Step 2 U World Notes

Question Main
Id
Division
2134
2386
2770
3195
Pediatrics
Medicine
Medicine
Pediatrics
Sub Division
Notes
Allergy & Immunology
an infant with a history of Giardia and recurrent sinopulmonary infections(

encapsulated organisms like h influenza and s pneumoniae because destrution of the
capsule requires a humoral immune response). since six months of age, suggesting a
genetic defect in B lymphocytes. lack of IgA also predisposes to Giardia infection.
the 23 valent pneumococcal vaccine contains capsular polysaccharides and induces a

relatively T-cell-independant B cell response. In contrast, the 13 valent pneumococcal
vaccine vaccine contains caspular polysaccharides conjugated to a protein antigen,
which allows for a more robust T cell dependent B cell response. 2. proliferation of
CD8 T cells occurw mainly in response to intracellualr pathogens. caertain live
attenuated vaccines such as the measles (MMR) and intranasal
ACE inhibitors are the most common cause of acquired angioedema. pts present with
edema in the face, mouth, lips, tongue, glottis and larynx. Laryngeal edema can cause
airway obstruction. - angioedema occurs due to the pro-infflammatory action of
bradykinin, which promotes edema, inflammation and the sensation of pain.
-angiotensin converting enzyme (ACE) aka Kininase; it functions to degreade
bradykinin. when ace is inhibited, levels of bradykinin increase, = angioedema.
common vairable immunodef or aquired hypogammaglobulinemia can have somewhat

similar presentation to Brutons agammaglobulinemia; however, pts with the former
usually manifest with less severe symptoms at a later age (15 to 35 yrs old) and their
no no absence or decrease in the number of circulating B cells, but serum
concentrations of IgG, IgA IgM and IgE may be decreased.
4080
Medicine
traveling to north africa, cdc reccomends administering the hep a, hep b, and typhoid
vaccines as well as a poilio booster vaccine. of these the most common vaccine
preventable infectious disease is hep a ... .most asian and african countries are high
risk zones.
4143
Pediatrics
pts with complement deficiency are at increased risk of bacterial infections, particularly
with encapsulated bacteria such as streptococcus pneumoniae, haemophilus
influenza, and neisseia meningitides. they are also at risk for autoimmune conditions.
4734
Obstetrics &
Gynecology
congenital rubella-> sensorneural hearing loss, cardiac abnormalities (PDA), cataracts,

glaucoma.
3880
Medicine
Biostatistics & Epidemiology
USMLE TIP: think of lead-time bias when you see "a new screening test" for poor
prognosis diseases like lung or pacreatic cancer.
A cross-sectional study is also known as a orevalence study. It is characterized by

thesimultaneous measurement of exposure and outcome. It is a snapshot study
design frequently used for surveys, mostly bc it has the advantage of being cheap and
easy to perform. 2. a randomized clinical trial directly compares two or more
treatments. usually subects are randomly asigned to an exposure (eg medication) or
placebo, and are followed for the development of the outcome (disease)
a case control study is use to compare the exposure of people with the disease
(cases) wo the exposure of the people without the disease (controls). the main
measure -> exposure odds ratio. 2. Incidence measures -> relative risk and relative
rate which are calculated in cohort studies, where people are followed over time for
the occurence of the dz. 3, prevalence offs ratio is calculated in cross-sectional studies
to compare prevalence of a dz between different populatio
3922
3931
Medicine
Medicine
4019
Medicine
relative risk is the risk of an outcome (eg DVT) in the exposed group (eg OCP) divided
by the risk of that outcomein the unexposed group. if RR= 1.0 (null value), then there
is no association between exposure and outcome (ordisease). an RR >1.0 indicates
that exposure is associated with increased risk of isease. an RR < 1.0 means that
exposire is associated with decreased risk of disease.
4109
Medicine
the p-value <0.01 indicates that the *** is statistically significant. a large sample size
decreases the P value for the *** and makes the confidence interval narrower. as a
result, the precision of the estimate increases.
4172
Medicine
incidence is the measure of the appearance of new cases. prevalence is the measure
of those with the disease in the population at a particular point in time. an increasing
prevalence and stable incidence can be attributed to factors which prolong the
duration of a disease (e.g. improved quality of care- this scenario is typical for the
USMLE)
4172
Medicine
incidence is the measure of the appearance of new cases - prevalence is the measure
of those with the diesease in the population at a particular point in tome.
-prevalence=(incidence)x(Time)
4184
Medicine
NPV is the probability of being free of a disease if the test result is negative. remember
the NPV will vary with the pretest probability of a disease. a pt with a high probability of
having a dz will have a low NPV, and a pt with a low probability of having a dz will have
a high NPV.
10505
Obstetrics &
Gynecology
Hemophilia A is an X - linked recessive disorder. On average, carrier mothers and

