“Buzz Words” Associated Disorder/Pathology
confirmed fasting BGL≥126 mg/dL classification for diabetes mellitus
confirmed 2 hour BGL≥200 during an OGTT using 75 gm glucose load classification for diabetes mellitus
symptoms of diabetes plus a casual BGL≥200 mg/dL…must be confirmed classification for diabetes mellitus
confirmed fasting BGL≥100mg/dL but <125 mg/dL plus impaired glucose tolerance classification for pre-diabetes
BGL≥100mg/dL but <125 mg/dL impaired fasting glucose
BGL <100 mg/dL normal fasting glucose
autoimmune beta-cell destruction leading to diabetes mellitus Type 1 diabetes mellitus
HLA B8 diabetes mellitus Class 1 association
HLA B15 diabetes mellitus Class 2 association
DR3 or DR4 of DR3/DR4 diabetes mellitus Class 2 association
α-glucosidase inhibitors drug for diabetes mellitus (decreases gut carbo absorption)
glitazones drug for diabetes mellitus (increases glucose uptake in muscle/fat)
metformin drug for diabetes mellitus (decreases glucose production)…can delay onset of diabetes
secretagogues (sulfonyl urea/glucophage) drug for diabetes mellitus (increase pancreatic insulin secretion)
Go BP FLAT Major anterior pituitary hormones
OP! Major FLAT BAG all pituitary hormones
ADH and oxytocin posterior pituitary hormones
bitemporal hemianopsia craniopharyngiomas, pituitary adenomas
trophic hormone deficiency hypopituitarism
pituitary adenoma that creates hormonal excess microadenoma
pituitary adenoma that creates hypopituitarism macroadenoma
cabergoline or bromocriptine treatments for macroadenomas
somatostatin analogs treatments for macroadenomas
Hypomania AT Proctor *blocked Sheehan’s syndrome
“Buzz Words” page 2 Associated Disorder/Pathology
lack of lactation, amenorrhea, hypothyroidism, and hypoadrenalism post-partum Sheehan’s syndrome
cystic tumor (sometimes lobulated) that is filled with oily green fluid…char appearance on MRI craniopharyngioma
suprasellar calcification on x-ray craniopharyngioma
palsy of eye movements due to damage of the oculomotor, trochlear, and abducens nerves craniopharyngioma
GnRH stimulation test FSH/LH deficiency
amenorrhea FSH/LH deficiency, prolactinomas
dwarfism GH deficiency in children
increased body fat and exercise intolerance GH deficiency in adults
decreased somatomedin C GH deficiency
dry, brittle hair TSH deficiency/hypothyroidism
cold intolerance TSH deficiency/hypothyroidism
weight gain TSH deficiency/hypothyroidism
puffiness in face and around eyes TSH deficiency/hypothyroidism
impaired memory TSH deficiency/hypothyroidism
delayed Achilles reflex recovery TSH deficiency/hypothyroidism
muscle weakness TSH deficiency/hypothyroidism
yellowish skin TSH deficiency/hypothyroidism
constipation TSH deficiency/hypothyroidism
TRH stimulation test for TSH deficiency
fatigue, weakness, headache, anorexia, orthostatic hypotension ACTH deficiency
metyrapone test ACTH deficiency/pituitary ACTH reserve
CRH stimulation test differentiates anterior pituitary from hypothalamic disease
no response with TRH stimulation test prolactin deficiency
central diabetes insipidus ADH deficiency
polyuria, polydipsia ADH deficiency
“Buzz Words” page 3 Associated Disorder/Pathology
low urine osmolarity, high volumes of urine diabetes insipidus
decreased milk ejection in lactating women oxytocin deficiency
gigantism excess GH (often because of pituitary adenoma) in children
acromegaly excess GH in adults
impotence prolatinomas/prolactinemias
hyperprolactinemia drugs (chlorpromazine, TCA), hypothalamic/pituitary disease, primary hypothyroidism
galactorrhea (w/o pregnancy) hyperprolactinemia
resin T3 uptake (RTU) thyroid function test…reflects TBG concentration
FT4-I (free T4 index) best test for thyroid function
serum TSH single best test for diagnosing primary hypothyroidism or hyperthyroidism
midline cystic mass thyroglossal duct cyst
radioactive I 131 uptake detects nodules in thyroid or acts as an index of thyroid activity
“hot nodules” active thyroid nodules on I 131 scan
“cold nodules” inactive thyroid nodules on I 131 scan
enlarged and tender thyroid, cervical lymphadenopathy, fever acute thyroiditis
goiter absolute or relative deficiency of thyroid hormone (often iodine deficiency), recurrent episodes of TSH stimulation, hemorrhage into a cyst, Hashimoto disease
antimicrosomal/antiperoxidase antibodies Hashimoto disease
BRPP in WDC clinical presentation of Hashimoto disease
goiter that has a “rubbery” feel Hashimoto disease
levothyroxine treatment for secondary hypothyroidism
hypothermia, mental status alterations, hypoventilation, bradycardia, hypoglycemia, adrenal insufficiency myxedema coma
anti-TSH receptor antibody Graves’ disease
infiltrative ophthalmopathy/exophthalmos Graves’ disease
“Buzz Words” page 4 Associated Disorder/Pathology
increased levels of glycosaminoglycans (hyaluronic acid and chondroitin sulfate) Graves’ disease
diplopia Graves’ disease
hyperpyrexia, tachyarrythmias, shock, acute metabolic encephalopathy thyroid storm
hoarseness, dysphagia malignant thyroid nodule
Orphan Annie nuclei thyroid papillary carcinoma
papillary fronds thyroid papillary carcinoma
psammoma bodies thyroid papillary carcinoma
thyroid cancer with lymphatic invasion with focal cervical lymph node involvement papillary carcinoma
thyroid cancer with blood vessel invasion without lymph node metastasis follicular carcinoma
“lung snow storm” follicular carcinoma
elevated calcitonin and amyloid medullary carcinoma
medullary carcinoma, primary hyperparathyroidism, pheochromocytoma MEN IIa
medullary carcinoma, mucosal neuromas, pheochromocytoma, marfanoid habitus MEN IIb
carcinoembryonic antigen (CEA) MEN IIa and II b
plethoric face Cushing’s syndrome
buffalo hump Cushing’s syndrome
purple striae Cushing’s syndrome
truncal obesity with skinny legs Cushing’s syndrome
hirsutism with acne Cushing’s syndrome
24 hour free urine cortisol test Cushing’s syndrome
low-dose or high-dose dexamethasone test Cushing’s syndrome
sky high cortisol, ACTH is low adrenal Cushing’s
sky high ACTH ectopic Cushing’s
Conn’s syndrome hyperaldosteronism
high aldosterone, low renin, normal ACTH and cortisol primary hyperaldosteronism
“Buzz Words” page 5 Associated Disorder/Pathology
high aldosterone, high renin secondary hyperaldosteronism
water deprivation test diabetes insipidus
decreased aldosterone (hypotension), decreased cortisol, increased androgens 21 beta-hydroxylase deficiency (CAH)
decreased aldosterone (but hypertension), decreased cortisol, increased androgens 11 beta-hydroxylase deficiency (CAH)
increased aldosterone, decreased cortisol, decreased androgens 17 alpha-hydroxylase deficiency (CAH)
masculinization plus hypertension 11 beta-hydroxylase deficiency (CAH)
masculinization,, hypotension, hyperkalemia 21 beta-hydroxylase deficiency (CAH)
hypertension, hypokalemia, phenotypically female but no maturation 17 alpha-hydroxylase deficiency (CAH)
hyponatremia due to dilution of body tissues SIADH
insulin induced hypoglycemia test (OGTT) for GH deficiency (gold standard)
impotence acromegaly
increased incidence of colon polyps/CA (endocrine disorder) acromegaly
enlarged hands and feet acromegaly
prognathism acromegaly
dental malocclusions acromegaly
increased risk for diabetes mellitus and hypertension (endocrine disorder) acromegaly
IGF-1 test, IGF-BP3 test GH level
prominent supraorbital ridges acromegaly
thick tongue acromegaly
one complication is cerebral edema (endocrine disorder) SIADH
generalized edema SIADH
persistent hyponatremia with hyperosmotic urine SIADH
nephrogenic diabetes insipidus, hypothyroidism complications of lithium use
polydipsia for cold water diabetes insipidus
water deprivation test diabetes insipidus
“Buzz Words” page 6 Associated Disorder/Pathology
easy bruisability Cushing’s syndrome
proximal muscle weakness Cushing’s syndrome
osteoporosis with vertebral fractures Cushing’s syndrome
hypogonadism in men Cushing’s syndrome
no pituitary suppression with a high-dose dexamethasone test ectopic Cushing’s syndrome
endocrine disorder associated with vitiligo Addison’s disease
loss of libido in women Addison’s disease
hyperpigmentation of skin and mucous membranes primary Addison’s disease, secondary Cushing’s disease
loss of androgen-dependent hair in women Addison’s disease
cosyntropin test/ACTH stimulation test Addison’s disease
low cortisol, low ACTH secondary Addison’s disease
low cortisol, high ACTH primary Addison’s disease
hyperaldosteronism in which peripheral edema is rare primary
hyperaldosteronism in which peripheral edema is common secondary
hypertension and hypokalemia primary hyperaldosteronism
the type of aldosteronism that is a normal event in pregnancy secondary hyperaldosteronism
type of aldosteronism related to atherosclerosis of the renal artery secondary hyperaldosteronism
ambiguous genitalia in girls and isosexual precocity in males at birth congenital adrenal hyperplasia
short child with well-developed trunk CAH (21-beta and 11-beta hydroxylase deficiencies)
hypogonadism in males at birth CAH (17-alpha hydroxylase deficiency)
metyrapone test Cushing’s disease (11-deoxycortisol increases if positive)
short tetracosactrin test Addison’s disease
hyponatremia, hyperkalemia, eosinophilia adrenal insufficiency
tetany primary hyperaldosteronism, autoimmune hypoparathyroidism
spironolactone treatment for primary hyperaldosteronism
“Buzz Words” page 7 Associated Disorder/Pathology
