Escolar Documentos
Profissional Documentos
Cultura Documentos
Thiamine (B1) Beriberi - peripheral neuropathy, Cardiomyopathy - dry or wet (high output failure)
Wernicke-Korsakoff - Alcoholics, confabulation, nystagmus, confusion
Pyroxidone (B6) Rare, neuropathy, Cheilosis (swollen cracked bright red lips)
Cobalamin (B12) Macrocytosis, Pernicious Anemia- megaloblastic, neuro chg. ataxia, Schilling test , more
in Strict Vegitarian.
Vitamin C Scurvy, bleeding gums, Connective Tissue problems, Can manifest 1 yr post defic.
Failure to Thrive Org.= decr. wt gain w/ other disease; Nonorg.=growth failure due to neglect
ßstimulation
< 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
Infectious Esophagitis Candida (thrush), HSV, CMV, immunocomp, diabetics, Dysphagia & odynophagia
Trachesoph Fistula Congenital defect, distal esoph, coughing & cyanosis when feeding, abd distention
Achalasia Dysphagia for solids & liquids, nocturnal cough, aspiration; Absent peristalsis & tight LES,
1
"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
Cullen's Sign Periumbilical cyanosis d/t hemoperitoneum = hemorrhagic pancreatitis, ruptured ectopic,
ruptured spleen
Gastric CA Adeno, H.Pylori gastritis, Virchow's Nodes, Types = ulcerating (shallow edges); polyploid
(intraluminal late mets); superficial (early CA) ; Linitus Plastica (all layers decr. elasticity) Mets to ovary =
Krukenberg Tumor
Diarrhea Osmotic = incr. H2O lumen incr. solutes in bowel; Secretory = electrolytes & H2O secreted not
absorbed; Malabsorption; Exudative secretion of blood plasma & mucus (mucosal inflammation); decr.
transit time (short bowel); incr. 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)
2
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, incr. 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
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, decr. 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
3
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 incr. ;
Ranson's Criteria: 3 or more = incr mortality
Admission: >55, gluc>200, LDH >350, AST >250 WBC > 16000
Within 48 hrs: Hct decr. 10%, BUN incr. >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, incr. 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)
4
Benign Hep Adenomas oral contraceptives
Insulinoma Insulin hypersecretion, hypoglycemic symptoms, Insulin levels still incr. 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
VonGierke's Disease glucose-6-phosphatase def.; big liver & kidneys, growth retardation, electrolyte
prob.
McArdles Disease musclephosphorylase is absent, muscle cramps & incr. myoglobin after exercise
Jaundice Prehepatic = hemolysis, gilbert's disease, Crigler Najjar; Hepatic = hepatocellular or cholestatic;
Post Hepatic = Biliary obstruction, AST & LDH also incr. ;
incr. unconj prehepatic; incr. conj = intrahepatic cholestasis or post hepatic disease ; incr. all fractions =
hepatocellular, hyperbilirubinuria = conj bili water soluble
ETOH Hepatic Disease Fatty liver => ETOH hepatitis => cirrhosis; AST incr. > ALT incr. ; incr. PT; decr. II,
VII, IX, X Clot
Cirrhosis necrosis and fibrosis, decr. serum albumin, anemia incr. 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, incr. ammonia incr. glutamine in CSF, EEG abnormal
Ascites Complication of hepatic disease; Paracentesis to examine ascitic fluid values should equal serum
if incr. albumin = malignant; incr. LDH > 60% of serum = malig or infective;
incr. WBC = infection
5
GI Bleeding Upper GI = melaena (black tarry) ; Lower GI = hematochezia (bright red) decr. 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
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, Colostomy
If it will help u guys just let me know I'll post rest of the systems
Thxn 2 eaziz
Cheers
Rheumatic Fever post strep infection, migratory arthritis, endocardits, subcutaneous nodules on
extensor surface, chorea, erythema marginatum, incr. 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 incr. pulm vasc resistance
Patent Ductus Arterio L=> R; Continuous machinery murmur; Indomethacin inject may close
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,
6
Bacterial Endocarditis Acute: S.aureus, Group A strep, N Gonh., Sub acute: Strep Viridans; New heart
murmurs, petechia over incr. half of body, Splinter hemorrhages on fingernails, Osler's Nodules (nodules
on fingertips) Roth's Spots (retinal hemorrhages)
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 decr. 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 decr. HR & incr. 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;
7
Torsades De Point is drug induced
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
Hypertrophic Cardiomyopathy Cong or acquired VH with normal afterload; incr. venous pressure, JVD,
ascites, edema, edema, pleural effusion, S4 on exam
Chronic Pericardtis Causes right sided failure; Kussmaul's Sign ( incr. 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, (ß decr. 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, incr. w/ valsalva; PR: 2nd L ICS, pulm HTN, clubbing, PE; PS: harsh; TR: 4th L ICS,
incr. loud w/ inspiration; bounding JVD, pulsatile liver; VSD: loud holoystolic, assoc w/ Down's
RESPIRATORY
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
Strep Pneumonia Red-brown sputum, lobar pneumonia, most common adult community acquired
Pneumovax vaccine = >65, immunocompromised, chronic disease
8
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 incr. 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
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 incr. incr. incr. sputum,
dyspnea, hemoptysis, Xray = incr. bronchial markings, "honeycombing"
Blue Bloaters Bronchitis>Emphysema; cough w/ mucous 3mos/yr x 2y; cyanosis, pulm HTN
Cystic Fibrosis auto recessive, COPD, Pancreatic insufficiency; meconium illeus, incr. 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
9
Laryngeal CA squamous cell, smoking & alcohol, hoarsness for several weeks
Asthma PFTs decr. FEV1; ABG resp alkalosis, decr. CO2; If CO2 incr. 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 (ßO2 & ßCO2; Xray
=pulm edema with normal cardiac silhouette, Positive pressure or PEEP ventilatory support
Pleural Effusions decr. 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; incr. 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, ßT4 incr. 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
10
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 incr. Ca mobilization from bones, incr. Vit D production decr. phos reabsorption in
distal tubules = decr. serum phos.
