectomy - Histoplasma capsulatum caused by bat droppings -looks like sarcoidosis on CXR - Coccidioides (valley fever) in dry states - Chlamydia pneumoniae: College kids, sore throat, long prodrome - Poor dental hygiene is associated with pneumonia caused by anaerobes - Influenza pneumonia is characterized by a more precipitous onset and fulminant course - The indolent course suggests an atypical pneumonia and Mycoplasma is the most common atypical agent - Lobar consolidation is seen in community-acquired pneumonia - Apical infiltration is seen in tuberculosis
What is responsible for color vision?
- cones - they express visual pigments other than just rhodopsin - each opsin still requires 11-cis retinal - difference in wavelength response of the pigments is due to slight differences in amino acids in and near to the retinal binding pocket
What is MEN type IIB?
-Mucosal neuromas (in 100% of the patients with MEN IIB)—in the nasopharynx, oropharynx, larynx, and conjunctiva -Medullary thyroid carcinoma (in 85% of the patients with MEN IIB)—more aggressive than in MEN IIA -Marfanoid body habitus
Congenital syphilis symptoms
-Neonatal death -Deafness -Saber shins -Neurologic impairment -Bone deformities (hutchinson teeth notching, saddle nose deformity)
What is Wegener's granulomatosis?
-necrotizing granulomatous vasculitis that affects small vessels of lungs, upper airways and kidneys -Tissue biopsy gold standard, but (+) c-ANCA is strongly suggestive -treatment includes immunosuppressives and glucocorticoids c-ANCA Ab, attacks ENT, lungs, kidney
How many degrees are there in uterine prolapse and what are they?
0 degree: No descent 1st degree: To the upper vagina / descent between normal and ischial spine 2nd degree: To the introitus / between ischial spines and hymen 3rd degree: Cervix is outside the introitus / within hymen 4th degree (sometimes referred to as procidentia): Uterus and cervix entirely outside the introitus / through hymen
How many days does MMR have to be separated by from when giving Varivax?
28 days d/t body not being able to cope with more than 1 vaccine
How long does it take to replenish iron stores?
6 months
When should infant eyes move in parallel without deviation?
6 months
How long does it take to correct iron deficient anemia?
6 weeks
What is Charcot-Marie-Tooth disease?
A HEREDITARY genetic disease of the peripheral nervous system characterized by peroneal muscular atrophy that affects motor and sensory nerves. Initially affects muscles in lower leg and foot, but eventually progresses to muscles of hands and forearm. Motor and sensory loss, loss of reflexes, hammer toes. "stork leg deformity"
What is livedo reticularis and what could it be associated with?
A purplish discoloration of the skin caused by dilation of capillaries and venules secondary to stasis or changes in underlying blood vessels A network-patterned discoloration of the skin caused by dilation of capillaries and venules POLYARTERITIS NODOSA
What is antithrombin III deficiency?
A rare hereditary disorder that generally comes to light when a patient suffers recurrent venous thrombosis and pulmonary embolism, and repetitive intrauterine fetal death (IUFD). Inheritance is usually autosomal dominant.
What is 5-hydroxyindoleacetic acid (5-HIAA)?
A serotonin metabolite. Measured in the urine, especially used in diagnosis/monitoring of carcinoid syndrome
What is associated with chromogranin?
A tumor marker for neuroendocrine tumors.
What is Vincent's angina?
AKA "Trench mouth" is Necrotizing gingivitis: Characterized by the "punched-out" appearance of the gingival papillae. Caused by an overgrowth of oral flora. Occurs most often in children and young adults in developing nations. Mainly occurs in sub-Saharan Africa.
What is a flame-like extravasation in GU indicate?
AKA "sunburst" indicates a extraperitoneal rupture, GU trauma
Which mosquito is the major vector for zika?
Aedes mosquito
What is the Pulfrich phenomenon?
After an episode of demyelinating disease/optic neuritis, a relative conduction delay in one eye can cause altered perception of motion which objects moving in a straight line appear to be moving in a curved trajectory. For example, a pendulum would appear to trace an elliptical path instead of a single-plane oscillation
In regards to nephrotic syndrome why does hypoalbunemia occur?
Albumin is the smallest and therefore the easiest to become excreted which leads to Hypoalbuminemia.
How do you treat tumor lysis syndrome?
Allopurinol
In regards to nephrotic syndrome why does hyperlipidemia occur?
Also losing proteins that inhibit synthesis of lipids = hyperlipidemia
What is Dermacentor variabilis?
American dog tick RMSF
What is the trick to remember the different anesthetics to differentiate Amides from Esthers?
Amides have 2 "i" Esters have 1 "i"
Which drug class can precipitate acute angle glaucoma?
Anticholinergics i.e. Metoclopramide
What are the different locations of infarction on EKG?