MEN type that is associated with pheochromocytoma MEN II (a and b)
5 P’s Pheochromocytoma (pressure (BP), pain (HA), perspiration, palpitations, pallor/diaphoresis
the rule of 10 for pheochromocytoma 10%: extra-adrenal, bilateral, malignant, children, familial
screening test for pheochromocytoma urine VMA (catecholamines)
best screening test for pheochromocytoma metanephrine
all pituitary hormones are decreased but prolactin, which is very high prolactinoma
pituitary hormone that inhibits secretion of FSH and LH prolactin
plasma renin concentration test hyperaldosteronisms
increased sorbitol in DM causes ? diabetic retinopathy
hypercalcemia MISHAP malignancy, intoxication, sarcoidosis, hyperparathyroidism, alkali syndrome, Paget’s disease
marfanoid phenotype MEN
Mucosal neuromas MEN
2nd test to order (after catecholamine labs) for pheochromocytoma CT scan of the abdomen to look for tumor
hormone that increases plasma Ca reabsorption and decreases plasma phosphate PTH
renal stones hyperparathyroidism
peptic ulcer disease, acute pancreatitis, bone disease hyperparathyroidism
osteitis fibrosa cystica hyperparathyroidism
short QT hyperparathyroidism
von Recklinghausen’s disease same thing as osteitis fibrosa cystica
brown tumor von Recklinghausen’s disease
hypercalcuria, hyperphosphaturia Hyperparathyroidism
renal failure contributes to ?primary/secondary? HPTH secondary
DiGeorge’s syndrome primary hypoparathyroidism
prolonged QT interval primary hypoparathyroidism
“Buzz Words” page 8 Associated Disorder/Pathology
Chvostek’s sign autoimmune hypoparathyroidism (hypocalcemia)
Trousseau’s sign autoimmune hypoparathyroidism (hypocalcemia)
inherited disease where kidneys do not respond to PTH pseudohypoparathyroidism
shortened 4th and 5th metacarpals pseudohypoparathyroidism
HAPSPAH causes of hypocalcemia (hypomagnesemia, alkalotic conditions, pseudohypoparathyroidism, secondary HPTH, primary hypoparathyroidism, acute pancreatitis, hypoalbuminemia)
secondary osteoporosis due to constant bone remodeling primary hyperparathyroidism
metastatic calcification of the skin, cornea, conjunctiva, ad kidneys Primary hyperparathyroidism
“hungry bone syndrome” potential consequence of parathyroid adenomectomy
Looser’s zones secondary hyperparathyroidism
rugger jersey spine secondary hyperparathyroidism
paresthesias of mouth and fingers hypocalcemia
muscle cramps, spasm, tetany hypocalcemia
metabolic acidosis with respiratory compensation DKA
normal anion gap <12
KUSMAL DDX of an anion gap metabolic acidosis (ketones, uremia, salycilates, methanol/ethylene glycol, alcohol, lactate)
acetone and acetoacetate testable ketone bodies
fruity or acetone breath DKA
Kussmaul respirations DKA
low body temperature DKA
glucose >700 DKA, hyperosmolarity
extracellular K high, total body K low DKA
total body sodium low DKA
large urine ketones DKA
high temperature in a DKA pt infections
initial aim of therapy for DKA rehydration
“Buzz Words” page 9 Associated Disorder/Pathology
only D/C insulin replacement in tx for DKA when? metabolic acidosis has been corrected
Give bicarb when pH is between ? 7.0-7.1
complication of too rapid rehydration of DKA pt cerebral edema
defining feature of diabetes hyperglycemia
test for diabetic’s compliance HbA1C
target range for HbA1C <7%
microvascular complications of diabetes (3) retinopathy, nephropathy, neuropathy
macrovascular complications of diabetes (3) coronary artery disease, peripheral vascular disease, diabetic foot
blot hemorrhages microaneurysms in diabetics’ eyes
diabetic retinopathy that leads to retinal detachment proliferative retinopathy
“stocking-glove” phenomenon polyneuropathy in diabetics
paresthesias in the longest nerves stocking-glove phenomenon
“down and out” eye 3rd CN palsy (focal neuropathy)
“down and in” eye 6th CN palsy (focal neuropathy)
Charcot’s foot Also called neuropathic foot (multiple fxs in diabetics’ feet)
necrobiosis lipoidica diabeticorum skin condition of diabetics (telangiectasia, atrophy, raised red barrier)
2 acute complications of diabetes DKA and hyperosmolar coma
diabetic blood pressure target <130/80 mmHg
diabetic LDL cholesterol target <100 mg/dL
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raised reticulocyte count, raised indirect bilirubin, diminished serum haptoglobin concentration hemolysis
Positive Direct Coomb’s test With hemolysis, indicates immune-mediated process (but not all ppl with positive test results have hemolysis)
3 examples of congenital hemolytic diseases Congenital spherocytosis, sickle-cell, glucose-6-phosphate deficiency
3 examples of acquired hemolytic diseases Warm and cold autoimmune hemolytic anemia, non-immune (i.e. mech. damage from leaky heart valve)
3 causes of reactive leukocytosis Infection, inflammation, neoplasia (differential is usually abnormal in neo)
“Buzz Words” page 10 Associated Disorder/Pathology
3 causes of leukopenia Increased consumption or destruction (hypersplenism), marrow failure (usually pancytopenia)
3 causes of reactive thrombocytosis Bleeding, infection, neoplasia
One cause of primary thrombocytosis Myeloproliferative disorders
2 causes of thrombocytopenia Immune thrombocytopenia (destructive), marrow failure (usually pancytopenia)
Band cell Infection, marrow “stress”
Blast cell Acute leukemia
Dimorphic blood film Seen in treated or transfused iron def and sideroblastic anemia
Howell-Jolly bodies Indicate splenectomy or hyposplenism
Hypersegmented neutrophils Vitamin B12 or folate deficiency
Hypochromia Always accompanied with microcytosis
Left shift Suggests infection
Leukoerythroblastic Indicates marrow infiltration…often secondary to cancer or fibrosis
Microangiopathy Indicates mechanical damage to RBCs
Metamyelocyte Infections, marrow “stress”
Myelocyte Part of leukoerythroblastic presentation
Pancytopenia Marrow failure
Polychromasia Increased erythrocytes on film (has grey appearance)
Increased reticulocytes Marrow erythropoiesis
Rouleaux cells High ESR…so, infection, myeloma, cancer, collagen disease, etc
Schistocyte Indicates damaged RBCs
Target cells Hemoglobinopathy, liver dz
Reduced serum iron Iron-def anemia, infections, inflam’s, cancer
Increased serum transferrin (TIBC) Iron-def anemia
Decreased serum transferrin/TIBC Infections, inflamm’s, cancers
Serum ferritin reflects?…except when…? Reflects total body iron stores, except in liver dz or acute inflamm
2 causes of increased indirect bilirubin Increased load of bilirubin (hemolysis), hepatocellular dysfunction
Low haptoglobin Hemolysis (of any cause), liver cell failure (low synthesis)
“Buzz Words” page 11 Associated Disorder/Pathology
What Hb electrophoresis is used for Diagnosing hemoglobinopathies
4 causes of microcytic anemia Thallesemia, iron-def, ACD, sideroblastic (TICS)
3 causes of normocytic anemia where RC<2% Acute blood loss, renal, aplastic anemia
4 causes of normocytic anemia where RC>3% Intrinsic defects (membrane), spherocytosis, enzyme def (glucose-6-phosphate), extra-cellular (autoimmune hemolytic anemia like sickle cell)
4 causes of macrocytic anemia Folate def, vitamin B12 def, alcoholic liver dz, hypothyroidism
2 megaloblastic anemias Folate def, vitamin B12 def
Elevated homocysteine Megaloblastic anemias
Increased MMA Vitamin B12 def
Target cells, tear drop cells Thallesemia
Heinz bodies Glucose-6-phosphate deficiency
Coomb’s test Autoimmune hemolytic anemia
Pernicious anemia Vit B12 def due to lack of intrinsic factor
Gold standard test for vit B12 def Schilling’s test
5 causes of vit B12 deficiency Pernicious anemia, IBD, malabsorption, malnutrition, antibiotic OD
Ranges of Hb for diagnosis of anemia Hb<13.5 gm/dL male, Hb<12.5 gm/dL *blocked female
Normal Hb range Approx 12-14 gm/dL
Normal SaO2 %, normal PaO2, decreased blood O2 content anemia
3 general causes of anemia Underproduction of RBCs, increased destruction or loss of RBCs, dilution of RBCs with increased plasma volume
Serum iron low, transferrin high, ferritin low, RDW increased Iron-def anemia
Serum iron low, transferrin normal, ferritin is normal Anemia of chronic dz
Gold standard for iron-def anemia (although rarely used) Bone marrow aspirate
MCV <80 fl, RC<2% Iron-def anemia
Microcytic, hypochromic anemia Iron-def anemia
7 causes of iron-deficiency anemia Bleeding (often GI), prematurity, Meckel’s diverticulum, milk baby, pregnancy, menorrhagia, PUD
Spoon nails (koilonychias) Iron-def anemia
“Buzz Words” page 12 Associated Disorder/Pathology
Plummer-Vinson syndrome Iron-def anemia
Plummer-Vinson syndrome triad Iron-def, esophageal web, achlorhydria
Tx for iron def Ferrous sulfate/gluconate
Side effect of use of sulfate/gluconate Stools turn black
Similar findings as iron-def anemia except can be normocytic or microcytic ACD
2 causes of ACD Chronic inflamm (RA), malignancy
Serum iron decreased, TIBC decreased, SaO2 decreased, serum ferritin increased, RDW normal ACD
Free RBC FEP increased ACD
Ringed sideroblasts (siderocytes) in bone marrow…mandatory test for diagnosis Sideroblastic anemia
Stains blue with Prussian blue stain Sideroblastic anemia
4 causes of sideroblastic anemia Alcoholism, pyridoxine (B6) deficiency, drugs (alkylating agents), Pb poisoning
Anemia that has ass’n with izoniazid therapy in tuberculosis Sideroblastic anemia
Serum iron increased, TIBC decreased, SaO2 % increased, serum ferritin increased, MCV <80 fl, RC>3% Sideroblastic anemia
