Review Cram Sheet

COMLEX II and USMLE II Review Cram Sheet 2/14/19, 9(45 PM
COMLEX II & USMLE II CRAM SHEETS

GASTROENTEROLOGY
Vitamins
Vitamin A
Night blindness, conjunctival dryness, corneal keratinization
Vitamin D
Ricketts - kids, long bone bowing; Osteomalacia-adults, demineralization
Vitamin K
Clotting deficiency with prolonged PT
Thiamine (B1)
Beriberi - peripheral neuropathy, Cardiomyopathy - dry or wet (high output failure)
Wernicke-Korsakoff - Alcoholics, confabulation, nystagmus, confusion
Niacin
Pellagra - Diarrhea, dermatitis, dementia, death
Pyroxidone (B6)
Rare, neuropathy, Cheilosis (swollen cracked bright red lips)
Cobalamin (B12)
Macrocytosis, Pernicious Anemia- megaloblastic, neuro chg. ataxia, Schilling test
Folate
Macrocytosis, megaloblastic anemia w/o neuro chgs., common in alcoholics
Vitamin C
Scurvy, bleeding gums, Connective Tissue problems, Can manifest 1 yr post defic.
Failure to Thrive
http://home.windstream.net/bethdo97/boards.htm Page 1 of 57
Org.= wt gain w/ other disease; Nonorg.=growth failure due to neglect stimulation
< 80% wt for Ht
Obesity
mild 20-40%, moderate 41-100, severe <101%; age, black women, low income
BMI= body wt (kg)/Ht (mm2) Normal 20-25
Pickwickian Syndrome = obesity, dyspnea, hypovent, CO2 retention, hypoxia
Boerhaave's Syndrome
esophageal rupture due to forceful vomit; Gastromediastinal fistula, dyspnea w/o hemetemesis, + Hammonds
sign = pneumomediastinum, L lung effusion
Dysphagia
Obstructive - solids 1st; Motor -solids = liquids
Infectious Esophagitis
Candida (thrush), HSV, CMV, immunocomp, diabetics, Dysphagia & odynophagia
Esophageal Atresia
Proximal esophagus, blind pouch
Trachesoph Fistula
Congenital defect, distal esoph, coughing & cyanosis when feeding, abd distention
Achalasia
Dysphagia for solids & liquids, nocturnal cough, aspiration; Absent peristalsis & tight LES, "Beak" esoph on
x-ray, 20-40 yrs old
Esophageal Cancer
squamous 90%
Dysphagia solids 1st, Cough & hoarse = laryngeal nerve, constricting bands = annular lesion, Risk factors=
smoking, alcohol, GERD, Barretts Esoph = adeno CA
Gastritis
Antral Creep=fundal tissue replaced by antral mucosa, Not preCA,
Risk Factors = NSAIDS, Alcohol, H.Pylori
PUD
Gastric = NSAIDS, eating no help, COPD,blood type A; 25%
Duodenal = H.Pylori, better w/ food, Liver cirrhosis, Blood type O ; 75%
Cullen's Sign
Periumbilical cyanosis d/t hemoperitoneum = hemorrhagic pancreatitis, ruptured ectopic, ruptured spleen
Zollinger-Ellison Synd.
Gastrinoma ( gastrin); recurrent ulcers, ½ are malignant
Gastric CA
Adeno, H.Pylori gastritis, Virchow's Nodes, Types = ulcerating (shallow edges); polyploid (intraluminal late
mets); superficial (early CA) ; Linitus Plastica (all layers elasticity) Mets to ovary = Krukenberg Tumor
Diarrhea
Osmotic = H2O lumen solutes in bowel; Secretory = electrolytes & H2O secreted not absorbed;
Malabsorption; Exudative secretion of blood plasma & mucus (mucosal inflammation); transit time (short
bowel); transit (bact. Proliferation)
Ischemic Colitis
Vascular compromise (atherosclerotic or embolic); abrupt abd pain after eating, bloody diarrhea, systemic sx.;
Barium X-Ray - Thumbprint = pseudo tumor
Irritable Bowel Synd.
Dx of exclusion (psych?); Tx: bulk supp, anticholinergics, antidiarrheals, TCA
Colonic Polyps
villous>tubular ; sessile>pedunculated for being CA; familial adeno polyps autodom.
Lactose Intolerance
Lactase deficiency, bloating & explosive diarrhea after milk; Ages 10-20
Celiac Sprue
Gluten sensitivity (wheat, rye, barley); amenorrhea 1st sx girls, Infants = FTT, abnormal stool, bloating,
Adults = malabsorption, vit deficiency; X-ray - dilated loops of bowel with thin mucosal folds; most common
cause of malbsorption
Tropical Sprue
nutritional defic, small bowel mucosal abnormal; Acquired - Caribbean, India, SE Asia; Megaloblastic
Anemia, glossitis, diarrhea, wt loss Tx Folic Acid & Tetracycline
Whipple's Disease
Infectious; middle aged men; multi-organ; Thickened mucosal folds, Foamy macrophage with rod shaped
bacilli that stain w/periodic acid (Schiff's Reagent)
Intestinal Lymphangiectasia
Children & young adults; cong or acquired telangiectasia of intramucosal lymphatic
Massive extremity edema w/ diarrhea, N/V; Tx: low fat w/ triglyceride supplement
Toxic Megacolon
Dilation > 6cm, Adults preceded by IBD (UC or Crohn's) Kids preceded by Hirschsprungs Ds; Sx: severely
ill, temp, abd pain, rebound, leukocytosis; X-ray - intraluminal gas along continuous seg of dilated bowel;
Tx: NPO, IV fluids & electrolytes, Antibiotics & Steroids, Rectal tube may alleviate but can cause
perforation
Inguinal Hernia
Indirect = infants, persistent processus vaginalis, protrudes thru ring, lateral Inf Epig.
Direct = Adults, medial to ing ring & inf epig artery, Weakness in Hesselbach's
Ulcerative Colitis
Colon & Terminal Ileum w/o skip lesions, w/ rectal bleeding, "lead Pipe" on X-ray (shortened, narrowed,
loses haustrations) Tx: Sulfasalazine, steroids, Immunosuppresents; Complications=perf, hemorrhage, Toxic
Megacolon, Colon CA
Diverticular Disease
Diverticulosis = false diverticulae, pearl sign on xray
Diverticulitis = infection, acute abd pain usually on left, may form fistulas to bladder, vagina or skin, CT w/
water soluble contrast during acute attack
Crohn's Disease
Granulomatous colitis; No bloody stools, 1st in terminal ileum, transmural, skip lesions, cobblestoning:
Complications=small bowel abscess, obstruction, perianal disease, malabsorption, toxic megacolo, Colon
CA. Surgery is not curative
Colon CA
Right Sided=napkin ring, anemia Left Sided=Apple core, pencil stools; Genetic; Annual rectal>40, Annual
Guaiac >50; Flex Sig q3-5y >50; Rectal CA-hematochezia
Volvulus
Rotation of Bowel; Newborns & elderly; Double Bubble; Birds Beak on Barium Enema, Tx: Left Sided =
decompression; Rt sided & kids = surgery
Intussusception
Telescoping of large bowel into an adjacent section; most common cause of obstruction in kids under 2;
Episodic Abd pain 1-2 min. Reflex = early vomit; Obstructive = omit late; Currant Jelly Stool; Small Infants
= Pallor, sweating, and vomiting. Leukocytosis with hemoconcentration, BE to reduce x 2 before surgery
Necrotizing Enterocolitis
Premature, birth weight, older infants with malnutrition; bilious vomit, abd distention, bloody stool, lethargy;
Thrombocytopenia; Small Bowel Distention; pneumatosis (air in bowel wall) TX; NG, TPN, IV antibiotics,
surgical Rx necrotic part
Cholera
Fecal - Oral, Rice Water Stools, Vibro Cholera; Endemic gulfcoast, Asia, Africa, Mid East; Severe
dehydration, Metabolic Acidosis, Tx: Tetracycline or Doxycycline
Shigella Dysentery
Small bact dose needed, Blood & mucous, Kids worse than adults, Fluid Replacement & Ciprofloxacin
Staph Enteritis
Onset 3-6 hrs; "Church Picnic epidemic; N/V/D, HA, fever recovery w/in 24 hrs
Salmonella Enteritis
Undercooked Poultry; nausea & cramps => watery &/or bloody diarrhea; No antibiotics prolongs excretion
of the organism
Viral Enteritis
Norwalk = yr round, Rota (kids) = winter; Coxsackie A1; echo, adeno
Botulism
Clostridium Botulinum, neuromuscular; onset 12-36 hrs; N/V/D, cranial nerve palsy, fixed dilated pupils,
resp failure, no fever, Wound induced = neuro w/o gi sx
Infants constipation 1st=> cranial nerve sx => cranial nerve Sx => Neuromuscular
Hemorrhagic Colitis
E coli 157, cramps, => watery diarrhea => bloody diarrhea Complications= Hemolytic-Uremic Syndrome,
thrombotic thrombocytopenic pupura
Pseudomembraneous Colitis
Antibiotic induced (clindamycin, ampicillin, cephalosporin) C. Diff; mail -> severe bloody diarrhea; Tx: stop
antibiotics, oral metronidazole in severe cases
Acute Pancreatitis
Pain radiates to back w/ N/V; Grey Turner's Sign (blue flank) Cullen's Sign (blue at umbilicus; Amylase &
Lipase ;
Ranson's Criteria: 3 or more = incr mortality
Admission: >55, gluc>200, LDH >350, AST >250 WBC > 16000
Within 48 hrs: Hct 10%, BUN >5, Ca< 8, PaO2 < 60, Base Def > 4, Fluid Seq>6L
Chronic Pancreatitis
ERCP to Dx; Alcoholics, Malabsorption & diabetes are results
Hepatitis
Hep A = Fecal oral, shedding before Sx; IG to travelers & contact with HAV infected
Heb B= Blood & STD; HbsAg early if persists = carrier; HbcIGM then HbcIgG for life
HBIG for needle sticks and infants born to + moms; assoc w/ hepatocell CA
Hep C Most common post transfusion hepatitis
Hep D = Co infection with B; Hep E = fecal oral
Cholelithiasis
Female, fertile, fat, forty; Ultrasound, RUQ pain after fatty meals, Calcified = preCA
Cholangitis
Charcot's Triad = Biliary Colic, Jaundice, Fever; Leukocytosis, Alk Phos
Hepatocellular CA
Mets 2x more than primary CA (breast, lung, colon), Budd Chari-thrombosis hep V.
Risk Factors = HBV, HCV, Alcoholic cirrhosis, Aflatoxins (fungal metabolites)

Benign Hep Adenomas
oral contraceptives
Exocrine Pancreatic CA
Ductal CA, Courvoiser's Law=palpable nontender GB in a jaundiced patient is a head of Pancreas tumor.
Tumor Body or Tail=splenic vein obstruction=> splenomegaly, gastritis, esoph varices
Insulinoma
Insulin hypersecretion, hypoglycemic symptoms, Insulin levels still after fasting
Whipple Triad: confirms hypoglycemia as source of Sx 1. Hypoglycemia, 2. Relieved with carb ingestion 3.
Sx occur while fasting
VIPoma
Makes Vasoactive peptide (VIP); Sx WDHA (watery diarrhea, hypokalemia, achlohydria; unexplained
secretory diarrhea; laparoscopy for Dx
Glucagonoma
tumor of alpha islet cells; 80% women; 80% malignant; Necrolytic Exfoliating Erythema characteristic
exfoliating lesion of the extremities
Pompe's Disease
1,4 glucosidase deficiency; fatal by age 2
VonGierke's Disease
glucose-6-phosphatase def.; big liver & kidneys, growth retardation, electrolyte prob.
McArdles Disease
musclephosphorylase is absent, muscle cramps & myoglobin after exercise
Jaundice
Prehepatic = hemolysis, gilbert's disease, Crigler Najjar; Hepatic = hepatocellular or cholestatic; Post Hepatic
= Biliary obstruction, AST & LDH also ;
unconj prehepatic; conj = intrahepatic cholestasis or post hepatic disease
all fractions = hepatocellular, hyperbilirubinuria = conj bili water soluble
ETOH Hepatic Disease