unaffected fathers have a 25% chance of having a son with hemophilia, a silent carrier
daughter, an unaffected son, or an unaffected daughter.
2686
Medicine
Cardiovascular System
the first line of medical therapy for hypertrophoc cardiomyopathy is either a b blocker
or a cardiac acting calcium channel blocker such as diltiazem since they promote
diastolic relaxation
2692
Medicine
digitalis is most useful in those heart failure patients who have systolic dysfunction and
have rapid ventricluar rates due to atrial flutter or afib.
2711
Medicine
Outflow obstruction in hypertrophic cardiomyopathy results from both septal

hypertrophy and systolic anterior motion (SAM) of the mitral valve.
2745
Medicine
asa, heparin, clopidigrel only stop the thrombus from progressing... ptca and
fibrinolysis distrupt the thrombus that is occluding coronary blood flow.
3065
Medicine
rickettsial infection can cause myocarditis
3689
Medicine
hyperthermia, leukocytosis, and coagulopathy are typical associations in regards to

exertional hyperthermia in non exertional hyperthermia, its commonly seen in the
elderly with significant underlying comorbidities that limit their ability to escappe or
cope with excessive heat... ... ice water immersion is assoociated with increased
mortality in nonexertional heat stroke.
3769
Medicine
Amiodarone is a class lll antiarrhythmic angent, well known for causing pulmonary
fibrosis. Thyroid dysfunction (hypo and hyper), hepatotoxicity, corneal deposits and
skin discoloration are other potential side effects.
4108
Medicine
inferior wall MI is due to occlusion of the right coronary artery occlusion wich can lead
to RV infarction?dysfunction rsulting in hypotension. RCA occlusion can cause AV
block. - inferior MI is most commonly associated with sinus bradycardia due o
increased vagal tone in the first 24 hours after infarction and decreased RCA bld
supply to the sa node. - acute pericarditis causes PR- segment depression and diffuse
ST elevation
4126
Medicine
afib is a common complication of hyperthyroidism - in patients with hyperthyroidismrelated tachysystolic afib, a beta- blocker is the drug of choice.
4171
Medicine
decreased tolerance to glucose is a well known side effect of thiazide diuretic

therapy.]thiazide diuretics can also unfavorably affect lipid metabolism by increased ldl
cholesterol and plasma triglycerides - electrolyte abnormalities that can be induced by
thiazide diuretics include hyponatremia, hypokalemia, and hypercalcemia. metabolic
syndrome= hypertension, dylipidemia, abdominal obesity.
4227
Medicine
immune mediated reactions are responsible for a variety of drug-induced conditions

such as membranous glomerulonephritis induced by CAPTORPIL.
4334
Medicine
retrosternal chest pain radiating to the left arm with associated diaphoresis, nausea,
and or vomiting usually (but not always) usually suggest ACS
Acute decompensated heart failure (systolic or diastolic) can present with acutely
pulmonary enedma. Tx for pts with acute decompensated heart failure and pulmonary
edema who have normal or elevated bld pressure includes supplemental oxygen,
assisted ventilation as needed, aggresive intravenous diuresis (loop like furosemide),
and possible vesodilatory therapy ( e.g nitroglycerine, nitroprusside).
4451
Medicine
4592
Medicine
the initial treatment of chronic venous disease includes leg elevation, exercise, and
compression stickings. patients not responding to initial conservvative measures
require venous duplex ultrasound to identify venous refluc or insufficience. patients
with persistant symptoms and documented reflux should be referred for endovenous
ablation.
4742
Medicine
patients with right ventricular myocardial infarction present with hypotension, elevated
jugular venous pressure, and clear lung fields, usually in the setting of inferior wall
myocardial infarction.
10763
Medicine
cyanide toxicity can occur in pts treated with nitriprusside who recieve prolonged
infusiosm higher dosesm or have underlying renal insufficiency. it presents with altered
mental status, lactic acidosis, seizuresm and coma.
10764
Medicine
Peripheral edema, ascites, and elevated jugular venous pressure with clear lung fields
is suggestive of right heart failure, most likely due to constrictive pericarditis. other
features include pericardial knock(middi CP results from a thickened and often
calcified pericardium that limits diastolic filling. Idiopathic pericarditis or pericardial
involvement from prior cardiac surgery (cabg or valve sx) mediastinal irradiation, tb,
malignancy, or uremia are common antecents.
2751
Medicine
Dermatology
Bullous pemphigoid is an autoimmune blistering disorder marked by pruritis, tense

bullae, and urtucarial plaques. The classic direct immunofluorescence finding is of IgG
and C3 distributed linear along the basement membrane zone.
Dermatology
Seborrheic dermatitis is characterized by fine, loose, waxy scales with underying

erythema on the scalp (dandruff), central face, presternal region, interscapular areas,
umbilicus, andbody folds. It may be seen in associated with parkinsonism or HIV but
can be seen in all ages. antifungal agents are effective in treating seborrheic
dermatitis.
Dermatology
seborrheic keratosis become more common with advancing age. SKs are benign
growths and most are commonly asymptomatic. lesions have a characteristic waxy
"stuck on", and well- circumsized appearance. Actinic keratosis is a premalignant
lesion characterized by dry, scaly, flat papules with an erythematous base. this
predisposes a pt to squamous cell carcinoma.
Dermatology
excisional biopsy with narrow margins is the preferred study for the diagnosis of
melanoma. if the depth of the lesion is less that 1 mm, the melanoma can be excised
with a 1 cm tumor free margin and they have a 99% 5-year survival. Tumors greater
than 1 mm in dept shold have a sentinal lymph node study,
Dermatology
warfarin-induced skin necrosis is a serious complication of oral anticoagulants. protein