Anterior wall ST elevation in leads V1 through V4 Inferior wall ST elevation in leads II, III, and AVF Lateral wall ST elevation in leads I, AVL, V5, and V6 Posterior wall ST depressions V1 through V3 and elevations in V8 and V9
Q-waves/ST elevations V1 thru V4 area of infarction and artery involved?
Anterior wall infarct, LAD
Q-waves/ST elevations I, aVL, V4-V6 area of infarction and artery involved?
Anterolateral, Mid LAD or CFX
Primary biliary cirrhosis
Anti-mitochondrial antibody
What is the Austin Flint murmur?
Associated with Severe aortic regurgitation. Low pitched and rumbling that can be heard mid to late diastole. Best heard over the apex.
What is Goodpasture's syndrome?
Autoimmune disease that attacks the basement membranes of the lungs, alevoli, and glomerulus - it is caused by viral infections and surgery of the lung or kidneys.
What are the different luxation injuries to teeth?
Concussion - The tooth is neither loose nor displaced; it may be tender with the pressure of biting because of inflammation of the periodontal ligament Subluxation - The tooth is loose, but not displaced from its socket; the periodontal ligament fibers are damaged and inflamed Intrusion - The tooth is driven into the socket, compressing the periodontal ligament and fracturing the alveolar socket Extrusion - The tooth is centrally dislocated from its socket; the periodontal ligament is lacerated and inflamed Lateral luxation - The tooth is displaced anteriorly, posteriorly, or laterally; the periodontal ligament is lacerated, and the supporting bone is fractured Avulsion - The tooth is completely displaced from the alveolar ridge; the periodontal ligament is severed, and fracture of the alveolus may occur
What is VACTERL?
Constellation of congenital conditions that occur together: 1. Vertebral (X-ray) 2. Anus imperforation/atresia 3. Cardiac (do echo) 4. Tracheal/Esophageal fistula or esophageal atresia 5. Renal (do u/s) 6. Limb defects If pt has one of these on presentation, always look for the others by doing the exam mentioned in parenthesis above.
What is the Budapest consensus criteria?
Continuing pain, which is disproportionate to any inciting event; for the clinical diagnosis of CRPS
What are the three types of tinnitus?
Continuous tinnitus: presbycusis or long-term hearing loss Episodic, low-pitched, rumbling tinnitus: Meniere disease Pulsatile tinnitus (whooshing): vascular cause
What is cANCA positive?
Crohn's
Chronic watery diarrhea in HIV?
Cryptosporidium
What is Ixodes scapularis?
Deer tick LYMES DISEASE
What is the turtle sign?
Delivered fetal head retracts against maternal perinium (pulls back inside vagina) -Indicated Shoulder Dystocia
What is associated with Celiac disease?
Dermatitis herpetiformis aka Duhring's disease
What are seen on x-ray for hypersensitivity pneumonitis?
Diffuse nodular densities are seen in hypersensitivity pneumonitis.
How do you treat lead poisoning?
Dimercaprol Calcium disodium "EDTA" - edetate a Chelating chemical
What is rhinophyma?
Enlarged nose; Subtype 3 Rosacea
What are Negri bodies?
Eosinophilic (pink), Cytoplasmic inclusion that occurs in brain cells infected with RABIES virus
HSV-4
Epstein-Barr virus
What is an erythematous appearance to oral leukoplakia what is it known as and the importance of it?
Erythroplakia and it's at an INCREASE risk of dysplasia or cancer (90%)
What are endoscopic stacked circular rings pathognomotic for?
Esophagitis
What is the Baden Walker System used for?
Eval of Pelvic organ prolapse Grade 1 - descent above the hymen Grade 2 - descent to the hymen Grade 3 - descent beyond the hymen Grade 4 - total prolapse
How do you know if the patient suffered from an intraperitoneal rupture?
Extravasated contrast material throughout the peritoneal cavity, which could outline the bowel and fill the cul-de-sac and the paracolic gutters, indicates intraperitoneal rupture
What is associated with carcinoid tumors?
Facial flushing, hemoptysis, wheezing WITH LOW BP!!!***
What cranial nerve is most commonly affected in necrotizing otitis externa?
Facial nerve
Describe factor V
Factor V, is a procoagulant clotting factor that amplifies the production of thrombin, the central enzyme that converts fibrinogen to fibrin, which leads to clot formation. Factor V is synthesized as an inactive factor that circulates in plasma. A small amount of thrombin at the site of a wound activates factor V by limited proteolysis. This activated factor V (factor Va) then serves as a cofactor in the prothrombinase complex, which cleaves prothrombin to generate more thrombin, in a positive feedback loop.
What is bell clapper deformity?
Failure of normal posterior anchoring of the gubernaculum, epididymis and testis So called because it leaves the testis free to swing and rotate within the tunica vaginalis of the scrotum much like the gong (clapper) inside of a bell. Trauma can also be causative.