Fatty liver => ETOH hepatitis => cirrhosis; AST > ALT ; PT; II, VII, IX, X Clot
Cirrhosis
necrosis and fibrosis, serum albumin, anemia PT, Not curable or reversible
Esophageal Varices
veins that expand to circumvent congested hepatic flow; Tx: vasopressin, balloon tamponade, endoscopic
sclerotherapy, transjugular hepatoporto shunt (TIPS
Hepatic Encephalopathy
altered consciousness, ammonia glutamine in CSF, EEG abnormal
Ascites
Complication of hepatic disease; Paracentesis to examine ascitic fluid values should equal serum if albumin =
malignant; LDH > 60% of serum = malig or infective;
WBC = infection
GI Bleeding
Upper GI = melaena (black tarry) ; Lower GI = hematochezia (bright red) Lig Trietz
Intestinal Obstruction
Vomiting common in small bowel, late in lg bowel, High pitched "tinkling" BS.
X-ray - prox dist = lg bowel; dilated loops of bowel with air fluid levels = sm bowel
Ileus
Paralytic obstruction of bowel due to loss of peristalsis
Pyloric Stenosis
Projectile vomit in neonates, visible peristaltic wave, String Sign
Meconium Ileus
Abnormal thick Meconium with undigested protein, associated with CF
Hirschsprung's Disease
No autonomic nerves in colon, Obstipation, late vomit, Megacolon, Toxic Enterocolitis if left untreated, BE
proximal dilated & distal narrow, ColostomyCARDIOVASCULAR
Contraindications to BP meds
Asthma/COPD = Bblockers, DM = Thiazides & Bblockers, Cardiac Failure = Bblockers & Ca Channel
Blockers; Pregnancy = Thiazides & ACE
Rheumatic Fever
post strep infection, migratory arthritis, endocardits, subcutaneous nodules on extensor surface, chorea,
erythema marginatum, Sed, WBC & ASO
ASD
L=>R; Wide split & fixed S2; patent foramen ovale
VSD
L=>R; pansystolic murmur left sternal border, thrill; most common defect; Eisenmenger's Syndrome = shunt
direction reversed due to pulm vasc resistance
Patent Ductus Arterio
L=> R; Continuous machinery murmur; Indomethacin inject may close
Tetralogy of Fallot
VSD, RVH, Pulmonic Stenosis, Overriding Aorta
Pulmonic Stenosis
R=>L, Early systolic click, High pitched systolic ejection murmur, soft or absent S2
Coarction of the Aorta
HTN arms but not legs, murmur heard on back, X-ray scalloping of ribs,
Bacterial Endocarditis
Acute: S.aureus, Group A strep, N Gonh., Sub acute: Strep Viridans; New heart murmurs, petechia over half
of body, Splinter hemorrhages on fingernails, Osler's Nodules (nodules on fingertips) Roth's Spots (retinal
hemorrhages)
Noninfective Endocarditis
Libman Sacks Disease associated with SLE
Aortic Aneurysm
Abdominal = pulsatile mass on exam, atherosclerosis, smoking HTN >4 cm = surgery Thoracic =Marfan's &
syphilis >7c = surgery; Dissecting =split between medial & adventitial layers "ripping in chest" Normal EKG
vs abnormal in MI
Peripheral Vascular Disease
Weak pulses, Atrophic skin, Little Hair growth, Nonhealing ulcers, intermittent claudication 5P's = pallor,
pain, pulseless, parathesia, paralysis
Raynaud's Phenomenon
Pallor, cyanosis, erythema of fingers, most are idiopathic, others related to collagen vascular disease Tx
vasodialators
Heart Dysfunction
Diastolic = difficulty filling ventricles; Systolic = problem ejecting blood from ventricle
Polyarteritis Nodosa
inflamed medium arteries->ischemia in tissues; men 3x> women, usually 40-50; Dx confirmed by biopsy or
angiography showing aneurysm of medium arteries
Giant Cell Arteritis
Temporal Arteritis; women >50; severe temporal or occipital HA, Amaurosis Fugax (temp blindness 1 eye)
Temporal artery swollen & tender, Dx confirmed by biopsy
Cor Pulmonale
COPD most common cause; Dyspnea & syncope on exertion, S/Sx Rt heart failure
Mitral Stenosis
Mitral facies = red rash on cheekbones, Loud S1 and opening snap after S2; Right heart failure TX with
diuretics; LAH=>Pulm HTN=>RVH Bblockers & Ca Channel Blockers to HR & preload; Progressive
Dyspnea
Mitral Regurge
Midsystolic click; Harsh blowing holosystolic murmur; MVP; LAH & LVH; wide S2 that widens more with
inspiration; Bblockers for Sx Valve replacement
Aortic Stenosis
Triad = Angina, Syncope & Dyspnea on exertion; Cong bicuspid valve, weak long pulse, LVH T wave
invesions; Left sided failure; Bblockers HR & coronary flow
Aortic Regurge
Decrescendo murmur, widened pulse pressure, "Water Hammer Pulse" (rapid up & down stroke); "Pistol Shot
over femoral Artery; 2o Austin Flint murmur= diastolic murmur as blood goes thru AV to hit MV. Kids =
cong VSD w/ MVP
Supraventricular Tachycardia
Sudden attacks due to reentry rhythm, P on T on EKG; #1 AV Nodal Reentry #2 Wolff Parkinson White =
reentry thru accessory muscle bundle, can cause V fib in a Pt with Afib; Torsades De Point is drug induced
Left Sided Failure
Dyspnea, Orthopnea, Paroxysmal nocturnal dyspnea, LVH
Right Sided Failure
Most common cause is Left sided failure; Neck vein distention, Liver big, Edema
MI
ST elevation, T wave inversion; CPK-MB 12 - 40 hr for peak; LDH peaks 3-6 days
Congestive Cardiomyopathy
Alcohol = chronic; Infection Coxsackie B or Trypanosoma cruzi (Chagas Disease)
Hypertrophic Cardiomyopathy
Cong or acquired VH with normal afterload; venous pressure, JVD, ascites, edema, edema, pleural effusion,
S4 on exam
Chronic Pericardtis
Causes right sided failure; Kussmaul's Sign ( neck vein distention on exertion) Dyspnea on exertion and
Orthopnea; pulsus paradoxus; Surg removal of pericardium is curative.
Pericardial Effusion
Friction rub, distant heart sounds, "water bottle" on x-ray; acute pericarditis = exudate; neoplasm or fibrosis
=transudate; symmetrically enlarged cardiac silhouette
Cardiac Tamponade
Pulsus paradoxus, Kussmauls Absent; pericardial fluid compresses heart, Becks Triad = Hypotension, ( pulse
pressure), JVD, Muffled heart signs
Heart Murmurs
AI: precordium, early diastolic, >S2, + heave; AS: 2nd R ICS & radiates to carotids, harsh, < S2; Diastolic =
r/o malignancy, check BP both arms; MR: Apex radiates to axilla, + heave, assoc w/ sever anterior MI,
endocarditis prophylaxisis; MS: Apex, late diastolic, opening snap after S2; MVP: Apex, blowing,
holosystolic, w/ valsalva; PR: 2nd L ICS, pulm HTN, clubbing, PE; PS: harsh; TR: 4th L ICS, loud w/
inspiration; bounding JVD, pulsatile liver; VSD: loud holoystolic, assoc w/ Down'sRESPIRATORY
Peritonsillar Abscess
uvula away; Head tilted toward, Trismus (can't open mouth)Strep or Bacteroides
Epiglottitis
H.flu type B, Insp. Stridor, Dysphagia with drooling, Thumbprint sign on xray
Larengitracheitis
Croup; Paraflu #1, RSV, Flu, barking cough, stridor hoarse, r/o epiglottitis
Acute Bronchitis
non smokers = M. pneumonia; smokers=S.pneumonia & H.flu
Bronchiolitis
Circumoral cyanosis (blue around mouth) RSV; kids < 2
Strep Pneumonia
Red-brown sputum, lobar pneumonia, most common adult community acquired
Pneumovax vaccine = >65, immunocompromised, chronic disease
H.Flu Pneumonia
COPD, children, slow onset with URI sx 1st, patchy bronchial infiltration on xray
Viral Pneumonia
Most common cause in kids, flu like prodrome, patchy infiltrates; WBC not a lot
Klebsiella Pneumonia
Alcoholics, aspiration, Currant Jelly Sputum, Encapsulated gram neg rod
Staph Pneumonia
Salmon colored sputum, Nosocomial, pneumatoceles on xray are pathognomic
Mycoplasma Pneumonia
atypical no cell wall to stain, young adults in close contact; xray worse than pt looks
Pseudomonas Pneum.
hospital acquired, CF, immunocompromised
Legionella Pneumonia
atypical, CNS & GI sx; confusion & ataxia, aerosolized water (air conditioning)
TB
fever, night sweats, wt loss, bloody sputum, Miliary = disseminated; Acid fast stain, PPD>10mm
nonimmunocompromised; ppd>5mm AIDS; Extrapulmonary manifestations= meningitis, pericarditis, bone
invasion (Pott's Disease)
Bronchiectasis
chronic destructive; dilation of bronchial tree, cough with sputum, dyspnea, hemoptysis, Xray = bronchial
markings, "honeycombing"
Emphysema
Destroyed alveolar walls, Risks: smoking, alpha 1 antitrypsin deficiency;
PFTS: FEV1; VC, FEV1/FVC < 60% normal
Blue Bloaters
Bronchitis>Emphysema; cough w/ mucous 3mos/yr x 2y; cyanosis, pulm HTN
Pink Puffers
Emphysema >Bronchitis; gradual dyspnea not hypoxic, underweight
Cystic Fibrosis
auto recessive, COPD, Pancreatic insufficiency; meconium illeus, sweat chloride
Sarcoidosis
non caseating granulomatous, increased Calcium, ground glass, bilateral hilar & paratracheal adenopathy is
pathognomic
Asbestosis
Increased risk of lung CA & mesothelioma, gradual dyspnea, nonproductive cough; no wheeze; diffuse linear
opacities on xray
Silicosis
increased risk of TB, SiO2 inhalation; metal mining; multiple small nodules & calcification of hilar lymph
nodes
Resp Failure
ABG=> PO2 50-60 mmHg; PCO2 >45 mmHg
Laryngeal CA
squamous cell, smoking & alcohol, hoarsness for several weeks
Lung CA
squamous>adeno>small(oat) cell; Squamous = hilar; Adeno = peripheral; Horner's Syndrome=invasion of the