C deficiency is sometimes associated with this condition. Females are most commonly
affected. It mostly occurs within weeks after starting therapy. presents with pain,
followed by bullae formation & skin necrosis;the breast, buttocks, thighs, and abdomen
are commonly involved. TX: vit K should be promptly administered in the early stages
& D/C warfarin if lesion progresses. start heparin
Dermatology
Pemphigus vulgarisis a blistering dz that occurs in the skin and mucous membranes.
characterized by FLACCID bulae that appear spontaneously and are tnder &painful
when they rupture. often lesions first appear in the oral mucous membranes and
rapidly become erosive. + nikolskys sign. autoantibodies formed against desmoglein.
tx:steroids. immunosuppressive agents such as azathioprine may be used with
prednisone and methotrexate. 2. Bullous pemphigoid is a benign pruitic dz.
Dermatology
Toxic epidermal necrolysis is an inflammatory hypersensitivity reaction to drugs

(especially sulfonamides, NSAIDS, anticonvulsants and allopurinol, or certain
infections (mycoplasma pneuminiae)... features-> acute mucocutaneous
disorders(erythematous macules, bullae, desquamation, and mucositis) TEN and
steven johnson syndrom are similar disorders distinguished byt he percentage of skin
involved: SJS involves <10% of the body surface area, TEN involves >30,
2755
2764
2767
2772
2775
2777
Medicine
Medicine
Medicine
Medicine
Medicine
Medicine
2778
Pediatrics
Dermatology
1. erythema multiform (EM) is an acute, self limited reaction to certain infections in

predisposed individuals. Herpes simplex virus is the most common infectious agent
assiciated. The classic EM lesion is a tergetoid papule or plaque. an acrofacial
distribution in favored, with palmar involvement being common. The targetoid lesions
of EM may have a central bulla, but nikolsky sign in neg.
3755
Pediatrics
Dermatology
birthmarks such as cafe-au-lait macules, ash-leaf spots, and port-wine stains are
associated with neurofibromatosis, tuberous sclerosis, and sturge-weber syndrome.
intracranial lesions and epilepsy are features of these neurocutaneous syndromes.
3811
Medicine
Dermatology
poison ivy and nickel jewelry can cause allergic dermatitis, which is a type IV
hypersenitivity reaction.
4011
Medicine
Dermatology
Herpetic whitlow is a common viral infection of the hand. it is caused by either type 1
or 2 herpes simplex virus and is self limiting. Health care workers who come in direct
contact with infected orotracheal secretions are at increased risk of developing
whitlow. EXTREMELY HIGH YIELD
4403
Medicine
Dermatology
cherry angiomas also known as senile hemangiomas, are the most common benign
vascular tumor in adults. ... cherry angiomas are always cutaneous and are not found
on mucosa or deep tissues.
Dermatology
actinic keratoses develop in predisposed individuals on chronically sun-exposed areas

of the skin. the lesion consist of erythematous papules with central scale and a
"sandpaper-like" texture. actinic keratoses can convert to squamous cell carcinoma in
approximately 1% of cases.
4410
Medicine
4704
2194
Pediatrics
Medicine
Dermatology
1. tinea corporis- treat with antifungals 2. cellulitis- treat with nafcillin (IV) whichis an
nIV antistaph antibiotic 3. retinoids are used topically to treat acne and psoriasis.
Ear, Nose & Throat (ENT)
1. otitis media result in ear pain, but it will usually cause erythema and/ or limited
mobility of the tympanic membrane 2, otitis externa usually results in ear discharge
and pain with pulling on the pinna. 3. cerumen impaction usually causes conductive
hearing loss. 4. glossopharyngeal neuralgia pts expierence intermitten, severe
stabbing pain in areas innervated by cranial nerves 9 and 10 which includes the ear.
2195
Medicine
muffled or "hot potatoe voice" and deviation of the uvula suggest a peritonsillar
abscess most likely as a complication of pt's tonsillits.. pts with peritonsillar abscess
typically have prominent unilateral lymphadenopathy. This condition can be fatal
secondary to either airway obstruction or spread of the infectrion into the
parapharyngeal space, which may lead to involvement of the carotid sheath. initial tx
consists of aspiration of the peritonsillar abcess and iv antibio
2640
Pediatrics
any male adolescent who presents with epistaxis, a localized mass, and a bony
erosion on the back of the nose has an angiofibroma until proven otherwise.
2830
Pediatrics
cholesteaoma is an abnormal growth of squamous epithelium in the middle ear.