Describe the three fundamental causes for othostatic HoTN and descriptions?
Hypotension without a compensatory increase in heart rate (< 10 beats/min) suggests autonomic impairment. Marked increase (to > 100 beats/min or by > 30 beats/min) suggests hypovolemia or if symptoms develop without hypotension, POTS.
What stage is an eight ball hyphema?
IV; total anterior chamber volume (It's completely full)
What is phlegmasia cerulean dolens?
Massive thrombosis causing venous insufficiency (painful blue leg).
what are lisch nodules?
Melanocytic hamartomas commonly associated with NF1, raised and usually tan, increase with age.
Why does chalazion appear more often in the upper eyelid?
More sebaceous glands in the upper eye lid
What is the most common viral organism and bacterial for parotitis?
Mumps (paramyxovirus) Staph Aureus
What is pheochromocytoma associated with?
NF type I MEN 2A/B Von Hippel-Lindau disease
What is the pentad of TTP?
Neurologic symptoms, Renal failure, Thrombocytopenia, Fever, Microangiopathic hemolytic anemia (Don't forget it. When I was an intern, my senior resident asked me this quesiton more times than I would like to remember.)
What is pellegra?
Niacin deficiency 4'Ds = diarrhea, dermatitis, dementia, and death
What are some causes for back pain?
Night pain, weight loss: malignancy Back pain + fever + neurological deficits: epidural abscess Acute bony tenderness: fracture Young, morning stiffness: seronegative spondyloarthropathy Urinary retention: cauda equina syndrome Pain with extension, relief with flexion: spinal stenosis IMAGE if red flags present
ST-DEPRESSIONS area of infarction and artery involved?
Posterior wall, RCA or CFX
Which eye tumors present with hyphema?
Retinoblastoma and melanoma of the iris.
What is felty syndrome?
Rheumatoid arthritis, splenomegaly, leukopenia uncommon form of RA accompanied by splenomegaly, granulocytopenia (long process)
What is Caplan syndrome?
Rheumatoid arthrtitis and pneumoconioses with intrapulmonary nodules coal workers pneumoconiosis + rheumatoid arthritis
What is anti-D globulin?
Rhogam
What is another name for staphylococcal scalded skin syndrome?
Ritters disease
HSV-6
Roseola - Spiking Fever followed by Rash
What two viruses can cause prenatal hearing loss?
Rubella and CMV
Strep PNA
Rust colored sputum, rigors, gram + paired lancets
Most common cause of septic arthritis?
S. Aureus
What are string of pearls on x-ray
SBO; small amount of gas caught between the valvulae conniventes in a fluid-filled SBO
What is the steel sign and what's it seen in?
SCFE double density from superimposition of epiphysis and metaphysis.
What does a cross leg pain test for?
SCIATICA; pain will occur on the opposite leg that will radiate past the knee
What is the parachute reflex?
Suspend baby prone and lower head towards surface. Arms and legs will extend. *4-6 months. Does not disappear*
What are infectious processes causing retinopathy?
Syphilis, Herpes simplex, Varicella Zoster, Toxo, and CMV = HIV
What are some atypical causes of apthous ulcers
Systemic lupus erythematosus (SLE) Inflammatory bowel disease (IBD) Behçet disease Reiter disease Gluten sensitivity Cancer HIV Inquire about sexual history of syphilis or herpes virus Inquire about current medications: NSAIDs β-blockers
What is becker's sign?
Systolic pulsation of the retinal artery/pupil; AORTIC REGURG
What is the difference between the left supraclavicular node and the right superclavicular node?
The left side! Virchow's node (left supraclavicular) is associated often with gastric cancer. The RIGHT supraclavicular node is assocated with Hodgkins lymphoma, as the right node drains the mediastinum and it is common for HL to originate in the mediastinum.
What is the moro reflex?
The neonate opens his or her arms wide, spreads his or her fingers, and seems to grasp at something after being startled.
What causes anosmia when URI is seen?
The olfactory epithelium is destroyed by viral infections and chronic rhinitis.
What is oncotic pressure?
The pressure exerted specifically by protein molecules in a compartment. It correlates with osmolality, and is also known as colloidal osmotic pressure. Remember, concentration calls!
Upper motor neuron damage to CN VII (central facial palsy) in right hemisphere?
The upper face is controlled by pathways from both sides of the face. Upper motor neuron lesions cross, findings on the left are due to lesions on the right. Lower motor neuron lesions of the face are ipsilateral. - note that the left side of her mouth has little movement as she talks, resulting in some dysarthric speech. On physical examination, the left side of her mouth droops, eyebrows raise symmetrically, frown is symmetric, and eyes close but left offers little resistance to opening.
What is a heliotrope rash?
There is periorbital edema and purplish rash over eyes; DERMATOMYOSITIS
What is congenital adrenal hyperplasia?