Hypoparathyroidism ßPTH, ßCa, incr. Phos, Tingling, tetany, Chvostek's sign (tap on face & get muscle
spasm) ; Trousseau's Sign (BP cuff up 3min => carpal tunnel sx; decr. Mg in alcoholics can lead to decr.
Ca due to ßPTH secretions
Hyperparathyroid Bones, stones, abd. Groans and psychic moans; 1o = excess PTH; 80% benign
adenoma; 2o due to decr. serum Ca=> vit D defic, renal tube prob and Ca loss
Kallman's Syndrome Male, anosmic, small testicles, azospermic d/t head trauma; decr. 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
11
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- incr.
cortisol, ACTH suppressible, cortisol not #4 Chronic glucocorticoid Tx
Familial Hypertriglyceridemia Trig incr. , LDL normal, Autosomal dominant, Pancreatitis, milky serum
Familial Combined Hyperlipidemia Auto dominant, incr. trig and cholesterol; no xanthomas
Hemochromatosis Auto recessive, incr. GI absorption of Fe; Excessive Fe, incr. Ferritin, incr. 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 incr. Na retention and incr. K
loss
excretion due to decr. Na, decr. BP (renin angio), incr. K
1o Conn's Syndrome = adrenal hyperplasia, adrenal adenoma Tx: spironolactone
2o incr. renin angiotensin system activity => decr. BP
GENTOURINARY
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
12
Hydronephrosis dilation of renal pelvis, incr. 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 incr. 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 decr.
erythropoietin; incr. Phos & decr. 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
Chronic Renal Failure >90% glomeruli destroyed; uremia incr. K, ßNa incr. phos, ßCa = renal
osteodystrophy
Hypernatremia > 155 mEq/L; due to dehydration, CNS depression (neuronal shrinkage); Diabetes
13
Insipidus= decr ADH = lots of dilute urine = dehydration = urine output incr.
Hyponatremia <135 mEq/L; pseudo if lipids are incr. incr. incr. high to displace polar Na; Osmotic =
diabetes incr. 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
Torsion of the Testes adolescents, swelling & tenderness, superior displacement, support does not
relieve pain, Emergent SURGERY
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, a 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 incr.
Fever of Unknown Origin > 100F for > 3 weeks despite active search for cause for > 1 week; need to get
14
CBC w/diff, blood cultures; kids = usually infection; adults = infectious, neoplasm, autoimmune
Types of Immunity Active Acquired= direct exposure - infection or vaccination; Passive Acquired =
temporary, serum Ab given (IG, breast milk)
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, decr.
platelets,
Chronic Granulamatous Disease Autosomal recessive, defect in phagocytic enzymes, recurrent bacterial
& fungal infections
15
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 contraindicated
Normocytic Anemia MCV 80 - 100; Hemolysis, Chronic disease, Bone marrow suppression (drugs,
leukemia) (aplastic)
Macrocytic Anemia MCV > 100; FOLATE DEF. = most common cause, decr. 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 = a 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, decr. Hct & incr. 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, decr. platelets, decr. HCT, incr. retic count, incr. incr. incr. 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
16
=> 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
DIC wide spread activation of coagulation cascade. decr. platelets, fragmented RBC, incr. PT & PTT ; decr.
fibrinogen, Pregnancy, malignancy, infections, massive trauma
Acute Lymphocytic Leukemia 80% childhood leukemia, peak age 3 - 7; usually B cell origin; incr.
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; incr. uric acid, incr. 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; decr. RBC with
normal WBC & platelets; Rouleau Formation = RBC pile up forming cylinders
17
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 = incr. RBC due to
dehydration; R/O 2o polycythemia = RBC mass incr. due to decr. oxygenation.
Eaton Lambert 90% assoc w/ small cell CA, decr. presynaptic Ca release = proximal muscle weakness;
hyporeflexia, dysautonomia, function incr. w/ stimulation; weakest in AM (opposite MG) Tx Tubocurare
DERMATOLOGY
Seborrheic 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
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 incr.