significantly large growths can damage the ossicles, resulting in conductive hearing
loss.
2836
Medicine
presbycusis is defined as sensorineural hearing loss that occurs with aging.
2844
Medicine
leukoplakia is a reactive precancerous lesion that represents hyperplasia of the

squamous carcinoma within 10 years. risk factors and some include smokeless
tobacco and alcohol use.
ear fullness in a particular is suggestive of Menieres disease, which results from an

abnormal accumulation of endolymph within the inner ear. pts with menieres disease
will often complain of hearing loss and tinnitus as well. 2. lateral medullar infarction,
also known as wallenberg syndrome, can present with intense vertigo. however, other
neurologic problems such as gaze abnormalities, limb ataxia, sensory loss, and
horners syndrome are often oresent as well.
3449
Medicine
4282
Medicine
Malignant (necrotizing) otitis externa is a severe infection of the external auditory canal
and skull base usually caused by pseudomona... Presenting symptoms are severe,
unrelenting ear pain (especially prominent at night); purulent drainage with a sense of
fullness; and conductive hearing loss on the affected side. as the infection spreads
beyond the external autidory canal, osteomyelitis of the skull or TMJ can develop &
present with pain with chewing.TX: IV ciprofloxacin
4376
Medicine
pts with menieres dz typically present with a combination of vertigo, ear fullness,
tinnitus, and hearing loss. First line therapy consists of environmental and dietary
modifications includingmaintenance of a low-salt diet
2178
Medicine
Endocrine, Diabetes &

Metabolism
antithyroid drugs (propylthiouracil and methimazole)'s side effect-> agranulocytosis is

the most feard side effect. it is caused by immune destruction of granulocyted, and in
most cases occur within 90 days of tx. routine monitering of the granulocyte count is
not advocated. Current reccomendations state that once the pt complains of fever and
sore throat, the antithyroid drug should be discontinued promptly and the WBC count
measured.WBC count less than 1000 warrant d/c
2179
Medicine

Metabolism
surgery is the most expensive therapy for graves disease and can be complicated by
recurrent laryngeal nerve paralysis.
2185
Medicine

Metabolism
Despite normal or elevated serum potassium levels, pts with hyperosmolar

hyperglycemic state or DKA have a total body K depletion due to excessive urinary
loss caused by glucosuria osmotic diruesis induced by hyperglycemia.
2425
2645
Obstetrics & Endocrine, Diabetes &

Gynecology Metabolism
Medicine

Metabolism
congenital adrenal hyperplasia is a group of disorders due to an enzyme deficiencies

for cortisol synthesis in the adrenal cortex. approximately 90 percent of cases are due
to 21 hydroxylase def. .. females typically present in their teens or twenties with acne,
irregular menses and hirtuism. boys usually present with precocious puberty..
hyponatremia is vvariable in both sexes. ACTH stimulation test is performed in a
patient with CAH, an exaggerate 17-hydroxyprogesterone
Glocagonoma is a rare pancreatic neuroendocrine tumor that usually oresents with
diabetes mellitus, necrolytic migratory erythema, weight loss, diarrhea, and am=nemia.
Necrolytic migratory erythema usually presents as erythematous papules or plaques
that coalesce to form a large, painful and inflammatory bister and/or crusting with
central clearing. NME commonly occurs in the perineum, extremetiesm and face. ct or
mri of the abdomen can localize the tumor.
3231
3487
3495

Metabolism
primary hyperaldosteronism is usually due to an adrenal adenoma or bilateral adrenal

hyperplasia. surgery is preferred for unilateral adrenal adenoma. Medical therapy with
aldosterone antagonists (e.g, spironolactone, eplerenone) is recommended for pts
with bilateral adrenal hyperplasia or with unilateral adrenal adenoma who either refuse
surgery or are poor surgical candidates.
Medicine

Metabolism
side effects of grave dz tx: ANTITHYROID DRUGS Agranulocytosis propylthiouracil

(hepatic failure, ANCA associated vaculitis; Methimazole: 1st trimester teratogen,
cholestasis. (those developing sore throat & fever should stop the ATD and check
WBC RADIOIODINE ABLATION: permanent hypothyroidism, worsening of
ophthalmopathy, possible radiation side effects SURGERY: permanent
hypothyroidism, risk of recurrent laryngeal nerve damage, risk of hypoparathyroidism.
Medicine

Metabolism
any pt with an acute, severe illness may have abnormal thyroid function test. this
condition is called sick euthyroid syndrom, and the most common thyroid hormone
pattern in such patients is a fall in total and free T3 levels with normal T4 and TSH
levels. (remember the low T3 syndrome)
Medicine
3497
Medicine

Metabolism
although Hashimotos thyroiditis is a histological diagnosis, positive

anti-thyroperoxidase (TPO) antibodies with an enlarged rubbery goiter are virtually
diagnostic.compressive symptoms (e.g dysphagia, voice change) are common. CT
shows a doughnut sign. Thyroid u/s shows a characteristic pseudocystic pattern. RAIU
is reduced. Core bx is required for dx. - the risk of thyroid lymphoma is about 60 times
higher in pts with Hashimotos thyroiditis
3498
Medicine

Metabolism
papillary carcinoma of the thyroid is the most common thyroid malignancy. risk factors
include exposure to radiation during childhood znc family history.