These people lack the enzyme the adrenal glands need to make the hormones cortisol and aldosterone and the body produces more androgen family of inherited disorders that lead to cortisol deficiency - most due to 21-hydroxylase deficiency (autosomal recessive) that leads to decreased cortisol production w/ elevated cortisol precursors - severe: mineralocorticoid deficiency w/ salt wasting - cortisol deficiency stimulates ACTH synthesis, leading to overproduction of adrenal androgens 21-hydroxylase deficiency that can present in its most severe, classic form as a newborn female infant w/ ambiguous genitalia and life-threatening salt wasting. Milder forms present later in life. 11Beta-hydroxylase deficiency is a less common cause of adrenal hyperplasia.
Vitamin B1 association?
Thiamine; beriberi
In regards to nephrotic syndrome why does edema occur?
Thus, Low oncotic pressure -> low osmotic pressure -> water driven out of vessels into tissues = EDEMA
What is the vestibular apparatus?
a sensory organ for detecting sensations of equilibrium.
How can you tell Left coronary artery occlusion on EKG?
aVR ST segment elevation > 1mm aVR ST segment elevation > V1 ST segment elevation
What are oligoclonal bands?
abnormal discrete bands seen on CSF gel electrophoresis associated with MS
What are the bulk forming laxatives?
absorb liquid in the intestines. This creates a bulky, more liquid-like stool that's softer and easier to pass methylcellulose (Citracel), polycarbophil (Fibercon), psyllium (Metamucil)
What is a "thumb print" sign on x-ray?
acute mesenteric ischemia
What is a Reed-Sternberg cell?
distinctive tumor giant cell seen in Hodgkin's lymphoma (AKA Owl-eye appearance)
What does an increase in hCG and inhibin + decrease in AFP and estriol indicate in quad screen during pregnancy?
down syndrome
What are drusen?
dry macular degeneration: -localized deposits of extracellular material, concentrated in the macula, and appear as small, bright yellow objects on ophthalmoscopy -Larger soft drusen are associated with vision loss -risk of progression to advanced AMD increases with the size and number of soft drusen
What is the double bubble sign on x-ray?
duodenal atresia associated with down syndrome and polyhydramnios in utero
Tapioca blisters should make you think of what diagnosis?
dyshidrotic eczema
What is dactylitis?
earliest manifestation of vaso-occlusive disease in sickle cell anemia - aka hand-foot syndrome - present 6-24mo - acute onset of pain and symmetric swelling of the hands and feet; sometimes only soft tissue swelling and sometimes fever - dactylitis is vascular necrosis of the metacarpals and metatarsals look like osteolytic lesions on plain radiographs
What is scrofula?
enlargement of oropharyngeal lymphoid tissues & cervical lymph nodes
What is Erythromelalgia?
episodic burning/throbbing of hands/feet with erythema polycythemia vera thrombocytosis
What is the most common cause of MVP?
myxomatous degeneration
What does an increase AFP indicate in quad screen during pregnancy?
neural tube or abdominal wall defects
Vitamin E association?
neuropathy, ataxia
Vitamin A association?
nightime blindness
Is cardiomegaly on x-ray suggestive of restrictive or constrictive cardiomyopathy?
restrictive
What three differentials should you be thinking about with monocular vision loss?
retinal artery occlusion optic neuritis Giant cell arteritis
What is rhegmatogenous detachment?
retinal tear
What is "pizza pie" in eye exam in reference to?
retinitis on eye exam CMV
Vitamin D association?
ricketts, osteomalacia
What is responsible for night vision?
rods
What is the woodscrew maneuver?
rotate posterior shoulder downward for dystocia
What is Ascaris lumbricoides?
roundworms Route: oral fecal Colicky pain, lives in small intestine
What is cerebral venous thrombosis?
sadjsad
S. Aureus PNA
salmon/pink colored sputum IVDA post-influenza, elderly, gram + cocci in clusters
What helminth is responsible for hematuria?
schistosomiasis
What organism is associated with esophageal varices?
schistosomiasis (trematode infection)
What is the Jarisch-Herxheimer reaction?
•Self-limited reaction to anti-treponemal therapy •Fever, malaise, nausea/vomiting; may be associated with chills and exacerbation of secondary rash •Occurs within 24 hours after therapy •Not an allergic reaction to penicillin •More frequent after treatment with penicillin and treatment of early syphilis •Pregnant women should be informed of this possible reaction, that it may precipitate early labor, and to call obstetrician if problems develop GIVE aspirin and antipyretic and it will pass **Desensitization is the answer for neurosyphills and pregnant women**
What is Fanconi syndrome?
↓ RBC production/pure RBC aplasia in *ADULT*, all other BM cell lines nL Hereditary *or* Secondary to Thymoma (autoimmune attack)