Coarse basophilic stippling Sideroblastic anemia
4 causes of Pb poisoning Eating flaky paint, lead mining, work involving incinerating batteries, drinking moonshine
Pica for paint and plaster Pb poisoning/sideroblastic anemia
Lead colic Severe abd pain…sideroblastic anemia/Pb poisoning
Wrist drag Sideroblastic/Pb poisoning
Claw hand Sideroblastic/Pb poisoning
Nerve involved with wrist drag Radial
Nerve involved with claw hand Ulnar
Lead lines on x-ray Sideroblastic/Pb poisoning
LEAD (mnemonic for Pb poisoning) Lead lines, encephalopathy, abdominal colic, dementia (learning disability)
Best screen and confirmatory test for Pb poisoning Blood Pb levels
“Buzz Words” page 13 Associated Disorder/Pathology
Urine beta-ALA increased Pb poisoning/sideroblastic
BAL Tx for Pb poisoning/sideroblastic
What BAL does Decreases metal’s binding ability to tissue proteins…permits its rapid excretion
EDTA Tx for Pb poisoning, sideroblastic
Why you give EDTA Prevents dangerous hypocalcemia
Target cells Thalessemia
Tear drop cells Thalessemia
Cooley’s anemia Thalessemia
Alpha-globins chains Thalessemia
Races for alpha-thalessemia Asians, blacks
Races for beta-thalessemia Blacks, Italians, Greeks
2 types of Hb that are increased in thalessemia HbA2 and HbF
Type of genetic defect in thalessemia Autosomal recessive
Gold standard test for thalessemia Hb electrophoresis
Oval macrocytes Megaloblastic anemias
Hypersegmented neutrophilia Megaloblastic anemias
MAD Causes of intrinsic normocytic anemias…membrane defects (spherocytosis), abnormal hemoglobins (sickle cell), deficient enzymes (G6PD)
Symptoms of anemia Dyspnea on exertion, weakness, fatigue, HA, angina, pica, etc
Increased alcohol intake Folate deficiency
Pure vegetarian B12 deficiency
Pica Iron deficiency, Pb poisoning (for paint and plaster)
Drugs that cause autoimmune hemolytic anemia Methyldopa, quinidine
Drugs that cause aplastic anemia Chloramphenicol, proprythiouracil
Drugs that cause hemolysis in G6PD Asprin, “fava beans”
Drugs that cause folate deficiency BCP, methotrexate, trimethoprim
Benzene exposure Aplastic anemia, acute leukemia
Pb exposure Lead poisonings, sideroblastic anemia
Menorrhagia Iron deficiency anemia
Increased number of pregnancy Iron deficiency, folate deficiency
“Buzz Words” page 14 Associated Disorder/Pathology
Family hx of bleeding Von Willebrand’s, Osler Weber Rendu
Bleeding with wisdom tooth extraction Coagulation deficiency
Anemias ass’d with African American race Sickle cell, G6PD, alpha and beta thalessemia
Anemia ass’d with Asian race Alpha thalessemia
Anemias ass’d with Greek/Italian race Beta thalessemia, G6PD
Anemias ass’d with RA ACD, Felty’s triad (splenomegaly, RA, autoimmune neutropenia)
Anemia ass’d with renal dz Normocytic anemia
Anemia ass’d with colon cancer Iron deficiency anemia
Sore tongue Iron deficiency anemia, B12/folate def
Steatorrhea/malabsorption Folate/B12 deficiency
Melena Iron-def (GI bleed)
Gallstones in a young woman Congenital spherocytosis
Itch after taking warm shower/bath Myeloproliferative dz
Smoky colored urine Hemoglobinuria due to intravascular hemolysis (PNH)
Dark yellow urine Bilirubinemia due to liver dz, hemolytic anemia
Splenectomy Congenital spherocytosis
Anemia as a child Thalessemia, sickle-cell, congen spherocytosis, G6PD
Previous gastrectomy Iron def, B12 deficiency
Bowel resection for IBD (Crohn’s or ulcerative colitis) B12 deficiency (terminal ileal resection)
Osmotic fragility test Congenital spherocytosis
Hypotension/tachycardia/positive tilt test Hypovolemia from blood loss
High output cardiac failure, wide pulse pressure Product of the low viscosity of blood in anemic states
Pulmonic flow murmur Severe anemia with reduced blood viscosity
Jaundice Extravascular hemolysis
Skin ulcers around ankles Sickle cell dz
Pallor of the conjunctiva, lips, palmar creases Severe anemia
Sallow, waxy complexion B12 deficiency
“Buzz Words” page 15 Associated Disorder/Pathology
Petechiae/ecchymoses Thrombocytopenia ass’d with bleeding, aplastic anemia, leukemia
Spider angiomas Alcoholic cirrhosis with anemias ass’d with alcoholism
Anemias ass’d with alcoholism folate def, sideroblastic anemia, iron def
Gum bleeding and hypertrophy Infiltration by acute monocytic leukemia, severe thrombocytopenia, phenytoin, scurvy
Glossitis B12 def, folate def, iron def
Positive stool guaiac Iron deficiency
Generalized lymphadenopathy Acute/chronic lymphocytic leukemia, acute/chronic myelogenous leukemia, malignant lymphoma
Localized lymphadenopathy Left supraclavicular node (Virchow’s node), metastatic stomach or lung cancer
Hepatomegaly Cirrhosis, metastasis, leukemic infiltration
RUQ pain Gallstones due to extravascular hemolytic anemia
Painful sternum or vertebra Multiple Myeloma, metastasis (breast or prostrate), acute leukemia
Frontal bossing/chipmunk face Increased ineffective erythropoiesis …as in severe beta thalessemia
Pathologic fracture Multiple Myeloma, metastasis
Subacute combined degeneration involving dorsal columns and lateral corticospinal tract B12 deficiency
Peripheral neuropathy Lead poisoning
Telangiectasia Osler Weber Randu dz with involvement of the GI tract (bleeding)
>30% blast cells Acute leukemia
Leukemias with <30% blast cells Chronic leukemia
6 clinical presentations ALL Bone pain, refusal to walk, fever, widespread petechiae/purpura, hepatosplenomegaly, lymphadenopathy
Only leukemia ass’d with thrombocytosis CML
Elevated LDH/uric acid Evaluation finding in ALL
Bone marrow aspirate Test for leukemia
PAS stain Positive in ALL
Tx for ALL Chemotherapy—good prognosis
Age bracket for AML 15-39 years
“Buzz Words” page 16 Associated Disorder/Pathology
5 clinical presentations of AML Fatigue, easy bruising, frequent infections, purpura/petechiae, hepatosplenomegaly
Auer rods AML…pathognomonic
Tx for AML Chemotherapy, bone marrow transplants
Age bracket for CLL >65 y/o
3 clinical presentations of CLL Fatigue, lymphadenopathy, hepatosplenomegaly
Lymphocytosis CLL
Leukemia ass’d with autoimmune hemolytic anemia CLL
Tx for CLL Manage supportively until symptoms show up…splenectomy and steroids for AHA and thrombocytopenia
Age bracket for CML 40-60 y/o
Leukemia ass’d with prior radiation exposure CML
4 clinical presentations of early stage CML Fatigue, malaise, weight loss, night sweats
3 clinical presentations of late stage CML Fever, bone pain, splenomegaly (blast crisis)
Low LAP score CML
Philadelphia chromosome CML
Tx for CML Bone marrow transplant
Common cause of death in CML Termination of life during a blast crisis (rapidly fatal in most cases)
High LAP score Ruptured appendix (leukoerythroblastic reaction)
Positive TRAP stain Hairy cell leukemia
B cell leukemia Hairy cell leukemia
Doughnut cells Iron deficiency anemia
Atypical lymphocytes Mononucleosis
Eosinophilia Neoplasms (CML, Hodgkin’s), allergies, asthma, collagenous dz’s, parasitic infections (NAACP)…plus, adrenal insuff
Basophilic stippling Sideroblastic anemia/lead poisoning
Streptococcal infections Sickle-cell anemia
Thrombotic thrombocytopenia purpura Microangiopathic hemolytic anemia, schistocytes
Schistocytes Microangiopathic hemolytic anemia and mechanical hemolysis (prosthetic heart valve replacement), HUS, DIC
Risk factors for NHL EBV, Burkitt’s, HIV
“Buzz Words” page 17 Associated Disorder/Pathology
Risk factors for HL W>M, 15-45, >60
Histology for NHL Varied
Histology for HL Reed-Sternberg
Type of lymphadenopathy with NHL Systemic
Type of lymphadenopathy with HL Regional
Test for NHL Biopsy, LP, CXR, CT
Test for HL Biopsy, LP
Tx for both NHL and HL Chemotherapy, radiation
Symptoms for NHL Fever, night sweats, weight loss, painless lymphadenopathy
Symptoms for HL Fever, night sweats, pruritis, weight loss
Clinical presentation for nodular sclerosing Hodgkin’s lymphoma Female dominant, anterior mediastinum involvement, prominent lymph nodes
Hodgkin’s lymphoma that has an excellent prognosis Lymphocyte predominance
Most aggressive Hodgkin’s lymphoma Lymphocyte depletion
EBV relationship Burkitt’s lymphoma, NHL
Place of involvement of Burkitt’s in American variant Abdominal cavity
Place of involvement of Burkitt’s in African variant Jaw location
Primary malignancy of plasma cell origin Multiple myeloma
5 clinical presentations of multiple myeloma Back pain, hypercalcemic symptoms, pathologic bone fractures, frequent infections, lethargy
RBCs in rouleaux formation Multiple myeloma
Bence-Jones proteinuria Multiple myeloma
Hypercalcemia Multiple myeloma
“punched-out” osteolytic lesions Multiple myeloma
Plasma cell infiltration with bone marrow biopsy Multiple myeloma
Negative bone scan Multiple myeloma
Multiple myeloma tx Chemotherapy, predinisone
Most common viral infections transmitted via blood transfusions HBV, HCV, HIV, CMV, HTLV-1, HTLV-2
5 clinical presentations of transfusions reaction Severe chills, high fever, dark urine (hemoglobinuria), acute tubular necrosis, renal failure
“Buzz Words” page 18 Associated Disorder/Pathology
When to obtain D-dimer When looking for DIC in transfusion rxns
First step in treating transfusion rxn Stop the transfusion
Next step for treating transfusion rxns IV hydration and give mannitol
Left shift, toxic granulation, Dohle bodies Absolute neutrophilic leukocytosis
Kind of leukocytosis that can be found in appendicitis Absolute neutrophilic leukocytosis