Metabolism
Papillary carcinoma of the thyroid is the most common thyroid malignancy. Risk factors
include exposure to radiation during childhood and family hx. - papillary carcin spreads
via lymphatics -follicular cancer spread hematogenous 2. Primary thyroid lymphomas r
rare and usually occur in pts with longstanding Hashimoto's thyroiditis. prognosis of
localized thyroid lymphoma is good

Metabolism
In leydig cell tumors, the estrogen production can be increased with secondary
inhibition of LH and FSh. 2. Choriocarcinoma is a germ cell tumor characterized by
increased serum beta HCG concentration 3, teratoma show elevations in the serum
concentration of AFP or beta HCG. 4. in seminomas, tumor markers are usually
normal, although beta HCG may be somewhat elevated with seminomas that contain
syncytiotrophoblastic giant cells. 5, yolk sac tumor-> increase in serum AFP

Metabolism
werdnig-Hoffman syndrome is an autosomal recessive dosorder that involves

degeneration of the anterior horn cells and cranial nerve motor nuclei. It is a cause of
"floppy baby" syndrome (the other cause is infant botulism) 2. myotonic congenital
myopathy is an autosomal dominant disorder characterized by muscle weakness and
atrophy (most prominent in the distal muscles of the upper and lower extremities),
myotonia, testicular atrophy, and baldness.
Medicine

Metabolism
symmetric distal sensorimotor polyneuropathy is the most common type of diabetic

neuropathy, and is characterized by "stocking glove" pattern of sensory loss. Aside
from symmetrical distal sensorimotor polyneuropathy, diabetes can also cause
mononeuropathihes of cranial and peripheral nervesl 2. Mononeuropathy multiplex
occurs when the pt expierences mulitple mononeuropathies, thus presenting as an
asymmetric polyneuropathy.
Pediatrics

Metabolism
Obese children and those of black or hispanic ethnicities are at increased risk of
precocious sexual development. premature adrenarche is caused by early activatation
of adrenal androgen release and is characterized by pubic hair (pubarche), axillary
hair, acne, and body odor in firls age <8 or boys age <9
Obstetrics & Endocrine, Diabetes &

Gynecology Metabolism
pregnant women have increased thyroid hormone production (increased total t4 and
t3) as well as increased thyroxine-binding globulin, with a net result of slightly elevated
free t4 and t3 and decreased TSH compared to non-preg women. 1. B-hcg stimulates
thyroid hormone production... increased b-hcg and increased t4 in 1st trimester
suppresses TSH secretion... the increased TBG binds extra T4, which results in a
significt increase in total t4 and a slight increase in free t4
3498
3594
3662
3795
3867
4124
Medicine
Medicine
Pediatrics
4239
Pediatrics

Metabolism
congenital adrenal hyperplasia caused by 21-hydroxylase deficiency results in

gonadotropin-independent (peripheral) precocious puberty, LH levels are low at
baseline and do not increase after stimulation with gnrh. advanced bone age, coarse
axillary and pubic hair, and severe cystic acne are seen in late onset (non classic)
congenital adrenal hyperplasia caused by 21-hydroxylase deficiency.
4286
Medicine

Metabolism
In the management os patients with hyperthyroidism, propranolol is generally used for

symptomatic relief until the underlying cause is identified and definitevly treated
EXTREMELY HIGH YIELD!
proximal muscle weakness with or without muscle atrophy can occue in 60-80% of pts
with untreated hyperthyroidism . Hio flexors and quadriceps are predominately
affected, and the weakness can gradually progress to involve the proximal muscles of
the upper extremeties... thyroid disease.
4382
Medicine

Metabolism
8871
Pediatrics

Metabolism
refeeding syndrome is a potentially fatal complication of nutritional rehabilitation in

anorexia nervosa. carbohydrate intake stimulates insulin activity , which in turn
promotes cellular uptake of phosphorus, potassium, and magnesium.

Metabolism
Primary hyperaldosteronism should be suspected in any hypertensive pt presenting

with LOW renin levels. pts typically develop hypertension, mild hypernatremia,
hypokalemia, and metabolic alkalosis. The elevated aldosterone supresses renin
secretion through a feedback inhibition. 2. The most common side effect of thiazide
diuretic includes hypokalemia, hyponatremia, hyperuricemia, and elevated bld sugar.
however, diuretics can decrease the effective arterial volume to the kid
8897
Medicine
2410
Obstetrics & Female Reproductive