cervical symp. Ganglion= miosis, ptosis, anhydrosis
Pancoast tumor = Horners + pain in arm or shoulder on affected side
Asthma
PFTs FEV1; ABG resp alkalosis, CO2; If CO2 or normal resp failure imminet
Massive Hemoptysis
>600 ml blood in 24 hrs; trauma; PE, aortic aneurysm, heart failure
Pneumothorax
Spontaneous = 15-35 y/o males; Tension = pressure in pleural spaces; displaces heart & lungs (mediastinal
shift) = surgical emergency
ARDS
acute lung injury with non-cardiogenic pulm edema, ABG =acute resp alkalosis (O2 & CO2; Xray =pulm
edema with normal cardiac silhouette, Positive pressure or PEEP ventilatory support
Pleural Effusions
tactile fremitus; dull; egophony (incr resonance; chg voice to high pitched)
Transudates: <3g protein, Plasma/serum protein<0.5; Plasma/serum LDH <0.6 caused by CHF, cirrhosis,
nephrotic syndrome
Exudates:Reverse labs; neoplasms & infections; triglycerides = chylous effusion; Pus = empyema (s.
Aureus); Meiggs syndrome = pleural eff, ascites pelvic tumors)
Pulmonary Edema
Pink, frothy sputum, Kerley B lines on xray; Incr cardiac silhouette if cardiac origin
Pulmonary Embolism
DVT (iliac & femoral) V/Q useful, angiography is god std for dx
RDS
<37 wks gestation, Lung maturity: L/S ratio >2, + PG; Beclomethasone hastens maturity; artificial surfactant
for kid
Pulm HTN
Primary = dx of exclusion; secondary valvular heart disease, L=>R shunt, chronic ateletasis (localized
collapse of alveoli)ENDOCRINOLOGY
Hypothyroid
Weight gain, Lethargy, Coarse hair & dry skin, irregular menses, cold intolerance, myxedema; Acquired =
Hashimoto's; Congenital = cretinism, severe I deficiency = hoarse cry; resp distress, cyanosis, poor feeding,
decr bone growth, T4 TSH
Wolff Chaikoff effect = inhibition of thyroid hormone release due to high doses of I during thyroid scan
Hyperthyroid
1. GRAVES: most common, autoimmune, antibodies bind to TSH receptors; incr thyroid hormone, pretibial
myxedema, Incr radio I uptake
2. SUBACUTE THYROIDITIS: tender, enlarged, Decr Radio I uptake, Sed Rate up, maybe followed by
period of hypothyroid
3. SILENT LYMPHOCYTIC THYRODITIS: transient, postpartum, no pain or fever, Radio I uptake decr,
lymphocytic infiltration, Tx Bblockers
4. TOXIC ADENOMA: multinodular goiter; nodules function autonomously, Excess T3 & T4; Scan shows a
few hot spots with cold background
5. THYROTOXICOSIS FACTITIA: exogenous thyroid hormone, no goiter
6. PLUMMERS : multinodular goiter, nodules become autonomous and secrete thyroxine
Sick Euthyroid
acutely ill patients; T3&T4 decr due to chgs in hormone metabolism; TSH not decreased => not truly
hypothyroid
Thyroid CA
Papillary = most common, best prognosis, Follicular = older, hematogenous spread to bone, lung, brain, liver;
Anaplastic = worse prognosis, local invasion, hoarse & dysphagia; Medullary= Calcitonin producing Cells,
MEN Type II(parafollicularC cells)
Diabetes
Dx: elevated random glucose sx, fasting BS > 140 x 2 days; Oral challenge >200 after 2 hrs; Type I: alpha
islet cells, HLADR3, HLADR4, HLADQ, ketoacidosis
Type II: insulin resistance; no HLA association, endogenous production enough so no ketoacidosis but do get
hyperosmolar coma(dehydrated, glucose 600-2000
Parathyroid Hormone
Ca mobilization from bones, Vit D production phos reabsorption in distal tubules = serum phos.
Hypoparathyroidism
PTH, Ca, Phos, Tingling, tetany, Chvostek's sign (tap on face & get muscle spasm) ; Trousseau's Sign (BP
cuff up 3min => carpal tunnel sx; Mg in alcoholics can lead to Ca due to PTH secretions
Hyperparathyroid
Bones, stones, abd. Groans and psychic moans; 1o = excess PTH; 80% benign adenoma; 2o due to serum
Ca=> vit D defic, renal tube prob and Ca loss
Diabetes Insipidus
Lack of ADH, polyuria and polydypsia
Kallman's Syndrome
Male, anosmic, small testicles, azospermic d/t head trauma; FSH & LH, no GNRH
SIADH
Excess ADH, Tumor, trauma, pulm disease, drugs; Hypoatremia, Conc. urine;
Acromegaly
Excess GH; bone & tissue enlargement; glucose intolerance, osteoarthritis
Addison's Disease
Decreased cortisol (aldosterone) Wt loss, fatigue, skin pigmentation, eosinophilia; Decr aldosterone, decr Na,
incr K; Give ACTH if cortisol doesn't increase Dx made
Cushing's Syndrome
Incr cortisol, Buffalo hump, moon facies, central obesity, Osteoporosis, #1 Cushing disease due to pit.
Adenoma, #2 Ectopic- ACTH from lung tumor, #3 Adrenal Cortical tumor- cortisol, ACTH suppressible,
cortisol not #4 Chronic glucocorticoid Tx
Waterhouse Friedrickson Syndrome
hemorrhagic infarct of adrenals, assoc w/ meningococcemia
Pheochromocytoma
Episodic HTN, Dx by urinary catecholamines
Familial Hypercholesterolemia
Autosomal dominant, Xanthomas (lipid on tendons) Xanthelasmas (lipids on eyelids) MI's in 40's,
Homozygous usually has total cholesterol
Familial Hypertriglyceridemia
Trig , LDL normal, Autosomal dominant, Pancreatitis, milky serum
Familial Combined Hyperlipidemia
Auto dominant, trig and cholesterol; no xanthomas
Familial Dysbetalipo-proteinemia
rare, problem with lipoproetin catabolism; palmar or tuberous xanthomas, risk periph vasc disease & CAD,
Abn VLDL, cholesterol & triglycerides
MEN I
Parathyroid , pituitary & Pancreatic tumors
MEN II
Pheochromocytoma, Parathyroid & medullary thyroid tumors
Hemochromatosis
Auto recessive, GI absorption of Fe; Excessive Fe, Ferritin, Transferrin saturation, cirrhosis, diabetes, bronze
skin
Wilson's Disease
Auto recessive, excessive Cu accumulation, ataxia & dementia, Kayser Fleisher rings on cornea
Hyperaldosteronism
Aldosterone works on distal renal tubule to facilitate Na retention and K loss
excretion due to Na, BP (renin angio), K
1o Conn's Syndrome = adrenal hyperplasia, adrenal adenoma Tx: spironolactone
2o renin angiotensin system activity => BPGENTOURINARY
Neurogenic Bladder
Bladder control requires: intact sensation(full) motor function (start void) Cerebral control (timing)
Atonic, distended with overflow= acute spinal cord injury or sensory impaired
Motor defect = sense full bladder but can't start emptying
Autonomous = spinal cord injuries after acute; bladder fills & empties reflexively
Hydronephrosis
dilation of renal pelvis, pressure in urinary system w/ or w/o ureter dilation
Fanconi's Syndrome
renal tubule defect; Urinary excretion of glucose, phos, AA; Tx: Vitamin D
Pyelonephritis & Pyelitis
Pyelonephritis = dilation of renal parenchyma, pyelitis = dilation of renal pelvis; E. coli; Different from
cystitis since there are WBC casts not just WBC's
Cystitis
WBC in spun sample, E. coli, freq, urge, dysuria & suprapubic pain
Bladder Ca
transitional cell CA; Risk factors = smoking, schistosomiasis, aniline dyes
Renal Artery Stenosis
Cause of 2o HTN; Fibromuscular dysplasia (young women) Atherosclerosis (older)
Urolithiasis
Ca = Calcium stones; Struvite Stones = post UTI w/ urea splitting bact (proteus or pseudo) when urine basic
MgNH4PO4 (struvite) stones ppt.
Uremic Syndrome
Symptomatic renal failure = GFR< 20 ml/min; CNS chgs, asterixis (flapping tremor) pericarditis, N/V,
yellow-brown skin (uremic frost) Normochromic, normocytic anemia due to erythropoietin; Phos & Ca =
renal osteodystrophy
Glomerulonephritis
Hematuria, proteinuria, RBC casts: Post strep = give Antibiotics only if still strep +, steroids no help;
Goodpastures- autoimmune, high dose steroids, uremia 3-9 mos.
Nephrotic Syndrome
Proteinuria > 3g/day, Edema, hypoalbuminemia & hyperlipidemia (milky serum); minimal chg disease in
kids; idiopathic Glomerulonephritis in adults
Acute Tubular Necrosis
most common cause of acute renal failure; ischemia or toxins; resolves in several weeks may need dialysis
Polycystic Kidney Disease
Auto dominant; multiple bilateral renal cysts; gross hematuria, proteinuria, pyuria, HTN, UTI's;
asymptomatic until adult; 15% have associated subarachnoid hemorrhage
Alport's Syndrome
X-linked, Type IV collage, deafness & renal failure in males
Wilm's Tumor
nephroblastoma, kids < 4yrs commonly, hematuria, abd mass; resection & chemo
Renal CA
adenocarcinoma; Triad: hematuria, abd mass & flank pain
Chronic Renal Failure
>90% glomeruli destroyed; uremia K, Na phos, Ca = renal osteodystrophy
Hypernatremia
> 155 mEq/L; due to dehydration, CNS depression (neuronal shrinkage); Diabetes Insipidus= decr ADH =
lots of dilute urine = dehydration = urine output incr.
Hyponatremia
<135 mEq/L; pseudo if lipids are high to displace polar Na; Osmotic = diabetes Na 1.6 for 100 mg/dl glucose
value is above 140.; SIADH, Central Pontine Myelinosis if corrected to fast
Hyperkalemia
> 5.5 mEq/L; muscle weakness, cardiac arrhythmia, met acidosis, oliguria, K sparring diuretics
Hypokalaemia
<3.5 mEq/L; muscle weakness, cardiac arrhythmias, resp failure, GI or renal loss
Urethritis
GC (gram - rodds in WBC, + thayer martin culture); nonGC = chlamydial; coinfection, Ceftrixone for GC,
Doxycycline for Chlamydia
Epididymitis
Induration & tenderness of spermatic cord; support relieves pain
Torsion of the Testes
adolescents, swelling & tenderness, superior displacement, support does not relieve pain, Emergent
SURGERY
Hydrocele
Painless lump, can be transilluminated; congenital process vaginalis remains in communication w/ abdomen
= indirect inguinal hernias
Varicocele
"bag of worms", assoc w/ infertility
Seminoma
Painless lump; does not transilluminate, most common testicular neoplasm in men < 30; Undescended testes
at greater risk even after surgical correction
Prostatitis
Nonbacterial > bacterial (GI organisms); recurrent UTIs; Rectal - warm, tender, boggy prostate; Tx
TMP/SMX
BPH
Enlarged rubbery prostate on rectal; Urinary retention, blockers; TURP, transrectal US more sensitive for Dx;
PSA can be falsely elevated
Prostate Ca
Firm, nodular irregular prostate, Bone mets; Alk Phos and PSA are
Bacters Syndrome
pre-auricular skin tag and kidney agenesis
INFECTIOUS DISEASES & IMMUNOLOGY
Fever
most common cause immed post op = atelectasis; 3-5 days postop = infection; > 2 wks post op = PE or
thrombophlebitis
Fever of Unknown Origin
> 100F for > 3 weeks despite active search for cause for > 1 week; need to get CBC w/diff, blood cultures;
kids = usually infection; adults = infectious, neoplasm, autoimmune
Inflamation
Rubor, Tumor, Calor, Dolor
Types of Immunity
Active Acquired= direct exposure - infection or vaccination; Passive Acquired = temporary, serum Ab given
(IG, breast milk)
Bacteremia
bacteria in blood but asymptomatic
Septicemia
bacteria in blood with symptoms
Immunizations in Kids
HEP B = mom + HbsAG = HBIG & 1st Hep B vaccine at birth
DTP = contraindications => progressive neuro disorder, Hx encephalopathy w/ in 7 days of previous dose;
Pertussis not given if > 7 y/o or if currently have pertussis
H FLU = not in kids > 5
POLIO = IPV if immunocompromised
MMR = not effective before age 1; don't give if less than 3 months since transfussion or IG use; ok for HIV
+; suppresses TB - give Tine(PPD) & MMR at same time or 4-6 weeks apart.
Adult Immunizations
TETANUS = booster q10y, No Hx immunization 2 td 1-2 mos apart then booster at 6-12 mos then on normal
10 y cycle
FLU = chronic resp problems, metabolic diseases, adults > 65; can cause false positive HIV test
HIV/AIDS
RNA retro, CD4 cells, Dx based on concurrent related diseases &/or CD4 , 200 cells/mm3; Flu-like illness,
antibodies 1 - 6 months after infection
AIDS related infections
CMV, HSV, VZV, EBV, TB, mycoplasma avium-intracellular, candida coccidioides, histoplasmosis,
cryptococcus, Pneumocystic carnii (protozoa) Toxoplasmosis, cryptosporidiosis, Giardiasis
DeGeorge's Syndrome
Thymic aplasia, Absent T cells, congenital heart disease, craniofacial abnormalities
Wiskcott- Aldrich Syndrome
X linked, no antibodies against encapsulated bacteria, eczema, platelets,
Chronic Granulamatous Disease
Autosomal recessive, defect in phagocytic enzymes, recurrent bacterial & fungal infections
Chediak-Higashi Syndrome
Autosomal recessive, recurrent strep & staph infections
Bruton's Disease
x-liked, agammaglobulinemia, N B cells or antibodies
Ataxia Telangectasia
Auto recessive, lymphopenia & IgA deficiency; gait abnormal, telangiectasia
Severe Combined Immunodeficiency
Deficits of B & T cells, IgA deficiency, recurrent infections esp resp & GI, IG administration
contraindicatedHEMATOLOGY & ONCOLOGY
Microcytic Anemia
MCV < 80; IRON DEFICIENCY = ferritin; CHRONIC DISEASE Fe, Transferrin, Ferritin; LEAD
POISONING; THALASSEMIA
Normocytic Anemia
MCV 80 - 100; Hemolysis, Chronic disease, Bone marrow suppression (drugs, leukemia) (aplastic)
Macrocytic Anemia
MCV > 100; FOLATE DEF. = most common cause, folate normal B12;
B12 DEFICIENCY: B12 absorbed when linked with IF from parietal cells, neuro sx,
Alpha Thalassemia
Acanthocytes (rounded projections from cells); Poikilocytosis (variable size); target cells, Very low MCV but
mild anemia, Hemoglobin H = chain missing; Asians, Dx by Hb electrophoresis,
Beta Thalassemia
Peripheral Smear = basophillic stippling, nucleated RBC, anisocytosis (chgs in size) Mediterranean &
African heritage; Minor = heterozygous, Major = homozygous
Sickle Cell Anemia
sickled cells, Hct & reticulocyte count, electrophoresis HbS + HbA neg. Salmonella osteomyelitis, S.
pneumonia sepsis.
Hemophilia
X linked factor VIII (A) or IX (B) deficiency; Prolonged PTT, Joint & soft tissue bleeding; Tx cryoprecipitate
& FFP
Von Willebrand's Disease
autosomal dominant deficiency of VIII & vWF, epistaxis, menorrhagia, bruising, increased PTT & bleeding
time
Eosinophilia
Allergic Drug Reaction; NAACP = neoplasm, asthma/allergies, Addison's disease, connective tissue