3 causes of absolute neutrophilic leukocytosis Increased production (infection), decreased adhesion (corticosteroids, epi), increased release from bone marrow (infection)
Polycythemia rubra vera Absolute neutrophilic leukocytosis
3 complications of lithium use Absolute neutrophilic leukocytosis, nephrogenic DI, hypothyroidism
2 causes of leukemoid reaction Infection (common in kids)…ass’d with appy, superinfection over malignancy
Leukocyte count in absolute neutrophilic leukocytosis >7000 cells
Leukocyte count in absolute neutropenia 1000-1500 cells (mild), 500-1000 cells (moderate), <500 cells (severe)
7 causes of absolute neutropenia Production problem (aplastic anemia), destruction problem (B12/folate def, PNH), drugs (propythiouracil), chemicals (benzene), infectious dz (HCV), increased destruction (Felty’s), increased margination
Definition of leukoerythroblastic rxn Immature WBCs and RBCs in peripheral blood
Type of leukemia ass’d with leukoerythroblastic rxn CML
Test for leukoerythroblastic rxn Bone marrow exam
Cell count for absolute lymphocytosis >4000 cells (adults)
Atypical lymphocytes Absolute lymphocytosis
Type of lymphocytosis ass’d with EBV Absolute lymphocytosis
Downey cells Infective mononucleosis
Hairy leukoplakia Caused by EBV
Nasopharyngeal carcinoma Ass’d with EBV
“Buzz Words” page 19 Associated Disorder/Pathology
6 clinical presentations of infective mononucleosis Exudative tonsillitis, petechiae on palate, sudden onset of rash with given ampicillin, posterior cervical adenopathy, tender hepatosplenomegaly, generalized painful lymphadenopathy
Drug given to reverse rash of ampicillin + EBV Predinisone
2 tests for infective mononucleosis Atypical lymphocytes, heterophile antibody test (Monospot)
Cell count for eosinophilia >700 cells
Excellent marker for polycythemia vera Basophilia
Basophilia Polycythemia vera, CML
Cell count for monocytosis >800 cells
Marker for chronic inflammation Monocytosis
5 clinical presentations of polycythemia rubra vera Pruritis after warm bath, epistaxis, plethora, splenomegaly, large retinal veins on fundoscopy
RBC mass increased, EPO level decreased PRV
Tx for PRV Daily asprin
Leukemias that PRV can convert to CML, AML
FAT RN Thrombotic thrombocytopenic purpura (fever, anemia, thrombocytopenia, renal dysfunction, neurologic abnormality)…you find purpura, too
Difference between TTP and HUS Hemolytic uremic syndrome is TTP w/o the fever and neurologic abnormalities
2 clinical findings in TTP Schistocytes, elevated indirect bilirubin
Definition for idiopathic thrombocytopenic purpura (ITP) Autoimmune platelet disorder
Common ass’n of ITP in kids Post-viral, self-limited
Evan’s syndrome ITP plus autoimmune hemolytic anemia
6 dz’s ass’d with ITP HL, NHL, CLL, HIV, SLE, RA
Afebrile, mucosal bleeding, epistaxis, menorrhagia, petechiae/purpura, no splenomegaly ITP (underlined differentiates it from TTP)
No schistocytes, platelet-associated IgG test ITP
“Buzz Words” page 20 Associated Disorder/Pathology
Tx for ITP Kids: spontaneously resolves, adults: corticosteroids…if they don’t work, IVIG for acute or splenectomy for cure
6 causes of DIC Sepsis, transfusion rxn, neoplasia, trauma (head trauma and burns), obstetric complications, allergy to heparin
Bleeding from venipuncture sites of incisional wounds DIC
Vascular collapse with hypotension, tachycardia, tachypnea, respiratory failure, evidence of diffuse bleeding, digital cyanosis/gangrene DIC
D-dimer high, platelets low DIC
Tx for DIC Treat underlying disorder, give cryoprecipitate to replenish fibrinogen
Sex relationship with hemophilia Males
Genetic relationship of hemophilia x-linked recessive
Excessive bleeding from mild trauma/surgical/dental procedures Hemophilia
Prolonged PTT but normal PT Hemophilia
Bleeding time is normal Hemophilia…distinguishes from Von Willebrand’s
Tx for hemophilia Factor VIII or factor IX concentrate
Distinguishes hemophilia A from B Nothing…they are indistinguishable
Genetic relationship of Von Willebrand’s Autosomal dominant…results in low VWF (helps platelets stick together)
Easy bruising, mucosal bleeding, postincisional bleeding Von Willebrand’s
Tx for Von Willebrand’s Desmopressin, fresh frozen plasma, avoid asprin
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Apraxia Inability to perform motor activities in the presence of intact motor and sensory systems and normal comprehension
Aphasia Impaired or absent communication by speech, writing, or signs (i.e. no spoken language)
Stereognosis Ability to identify an object by touch
Asterognosis Inability to identify an object by touch
Dyscalculia Inability to perform calculations
“Buzz Words” page 21 Associated Disorder/Pathology
Dysgraphia Inability to perform writing
Graphestesia Ability to identify numbers
Agraphesthesia Inability to identify numbers
Anisocoria Difference in pupil sizes
Agnosia Ability to recognize a specific sensory stimulus despite preserved sensory function (i.e. visual agnosia is inability to recognize a visual stimulus despite normal vision)
Bleeding in bridging veins Subdural hematoma
Slow-onset hematoma Subdural
Concave shaped hematoma Subdural
Lens-shaped hematoma Epidural
Hematoma from blunt force trauma Epidural
Hematoma ass’d with lucid intervals Epidural
Middle meningeal artery hematoma Epidural
Rapid onset hematoma Epidural
Convex shaped hematoma Epidural
Anisocoria Epidural hematoma
“blown pupil” Epidural hematoma
Uncal herniation Epidural hematoma
Pie on the floor Upper homonymous quadrantanopia
Pie in the sky Lower homonymous quadrantanopia
Medial longitudinal fasciculus (MLF) Multiple sclerosis
Aphasia where you comprehend, but you can’t speak Wernicke’s aphasia
Aphasia where you can speak, but you can’t comprehend Broca’s aphasia
Meyer loop visual defects “pie in the sky”, “pie on the floor”
Meyer loop visual defect ass’d with parietal lobe damage Pie on the floor
Meyer loop visual defect ass’d with temporal and occipital lobe damage Pie in the sky
COLA Frontal lobe functions: concentration, orientation, language, abstract thinking
“Buzz Words” page 22 Associated Disorder/Pathology
Lobe that is affected by Alzheimer’s Frontal
Eye that is down and out Third nerve palsy
Eye that is down and in Sixth nerve palsy
Part of brain that CNs come from Midbrain
Part of brain ass’d with ataxia Cerebellum
Probs with gait, nystagmus Ataxia
Ataxia is ass’d with? Multiple sclerosis
Dorsal root degeneration B12 deficiency
3 examples of cognitive disorders Dementia, delirium, amnesia
2 parts of cognition Thought processes, memory
4 general causes of cognitive disorders GMC, substance-induced (persisting), multiple etiologies, unknown (NOS)
The difference between delirium and dementia Time (delirium is short-onset, dementia is gradual-onset)
Clouding of consciousness Delirium
Impaired cognition only Delirium
Impaired cognition and memory Dementia
DEMENTIAA Causes of dementia: degenerative, endocrine, metabolic, encephalopathy, neoplasms, toxic/trauma, infection, abuse (child, elderly), affective disorder
3 examples of degenerative disorders that lead to dementia Alzheimer’s dz, Huntington’s dz, Parkinson’s dz
3 examples of toxic substances that lead to dementia Medications, alcohol, inhalants
3 examples of infections that lead to dementia HIV, neurosyphilis, CJ (Crutzfield-Jakob or mad cow)
3 examples of metabolic disorders that lead to dementia Chronic hypoglycemia, electrolyte imbalance, vitamin deficiency
2 examples of endocrine probs that lead to dementia Thyroid probs, parathyroid probs
Age in which most Alzheimer’s dz cases set in after 40 y/o
Diagnosis of exclusion Alzheimer’s dz
Down’s syndrome increases the risk of? Alzheimer’s dz
Neurofibrollatory plaques Alzheimer’s dz
Beta-globulins Alzheimer’s dz
Amyloidosis Alzheimer’s dz
“Buzz Words” page 23 Associated Disorder/Pathology
Dementia that is consistently inconsistent Alzheimer’s dz
Impaired memory, difficulty problem solving, decreased spontaneity, inability to respond to environ with the pt’s usual speed and accuracy, agitations Alzheimer’s dz
Tx of Alzheimer’s dz Make environ safe, written daily reminders, education, maintain adequate hydration, nutrition, exercise, and cleanliness
Impaired memory with clear consciousness and relatively intact cognition Amnestic disorder
Korsakoff’s syndrome Amnestic disorder caused by thiamine (B1) deficiency
Tactile hallucinations Korsakoff’s syndrome
Alcohol abuse, gastric carcinoma, HIV-spectrum dz, marasmus Korsakoff’s syndrome
Dementia that is probably reversible Amnestic disorder
Triad of hallucinations, confabulations, retrograde amnesia Korsakoff’s disorder
Tx for amnestic disorder Tx underlying cause and involve psychiatrist
3 kinds of primary headaches Migraine, tension, cluster
“worst headache in my life” Subarachnoid hemorrhage
Headaches that need immediate treatment/workup SAH, tumor, temporal arteritis, meningitis
An old headache req’s immediate workup when? There has been a change in character or intensity
IQ=LD Characteristics of a HA: intensity, quality, location, duration
Jaw claudication TMJ, temporal arteritis
HA ass’d with N/V Migraine
Signs ass’d with HA that warrant immediate tx/workup Papilledema, focal neurological deficits
If SAH is suspected with a negative head CT, what test needs to be done? LP
CT that is done to look for SAH Without contrast
Why is the CT done w/o contrast in SAH Contrast medium can cause seizures