Gynecology System & Breast
Tamoxifen acts as an estrogen antagonist on breast tissue, and is used in the tx and
prevention of breast cancer... it acts as an estrogen receptor agonist on the
endometrium and increases the risk of endometrial carcinoma. Tamoxifen has an
overall mortality benefit, and also decreases risk for osteoporosis. (estrogen receptor
agonist on osteoclasts, inhibiting bone turnover) 2.ischemic optic neuropathy
associated with use of phosphodiesterase inhib (viagra) sildenafil
2411

transvaginal ultrasonogram is more accurate than transabdominal ultrasoonogram in

diagnosing ectopic pregnancy, and should be performed when beta hCG levels are
between 1500 and 6500 IU/L.
2413

woman with PCOS are oligo-, or anovulatory and are defficient in projesterone
secretion... this unopposed estrogen stimulation leaves them at increased risk for
endometrial cancer.
2418

women with abnormal uterine blding should undergo endometrial bx to evaluate for
hyperplasia versus cancer. progestin therapy is the tx of choice for those with NO
atypa. hysterectomy is the tx of choice hyperplasia with atypia
2608

traztzumab with chemo can cause cardiotoxicity and so an echo should be performed
before starting therapy so baseline can be established.
3120

fibroids= heavy blding with clots, constipation, urinary frequency, pelvic

pain/heaviness, enlarged uterus. adenomyosis: the endometrial glads invade the
uterine musculature.....clinical features= dymennorrhea pelvic pain, menorrhagi, bulky,
globular and tender uterus. endometrial cancer/hyperplasia= h/o obesity, nulliparity,
chronic anovulation, irregular bleeding, small, nontender uterus endometritis= recent
intrumentation of the uterus, fouling smelling discharge, fever.
4230
Female Reproductive
System & Breast
granulosa cell tumors are fairly common and represent 10% of all malignant ovarian
tumors. they can occur at any age, but usually follow a bimodal age distribution. when
occuring before puberty, precocious puberty is often the presenting feature. the tumor
produces excessive amounts of estrogen and causes isosexual precocious puberty.
Female Reproductive
System & Breast
vaginal foreign bodies in children often present with foul-smellingh vaginal discharge
and vaginal spotting or blding. toilet paper is the most common vaginal foreign body.
Removal with a calcium aglinate swab or irrigation with warmed fluid should be
attempted after a topical anesthetic has been applied. sedation and general
anesthesia may be required in some cases.
4870
8917
8953
2149
Pediatrics
Pediatrics

cervical screening should start at age 21 in most women (except those with HIV or
SLE, and orhgan transplant or immunocompromised individuals) regardless of the
onset of sexual activity. routine testing for HPV is not indicated for women age <30.
HPV vaccine is recommended for all girls and women (except those who are pregnant)
age 9-26 regardless of HPV status or sexual activity.

uterine leiomyoma (myoma/fibroid), a benign smooth muscle tumor asrising from the
myometrium. Fibroids are the most common pelvic tume found in women ( especially
african american). they can compress the bladder or sigmoid colon, resulting in urinary
frequency or hydronephrosis or constipation. fibroids can distort and enlarge the
uterus. 2. adenomyosis is most often seen in parous women and occurs when the
endometrium grows into the myometrium. <12weeks in size
Medicine
1. cholelithiasis presents with right upper quadrant pain and fatty food intolerance. it
does not cause chronic diarrhea and weight loss. 2. pain accompanied by
malabsorption may be due to chronic pancreatitis or chrons disease... these usually
produce abnormal ct and xray findings.
Gastrointestinal & Nutrition
3587
Medicine
gatrinomas (zollinger) are the most common type of pancreatic endocrone tumor seen
in multiple endocrine neoplasia (MENI). autosomal dominant. 1. MENI tumor
supressor gene on chromosome 11typically causes a predisposition to parathyroid,
pituitary, and pancreatic tumors. parathyroid adenomas are the most common
parathyroid manifestation and commonly cause primary hyperparathyroidism. 2.
MEN2 is caused by a germline mutation involving the RET proto-oncogene on
chromosome 10
4106
Medicine
increased production of stomach acid inactivates pancreatic enzymes.
4389
Medicine
the most common site of colon cancer metastasis is the liver. liver metastases
manifest as right upper quadrant pain, mildy elevated liver enzymes, and firm
hepatomegaly. The dx is confirmed bt CT of the abdomen.
amiodrone can increase the serum levels of digoxin and cause toxicity in a patient on
a stable digoxin regimen. acute digoxin toxicity typically presents with gi symptoms (eg
anorexia, nausea, vomiting, abdominal pain). chronic digoxin toxicity presents wih less
pronounced gi symptoms but more neurologic and visual symptoms (eg changes in
color vision, scotomas, blindness).
ulcerative colitis can be confirmed by friable mucosa on colonoscopy and biopsy

demonstrating mucosal inflammation. The increased incidence of colorectal carcinoma
in pts with UC requires annual surveillance colonoscopy beginning 8-10 years after the
diagnosis is made. 1. pts with UC are at increased risk for primary sclerosing
cholangitis. an elevated alkaline phosphatase in a pt with UC should raise suspicions
for PSC, but their is no routine screening to prevent PSC.
Vanishing bile duct syndrome is a rare condition characterized by progressive