disorders, parasites
Thrombotic Thrombocytopenic Pupura
adults > kids, women > men; platelets consumed in clotting reactions, Fluctuating neurologic defects,
platelets, HCT, retic count, LDH, acute onset not autoimmune
Idiopathic Thrombocytopenic Pupura
kids > adults, autoimmune destruction of platelets, Purpurea & Petechia , Platelets<10000, Epistaxis,
menorrhagia
Hemolytic Uremic Syndrome
Usually caused by E. coli toxin, RBC fragments on smear, RBC destruction => acute renal failure, 2o
thrombocytopenia, abd pain & diarrhea after a flu or URI prodrome; platelets derc, LDH greatly increased
Hodgkin's Lymphoma
Painless cervical lymphadenopathy, Reed Sternberg cells (multinucleated reticular cells), 80% survival
Burkitt's Lymphoma
B cell lymphoma, Associated with Epstein-Barr virus, children & young adults
Hereditary Spherocytosis
dominant deficit in RBC membrane proteins, damaged cells get trapped in spleen. Spherical RBC &
reticulocytosis on smear. Coombs neg.
G-6-PDase Deficiency
X linked hemoglobin accumulates in RBC (Heinz bodies) hemolysis occurs after ingestion of oxidant
Agranulocytosis
neutrophils = decr production or incr destruction
DIC
wide spread activation of coagulation cascade. platelets, fragmented RBC, PT & PTT ; fibrinogen, Pregnancy,
malignancy, infections, massive trauma
Acute Lymphocytic Leukemia
80% childhood leukemia, peak age 3 - 7; usually B cell origin; lymphoblasts, few other cells on bone marrow
biopsy
Acute Myelocytic Leukemia
affects myeloid cells (N,B,E,erythrocytes, megakarocytes) adults > kids; DIC possible, gram neg and fungal
infections, Auer Rods (red staining intracellular inclusions.
Chronic Myelocytic Leukemia
Philadelphia Chromosome (acquired translocation chromosome 9 & 22), tumor cells are more mature, Dx in
middle aged, WBC > 150000; uric acid, B12 (B12 carrier protein produced by WBC); leukocyte alkaline
phos decr or absent, RBC normal
Blast crisis transforms it to acute leukemia
Chronic Lymphocytic Leukemia
Disorder of mature B cells (rarely T); B cells don't differentiate into plasma cells, men > women; usually >
50; No Blast Crisis
Hairy Cell Leukemia
B cell transformed into tumor cell with fine hair like projections; pancytopenia, red pulp of spleen infiltrated
Multiple Myeloma
Plasma cell proliferation and monoclonal IG; men = women; peak 50 - 60, 1 - 3 year survival; xrays show
osteolytic bone lesions, Increased urine protein (Bence Jones)
Waldenstrom's Macroglobulinemia
single B cell line = monoclonal IM over production; RBC with normal WBC & platelets; Rouleau Formation
= RBC pile up forming cylinders
Mycosis Fungoides
Clonal proliferation of CD4 T cells; infiltrates dermis & epidermis, thickened & nodular skin lesions
Polycythemia Vera
overproduction of all 3 cell lines; RBC > 1,000,000, Hct > 60%; men & women peak age 60; Bone biopsy-
hypercellular with absent Fe stores; R/O spurious polycythemia = RBC due to dehydration; R/O 2o
polycythemia = RBC mass due to oxygenation.
Eaton Lambert
90% assoc w/ small cell CA, presynaptic Ca release = proximal muscle weakness; hyporeflexia,
dysautonomia, function w/ stimulation; weakest in AM (opposite MG) Tx Tubocurare
DERMATOLOGYSeborrheic Dermatitis
Red skin with greasy scales, worse in winter & when under stress, Se or Tar soap
Psoriasis
HLA-B27, Similiar sx to RA but w/ neg RF, Silvery scaled plaques w/ sharp demarcations, Pitted fingernails
Pilonidal Cyst
Hair lined tract in sacral area = "Jeep Seat"
Actinic Keratoses
Firm, yellow scale, Due to sun exposure, can lead to squamous cell CA
Skin CA
Basal Cell > Squamous; Basal Cell = pearly papule w/ dilated blood vessels and central depression;
Squamous Cell: Red papule w/ crusted surface, later nodular and ulcerated, rarely mets; Assoc w/ sun
exposure
Malignant Melanoma
Change in size, shape or color of a mole, Usually superficial spreading, Mets as invasion goes deeper than
0.76 mm; itchy & ulcerated
Contact Dermatitis
1o = irritant contact - direct injury, all w/ contact affected, Occurs w/ 1st exposure
Allergic = type IV hypersensitivity, T cell medicated, Never 1st exposure
Carbuncle
Abscess of skin caused by several boils coming together
Dermatopytoses
TINEA CORPORIS: ring worm of body (round lesion w/ raised borders, spreads peripherally w/ central
clearing) TINEA CRURIS: Jock Itch; TINEA PEDIS: Athletes Foot; TINEA UNGUIUM : Toenails; TINEA
CAPITIS: ring worm of scalp;
NEVI
PIGMENTED: (Benign) sun exposed areas in children & adolescents
DYSPLASTIC: 2-12 mm, more irregular, unexposed areas, Multiple dysplastic Nevi = familial risk of
melanoma
Hemangiomas
NEVUS FLAMMEUS: Port wine stain - flat, purple, does not fade
CAPILLARY: strawberry mark, raised, bright red, regress spontaneously by age 5
CAVERNOUS: Raised red or purple, enlarged vascular spaces
MUSCULOSKELETAL & CONNECTIVE TISSUE
Osteoarthritis
morning stiffness, bone spurs, osteophytes, DIP = heberdon's nodes, PIP = Bouchard's nodes, also affects
hips, knees, spine
Rheumatoid Arthritis
Symmetric, PIP & MCP joints NOT DIP, Subcutaneous nodules, 70% +RF
Gout
Affects big toe (Podagra), pinna of ear; Negatively birefringent crystals; Sodium urate; Colchicine or
NASIDS for acute attacks
Pseudo Gout
Calcium pyrophosphate dihydrate; Knee most affected; Positively birefringent
Phocomelia
Hands & feet attached to trunk, Thalidomide
Slipped Capital Femoral Epiphysis
Overweight Teens; stiffness=>weakness=>pain radiating down anteromed thigh to knee, ext rot of leg;
avascular necrosis
Lyme Disease
Borrelia burgdorfi, Ixodes tick, arthralgias, Rash w/ central clearing = erythema chronicum migrans, CNS
chgs 1 month after exposure
Osteoporosis
mass of bone; hip & wrist fx most common; estrogen, Ca & Phos normal; Risk factors = post menopause,
Caucasian, Asian, smoking, alcohol, corticosteroids, Cushings, hyperparathyroid, hyperthyroid; Etidronate -
inhibits osteoclast activity, used for men & women who can't take estrogen
Systemic Lupus Erythematosus
Malar (butterfly) rash, arthralgias (raynauds), ANA sensitive; Anti dsDNA specific; Neuro = HA, psychosis,
seizures, aseptic meningitis; Check for hemolytic anemia w/ Coombs; Renal = BUN Cr, + protein = immune
complex glomerulonephritis
Polymyositis & Dermatomyositis
inflammation of skeletal muscles; violet discoloration of eyelids (heliotrope rash), elevated muscle enzymes
(CPK, SGOT, SGPT, LDH) symetric proximal muscle weakness; hips & shoulders 1st
Ankylosing Spondylitis
"Bamboo shoots" = vertebral squaring w/ bony outgrowths, paraspinal lig. Calcifications on xray; sacroiliac
involvement is diagnostic; HLA-B27; ESR
Shoulder Hand Syndrome
Pain, stiffness, swelling in hand and shoulder; Occurs 1 month after MI or other acute disease
Bone Mets from Primary
breast, lung, prostate, kidney, thyroid
Paget's Disease
Osteolytic => osteoblastic; Frontal "bosing" (enlarged skull with rounded forehead) bow legs and shortened
spine; alk phos, Ca & phosphorus levels normal; "Cotton Wool" appearance on skull xray; high output
cardiac failure
Congenital Hip
Femoral head partially or completely dislocated from acetabulum; BARLOWS: dislocates hip when abducted
and pressure; ORTOLANI'S: reduces dislocation by abduction and flexion
Osteochondritis
Inflammation of bone & cartilage; Osgood Schlaters - teens, tibial tubercle, pain& swelling at the insertion of
the patellar tendon
Osteomyelitis
Bone infection; Local or hemtogenous spread; Prepuberty infection is in metaphysis; Salmonella - sicklers; S.
aureus; pseudomonas; ESR; WBC; Radionucleotide bone scan w/ in 72 hrs; 4-6 wks organism specific
antibiotics
Septic Arthritis
S, aureus = most common; N. Gon most common sexually active; synovial fluid = WBC and + culture;
Ceftriaxone NG infection; Nafcillin for others
Degenerative Disk
Nucleus Pulposa herniates post or postlat.; Lumbosacral = sciatics = L3L4; + pain on straight leg raise;
CaudaEquina Syndrome
Lg midline post. Hemorrhage compressing C.E. Urinary and bowel incontinence; bilateral leg weakness
Polymyalgia Rheumatica
older women; assoc w/ temporal arteritis; Morning stiffness; swelling 1-2 joints; no weakness; ESR; neg.
Rheum factor; steroid response immediate
Fibromyalgia
"Trigger Points" reduce pain, IBS, depression, anxiety
Osteosarcoma
teenage boys, distal femur & proximal tibia; mets to lungs
Eosinophillic Granuloma
20-40; granuloma w/ histiocytes, eosinophilic infiltrate & fibrosis; multifocal = poor prognosis
NEUROLOGY
Blindness
visual acuity 20/400 with best possible correction
Open Angle Glaucoma
Increased intraocular pressure, gradual, bilateral vision loss => tunnel vision, elderly, diabetics, African
Americans, familial; halos around lights, cuping of ocular disc, Beta Adrenergic blockers to treat; amt
aqueous humor produces
Closed Angle Glaucoma
Rapid rise in pressure due to blockage of aqueous drainage in the eye; Severe pain, blurred vision, halos,
Nausea, Abd pain; Reddened eye, upper lid edema, steamy cornea, dilated non-reactive pupil; mannitol, oral
glycerin or carbonic anhydrase in acute attack, Beta adrenergic blockers for prevention
Diabetic Retinopathy
Black spots, "cobwebs", flashing lights; cotton wool spots (infarct of vessel wall) neovascularization, hard
yellow exudates
Cataracts
Painless clouding of lens; Age most common cause, Assoc. W/ smoking & alcohol; Absent red reflex.
Senile Macular Degeneration
Main cause of vision loss in the elderly; Atrophic degeneration or Leakage of Retinal Vessels , gradual loss of
VA, Decr central vision, hemorrhagic or pigmented regions in the macula; Neovascular Membranes (Bruch's
membrane)
Conjunctivitis
Acute inflammation, Adenovirus, a lot of discharge, no blurring, purulent if bacteria
Uveitis
Inflammation of the uveal tract (iris, ciliary body & choriod layer), haziness, floating spots; Photophobia &
redness = iridocyclitis; "salt & pepper fundus = syphillis
Central Retinal Occlusion
sudden painless loss of sight in one eye, Pale fundus, cherry red spot fovea & boxcar appearance of veins
Central Vein Occlusion
unilateral loss of sight that is more gradual, Swelling of optic disc, cotton wool spots & tortuous dilated veins
Retinoblastoma
Childhood malignancy of immature retina, associated with other malignancies later in life, "white reflex or
"cat's eye.
Hearing Loss
Rinne's Test: hold against mastoid process then adjacent to pinna, norm = pinna louder, if not maybe
conductive loss; Weber Test: Midline of forehead, unilateral conductive loss = louder in affected ear;
unilateral sensorineural = louder in unaffected ear
Presbycusis
normal loss of hearing associated with age, sensorineural
Mastoiditis
Usually following otitis media, Redness & swelling w/ fever & pain; X ray = destroyed mastoid air cells &
fluid in the air pockets, IV antibiotics
Meniere's Disease
Severe vertigo w/ N/V, hearing loss, tinnitus worse during attack of vertigo
Acoustic Neuroma
Vestibular Schwannoma; tumor of CN VIII; Hearing loss, dizziness, tinnitus;
Migraine
2x women : men; Age of onset 10 - 30; gone by age 50; family Hx; stress, bright lights, menstruation, fatigue,
tyramine, monosodium glutamate, nitrites; Aura prior to onset; visual, scintillating scotomas (small areas of
visual loss) , dull throbbing, unilateral; N/V, photo & sound sensitivity;
Cluster Headache
Men age 20-50; alcohol & vasodilators; severe, nonthrobbing, unilateral, recur same time each day for weeks,
Horners syndrome & periorbital pain; Tx: ergot & lidocaine
Tension Headache
cause unknown, most common type; bilateral, occipital, constant; muscles tight
Tumor Associated Headaches
progressive, increasing, dull, nonthrobbing, worse w/ postural chgs, exertion. Disrupt sleep, assoc w/ N/V
Trigeminal Neuralgia
Tic douloureux; severe, "lightening" pain in V1 & V2 distribution of CN V; Trigger Pts
Tx: carbamazepine & phenytoin; Surgical decompression of CN V
Partial Seizures
Simple = focal sx, conscious, Jacksonian = simple muscle twitch that spreads progressively; 2o generalization
= simple becomes grand mal; Complex Partial = automatism, olfactory hallucinations, fear, deja vu, loss of
contact w/ environment; postictal confussion
Generalized Seizures
Absence = petit mal; brief, freq. Loss of consciousness w/o loss of muscle tone, rapid eye blinks, no aura, no
postictal
Grand Mal= tonic clonic, preceded by GI upset or mood chg; tonic - 30 sec, clonic 1-5 min w/ alternating
relax & contract of muscles, unconscious, then confussion & postictal
Status Epilepticus
continuous seizures w/o regained consciousness, grand mal progress or withdrawal of anticonvulsants;
Complications = high fever, circulatory collapse, brain damage; Diazapam until controlled, Treat potential
causes (glucose, thiamine, narcan)
TIA
sudden, brief, emboli or arterial stenosis, Risks: obesity, smoking, DM, hyperlipidemia, Carotid artery=
unilateral, contralateral hemiparesis & parathesia w/ ipsilateral blindness; Aphasia if dominant hemisphere
involved, Vertebrobasillar = brainstem dysfunction => vertigo, confusion, blindness, diplopia, weakness,
parathesia of extremities
Aneurysm
localized vessel dilation, Berry Aneurysm = circle of Willis assoc w/ polycystic kidney disease & coarction
of aorta
Subarachnoid Hemorrhage
between pia & arachoid; usually rupture of a cerebral artery aneurysm or AV malformation; Worst HA,
syncope, nuchal rigidity, vomiting, nonfocal abnormalities, decr consciousness, CT first if neg then lumbar
puncture mandatory.
Intracerebral Hemorrhage
Chronic HTN or local thrombus 2o to ischemia; Supratentorial: transtentorial herniation, w/ brainstem