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
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;
Hemangiomas NEVUS FLAMMEUS: Port wine stain - flat, purple, does not fade
CAPILLARY: strawberry mark, raised, bright red, regress spontaneously by age 5
18
CAVERNOUS: Raised red or purple, enlarged vascular spaces
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
Lyme Disease Borrelia burgdorfi, Ixodes tick, arthralgias, Rash w/ central clearing = erythema chronicum
migrans, CNS chgs 1 month after exposure
Osteoporosis decr. mass of bone; hip & wrist fx most common; decr. 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 = incr. BUN incr. Cr, + protein = immune complex glomerulonephritis
Ankylosing Spondylitis "Bamboo shoots" = vertebral squaring w/ bony outgrowths, paraspinal lig.
Calcifications on xray; sacroiliac involvement is diagnostic; HLA-B27; incr. ESR
Shoulder Hand Syndrome Pain, stiffness, swelling in hand and shoulder; Occurs 1 month after MI or
other acute disease
19
Paget's Disease Osteolytic => osteoblastic; Frontal "bosing" (enlarged skull with rounded forehead) bow
legs and shortened spine; incr. 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 decr. 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
Septic Arthritis S, aureus = most common; N. Gon most common sexually active; synovial fluid = incr.
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; incr. ESR; neg. Rheum factor; steroid response immediate
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; decr. 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
20
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)
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
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,
21
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.
22
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, decr. 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/ incr. 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
23
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: decr. glucose, incr. neutrophils, incr. protein, incr. opening pressure; Tx: ampicillin & cefotaxime =
infants; 3rd generation cephlosporin in kids > 3mos and adults
Aseptic Meningitis nonbacterial meningeal irritation; CSF = incr. lymphocytes, normal glucose, neg gram
stain & bacterial cultures, mild incr. protein, normal opening pressure; supportive Tx
Fungal/TB Meningitis CSF: incr. lymphocytes, decr. glucose, incr. protein, incr. 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,
24
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, incr. 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 incr. 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 = incr. 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, incr. DTR, incr. tone, weakness, toe walking, scissors
gait
Muscular Dystrophy Duchenne most common type; X linked recessive, mutation in dystrophin gene; CK
incr. 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
25
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
GYNECOLOGY
Trichomonas Vaginitis Yellow green discharge, Strawberry patches, Motile flagellated, Tx: Metronidazole
Gardenerella Vaginitis KOH whiff test = fish; Clue cells, most common symptomatic infection;
Metronidazole
PID Cervical motion tenderness, Purulent discharge, assoc w/ ectopic pregnancy & infertility;
Leukocytosis, neutrophilia, incr. ESR
Candida cottage cheese, red vulva; Pseudohypahe & spores on wet mount, DM, antibiotics, OC,
pregnancy
Toxic Shock Syndrome Staph aureus exotoxin, rash, high fever, hypotensive shock
Chancroid H. Ducreyi, tropical & sub tropical climates, gram neg; Tx Emycin or Ceftriaxne
Herpes Genitalis HSV II clear sores , multinucleated giant cells w/ intracell inclusions; Tzanck smear
Paget's Disease of Breast Intraductal Ca in main excretory ducts; crusting erosion of nipples w/ or w/o
discharge
26
Polycystic Ovarian Disease incr. LH, decr. or normal FSH; hirsutism, obesity, menstrual irregularities,
infertility
Menopause Avg age =51; incr. FSH & LH; Hot flashes, Atrophic vaginal epithelium
Urinary Incontinence Stress = incr. intra abd pressure, leak small amts of urine; Kegel exercises, estrogen
Urge = detrussor instability; lg amts of urine leaked immediately after urge to void
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 & 1Cool; Mild Dysplasia = lowgrade epithelial lesion;
Mod/Severe=high grade intraepithelial;
Carcinoma in situ incr. nuclear/cytoplasm, dense chromatin, crowding, incr. mitosis; Koilocytes = HPV,
pyknotic nucleus, perinuclear halo; Risks: early sex, multi partners, smoking, decr. social class, HPV;
Culposcopy = white epithelium, mosiacism, punctation, atypical vessels
27
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
Choriocarcinoma HCG
Sexcord-Stromal Tuors Granulosa: 50% post menopause, incr. 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
28
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
Chemotherapy Cyclophosphamide (Cytoxan) = ovarian, hem, cystits, alopecia, decr. bone marrow, N/V
Cisplatinum = ovaian, renal toxic, ototoxic, bone marrow ß, 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, decr. 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 - incr. Spina bifida, decr. Down's, detect lung maturity, early
2nd trimester
Non stress Test > 2 fetal movements accompanied by incr. 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
29
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
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, decr. transverse and incr. AP diameters, decr. subpubic angle
Android= triangular inlet, decr. subpubic angle, prominent spines
Platypoid= incr. transverse and decr. 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
30