ductopenia, or loss of intrahepatic bile ducts. the most common cause of ductopenia in
adults is primary biliary cirrhosis. 2. the pathologic hallmarks or primary sclerosing
cholangitis are periductal portal tract fibrosis and segmental stenosis of extrahepatic
and intrahepatic bile ducts.
4463
4492
4624
Medicine
Medicine
Medicine
4851
Pediatrics
ultrasound is the first line modality in diagnosing intussusception. A positive "target

sign" should prompt reduction with air or water-soluble contrast enema.
intussusception is the most common cause of intestinal obstruction in children 6-36
months. the ileocolic junction is most frequently involved, with invagination of the ilium
into the colon. gastroenteritis are thought to play a role in inflaming intestinal lymphatic
tissue (peyer patches),wich can serve as lead point
4557
Surgery
General Principles
abdominal pain that refers to the shoulder suggests an intraabdominal pathology that
is causing peritonitis and irritation of the diaphragm (Kehr sign) phrenic nerve also
mediates sensation for the hsoulder region.
Hematology & Oncology
autoimmune hemolytic anemia and hereditory spherocytosis can cause extreavascular

hemolytic anemia. a negative family history and positive coombs test suggest AIHA; a
positive family history and negative coombs test suggest hereditory sphereocytosis.
the peripheral bld smear in both conditions may show spherocytes without central
palor.
in the acute setting, one of the primary treatments for stroke in a sickle cell patients is
exchange transfusion. it helps to decrease the percentage of sickle ceels in the
bldstream and makes an additional stroke less likely... continuing the hydroxyurea
should also help to decrease the percentage of sickle cells by increasing the
proportion of Hgb F.
Giant cell tumor of bone is a benign and locally aggressive skeletal neooplasm seen in
young adults that usually presents with knee pain, swelling, & decreased ROM at the
involved site. it typically presents as osteolytic lesions (soap bubble appearance on
radiographs) in the epiphyseal regions of the long bones and most commonly involve
the distal femue and proximal tibia around the knee joint. SURGERY (e.g intralesional
currettage with or w/o bone grafting) is 1st line tx.
warfarin-induced skin necrosis typically occurs within the first few days of warfarin
therapy. It is caused by a rapid decline in protein C levels, usually in pts with underling
heriditary protein c defiency. 1. Heparin induced thrombocytopenia is caused by
autoantibodies to platelet factor 4 (PF4) complexed with heparin, and it characterized
by thrombocytompenia, arterial or venous thrombosis, and necrotic skin lesions at
heparin injection sites within 5-10 days of therap
CLL is the most common type of leukemia in western countries. it is almost always
seen in the elderly and are diagnosed incidentally. lymphotcytosis is the classical
signature mark of the dz. MOst cells have an over-matured look bc the
hypercondensed nuclear chromatin material. Smudge cells are highly characteristic.
other signs include lymphadenopathy and splenomegaly. as the dz advances, anemia
and thrombocytopenia are seen.
2248
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2865
Medicine
Pediatrics
Medicine
Medicine
Medicine
2868
2870
Medicine
Pediatrics
hairy cell leukemia is a type of B-lymphocytic derived chronic leukemia. The bone
marrow may become fibrotic; therefore bone marrow aspirates are frequently
unsuccessful ( a dry tap). the cytochemical feature includes a tartrate-resistant acid
phosphatase (TRAP) stain.
hereditary spherocytosis should be suspected in pts with reticulocytosis,

hyperbilirubinemia, spherocytosis, and a family hx of anemia. The hemoglobin itself is
normal in HSThe diagnosis should be confirmed with eosin-5-maleimide binding and
acidified glycerol lysis tests. 2. Hemoglobin elesctrophoresis is used to diagnose
hemoglobinpathies such as sickle cell disease or thalassemia. 3. paroxysmal nocturnal
hemoglobinuria (PNH) is diagnosed by erythrocyte CD55 and CD 59
2886
Medicine
A leukemoid reaction is a marked increase in leukocytes due to a severe infection of

inflammation. An increased leukocyte alkaline phosphatase (LAP) score is typical for
this condition. 1. the leukocyte alkaline phosphatase score is high in leukemoid
reactions, and usually low in chronic myeloid leukemia.
2949
Medicine
fresh frozen plasma is the therapeutic agent of choice for the coagulopathy in pts with
liver failure. acute blding in pts pts with liver failure is beast treated with FFP, which
has all the clotting factors. -the liver synthesizes all clotting factors except factor Vlll.
1. glomerulonephritis can occur as a complication of streptococcal pharyngitis (even if

treated) symptoms: hematuria, proteinura, htn and edema. 2. renal cell carcinoma
occurs predominantly in men age 50-80 yrs and is rare in children 3. posterior urethral
valves can cause bilateral obstructive uropathy. boys who present later in lifefrequently
have UTIs and signs of renal failure.
G6PD-> hemolytic anemia following oxidative stress (infection, sulfa drugs, fava
beans)... x-linked, often men... manifestations: pallor and fatigue, dark urine, jaundice,
abdominal/back pain... Lab finding: bite cells with heinz bodies (denatured hemoglobin
precipitates), neg coombs test, g6pd activity level (may be normal during attack)..
Management: remove or treat responsible agent/condition, supportive care.
3552
3609
Pediatrics
Medicine
3647
Pediatrics
Howell-jolly bodies are nucleau remnants of rebs which are generally removed by a
functional spleen; therefore, their presence in a peripheral smear suggests functional
asplenia in sickle cell patients. 2. heinz bodies seen in g6pd deficiency 3. basophilic
stippling are ribosomal precipitaes which appear as blue granules of various sizes
dispersed throught the cytoplasm of the red cell. These are often seen with
thalassemias, as well as lead or heavy metal poisoning.
3818
Pediatrics
Diamond-Blackfan anemia is a macrocytic pure red aplasia associated with several