compression & midbrain bleeding, hemiparesis; Cerebellar : acute hydrocephalus due to CFS flow blockage;
Acute onset HA w/ progressive neurological chgs.
Stroke
Middle Cerebral: most often, contralateral limb weakness, sensory loss, homonymous hemianopsia, dominant
hemisphere = aphasia, nondominant = sensory neglect & apraxia
Posterior Cerebral: contralateral homonymous hemianopsia & sensory loss, thalamic pain, hemiballistic
movement disorder
Vertebrobasilar artery: fatal, unilateral occlusion = ipsilateral CN abnormalities, contralateral weakness;

Complete occlusion = opthalmoplegia, defective pupil constriction, bilateral weakness, paralysis, decreased
consciousness, dysphagia & dysarthria; completed = neuro stable; Evolution = progressive signs over 1-2
days
CT positive 48 - 72 hrs after onset.
Cavernous Sinus Thrombosis
CN palsies, fever, exophthalmos, papilledema, HA, consciousness, occasional seizures; IV antibiotics

immediately
Acute Subdural Hematoma
rapid bleed between arachnoid & dural layers; Tearing of bridging veins, Sx slower to progress, Signs of
transtentorial herniation w/ deepening coma, progression from decorticate to decerebrate posture, mid
position or fixed & dilated pupils, spastic hemiplegia w/ DTR. LP is contraindicated because may lead to
herniation
Chronic Subdural Hematoma
Delayed formation of a subdural clot, Sx weeks after head injury, Elderly & alcoholics; Progressive daily
HA, fluctuating consciousness & mild hemeparesis
Epidural Hematoma
Between dura & skull, less common than subdural, injury to arteries (middle meningeal); Rapid brain
compression, permanent neurological problems or death; Brief lucid period after head injury; progressive
neuro signs
Concussion
Injury due to blunt trauma; short loss of consciousness w/ intact brainstem function; post traumatic
confussion syndrome w/ transient retrograde or anterograde amnesia; HA, vertigo, mild cognitive dysfunction
Toxic Vestibulopathies
Alcohol: positional vertigo & nystagmus w/ in 2 hrs of ingestion
Aminoglycosides: ototoxic, vertigo, N/V ataxia, sx last 1-2 wks after ending tx
Salicylates: reversible vertigo, tinnitus, sensorineural hearing loss
Quinine & Quinidine: cinchonism (color vision defects, tinnitus, hearing loss, vertigo, flushed skin, N/V, abd
pain & sweating
Cisplatin: ototoxic, reversible vertigo, tinnitus, hearing loss, sensory neuropathy
Toxic Neuropathies
Lead: multi motor neuropathy; acute encephalopathy in children
Organophosphates: delayed motor neuropathies, cholinergic crisis
Arsenic and Thallium: acute onset symetrical sensorimotor polyneuropathy
Isoniazid: Reversible sensory polyneuropathy reversible w/ concurrent pyridoxine
Gold: symetrical polyneuropathy
Bacterial Meningitis
1st month life = group B strep & E. coli; Older kids = H. flu; Adults = S. pneumonia
N. meningiditis at any age = 50% have petechial rash
Brudzinski sign = neck flexion when supine causes involuntary hip & knee flexion
Kernig's Sign: extension of knee in pt w/ flexed hip is painful
CSF: glucose, neutrophils, protein, opening pressure; Tx: ampicillin & cefotaxime = infants; 3rd generation
cephlosporin in kids > 3mos and adults
Aseptic Meningitis
nonbacterial meningeal irritation; CSF = lymphocytes, normal glucose, neg gram stain & bacterial cultures,
mild protein, normal opening pressure; supportive Tx
Fungal/TB Meningitis
CSF: lymphocytes, glucose, protein, opening pressure; AIDS = cryptococcal meningitis
Encephalitis
Inflammation of brain tissue; Viral etiology = CSF lymphocytes, normal glucose & negative bacterial
cultures; Acylcovir x10 days
Reye's Syndrome
follows viral infection; fatty infiltrate of organs; Usually kids; Salicylates can induce
Sudden onset of encephalopathy, severe vomiting, & liver dysfunction; liver biopsy w/ fatty infiltrates
confirms Dx.
Neurosyphillis
Argyll Robertson Pupil (small, reacts to light but not accommodation); Psych disorders, Tabes Dorsalis; Tx:
Procaine Penn G x 21 days; Examine CSF q 3-6 months until normal x 2 yrs.
Rabies
Dogs worldwide; wild animals in US, Sx: malaise, fever, restlessness 1st. Sx progress to extreme excitement
w/ painful laryngeal & pharyngeal spasms, Tx: Passive IG and active vaccine
Polio
Fecal-oral; aseptic meningitis, paralysis w/o loss of sensation; Asymmetric paralysis during a febrile illness
suggests it; Tx is palliative; OPV for all except immunocompromised who get IPV
Primary Neoplasms
Glioblastoma Multiforme: most common in adults, high mortality; Meningioma: most common benign tumor
in adults; Cerebellar Astrocytoma & Medulloblastoma: most common in kids
Huntington's Disease
Autosomal dominant, Age 30-50; subtle dementia, irritability, antisocial, chorea, death 10-15 yrs after onset,
atrophy of caudate nucleus & cerebral cortex, Tx D2-receptor antagonists (haloperidol)
Parkinsonism
Idiopathic - loss of dopaminergic cells in substantia nigra; Pin rolling temor, masklike facies, lack of arm
swing when walking, cogwheel rigidity, difficulty initiating movement, small shuffling steps w/ increasing
speed (festinating gait). Tx: Levadopa (dopamine precursor), Amantadine, bromocriptine (dopaminergic
agonists), Benzotropine (anticholinergic)
ALS
Lou Gehrig's Disease
Progressive loss of anterior horn cell function; Initially = LMN dysfuntion w/ hand & foot weakness &
atrophy; asymmetric progression, No sensory abnormalities; Later= UMN dysfunction w/ muscle spasticity,
DTR, extensor plantar reflexes
Tay Sachs Disease
Autosomal recessive; Eastern Europe jews & french Canadians; Absence of Hexosaminidase A, can't
metabolizes lipid gangliosides, build up in brain; Progressive dev. delay, paralysis, blindness, dementia; death
by age 4
Multiple Sclerosis
Progressive demyelinating, women>men; Peak onset 20 - 40; Gradual & variable CNS sx suggest dx; CSF =
mild proteins, mild lymphocytes , oligoclonal bands, MRI = multi plaques in white matter
Guillain-Barre Syndrome
polyneuropathy after mild viral illness, inoculation or surgery; Most common acquired demyelinating
disorder; progressive bilateral weakness of legs, proximal weakness, abnormal DTR, instability of temp &
BP; CSF = protein w/ normal pressure, glucose & cell numbers; Plasmaphresis speeds recovery;
Corticosteroids are contraindicated
Cerebral Palsy
CNS damage before age 5; Risks: Prematurity, IUGR, inutero complcations, neonatal jaundice, birth trauma,
asphyxia, spastic syndrome, DTR, tone, weakness, toe walking, scissors gait
Myasthenia Gravis
autoimmune, antibodies against acetylcholine receptors at neuromuscular junctions, women, age 20 - 40;
Ptosis, diplopia, dysarthria, enhanced muscle fatigue, thymoma on chest x-ray; Tx exogenous
anticholinesterase (edrophonium or neostigmine); Thymectomy in pts < 60; steroids or azathioprine if
unresponsive to tx
Muscular Dystrophy
Duchenne most common type; X linked recessive, mutation in dystrophin gene; CK before onset of sx; By
age 5 toe walking, waddling gait, can't run; Prox legs 1st then prox arms; Pseudohypertrophy of calves = fat
infiltrates in muscles;
Coma
dysfunction both cerebral hemispheres or RAS; Acute onset = subarachnoid hemorrhage or brainstem infarct;
progressive min-> hours = Intracerebral hemorrhage; days => weeks = chronic subdural hematoma, tumor or
abscess; No laterialization following delirium = metabolic; Pupil size: dilated nonreactive = at or below
midbrain, pinpoint = pontine; opiod OD, Constriction intact w or w/o extraoccular impairment = metabolic;
Localizing response to pain = superficial coma; Decorticate (flex @ elbow, ext leg) = thalamic lesion of
compression; Decerebrate (elbow & leg extension) = midbrain; No response to pain = pontine or medullary
Gait Abnormality
Cerebellar lesions = truncal ataxia, broad based, unsteady, irregular; can't turn
Corticospinal = affected leg circumducts as it steps forward, scissors if bilateral
Extrapyramidal = festinating gait, flexed posture, small rapid steps, no arm swing
Motor System = Footdrop - anterior tibial; Calf muscle - can't toe walk; Pelvic muscle - waddling gait.
Arnold Chiari Syndrome
Cong. Protrusion of medulla thru foramen magnum; unusual sensory & motor chgs, Onset ~ 40
Cold Calorics
Test vestibular system, Slow deviation toward ear w/ cold water = brainstem intact, fast nystagmus away =
contralateral cortex intact; COWS = cold opposite Warm same for fast component
GYN
Trichomonas Vaginitis
Yellow green discharge, Strawberry patches, Motile flagellated, Tx: Metronidazole
Gardenerella Vaginitis
KOH whiff test = fish; Clue cells, most common symptomatic infection; Metronidazole
Condyloma Acuminata
Warts, HPV 6, 11, Not assoc w/ cervical cancer
PID
Cervical motion tenderness, Purulent discharge, assoc w/ ectopic pregnancy & infertility; Leukocytosis,
neutrophilia, ESR
Candida
cottage cheese, red vulva; Pseudohypahe & spores on wet mount, DM, antibiotics, OC, pregnancy
UTI
E coli, Dysuria, frequency, urgency; Tx: TMP-SMX, Bactrim, Septra
Toxic Shock Syndrome
Staph aureus exotoxin, rash, high fever, hypotensive shock
Chancroid
H. Ducreyi, tropical & sub tropical climates, gram neg; Tx Emycin or Ceftriaxne
Chlamydia Trachomatis
Intracellular, columnar epithelium, mucopurulent, Immunofluoresent discharge, Tx: Doxycycline (Emycine if