Xanthochromia in LP SAH
“Buzz Words” page 24 Associated Disorder/Pathology
When do you order a CT/MRI for pts with HA? Suspicion of SAH, elevated ICP, if pt has a focal neurological finding
Acute HA differential (9) SAH, hemorrhagic stroke, HTN encephalopathy, meningitis, seizure, acutely elevated ICP, post-LP, ocular dz (glaucoma, iritis), new migraine HA
Subacute HA differential (7) Temporal arteritis, intracranial tumor, subdural hematoma, pseudotumor cerebri, trigeminal neuralgia, postherpetic neuralgia, HTN
Hematoma ass’d with falling Subdural hematoma
Chronic/episodic HA differential (6) Migraine, cluster, tension HA, sinusitis, dental dz, neck pain
Women <30 y/o Migraines
Headache ass’d with family hx Migraines
Serotonin/vascular problems Migraines
6 common triggers of migraines Chocolate, stress, fasting, menses, OCPs, bright light
Throbbing headache Migraines
Nausea, vomiting, photophobia, noise sensitivity Migraine
Unilateral headache Migraine
Aura Migraine
Visual symptoms like scintillating lights, scotomas, field defects Migraines
When to do a CT/MRI with migraines Upon first presentation
Transient focal neurologic deficits Can be ass’d with migraines
4 drugs used for migraines Asprin/NSAIDS, sumatriptin (a 5HT 1 agonist), ergot (partial 5HT 1 agonist), and opiates
5 drugs used for migraine prophylaxis Beta blockers (propranolol), ergots, TCA (amytriptyline), calcium channel blockers, and valproic acid
Drugs that should not be used for migraine prophylaxis Narcotics
Vise-like or tight pain Tension headache
Pain exacerbated by bright light, noise, fatigue, stress Tension HA
HA concentrated in occipital and neck region Tension HA
Diagnosis of exclusion in HA’s Tension HA
“Buzz Words” page 25 Associated Disorder/Pathology
Tx for tension HA’s Relaxation, massage, hot baths, avoidance of exacerbating factors, abortive drugs (NSAIDS, sumatriptan, ergots), and prophylactic drugs (calcium channel blockers, beta blockers, TCA)
HA that affects men more than women…avg age 25 Cluster
Brief, severe, unilateral periorbital HA Cluster
HA affecting same part of the head and taking place at the same time of the day (usually at night), and at the same time of year Cluster
HA that can be precipitated by use of alcohol or other vasodilators Cluster
CHIN Physical exam for cluster: conjunctival injection, Horner syndrome (ptosis, anhydrosis, miosis), ipsilateral tearing, nasal stuffiness
#1 choice of therapy for cluster HA’s High flow oxygen (100% non-rebreather mask)
5 prophylactic drugs for cluster HA’s Ergots, calcium channel blockers, predinisone, lithium, valproic acid
Cognitive disorder with short and fluctuating course Delirium
10 general causes of delirium Infection, autoimmune dz, ICU psychosis, hypoxia, CVA, “sundowning”, electrolyte abnormality (uremia), endocrine, Wilson’s dz, drugs (HAISIC WEED)
Drugs ass’d with delirium Corticosteroids (abrupt withdrawal), DTs
HIDE (major causes of delirium) Hypoxia, infection (esp UTI in elderly), drugs (esp anticholinergic), electrolyte disturbances
Waxing and waning levels of consciousness Delirium
Perceptual disturbances (hallucinations, illusions) Delirium
Tachycardic, diaphoretic Delirium
Paranoid, combative, short attention span Delirium
It is especially impt to check the medication list in? Delirium
Age that most dementia pts are above 85 y/o
Autosomal dominant, chromosome 4 Huntington’s dz
“Buzz Words” page 26 Associated Disorder/Pathology
Caudate nucleus (in basal ganglia) Huntington’s dz
SHE PALM Infections that cause dementia: syphilis, HIV, encephalitis, prion dz’s (CJ), abscess, Lyme’s dz, meningitis
Clear sensorium Dementia
MAD SOAP note with clear sensorium PE for dementia: memory impairment, aphasia, apraxia, agnosia, (disturbance in: ) sequencing, organizing, abstract thought, planning
Ratio of dementias that are reversible Fewer than 10%
Drugs that will worsen disinhibition and confusion in dementia Benzodiazepines
5 A’s of dementia/Alzheimer’s Aphasia, apraxia, agnosia (don’t know who ppl are), amnesia, abstract thought
Diagnosis of exclusion in dementias Alzheimer’s
Infection of the leptomeninges Meningitis
Risk factors for meningitis (5) MC: Ear infection, sinusitis, sick contacts…other: immune deficiency, recent neurosurgical procedures
Positive Kernig’s and Brudzinski’s signs Meningitis
Fever, HA, neck stiffness, photophobia Meningitis
Age which pts may not show signs of meningitis Less than 2 y/o
Never do a LP if? Papilledema, focal neurological signs)
Tx for meningitis IV antibiotics and supportive care
Prophylactic drug against meningococcal meningitis Rifampin
Grade IV astrocytoma Glioblastoma multiforme
Zebra tumor Acoustic neuroma/schwannomas
TV IS Costly in New Zealand Acoustic neuroma: tinnitus, vertigo, ipsilateral hearing loss, sensory change in the face, cerebellar dysfunction, neurofibromatosis (café au lait), zebra bodies
Brain tumor common in children Medulloblastoma
Tumor that may lead to hydrocephalus ependymoma
Ruptured Barry aneurysm SAH
“Buzz Words” page 27 Associated Disorder/Pathology
Risk factors for Barry aneurysm rupture Familial HTN and polycystic kidney dz
3 steps for assessing SAH 1: CT scan, 2: LP (if no ICP), 3: angiogram
Contralateral hemiparesis followed by hemiplegia Epidural hematoma
Blown pupil usually occurs secondary to what? Uncal herniation
Tx for epidural and subdural hematomas Emergent neurosurgical evacuation
Hematoma common in elderly and alcoholics Subdural
Hematoma where symptoms usually start 3 weeks after minor head injury Subdural hematoma
Crescent-shaped, concave hyperdensity that does not cross the midline Subdural hematoma
Bruising in the clavicular region should make one suspect? Cervical spine injury until proven otherwise
5 causes of coma Meningeal disorders, toxins, seizures, basilar artery stroke, brain stem ischemia
3 most common causes of intracranial hemorrhages Trauma, aneurysm, HTN
First test for intracranial hemorrhage, and confirmatory test Stat CT, cerebral angiogram
Placement of needle in LP Between L4 and L5
What test helps differentiate between ischemic and hemorrhagic, cortical or subcortical strokes CT scan
Stroke ass’d with mental status change Cortical stroke
Stroke that is ass’d with a dysfunction in a restricted area of the brain Subcortical stroke
Where lacunar infarcts occur In regions supplied by small perforating vessels
4 things ass’d with middle cerebral artery stroke Aphasia (dominant hemisphere), neglect (nondominant hemisphere), contralateral paresis, homonymous hemianopsia
6 things ass’d with anterior cerebral artery stroke Leg paresis (contralateral leg weakness), amnesia, foot drop, gait dysfunction, personality changes, cognitive changes
3 things ass’d with posterior cerebral artery stroke Contralateral homonymous hemianopsia, memory deficits, dyslexia
“Buzz Words” page 28 Associated Disorder/Pathology
5 things ass’d with basilar artery stroke Coma, cranial nerve palsies, apnea, dysphagia, visual symptoms
3 things ass’d with lacunar stroke Pure motor or sensory stroke, dysarthria (clumsy hand), ataxic hemiparesis
TIAs duration <24 hrs
Primary drugs used for embolic stroke Coumadin and heparin
Level you let BP rise to after a stroke to maintain brain perfusion 200/100
TPA is effective if given in what time frame? W/in 3 hrs of onset of symptoms
Carotid endarterectomy is indicated if stenosis is? >70%
Carotid endarterectomy is contraindicated if stenosis is? 100%
3 of the treatments used to prevent stroke Asprin, carotid endarterectomy, anticoagulation
Wernicke’s aphasia results from the stroke of what vessel? Middle cerebral artery (MCA)
Fluent expressive speech that is empty of meaning Wernicke’s aphasia
Aphasia where etiology is usually embolic Wernicke’s aphasia
Comprehension, naming, and repetition of language are impaired Wernicke’s aphasia
Speech is nonfluent, with decrease rate and short phrase length, and impaired speech articulation Broca’s aphasia
Artery involved with Broca’s aphasia Superior MCA stroke
Area of brain involved in Broca’s aphasia Inferior frontal lobe
Palsy ass’d with Berry aneurysms Third nerve palsy
4 causes of parenchymal hemorrhage HTN, tumor, vascular malformations (AVMs, cavernous hemangiomas), amyloid angiopathy (seen in elderly)
Most impt diagnostic test for seizures EEG
Abrupt onset, sudden loss of consciousness, usually w/o aura, followed by postictal confusion Generalized seizures
2 most common types of generalized seizures Absence (petit mal), tonic-clonic (grand mal)
Cyanosis, incontinence Tonic-clonic/grand mal
“Buzz Words” page 29 Associated Disorder/Pathology
Elevated serum prolactin level Tonic-clonic/grand mal
Most common direction of shoulder dislocation in tonic-clonic/grand mal Posterior
Seizures that begin in childhood, subside in adulthood, and are often familial Absence/petit mal seizures
Child daydreaming or staring in class Absence/petit mal seizures
Seizures with no loss of muscle tone Absence/petit mal seizures
Eye fluttering or lip smacking Absence/petit mal seizures
3 per-second spike and wave discharges Absence/petit mal seizures
Todd’s paralysis Postictally has a focal neurological deficit that resolves within 1-2 days
Temporal lobe, impaired level of consciousness, auditory or visual hallucinations Complex partial seizures
Déjà vu Complex partial seizures