pregnant)
Herpes Genitalis
HSV II clear sores , multinucleated giant cells w/ intracell inclusions; Tzanck smear
Molluscum Contagiosum
umbilicated nodule, remove & cauterize
Endometriosis
Ectopic endometrium tissue, Dysmenorrhea, Dyspareunia, infertility
Paget's Disease of Breast
Intraductal Ca in main excretory ducts; crusting erosion of nipples w/ or w/o discharge
Polycystic Ovarian Disease
LH, or normal FSH; hirsutism, obesity, menstrual irregularities, infertility
Menopause
Avg age =51; FSH & LH; Hot flashes, Atrophic vaginal epithelium
Urinary Incontinence
Stress = intra abd pressure, leak small amts of urine; Kegel exercises, estrogen
Urge = detrussor instability; lg amts of urine leaked immediately after urge to void
1o Amenorrhea
Absence age 16 w/ 2o sex development or absence by age 14 w/o 2o characteristics
Anatomic Abnormalities; Ovary Failure ( FSH & LH, estradiol) (XO, turners, no ovary); Pituitary =
Prolactinoma presents w/ galactorrhea (Bromocriptine to Tx), Hypothalamic = FSH & LH, (anorexia,
exercise, stress); XY karotype
2o Amenorrhea
Absence for 6 mos if prev normal; absence for 12 months if prev oligomenorrhea; r/o pregnancy;
Galactorrhea = prolactinoma; Hirsutism = polycystic ovarian; Tx: 1st = progestin challenge (bleed w/ in 2
wks) if no bleed measure FSH levels
1o Dysmenorrhea
correlates w/ 1st day of menses, cyclic, begins in adolescence, low back & abd pain, N/V/D, fatigue, HA
2o Dysmenorrhea
acquired, Sx don't correlate w/ 1st day of cycle, Endometriosis most common cause
Asherman's Syndrome
intrauterine adhesions after D&C; destruction of endometrium => amenorrhea
Fibroademoma
Age 19 -29, stromal fibrosis; nontender, estrogen sensitive, regress w/ menopause
Fibrocystic Breast Disease
Age 29 - 39, may have green nipple discharge; tender w/ ovulation, regress w/ pregnancy,
Breast Disease Age 39-49
malignant = intraductal Ca (bloody nipple discharge); Papillary #1 cause of nipple discharge; Sclerosing
Adenitis
Breast Ca
Upper outer quadrant, Mets = bone, liver, lung, brain; Risks: Family Hx, menarche < 12, 1st pregnancy > 35;
late menopause, null parity, obesity, other breast, radiation, reserpine
PAP Smear
Atypia = inflamm, infection HPV (16 & 18); Mild Dysplasia = lowgrade epithelial lesion; Mod/Severe=high
grade intraepithelial;
Carcinoma in situ
nuclear/cytoplasm, dense chromatin, crowding, mitosis; Koilocytes = HPV, pyknotic nucleus, perinuclear
halo; Risks: early sex, multi partners, smoking, social class, HPV; Culposcopy = white epithelium,
mosiacism, punctation, atypical vessels
Cervical CA
90% squamous cell; s/sx: Early = postcoital bleeding, intermenstral bleed, Late= backache, leg pain, edema,
hematuria Tx: Ia=TAH, iB & IIA = rad hysto & pelvic lymph nodes, IIB -IVA = Radiation - Brachytherapy
=> Radium, Cesium
Endometrium CA
most common gyn malignancy; Risks: obesity, DM, HTN, anovulation, early menses, later menopause,
nullparous, unopposed estrogen; Dx : abnormal menses, post menopausal bleeding; EMB, D&C; Histologic=
grade 1-3 based on differentiation;
AdenoCA=70%; Adenocanthoma=benign squamous, best prog; adenosquamous= malig squam, poor prog;
Papillary Serous = acts like ovarian CA, Clear Cell = poorest prog, older, DES, least common Tx; TAH/BSO,
perioneal wash, pelvic & aortic nodes, Adjuvant Rad if + nodes, cervical +, > ½ myometrium, higrade
Ovarian CA
Abd./pelvic mass, ascites, early satiety, CA125, CEA, CA19-9, 75% w/ stage 3; Path types = Serous
(psammoma bodies), Mucinous, Endometroid, Clear Cell (hobnail bodies) Brenner; Staging: 1A= 1 ovary, 1B
= both ovaries; 1C= + wash, tumor rupture; IIA = fall tubes/uterus, IIB other pelvic structures, IIB + wash
rupture w/ spread; IIIA gros in pelvis, micro to diaphragm or omentum, IIIB Intra abd < 2 cm, IIIC: intra abd
> 2cm, pelvic/aortic nodes, inguinal nodes; IV = distant spread, pleural effusion w/ malig cells, liver/spleen
mets; Tx: debulk tumor surgery, Chemo = cisplatin/cytotoxin, taxol; Radiation (bowel obstruction);
Teratomas
immature (neuro epithelial); mature (dermoid)=95% of all teratomas, hemolytic anemia; LDH elev, CA125
Dysgerminomas
most common malignant, 15% bilateral, radiosensitive
Endodermal Sinus Tumor
Schiller Duvall Body, AFP
Embryonal CA
HCG, AFP, CA125
Choriocarcinoma
HCG
Sexcord-Stromal Tuors
Granulosa: 50% post menopause, estrogen, Call-Exner bodies
Sertoli-Leydig: most often virilizing; Gonado Blastoma: gonadal dysgenesis
Krukenburg Tumor:
Ovarian mets from GI & breast; Signet ring cells
Vulvar CA
TNM staging, squamous cell, Vulvar pruritus; Pagets= adenoca of vulva, 20% assoc w/ breast, GI, cervical
CA
Gestational Trophoblastic -
Benign: Complete Mole = 46 XX, paternal, no embryonic tissue; Incomplete = 69 XXY triploid, paternal, no
fetal/ embryonic tissue
Malignant: Invasive= molar villi; Choriocarcinoma = no villi, any pregnancy; Placental Site = non molar
gestations
S/Sx: size > dates, hyperemesis, hyperthyroid, large theca lutein cyst
F/U = CBC. Liver function, BUN, CR, TSH, HCG, US, CXR; TX = D&C
Weekly HCG' until 3 values that are non detectable then 1/mo x 1yr, BCP x 1 yr
Ca in Pregnancy
Melanoma = worsened by preg, can met to placenta or fetus
Breast CA = most common CA in pregnancy
Chemotherapy
Cyclophosphamide (Cytoxan) = ovarian, hem, cystits, alopecia, bone marrow, N/V
Cisplatinum = ovaian, renal toxic, ototoxic, bone marrow , N/V
Adrimycin (Doxyrubicin)= endomet, ovarian; cardiotoxic (heart failure)
Bleomycin= cervical, germ cell, Pulmonary fibrosis
Vincristine= cervical germ cell; neurotoxic
Methotrexate = GTN, germ cell, hepatic & renal toxic, bone marrow
OBSTETRICS
Hydantiform Mole
Preeclampsia 1st TM, Very high Beta HCG, Snowstorm on US
Ectopic Pregnancy
Beta HCG rises slowly, Amenorrhea, spotting, pain, Empty gestational sac on ultrasound, Ampulla of
fallopian tube is most common site
Gestational Age
Nagel's = Add 7 days to FDLMP subtract 3 months; fundal ht in cm after 13 weeks
Amniocentesis
Adv maternal age, abn AFP - Spina bifida, Down's, detect lung maturity, early 2nd trimester
CVS
Adv. Maternal age, late 1st trimester
Non stress Test
> 2 fetal movements accompanied by FHR of 15 bpm for at least 15 sec w/ in 20 min period
Contraction Stress Test
Negative = 3 contractions in 10 min, lasting 40 sec w/o late decelerations
Positive = consistent & late decelerations
Biophysical Profile
Nonstress test, fetal breathing, movement, adeq, amniotic fluid, limb extension
Fetal HR
normal 120-160, Brady = mild 100-120, < 100 severe; Tachy = mild 161-180; severe > 180
Decelerations
Early = shape is mirror of contraction, head compression
Variable = shape varies, cord compression
Late = starts as contraction peaks, recovery after contraction is terminated, uteroplacental insufficiency
Placental Previa
Partial - partially over os; Complete= covers OS, Marginal = at edge of OS, Complete Previa is indication for
C section
Placental Abruption
Premature separation of a normally implanted placenta, vag bleed, uterine tenderness, back pain, hypertonic
uterus, fetal distress
Preeclampsia
HTN w/ proteinuria & edema after 20 wks gestation
Eclampsia
Preeclampsia + seizures
Gestational Diabetes
1 hr > 140 then do 3 hr; 3hr test = fast > 120, 1 hr > 190; 2 hr > 165, 3 hr > 145; Macrosomia, RSD, Cong
abnormalities
Types of Pelvises
Gynecoid = round inlet, nonprominent spines, wide subpubic angle
Anthropoid = heart shaped inlet, transverse and AP diameters, subpubic angle
Android= triangular inlet, subpubic angle, prominent spines
Platypoid= transverse and AP diameters
Leopold's Maneuvers
fundal palpation, sides of uterus from feet of mother, lower part of uterus, sides of uterus from head of
mother
Stages of Labor
1. Onset contract => full dilation 2. Full dilation to delivery of head 3. Delivery of fetus to delivery of
placenta 4. Delivery of placenta to 1 hr later
Cardinal Movements
Engagement, descent, flexion, int rotation, extension, ext rotation, expulsion
Post Partum Hemorrhage
Uterine Atony (most common); Placental Accreta: Accreta = superficial invasion into myometrium, Increta =
deeper, Percreta = invasion to serosa of uterus; Undiagnosed lacerations, Coag defect; Retained placental
fragments
Apgar Scoring
Heart Rate, Resp. Effort, Muscle Tone, Reflex Irritability, Color
Shoulder Dystocia
Maternal obesity, diabetes mellitus, postterm pregnancy
Cesarean Section Indications
Health of mom or baby endangered by labor, Dystocia precludes vag delivery, Emergent situation, Herpes,
Prev C section if contributing factor still exists, Malpresentation of fetus
Premature Rupture of Membranes
Pooling of fluid in vagina, + nitrazine test, + ferning test, risk of endometritis
Polyhydraminos
Duodenal Atresia, Tracheoesophageal fistula, Anencephaly
Oligohydraminos
Renal Agenesis, Pulmonary hypoplasia
PEDIATRICS
Fetal Alcohol Syndrome
IUGR, Microcephaly, Short palpebral fissures & philtrum, Cardiac Abnormalities, SGA, mental retardation,
microencephaly
Fetal Narcotic Exposure
Hypertonicity, Sweating, Stuffy Nose
Fetal Cocaine Exposure
Limb reduction malformations, Intestinal Atresia, Jittery, tremors
Grey Baby Syndrome
chloramphenicol use, metabolism due to immature liver, CV collapse, maybe fatal
Erythroblastosis Fetalis
Rh neg mom Rh + baby; Subsequent Rh + babies are at risk; Give RhoGam - binds to fetal RBC, prevents
Antibodies from being made
Beckwith Weiderman
neonatal hypoglycemia d/t hyperinsulinemia, macroglossia, giantism, omphalocele, kidney anomalies, facial
nevus flammus, poor prognosis
Apt Test
Determine cause of neonatal rectal bleed; differentiates adult vs fetal hemoglobin
Dubin Johnson
Chronic idiopathic jaundice
Erb Duchenne
C5-C6, flail arm (int rotation & abduction) due to traction on head during delivery; If c4 involved - paralytic
diaphragm also present
Henoch Schoenlein Pupura
kids, allergic vasculitis, non-blanching petechiae or pupura on lower extremities only, arthralgias, abd pain,
hematuria, proteinuria, coag & platelets are WNL; Immune mediated after virus or strep
Kawasaki's
look sick w/ fever > 5d, truncal rash, cervical nodes, URI sx, "glove" desquamation on palms, feet, lips;
Assoc w/ coronary artery aneurysm; TX: High dose asa, IV gammaglobin, Steroids contraindicated
4 out of 5 =bulbar conjunctivitis, erythematous mouth, lips & tongue; polymorphous erythematous rash,
induration of hands & feet w/ erythema, solitary unilateral cervical lymph node < 1.5 cm; Thrombocytosis
after 10th dy is common
Kleinfeltters
XXY, most common hypogonadal syndrome; + BARR body, small firm testicle, azospermia, FSH
Meckel's Diverticulum
2 ft from ileocoecal valve, 2 in long, 2& population, 2 tissue types (gastric or pancreatic) sx before 2 yrs old
Newborn Blood
85 cc/kg, Hgb 14 - 22 gms/dl HCT 44-64%; alk phos than adults & is until adolescent growth spurt
TORCH
Toxoplasmosis, syphillis, rubella, CMV, herpes
CMV
maybe asymptomatic or deafness, blindness, jaundice, petechia, fever, seizure, mental retardation, IUGR;
Transplacental passage of virus
Cong. Rubella
IUGR, cataracts, glaucoma, microphthalmia uveitis, retinitis
Kernicterus
unbound bili crosses blood brain barrier resulting in neuro problems or death
Prolonged Hyperbili
Bili > 10 at 10 days of life
Photo therapy can be used as long as direct isn't > 1 mg%
Hemorrhagic Disease of Newborn
Deficiency of vitamin K dependent factors (2-7-9-10)
Intrauterine Shunts
placental, ductus venousus , foramen ovale, ductus arteriosus
Ductus venosus = ligamentum venosus; Ductus Arteriosus = Ligamentum Arteriosus
Growth & Development
1st teeth - 6-9 mos; Neuromuscular development in cephalocaudid direction; 4 wks regard face, smile 4-6
wks, social laugh 4-5 mos; 15 mos stack 2 blocks; 18 mos stack 3 blocks; walk up stairs 20 mos ; w/ alt feet 3
yrs;
Drawing = circle 2.5-3; cross 3-4; Square 4-5; Triangle 5; Diamond 6 yr
Wt Gain = BW by 10d; 15 lbs 1st yr, 6-7 lb 2nd yr
Length = 10 in 1st yr, 5 in 2nd yr; < 2in / yr is abnormal
Head Circumference: 0-35; 3-40, 9-45, 3-50, 9-55 cm
# Alveoli increase as lungs grow; # nephrons don't increase after term
ADHD
3x more male than female; inattentiveness, impulsivity, hyperactivity
SIDS
Peak 2-4 mos, declines after 6 mos; 60:40 male:female;
Risk Factors: < 20yrs old, poverty, smoking
Apnea of prematurity in infants < 34 wks gestation; Tx: tactile stimulation, decr environmental temp, incr O2,
transfuse to get Hct to 45%; CPAP, theophylline, last resort = mech vent
Special Human IG
hepatitis B, Rabies, Tetanus, Varicella Zoster, CMV
CHF in Peds
cardiomegaly, tachypnea, hepatomegaly
Noncyanotic Cong Heart Disease
ASD, VSD, AV septal defect, PDA, coarction of aorta, aortic stenosis, MVP
Cyanotic Heart Disease
Tetralogy of fallot, pulm Atresia w/ VSD, tricuspid Atresia, hypoplastic left heart, transposition of great
vessels, anomalous pul venous return, truncus arteriosus
Rheumatic Fever
carditis, polyartheritis, sydenham chorea, erythema marginatum, subcutaneous nodules; Mitral insuffucuency
most common valvular residual = Carey Coombs murmur
Acute Myocarditis
Coxsackie B #1, Coxsackie A, CMV, mumps, herpes, adenovirus
Otitis Media
Moraxella Catarrhalis #1 cause of bacterial in infants < 18 mos
Epiglotitis
prior to vaccine H. flu most common cause; peak ages 3-8 ys
Resp Infections < 5
Viral pneumonia = RSV, Bacterial pneumonia = strep; Lower resp infection = mycoplasma pneumonia (
Eaton Agent, 1o atypical pneumonia or walking pneumonia); Croup = rhino, RSV #2;
Pyelonephritis
poor feeding, irritability, and seizure ; r/o sepsis
Hemorrhagic Cystitis
Adenovirus
Neurogenic Diabetes Insipidus
x linked recessive, renal ADH receptors; Sx polyuria, polydipsia, FTT; r/o psychogenic polydipsia; Due to
hypofunctioning hypothalamus or posterior pituitary w/ ADH deficiency
Rashes
Measles (rubeola); Face then body; Cough, Coryza, Conjunctivitis, Koplik's spots
Scarlet Fever= red skin folds (Pastia sign), strawberry tongue, sandy exanthum on trunk => flexor surfaces
German Measles (Rubella)
Filatov Dukes Disease (4th. No longer used)
Erythema Infectiosus (5th disease) parvo B19, slapped cheek; circumoral pallor => lacy reticular rash
Roseola infantum (herpes 6)High fever then after fever get rash 1st on trunk then face
Rash on face 1st = measles, 5ths, Rubella
Rash on Trunk 1st = Scarletina, Roseolla, Chickenpox
Rashes on Palms & Soles = Erythema Multiforme (Stevens Johnson); Hand Foot & Mouth (Coxsackie A19;
Kawasaki, Rocky Mt Spotted Fever, 2o syphillis, TEN, Dermatomyositis
Infectious Mono
EBV, Dx by positive heterophile test (Paul Brunnel Ab); hepatosplenomegaly
Conjunctivitis
Neonatal infectious = Chlamydia trachomatis,minimal discharge, congestion & edema 7-14 days after birth
Rocky Mountain Spotted Fever
Rickettsia rickettsii, high fever, peripheral rash, Atlantic seaboard, wood & dog ticks
Cat Scratch Disease
R. Henselae; regional lymphadenitis; Chemical = silver nitrate
PKU
blonde hair, MRDD, seizures, eczemoid rash
Galactosemia
Auto recessive, n/v/d, jaundice, hepatomegally, cirrhosis & cataracts if untreated
Homocysteinuria
tall thin stature w/ MRDD sublaxation, lens, genu valgum (knock knee), pectus carinatum
Lesch Nyhan
Purine metabolism; normal until 6-8 mos; loss of motor milestones; spasticity, self mutilation without loss of
sensory feeling; Urine has orange uric acid crystals
Self mutilation w/ loss of sensory = familial dysautonomia
Hurler's Syndrome
mucopolysaceharidosis, grotesque coarse features, skeletal anomalies, dead by age 10
Glycogen Storage Disease
Von Gierke, Pompe, Forbes
Tay Sachs
Lipid Storage, Jewish , defic of hexosaminidase A; normal at birth then loss of motor milestones & hypotonia
at 6 mos, Death by age 2; Cherry red macula
ALL
most common malig of childhood, peak at age 4; thrombocytopenia, anemia, elevated uric acid & LDH; Dx
by bone marrow biopsy showing infiltration of leukemia blast cells; CXR = mediastinal mass or widening, 2o
ary to lymphadenopathy
Brain Tumors
most common solid tumor of childhood; < 2 intratentorial tumors > 2 supreatntorial tumors
Morning vomiting = posterior fossa ependymoma
Astrocytoma most common brain tumor
Hodgkins Lymphoma
Reed Sternberg Cells; Painless cervical lymphadenopathy
Neuroblastoma
Neural crest of sympathetic ganglia or adrenal medulla; 50% before age 2; 90% before age 5; and mass that
crosses the midline
Nephroblastoma
asymptomatic abd mass; HTN, Ages 2-5; Aniridia (loss of iris) hemihypertrophy Also called Wilm's Tumor
Rhabdosarcoma
Most common soft tissue sarcoma; < 10yrs old; nasal, aural, anus or vaginal area
Ewing Sarcoma
diaphyses
Osteosarcoma
Metaphyses, #1 site distal femur
Retinoblastoma
Neuroectodermal malignancy , most occur before age 5; Leukocoria (white pupil reflex)
G6PDase Defic
most common red cell enzyme deficiency that causes hemolytic anemia; usually asymptomatic until exposed
to stress, infection or certain foods; Cause of hyperbilirubinemia in Chinese or Mediterranean but NOT
BLACK infants; Avoid sulfa drugs
PSYCH
Axis Determination
I = clinical psych disorders II personality disorders, III Coexisting medical conditions IV psychosocial
stressors, V global assessment of functioning
Schizophrenia
Positive Sx: delusions, hallucinations, bizarre behavior; Negative Sx: alteration of affect, ambivalence,
apathy, loosening of associations; males=females; industrial nations have prevalence; Misalignment of cells
in cortex; ventricle size; activity in frontal cortex on PET scan.
Disorganized: insidious, incoherent, inappropriate affect, social impaired
Catatonic: rigidity, posturing or excitement, negativism
Paranoid: highest functioning type, grandiose, jealous, persecution
Undifferentiated: not defined by other subtypes
Melerill = Retrograde ejaculation, Tx: Respiradol (Best side effect profile), Clozaril (agranulocytosis w/
weekly CBC) prescribed weekly,
Neurolyptic Malignant Syndrome = temp, CPK, rigidity
Schizophrenifrom
same sx as schizophrenia but have lasted for less than 6 months
Schizoaffective
mood disorder and separate psychotic sx. Must experience 2 weeks of psychotic sx w/o mood impairment for
dx to be made; Antidepressants are 1st line tx
Major Depression
loss of interest in activities, sleep, wt, concentration, hopelessness, suicidal ideation, nihilism; Seasonal
affective, Vegetative (non functioning can be terminal) Dysthymia(chronic low level); Reactive related to
environment w/o severity id sx; Masked 1o depression denied or hidden by other sx
Depression & anxiety can occur together & can be treated w/ an antidepressent; Left anterior or rt posterior
stroke => possibility of depression; Tx: 1st Tricyclic (Imiprimine); SSRI = side effects; Trazadone=priapism
Asendin (Amoxipine) = Extrapyramidal Symptoms
BiPolar
Bimodal peak 20's & 30'sCycling mood= highs w/ euphoria, hyperactive, pressured speech, flight of ideas,
decr need for sleep, delusions, inflated self esteem, risks, poor judgement; Lows are major depressive
episodes tx: lithium
Panic Attacks
Sudden, unprovoked onset of fear, impending doom, palpitations, SOB, chest pain, smothering, dizziness.
May be associated w/ agoraphobia Tx: with SSRI's
Phobias
Persistent and irrational fear of a specific object or activity or situation. Tx like a phobia
Obsessive Compulsive
Persistent, unwanted thoughts, impulses or images
repetitive, purposeful intentional behaviors meant to decrease tension caused by the obsessive thoughts;
genetic Tx: Anafranil (Tricyclic) Prozac & Luvox (SSRI)
PTSD
intrusive recollections, daydreams, nightmares, poor concentration, psychic numbing; Tx: don't treat w/ meds
unless compulsion component
Studies: Buffalo Creek Disaster, Beverly Hills Nightclub
Dissociative Disorder
Amnesia = loss of memory, Fugue = assoc w/ physical flight, Identity Disorder = multiple ego states;
Depersonalization = feelings of self estrangement or unreality
Whirndingo
Fear of becoming a cannibal
Amok
sudden unprovoked outburst of wild rage usually ending in homicide
Coprolalia
Feces & filth
Koro
penis is shrinking and may disappear
Latah
imitate words or actions to which they are exposed
Piblotko
Run around in snow naked
White Out Syndrome
lack of diverse stimuli in snow clad environment
Narcolepsy
REM sleep, sudden onset of daytime sleep and cataplexy; REM sleep is inappropriately present at beginning
Personality Disorders
Cluster A = Bizarre = Paranoid, Schizoid (no close relationships, restricted emotions) Schizotypical (schizoid
+ odd or distorted behavior or cognition)
Cluster B = Over emotional = Antisocial (Disregard for social norms) Borderline, Histrionic, Narcissistic
(self centered)
Cluster C = Anxiety & Fear = avoidant, dependent, Obsessive compulsive
POISONING & ACCIDENTS
Burns
1st= only epidermis, red no blister; 2nd = hyperemic, blister; partial thickness; 3rd = full thickness, leathery no
pain; 4th = electrical injuries, damage to nerves & bone; entry & exit burn; Fluid resc. If > 20% Parkland
formula = 3-4 ml/kg LR x % burn RULE of 9's: head = 9; ant trunk= 18 post trunk = 18, each ext = 9; each
ext = 18, Perineum = 1
Common Poisons & Antidotes:
Aspirin = Dialysis; Acetaminophen =N-acetylcystine; Digitalis = lidocaine; Methanol & Ethylene Glycol =
Ethanol; CO = O2; Narcotics = Narcan, Naloxone; Iron = Deferoxamine; Cu, As, Pb = Penicillamine;
Cyanide = Sodium nitrite, or sodium thiosulfate
Types of Fx
Open(compound); Simple(closed); Greenstick (incomplete, children usually); Spiral (twisting breakage);

Comminuted (multi bone fragments)
Vertebral Fx
Most common cause of paraplegia & quadriplegia, Compression Fx seen in elderly due to osteoporosis &
DJD
Hip Fx
Avascular necrosis of femoral head if blood flow is compromised; Tx: immobilization, bedrest, surgery;
Prevention= safety & Ca supplement in women
Skull Fx
Signs of Fx: 1.Battle's Sign = discoloration over mastoid bone; 2. Blood draining from ears, 3. Bruising of
orbit, CN palsies, CSF leakage from ears & nose
Rib Fx
Most common thoracic injury; usually 5-9, local pain worse w/ inspiration
Colles Fx
most common wrist fx; breakage & displacement of distal radius, Attempted to break fall on outstretched
hand
Elbow Fx
<10 yrs old, fall on outstretched hand w/ elbow in full extension; Compression or radial or median nerve or
brachial artery; Improper care => Volkman's Ischemic Contracture
Pelvic Fx
MVA, 30% blood volume can be lost; Tx as if shock victim
Tibial Fx
Compartment syndrome= bleeding into tight compartments=> blood supply compression=>muscle ischemia;
6 Ps = pain, pallor, pulselessness, puffiness, parathesia & paresis (weakness) or paralysis. Surgical opening of
compartment
Sprains
Tx = RICE => Rest, Ice, Compression, Elevation
Concussion
transient loss of consciousness; Coup = bruising under site of injury; Contrecoup = bruising on side
contralateral to injury
Blunt Eye Trauma
periorbital echymosis, hyphema (bleed into anterior chamber; edema; Blowout Fx = Fx of orbital bone;
Aspirin & anticholinergics are contraindicated
Blunt Ear Trauma
Auricular Hematoma (cauliflower ear) Tx prompt drainage to prevent dissolution of cartilage
Dog & Cat Bites
Pasturella multocida; Tx tetanus & rabies if needed, antibiotics
Snake Bite
Splint affected area & transport; In US usually pit vipers
Spider Bite
Black Widow: Vomiting, abd pain, shock; Tx Calcium gluconate & methocarbamol; Local bite Tx not needed
Brown Recluse: bite becomes black scab w/ assoc fever, rash, vomiting & jaundice; DIC can occur; Tx:
Dexamethasone, dapsone, colchcine & total excision of lesion
Hypovolemic Shock
Hemorrhage, Burns, Vomiting, Diarrhea; pale skin, JVD, vasc resistance, pulse Tx: rehydrate, transfusions,
Septic Shock
Infection, gangrene, necrosis,CV obstruction; pale/pink skin; flat neck veins, pulse or vascular resistance Tx
ventilation, Fluids, antibiotics
Cardiogenic Shock
Pale skin, flat neck veins, pulse, vascular resistance; Tx: medication for underlying problem, pacemaker,
Neurogenic Shock
Spinal cord injuries, drug OD; Pink skin, flat neck veins, normal => low pulse, low vascular resistance Tx:
ventilation, fluids, drainage
PUBLIC HEALTH
Levels of Prevention: 1o = actions to incidence of health problems (prenatal care, immunizations)
2o = interventions at early stage of disease to limit development (DM screen, PAP)
3o = interventions to treat problem and prevent further morbidity & mortality
Special Tests Complement & Complement disorders C3, C4, CH50
Rheumatiod - ANA, RF
Lupus - DNA, Anti Smith Antibody
Scleroderma - Scl-70, Anti Centromere
Sjogrens -SSA Anti Ro, Anti LA
Prostate = PSA, Pancreatic = CA 19-9,Ovarian=CA125; Breast = CA15-3 & CA27-29
Testiclar = BHCG, AFP, Thyroid = Calcitonin
10 Biliary Cirrhosis = Anti mitochondrial antibody
Wilson's Disease = Ceroluplasmin Antibody
Liver = Alpha 1 antitrypsin
Thyroid - Antimicrosomal antibody, Thyroglobin antibody
Incidence # new cases / total population
Prevalence # cases at a given time / total pop at that time
Disease Frequency # people w/ disease / population at risk
Case Fatality # who die in a given period/ # people w/ disease
Relative Risk Only from cohort study; a/a+b divided by c/c+d; >1 positive assoc, < 1 negative association,
=1 no association ==> disease if exposed /disease if not exposed
Odds Ratio Only from case control; odds of getting if exposed / odds of getting if not exposed (ad/bc)
Mortality Rate # people that die w/ in current population
Std Mortality Rate Adjusted according to age distribution
Attributable Risk exposed rate - unexposed rate
Sensitivity a/a+c; accurate diagnose ; False +
Specificity d/b+d; Prob of neg test in those truly neg; false neg
OMM
Fryettes Laws
1. Side bending then rotation in neutral position
2. Flexion or extension with rotation then side bending
3. Motion free in one direction is restricted in the other
Ribs
1-5 pump handle, 6-10 bucket handle, 11-12 caliper; Elevated = expiration restricted Treat lower ribs 1st;
Depressed = inhalation restriction, treat upper ribs 1st
Flexion Test
Standing = ilia sacral; Seated = sacroiliac; false neg = tight hamstrings on standing flexion; False positive =
tight quads on standing flexion
Sympathetic Innervations
Head & Neck = T1-4; Lung T2-5 bilat; Heart T2-5 Left, Stomach T5-9 Left; Duodenum T10 rt; Gall Bladder
T9 rt; Liver T5-9 Rt, Pancreas T6-9 bilat, Kidneys, Ovaries, Testes T10-L1 of respective side; Adrenals T10-
11, Appendix T11-12 Rt, Bladder L3-4, Uterus L4-5, Rectum & Anus L4-5
Parasympathetic Innervations
Eyes=CN III; Nasal sinuses, Eustachian Tube=CN VII; Soft Palate, Salivary Glands=CN IX; Thyroid thru
Transverse Colon=CN X (Vagus); Right Colon & Pelvis= Pelvic Splanchnic Nerves S2-4
Somatic Dysfunction
An altered or impaired function of related components of the somatic system
Qualities: Texture chg, asymmetry, ROM, tenderness
Treatment Types
Direct = engages restricted barrier & pushes thru it, Force takes it from where it is to where it will not go
Indirect = Move away from the barrier, Leaves the structure in the position it was
Direct Technique Used For:
Subacute or chronic, no assoc osseous pathology post closure of epiphyseal plate, Short restrictors
Indirect Technique Used For
Acute, A lot of pain, a lot of restriction, non closure of epiphysis
HVLA Contraindications
Direct, Passive
Absolute = Weak bony structure, spinal cord, nerve compressions, Danger of vascular damage;
Relative: lax ligament, acute inflammation, pregnancy, Calcification of aorta, Recent MI, spondylosis,
Ankylosin Spondylitis, Osteoporosis, Chronic Steroid use, Acute disk disease, Extreme scoliosis, Cauda
Equina Syndrome, Adv. Degenerative disease, Severe DM, Hx or current malignancy, Agenesis Odontoid
process, Vertigo
Counter Strain
Passive Indirect
Put joint into position of greatest comfort; Agonist-Antagonist pair; Strain due to rapid stretching followed by
protective immediate shortening of agonist along with rapid shortening then lengthening of antagonist
Most comfort of pt (70%) Hold for 90 sec (120 secs for ribs) Reactions to Tx: generalized soreness, treat no
more than 6 TP at a time, 3 days between Tx;
Muscle Energy
Active then passive, direct
Type I = Joint mobilization using direct muscle force
Type II = Muscle lengthening using postisometric relaxation, "Resetting the Gamma Gap or Synaptic Fatigue
Type III = Muscle lengthening using Reciprocal Inhibition
Type IV = Muscle relaxation using Crossed Extensor Reflex - Used w/ sever injury (flexor muscle on one
extremity is contracted the flexor on opposite extremity relaxes & extensor contracts)
Natural Body Rhythms
Cardiac/Vascular, Ventilatory, Visceral, Cranial Rhythmic Impulse (CRI), Slow Undulating (Breath of life)
Articular Mobility of Cranial Bones
Newborn: Base is cartilage for stability, vault is membrane for accommodation
Sphenoid motion - influences facial & frontal bones; Occipital Motion - influences temporals (mandible &
hyoid) & parietals
Motion of Sacrum between the Ilium
Superior transverse axis, Located at S2, Only area of anterior convergence & posterior divergence of the SI
joint
Coordination of motion
Inhalation = midline flex, paired ext rotate, sacral base post, SBS rises
Exhalation = midline extension, paired int. rotation, sacral base anterior SBS falls
Sacrum & Temporal follow movement of occiput; Facial bones follow motion of sphenoid
Strain Patterns
Torsion, Side bending rotation, Vertical Strain, Lateral Strain, Compression
Naming Convention
Vert unit, AP, side bending, rotation
Type of Motion
C0-C1 (OA) Type I; C1-C2 Rotation; C2-C7 Type II; C7-L5 Type I & IIACID BASE
pH acedemia <7.35-7.45< alkalemia
pCO2 Resp alkalosis < 35 - 45 < Resp acidosis
HCO3 Metabolic Acidosis < 22-26< Metabolic alkalosis
Anion Gap = (NA) - [(Cl) + (HCO3)]
Primary disorder pCO2 or HCO3 altered same way as pH