Automatisms Complex partial seizures, petit mal seizures
Mimics schizophrenia and acute psychosis Complex partial seizures
Seizure that is a medical emergency Status epilepticus
Seizures >30 min Status epilepticus
ETOH/sedative withdrawal Status epilepticus
Autoimmune acquired demyelinating dz Multiple sclerosis
Twice as common in women as in men and a peak incidence of 20-40 years Multiple sclerosis
Disorder of temperate climates Multiple sclerosis
Relapsing, remitting Multiple sclerosis
White matter gliotic lesions MS plaques
Cluster around periventricular areas, spinal cord, cerebellum, brain stem MS
Myelin sheaths destroyed MS
Disseminated lesion in time and space MS
Neurologic complaints that are separated in time and space MS
“Buzz Words” page 30 Associated Disorder/Pathology
Limb weakness, optic neuritis, paresthesias, diplopia, urinary retention, vertigo MS
5 exacerbating factors of MS Pregnancy, heat, infection, trauma, vigorous activity
Classic triad in MS Scanning speech, intranuclear ophthalmoplegia nystagmus, intention tremor
Mononuclear pleocytosis MS
Oligoclonal bands MS
Prophylactic immunosuppressant or beta interferon MS
Dopamine depletion in the substantia nigra Parkinson’s dz
Substantia nigra is in? Basal ganglia
Lewy body Parkinson’s dz
3 toxins that can cause nonidiopathic Parkinson’s Carbon monoxide, manganese dust, cyanide
3 drugs that can cause nonidiopathic Parkinson’s Neuroleptics (antipsychotics), MPTP (byproduct from synthetic heroin), metoclopramide
Clues to nonidiopathic Parkinson’s Younger age of onset, lack of response to levodopa, and rapid progression of dz
Resting tremor Parkinson’s dz
Bradykinesia Parkinson’s dz
Cogwheel rigidity Parkinson’s dz
*blocked-rolling Parkinson’s dz
Shuffling steps Parkinson’s dz
Festinating gait Parkinson’s dz
Postural instability Parkinson’s dz
4 cardinal features of Parkinson’s Resting tremor, bradykinesia, rigidity, postural instability
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2 conditions that cause radiation of pain to ipsilateral shoulder Cholecystitis, ruptured ectopic pregnancy, splenic rupture
Porcelain gallbladdar Probably means malignancy
Calculi with “popcorn” appearance Pancreatic stones
Tx for giardiitis Flagyl
Best antibiotic to use for bacterial diarrhea TMP-SMZ
Avoid antimotility agents in patients with…? Bloody diarrhea, high fever, or systemic toxicity
“Buzz Words” page 31 Associated Disorder/Pathology
The most likely cause of acute diarrhea Infectious
Acute onset, healthy patient, travel history Infection
Acute onset, old patient Ischemic colitis
Chronic history, diarrhea alternating with constipation IBS
Chronic history, young patient, bloody diarrhea Ulcerative colitis
Chronic history, postprandial gas, cramps Lactose intolerance
Weight loss, fatty stools Malabsorption
Elderly women, watery diarrhea Collagenous colitis
Long-standing history of diabetes, autonomic neuropathy, nocturnal Diabetic diarrhea
Persisting despite fasting Secretory diarrhea
Young women, anorexic/bulimic, health professional Laxative abuse
Nursing home pt, dementia, multiple CVAs Fecal impaction, fecal incontinence
Hospitalized pt, recent infection with antimicrobial use Clostridium difficile
Rice water diarrhea Cholera
Acute onset, myalgia Viral
Travel, upper GI symptoms (gas, bloating, nausea) Giardia
Travel, watery diarrhea Enterotoxic E. coli
Travel, bloody diarrhea, fever, pain Shigella, enteroinvasive E. coli
Hamburger, hemolysis, uremia Enterohemorrhagic E. coli
Acute immediate postprandial (<4 hrs) with upper GI symptoms S. aureus
Acute onset, healthy pt bloody diarrhea Campylobacter jejuni
Immunocompromised, weight loss, high volume watery diarrhea Cryptosporidium
Flushing, wheezing, right-sided heart failure Carcinoid tumor
Multiple ulcers Zollinger-Ellison syndrome
Migratory rash, hypoglycemia Glucagonoma
Anorexic/bulimic, health professional Laxative abuse
ETOH hx, diabetes Pancreatic insufficiency
“Buzz Words” page 32 Associated Disorder/Pathology
Obstructive jaundice, ileal resection Bile salt insufficiency
Travel Tropical sprue
IVDA, homosexuality, HIV Cryptosporidium
History uterine, prostate cancer, lymphoma Radiation enteritis
Childhood history Celiac sprue
Congenital immunodeficiency Giardia
Small bowel diverticulas, strictures, motility disorder Bacterial overgrowth
Papules, vesicles, bullae Celiac sprue
Multiple abdominal operations Short bowel syndrome
2 disorders in IBD Ulcerative colitis and Crohn’s disease
3 races most likely to have IBD Whites, Ashkenazi Jews
Age groups of first presentation for IBD Teens and early 20s
Skip lesions Crohn’s dz
GI from mouth to anus Crohn’s dz
Inflammatory pseudopolyps Ulcerative colitis
Crypt abscesses Ulcerative colitis
Lead pipe appearance on x-ray Ulcerative colitis
Frequent bloody stools Ulcerative colitis
IBD with the most risk for colon carcinoma Ulcerative colitis
Noncaseating granulomas CD
String sign in the terminal ileum CD
Cramping—RLQ pain CD
Sclerosing pericholangitis UC
HLA-B27 plus ankylosing spondylitis/uveitis UC
Erythema nodosum UC
Arthritis UC
Fistula formation CD
Obstruction CD
Ca oxalate renal stones CD
Aphthoid ulcers, deep linear ulcers CD
Cobblestone pattern CD
“Buzz Words” page 33 Associated Disorder/Pathology
IBD that can be cured by bowel removal UC
Pyrosis GERD
Water brush taste GERD
Burning that worsens with reclining GERD
Ass’d with Barrett’s esophagus GERD
Nissen fundoplication Surgery for GERD
Ass’d with esophageal adenocarcinoma GERD
Most common type of esophageal CA Squamous cell carcinoma
Eval for esophageal CA EGD plus biopsy
Zenker’s diverticulum is ass’d with this type of dysphagia Oropharyngeal dysphagia
2 reasons for odynophagia Infectious agents, chemical agents
Pt who smokes and drinks Esophageal CA
Pt with iron deficiency anemia Esophageal webs
Pt with AIDS Candida (oral thrush)
Dysphagia solids>liquids Obstructive dysphagia
Dysphagia with solids and liquids Motility dysphagia
Older pt with dysphagia CA, Zenker’s diverticulum
Younger pt with dysphagia Peptic stricture
Weight loss, smoker/drinker, pain CA
Postprandial cough, regurgitation Zenker’s diverticulum
Long hx of reflux Peptic stricture
Sudden onset dysphagia to solids Schatzki ring
Iron deficiency anemia Plummer-Vinson syndrome
Psychiatric hx Lye stricture
Test to order for Zenker’s diverticulum Barium esophagram
Test to order for peptic stricture Endoscopy or esophagram
Test to order for Scatzki ring Endoscopy or esophagram
Test to order for lye stricture Endoscopy or esophagram
Middle aged women, Raymond’s, skin finding with motility dysphagia Scleroderma
“Buzz Words” page 34 Associated Disorder/Pathology
Long hx of dysphagia to solids and liquids, aspiration with motility dysphagia Achalasia
Reduced peristalsis, reduced LES in manometry Scleroderma
Reduced peristalsis, high LES in manometry Achalasia
Disordered peristalsis, high amplitude contractions on manometry Diffuse esophageal spasm
Normal to reduced peristalsis, low LES on manometry Reflux
Urease breath test Gastritis test
Serum antibody to H. pylori Gastritis, PUD test
Coffee ground emesis PUD
Dull/burning/aching epigastric pain that improves with meals PUD
Rigid abdomen PUD
Epigastric tenderness PUD
Serum gastrin Test for Zollinger-Ellison syndrome
3 aims at tx for PUD Mucosal protection, decreased acid production, eradicating H. pylori
Drug that can cause gynecomastia in men Cimetidine
Cimetidine is used for PUD
Parietal cell vagotomy PUD
Top 2 etiologies with pancreatitis Alcoholism, gallstones
Severe epigastric pain Pancreatitis
Flank discoloration (plus name for it) Acute pancreatitis, Gray-Turner sign
Sentinel loop on x-ray Acute pancreatitis
Colon cutoff on x-ray Acute pancreatitis
Popcorn appearance on x-ray Chronic pancreatitis
Congenital malformation that leads to chronic pancreatitis Pancreas divisum
Steatorrhea Chronic pancreatitis
Glycosuria Chronic pancreatitis
Pancreatic calcifications Chronic pancreatitis
Chronic, severe, intractable pain Chronic pancreatitis
Part of pancreas most likely to have CA Head of pancreas
“Buzz Words” page 35 Associated Disorder/Pathology
2 risk factors for pancreatic CA Smoking, high-fat diet
CA that has fast mortality almost 100% of the time Pancreatic CA
Courvoisier’s sign Pancreatic CA
Trousseau’s sign Pancreatic CA
ERCP Pancreatic CA
Transcutaneous pancreatic biopsy Pancreatic CA
Whipple procedure Pancreatic CA
2 causes of loss of gastric pressure gradient Increased intragastric pressure, decrease in LES tone
Often misdiagnosed as asthma in infants GERD
Normal squamous epithelium is replaced by a metaplastic columnar Barrett’s esophagus
Chocolate and peppermint as aggravating factors Reflux esophagitis
Drug that can cause tardive dyskinesia Reglan/metoclopramide
Esophagitis that is found mainly in Immunocompromised pts Infectious
Do not induce vomiting Corrosive esophagitis
NG tube contraindicated Corrosive esophagitis
Presents with angina-like symptoms Diffuse esophageal spasm
Dilated esophagus Achalasia
Bird beak stricture Achalasia
Halitosis Zenker’s diverticula
Outpouching of esophagus Zenker’s diverticula
Retching, forceful vomiting, perforated Esophageal rupture
Alcohol use, vomiting, tears lower esophageal area, bright red blood emesis Mallory-Weiss syndrome
Air-fluid levels, esophagus tears, mediastinitis Boerhaave’s syndrome
Always consider malignancy with PUD
Nocturnal pain that awakens pt PUD
Significant vomiting or weight loss Malignancy PUD
Anemia, guaiac positive, elevated amylase PUD penetration into pancreas
“Buzz Words” page 36 Associated Disorder/Pathology
Board-like abdomen PUD duodenal
Early satiety Gastric carcinoma
Succession splash Gastric cancer
Decrease in gastric bubble on x-ray Gastric cancer
PUD that is more likely to perforate Duodenal
PUD with increased risk of gastric CA Gastric
Last resort surgery for pancreatic CA Vagotomy and antrectomy
Another name for stress ulcer Marginal ulcer
Most common clinical finding in marginal ulcers GI hemorrhage
Painless ulcers in the stomach Marginal ulcers
Ulcers that are less likely go to be relieved by vomiting, food Marginal ulcers
Ulcer ass’d with increased ICP Cushing’s ulcer
Another name for gastrinoma Zollinger-Ellison syndrome
Ulcers not responsive to conventional PUD treatments Zollinger-Ellison syndrome
Test of choice for Zollinger-Ellison syndrome Gastrin levels
Hepatic or IVC thrombosis secondary to hypercoagulability Budd-Chiari syndrome
Portal HTN, fever, abd pain Bacterial peritonitis
Portal HTN, asterixis, delirium Hepatic encephalopathy
Portal HTN, hematemesis, GI bleed Esophageal varices
Abdominal fluid wave Portal HTN
Spider angiomata Cirrhosis/portal HTN
Caput medusae Dilated abdominal veins…portal HTN
Gynecomastia and testicular atrophy Portal HTN
Hepatic encephalopathy is due to? Increased ammonia levels
1st place you see jaundice Scleras
Cirrhosis is a product of? Long-term hepatitis or long-term granulomatous dz
Large amts of Hb Hemochromatosis
Increased indirect hepatic vein wedge pressure Portal HTN
“Buzz Words” page 37 Associated Disorder/Pathology
Dull periumbilical pain that waxes and wanes Appendicitis
Sharp, continuous, localized, increasingly severe pain in the RLQ Appendicitis
Tenderness upon rectal exam with suspicion of appy Suggests an inflamed posterior appendix
Appendicieal fecalith on AXR Appendicitis
Free air level with appy Perforation of bowel
5 F’s Fat, female, fertile, forty, and flatulent…cholelithiasis and biliary colic
Pigment stones Chronic hemolysis
Colicky pain in the RUQ Cholelithiasis and biliary stones
Postprandial abd pain Cholelithiasis and biliary stones
RUQ tenderness and palpable gallbladdar Cholelithiasis and biliary stones
Gangrene of the gallbladdar Acute cholecystitis
Acalculous cholecystitis Cholecystitis in the absence of cholelithiasis
Murphy’s sign Cholecystitis
Absence of gallbladdar on HIDA scan Acute cholecystitis
Increased amylase Pancreatitis
Intraoperative cholangiogram Rules out common bile duct stones in cholecystitis
In what pts do you delay cholecystectomy until acute inflamm resolves? In pts with sig medical problems (including diabetes)
Infection/inflamm of the biliary tree usually secondary to gallstones or malignancy Cholangitis
sclerosing cholangitis Ulcerative colitis
Pancreatic pseudocyst Cholangitis
Charcot’s triad Cholangitis…RUQ pain, jaundice, and fever/chills
Reynold’s pentad Cholangitis…Charcot’s triad plus shock and altered mental status
Leukocytosis, increased bilirubin, increased alkaline phosphatase Cholangitis
ERCP is gold standard Cholangitis
Emergent bile duct decompression Tx for cholangitis
Anti-HAV IgM Hepatitis A
“Buzz Words” page 38 Associated Disorder/Pathology
Coca cola urine Hep A
Undercooked shellfish Hep A
Chronic form of hepatitis Hep C
Type of hepatitis PAN can cause Hep B
P-ANCA PAN
Drug whose OD can cause immediate, fulminant hepatitis Acetominophen
Antidote to acetominophen OD Mucomist/mucostat
Transmission route of hep A Fecal-oral transmission
Hepatocellular carcinoma Hep A
Major cause of hepatocellular carcinoma worldwide Hep B
Hep D has to occur with? Hep B
Pregnant women hepatitis Hep E
Causes of granulomatous hepatitis TB, fungal infection, sarcoidosis, other granulomatous disease
Tender hepatomegaly Acute hepatitis
Dramatically elevated ALT/AST Acute hepatitis
Hepatitis serology Acute hepatitis
Increased AST Alcoholic hepatitis
Two types of hepatitis alpha-interferon is used for Hep B and hep C
AST:ALT > 2 suggests what type of hepatitis Alcoholic hepatitis
Percentage of pts with HCV that will develop chronic hepatitis 80%
Kaiser-Fletcher ring Copper ring around the iris…Wilson’s dz
Sky high ferritin Hemochromocytosis
Cardiomegaly, bronzing in DM, Fe overload, positive stain with Prussian blue Hemochromocytosis
Elevated ALT/AST lasting >6 mos Chronic hepatitis
Epidemic, institutionalized Hep A
Health care worker, IVDA, prostitutes and their clients Hep B
Blood transfusions (prior to 1988), IVDA Hep C
Fulminant hepatitis, chronic hepatitis B gets acutely worse Hep D
“Buzz Words” page 39 Associated Disorder/Pathology
Homeless, ETOH Alcoholic hepatitis
Young women Autoimmune hepatitis
Hep with pulmonary dz Alpha-1 antitrypsin deficiency
Hep with neuropsychiatry dz Wilson’s dz
Hep with diabetes, heart dz Hemochromocytosis
Hep with recurrent lung infections Cystic fibrosis
Hep with fat ppl Fatty liver
Hep with hypercoagulable history Budd-Chiari syndrome
High indirect bilirubin Extrahepatic causes of hepatitis
High direct bilirubin Intrahepatic causes of hepatitis, or stone stuck in bile duct
Jaundice, middle aged women, itching, high alk phos Primary biliary cirrhosis
Jaundice, young man with hx of diarrhea Primary sclerosing cholangitis
Septic pt, jaundice Cholangitis
Jaundice, chronic alcoholism Chronic pancreatitis/pancreatic CA
Jaundice, prior biliary surgery Bile duct stricture
Coffee ground emesis Hematemesis
Two large bore IV lines ASAP Upper GI bleed
Common cause of small bowel obstruction Adhesions
Copious emesis SBO
Cramping pain with obstruction SBO
Surgical scars SBO
High-pitched “tinkly” bowel sounds SBO, LBO
Peristaltic rushes SBO
Absence of bowel sounds SBO
Deep and cramping pain Large bowel obstruction
Abdominal distension LBO
Feculent emesis LBO
Abdominal tympany LBO
Type of obstruction with more acute onset, less cramping pain, more emesis, less distension SBO
Ogilvie’s syndrome Small bowel pseudo-obstruction
Retching, ETOH, binging Mallory-Weiss tear
“Buzz Words” page 40 Associated Disorder/Pathology
ETOH history, massive bleed, portal HTN, encephalopathy Esophageal varices
OTC drugs, arthritis, HA NSAIDs
Renal failure Gastric AVMs
History of AAA repair Aortoenteric fistula
Typical ulcer history Ulcer bleed
Family history, nose bleeds Hereditary hemorrhagic telangiectasias
Recent burn, neurosurgery, ICU Stress ulcer
Old pt, aortic stenosis Colonic AVMs
Old pt, lots of vascular dz Ischemic colitis
Post op for AAA repair Ischemic colitis
Recurrent brisk, painless bleed Diverticulosis, AVMs
Young pt, constipated Hemorrhoids, *blocked fissure
Chronic bloody diarrhea Ulcerative colitis
Outpouching of mucosa Diverticular dz
Most common site of diverticulas Sigmoid colon
LLQ pain Diverticular dz
Low grade fever, lower abd mass, positive stool guaiac test, lower GI bleed Diverticulitis
Avoid flexible sigmoidoscopy and barium enemas when? In initial stages of diverticulitis
Pencil thin stools Colorectal CA
Frank or occult blood in the stool Colorectal CA
Blood in the stool with symptoms of anemia, weight loss Colorectal CA
Idiopathic functional disorder IBS
Comorbid psychiatric disorders IBS
Alternating diarrhea and constipation IBS
Unremarkable PE except for mild abd tenderness IBS
Diagnosis of exclusion IBS
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Ripping, tearing pain that radiates to back Aortic dissection
PAM & SUE Life threatening causes of chest pain—pulmonary embolism, aortic dissection, MI, spontaneous pneumo, unstable angina, esophageal rupture
“Buzz Words” page 41 Associated Disorder/Pathology
Sharp, stabbing, piercing, precisely located pain Somatic pain…rel to skeletal, chest wall, voluntary…not autonomic
Less distinct, dull, aching, hard to describe and locate pain Visceral pain…rel to organs and great vessels
4 examples of somatic pain Pulmonary embolism, MS, spont. Pneumo, pneumonia…Paula is PMSing
3 examples of visceral pain MI, angina, dissection…MAD
Pts who have MI’s with no diaphoresis or pain Diabetics
Younger pts with MI’s Cocaine use or syndrome X
Most impt tool for diagnosing MI History
Duration of angina 5-15 minutes
Time it takes for angina to go away with rest 3-5 minutes
Type of angina that lasts longer Unstable angina, or angina related to an active MI
Most likely time of the day for an MI to occur 2 am-noon
Chest pain that slowly builds up to maximum MI
Chest pain that has a more immediate onset Musculoskeletal
Percentage of the time that a GI cocktail will relieve angina/MI symptoms 30%
Sharp, sudden stabbing pain that worsens with movement Musculoskeletal
Heavy, pressure, squeezing, burning pain Angina/MI
Leads that pericarditis causes ST elevation in All leads
Left sided pain that radiates to L arm, substernal pain, neck pain, jaw pain Angina/MI
Pain in the back and upper abdomen Dissection
Pain that mimics angina but dies not usually radiate GI pain
Systolic difference of >20 mmHg between arms Arterial obstruction to arm
Loud S1 Mitral stenosis, short PR interval
Quiet S1 Very calcified mitral valve, long PR interval
Loud S2 Hyptertension
Quiet S2 Aortic stenosis
“Buzz Words” page 42 Associated Disorder/Pathology
Wide splitting Pulmonary stenosis, RBBB, mitral regurgitation
Fixed splitting Atrial septal defect/ASD, right ventricular failure/RVF