Review Cram Sheet

Caricato da

Informazioni sul documento

Copyright

Formati disponibili

Condividi questo documento

Condividi o incorpora il documento

Opzioni di condivisione

Hai trovato utile questo documento?

Questo contenuto è inappropriato?

Copyright:

Formati disponibili

Review Cram Sheet

Caricato da

Copyright:

Formati disponibili

COMLEX II and USMLE II Review Cram Sheet 2/14/19, 9(45 PM

COMLEX II & USMLE II CRAM SHEETS

Night blindness, conjunctival dryness, corneal keratinization

Ricketts - kids, long bone bowing; Osteomalacia-adults, demineralization

Clotting deficiency with prolonged PT

Beriberi - peripheral neuropathy, Cardiomyopathy - dry or wet (high output failure)

Wernicke-Korsakoff - Alcoholics, confabulation, nystagmus, confusion

Pellagra - Diarrhea, dermatitis, dementia, death

Rare, neuropathy, Cheilosis (swollen cracked bright red lips)

Macrocytosis, Pernicious Anemia- megaloblastic, neuro chg. ataxia, Schilling test

Macrocytosis, megaloblastic anemia w/o neuro chgs., common in alcoholics

Org.= wt gain w/ other disease; Nonorg.=growth failure due to neglect stimulation

< 80% wt for Ht

BMI= body wt (kg)/Ht (mm2) Normal 20-25

Pickwickian Syndrome = obesity, dyspnea, hypovent, CO2 retention, hypoxia

Obstructive - solids 1st; Motor -solids = liquids

Candida (thrush), HSV, CMV, immunocomp, diabetics, Dysphagia & odynophagia

Proximal esophagus, blind pouch

Antral Creep=fundal tissue replaced by antral mucosa, Not preCA,

Risk Factors = NSAIDS, Alcohol, H.Pylori

Gastric = NSAIDS, eating no help, COPD,blood type A; 25%

Duodenal = H.Pylori, better w/ food, Liver cirrhosis, Blood type O ; 75%

Gastrinoma ( gastrin); recurrent ulcers, ½ are malignant

Irritable Bowel Synd.

Dx of exclusion (psych?); Tx: bulk supp, anticholinergics, antidiarrheals, TCA

villous>tubular ; sessile>pedunculated for being CA; familial adeno polyps autodom.

Children & young adults; cong or acquired telangiectasia of intramucosal lymphatic

Diverticulosis = false diverticulae, pearl sign on xray

Norwalk = yr round, Rota (kids) = winter; Coxsackie A1; echo, adeno

Ranson's Criteria: 3 or more = incr mortality

ERCP to Dx; Alcoholics, Malabsorption & diabetes are results

Hep C Most common post transfusion hepatitis

Hep D = Co infection with B; Hep E = fecal oral

Charcot's Triad = Biliary Colic, Jaundice, Fever; Leukocytosis, Alk Phos

Risk Factors = HBV, HCV, Alcoholic cirrhosis, Aflatoxins (fungal metabolites)

Benign Hep Adenomas

Insulin hypersecretion, hypoglycemic symptoms, Insulin levels still after fasting

1,4 glucosidase deficiency; fatal by age 2

musclephosphorylase is absent, muscle cramps & myoglobin after exercise

unconj prehepatic; conj = intrahepatic cholestasis or post hepatic disease

all fractions = hepatocellular, hyperbilirubinuria = conj bili water soluble

ETOH Hepatic Disease

altered consciousness, ammonia glutamine in CSF, EEG abnormal

Paralytic obstruction of bowel due to loss of peristalsis

Projectile vomit in neonates, visible peristaltic wave, String Sign

Abnormal thick Meconium with undigested protein, associated with CF

L=>R; Wide split & fixed S2; patent foramen ovale

Patent Ductus Arterio

L=> R; Continuous machinery murmur; Indomethacin inject may close

VSD, RVH, Pulmonic Stenosis, Overriding Aorta

Coarction of the Aorta

Libman Sacks Disease associated with SLE

Peripheral Vascular Disease

Giant Cell Arteritis

Left Sided Failure

Dyspnea, Orthopnea, Paroxysmal nocturnal dyspnea, LVH

Right Sided Failure

Alcohol = chronic; Infection Coxsackie B or Trypanosoma cruzi (Chagas Disease)

non smokers = M. pneumonia; smokers=S.pneumonia & H.flu

Circumoral cyanosis (blue around mouth) RSV; kids < 2

Red-brown sputum, lobar pneumonia, most common adult community acquired

Pneumovax vaccine = >65, immunocompromised, chronic disease

Alcoholics, aspiration, Currant Jelly Sputum, Encapsulated gram neg rod

Salmon colored sputum, Nosocomial, pneumatoceles on xray are pathognomic