Paradoxical splitting LBBB
S3 present Volume overload, aortic regurgitation, mitral regurgitation, any dilated cardiomyopathy
S4 present Pressure overload, aortic stenosis, hypertension, hypertrophic cardiomyopathy, cardiac ischemia
ST depression and T wave inversion Ischemia
Percentage of time that EKG is negative in an active MI 50%
Hampton’s hump Pleural effusion…wedge shaped infarct
Westermark’s sign Pleural effusion…oligemia in the embolized lung zone
Wide mediastinum on x-ray Aortic dissection
Tracheal deviation on x-ray Pneumothorax
Best enzyme level to use for MI Troponin
Young anxious woman Mitral valve prolapse
Pleuritic chest pain Pericarditis, pleuritis, pleural effusion, PE
Sudden onset with shortness of breath in young, thin pt COPD, chest trauma, or pneumothorax
Post-op, obese, sedentary, hypercoagulable with SOB Pulmonary embolism
Pain reproduced with palpation Costochondritis
Pain a few days post-MI Pericarditis
Pain a few weeks post-MI Dressler’s syndrome
Wheezing triggered by cold, exercise Asthma
Sudden onset, hypotension Tension pneumothorax
Cough, pleuritic chest pain, dullness to percussion Pleural effusion
Anxious, paresthesias Hyperventilation
Productive cough Pneumonia
Drugs that cause lupus-like syndrome, pleurisy Procainimide, hydralazine
Persistent tachycardia Pump failure
Bradycardia Inferior wall ischemia
“Buzz Words” page 43 Associated Disorder/Pathology
Hypotension, JVD, clear lung RV infarct
New systolic murmur, early Papillary muscle dysfunction
New systolic murmur, late VSD
Post MI chest pain Ischemia or pericarditis
Hypotension (esp sudden), JVD, pulsus paradox Cardiac tamponade
Chest pain, pleural effusion 6 wks later Dressler’s syndrome
Beck’s triad JVD, muffled heart tones, pulsus paradoxicus
Pathognomonic for cardiac tamponade Beck’s triad
Normal CO 4-8 liters/min
Normal SV 50-100 cc
Preload Pressure which fills the left ventricle during diastole
Equivalent to pulmonary artery wedge pressure (PAWP) Preload
Measures venous return from the vena cava Preload
Afterload Pressure against which the left ventricle pumps, or, mean aortic pressure
Contractility Ability of the heart to increase the force of its contractions independent of preload
3 things that lead to CHF Cardiomegaly, pulmonary edema, dependent body edema
Invasive way to monitor actual CO Swan Ganz catheter
CHF where symptoms are dyspnea and orthopnea Left ventricle failure
CHF where symptoms are dependent edema, congestive hepatomegaly, and systemic venous distention Right ventricle failure
Hypotension without peripheral edema Acute CHF
BP is maintained, peripheral edema present Chronic CHF
Cephalization on CXR Indicator or CHF…visible vascularity beyond hila and in upper lobes of lungs
Paroxysmal nocturnal dyspnea CHF
Pink frothy sputum Pulmonary edema
Classic sign of RVF Dependent edema
Anasarca Severe massive edema, whole body
“Buzz Words” page 44 Associated Disorder/Pathology
Early sign of RVF JVD
Dilutional hyponatremia CHF
First symptoms of LVF Exertional dyspnea
Cheyne-Stokes respirations LVF
“Kentucky” heart sounds LVF
S3 and S4 sounds LVF
Summation gallop LVF
Pulsus alternans LVF
Subendocardial ischemia LVF
Kerley A lines on CXR Interstitial edema…long…represent a transudate into interlobular septa
Kerley B lines on CXR Interstitial edema…short…represent interlobular septa thickened by edema
Bilar haze on CXR Alveolar edema
Murmur of tricuspid insufficiency RVF
Nutmeg liver Congestive hepatomegaly…RVF
Ascites RVF
Mitral insufficiency murmur LVF
Pillow orthopnea at night LVF
New onset mitral regurgitation, cardiogenic shock, pulmonary edema, tachycardia MI
Dressler’s syndrome Autoimmune process with fever, pericarditis, and increased ESR occurring 2-4 wks post-MI
# of PVCs per minute that is dangerous More than 6
STEMI ST elevation MI
Non-STEMI Non-ST elevation MI
2 causes of STEMI Clots, plaque where artery is completely occluded
Higher acute mortality in MI STEMI
2 causes of non-STEMI Clots, plaque where artery is not completely occluded
STEMI acute coronary syndrome (ACS) Occlusive thrombus
Non-STEMI ACS Microvascular embolization of platelet aggregates
Pericardial friction rub Myocarditis
“Buzz Words” page 45 Associated Disorder/Pathology
Valvular problem that increases risk of CHF during MI Mitral valve regurgitation
Left-sided valve vegetations Typical endocarditis…usually community-acquired
Right-sided valve vegetations IVDA
5 risk factors for infective endocarditis Rheumatic heart disease, valvular heart disease, presence of prosthetic heart valve, IVDA, bacteremias
Common causative organism for IVDA endocarditis Staph aureus
Organism for subacute bacterial endocarditis Strep viridians
Organism for prosthetic heart valves Staph epidermidis and aureus, candida
Most consistent sign of infective endocarditis Fever
Low grade fever Subacute bacterial endocarditis
High grade fever Acute bacterial endocarditis
Fever of unknown origin Bacterial endocarditis
Best time to take a blood culture with suspicion of BE When fever spikes
Type of BE that is insidious, presenting with low-grade fever that may last for weeks with cough and SOB SBE
BE with high fever and shaking chills ABE
Decrescendo/regurgitant murmur Infective endocarditis
Osler’s nodes Small, tender nodes on finger and toe pads…infective endocarditis
Janeway lesions Small, peripheral hemorrhages/purpura/petechiae…infective endocarditis
Splinter hemorrhages Subungual petechiae…infective endocarditis
Roth’s spots Retinal hemorrhages…yellow in the center and red in the periphery…infective endocarditis
Multiple blood cultures positive with the same pathogen Infective endocarditis
Septic emboli on CXR Infective endocarditis
Elevated ESR (sky high) Infective endocarditis
Time to give a-bio prophylaxis for IE before bacteremia procedures 1-2 hrs before and no more than 6-8 hrs before
“Buzz Words” page 46 Associated Disorder/Pathology
Surgery that is ass’d with the highest incidence of bacteremias after the procedure Periodontal surgery
Most Frequent…
diabetes mellitus in children Type 2 diabetes
age category for Type 1 diabetes children
benign thyroid tumor follicular adenoma
thyroid cancer papillary carcinoma
primary benign (brown tumor) of the adrenal medulla in adults pheochromocytoma
symptomatic presentation of hyperparathyroidism renal stones
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Anemia (overall) Iron-deficiency anemia
Anemia in malignancy ACD
Sideroblastic anemia alcoholism
Thalessemia Beta-thalessemia
Anemia in alcoholics Folate deficiency
Type of cancer in children Malignant proliferation of hematopoietic cells (leukemias)
Cancer of childhood ALL (acute lymphocytic leukemia)
Hodgkin’s lymphoma Nodular sclerosing
Lymphoma in children Burkitt’s lymphoma
infective organism in infective mononucleosis EBV
other common infective organisms in infective mononucleosis Toxoplasmosis, CMV
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Type of headache diagnosed in adults Tension
Pharmacological causes of delirium Corticosteroids, DTs
Primary brain tumor Glioblastoma multiforme
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Injury to abdomen following blunt trauma Splenic damage/rupture
Motility disorder Diffuse esophageal spasm
Abdominal emergency among those <35 yrs of age Appendicitis
Etiologies of appendicitis Lymphoid hyperplasia, fecalith obstruction
Hiatal hernia Sliding hiatal hernia
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Infective endocarditis Left-sided
Most Common Cause of…
diabetes mellitus in children obesity
hypopituitarism in adults non-functioning pituitary adenoma
second MCC of hypopituitarism in adults Sheehan’s postpartum necrosis
hypopituitarism in children craniopharyngiomas
primary hypothyroidism Hashimoto’s thyroiditis
hyperthyroidism Graves’ disease
Cushing’s syndrome iatrogenic
Addison’s disease in underdeveloped countries adrenal tuberculosis
Conn’s syndrome (primary aldosteronism) benign adenoma of the adrenal cortex (usually unilateral)
three MC causes of generalized hypopituitarism pituitary adenoma, craniopharyngioma, Sheehan’s syndrome
hyperaldosteronism Conn’s syndrome
hypercalcemia in the ambulatory setting hyperparathyroidism (from benign parathyroid adenoma)
hypercalcemia in the inpatient setting malignancy
primary hypoparathyroidism previous surgery/parathyroidectomy or thyroidectomy
2nd MCC of primary hypoparathyroidism autoimmune hypoparathyroidism (MEN)
hypocalcemia hypoalbuminemia
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Iron-deficiency anemia Bleeding (often GI)
Leukoerythroblastic reaction Metastatic breast cancer
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Dementia Alzheimer’s dz
Death in Alzheimer’s pts Secondary to aspiration pneumonia or other infections, neglect
Meningitis in HIV pts cryptococcus
Intracranial hemorrhage trauma
Stroke Atherosclerosis of the extra cranial vessels
SAH Ruptured Berry aneurysm
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Shock w/o GI bleed Ruptured spleen
Pediatric diarrhea Rotavirus infection
Portal hypertension Liver cirrhosis
Cirrhosis Alcoholism
Inflammation of the liver Alcoholism (i.e. not infection)
Acute lower GI bleeding in pts >40 yrs of age Diverticulosis
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Right heart failure Left heart failure
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