congenital anomolies such as short stature, webbed neck, cleft lip, shielded chest and
triphalangeal thumbs. .... therapy is mainly corticosteroids.
hemolytic uremic syndrom is typically a diseaae of young children. it is usually

preceded by an acute diarrheal ilness due to pathoges ecoli serotype 0157:h7 ,
shigella, salmonella, yersinia, and campylobacter species. gi bleeding is a common
symptom. physical exam usually reveals purpura and hypertension. the hallmart
finding is microangiopathic hemolytic anemia. the urine contains hemoglobin,
hemosiderin, albumon, rbc's, wbc's and casts. THALASEMIA= hepatosplenomegaly,
targ
Normochromic normocytic anemia is due to erythropoietin deficiency is very common

in pts with end stage renal dz. recombinant erythropoietin is the tx of choice; however,
iron supplements should be given before erythropoietin in pts with evidence of iron
def. - The most common side effects of recombinant erythropietin are worsening of htn
(30% of pts), headaches (15%) and flulike symptoms(5%) EXTREMELY HIGH YIELD!!!!
features suggesting multiple myeloma-> the combination of back pain, anemia, renal
dysfunction, and elevated ESR is very typical in 70% of pts. HYpercalcemia results
from bone lysis caused by humoral factors released by the plasma cells and the
expanding cell mass. 1. FYI: hypercalcemia is any malignancy indicates poor
prognosis. manifestations of hypercalcemia (usually >12) include constipation,
anorexia, vomiting, weakness, polyuria and neurologic abnl (confusion or letha
1. an acutely ill person with underlying liver disease can become vit K deficient in as
little as 10 days. 2. factor V leiden causes a hypercoagulable state due to activated
protein C resistance. 3. Factor Vlll defic is an X linked inhereted plasma coagulation
disorder that primarily prolongs the PTT. 4. Hypersplenism can occur in pts with
cirrhosis, portal hypertension & splenomegaly. 5. von willebrand dz is the most
frequently diagnosed inherited blding dis in adult
the most common cause of folic deficiency is nutritional due to por diet and/ or
alcoholism. Folic acid deficiency can be caused by some drugs; these drugs can
impair the absorption of folic acid ( e.g. phenytoin or antagonize its physiologic effects
(e.g. methotrexate, trimethoprim).
3896
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4147
Pediatrics
Medicine
Medicine
Medicine
Medicine
4193
Obstetrics &
Gynecology
to prevent the maternal immune system from developing anti D antibodies, anti D
immune globulin is first administered at 28 weeks gestation, and repeated within 72
hours of delivery... The KLEIHAUER-BETKE (KB) test is commonly used to determine
the dose... O negative bld type indicates the pt is Rh negative. 2. other indications for
anti D immune globulin include amniocentesis, chorionic villus sampling, and external
cephalic version.
4331
Medicine
1. acute glomerulonephritis is characterized byt he rapid development of gross or

microscopic hematuria, decreased GFR, and hypertenion.
Hereditary spherocytosis is an inherited disorder that increases red bld cell membrane
fragility. The classic presentation includes hemolytic anemia, jaundicem and
splenomegaly in a person of norther european ancestry. Acute cholecystitis from
pigminted gallstones is a common complication.
4333
Medicine
4342
Pediatrics
pneumococcal vaccination plus penicillin prophylaxis can prevent almost all cases of
pneumococcal sepsis in ots with sickle cell anemia... twice daily administration of
prophylactic penicillin should also be given to children with sickle cell disease until they
reach 5 years old.
4348
Medicine
PIca is an appetite for items other than food, such as paper products, clay, dirt...
occasionally develope in iron deficiency anemia. Pagophagia is pica for ice.
4349
Medicine
the mainstay of treatment for the anemia of chronic disease is supplemental

erythropoietin.
4357
Medicine
folic and cobalamin deficiency both cause macrocytic anemia with hypersegmented
neutrophils.
howell-jolly bodies on a peripheral bld smear are nuclear remnants within rbc's that
are typically removed by the spleen. they are evident as single round, blue inclusions
on wright stain. the presence of howel jolly bodies indicated physical absence of the
spleen or functional hypospenism due to splenic autoinfarction. penicillin allergic
reaction and other betalactam abx have been associated with autoimmine hemolytic
anemia.
increased levels of homocystein predisposes to venous thrombosis as well as

atherosclerosis. presumably due to a combination of direct vascular damage,
activation of clotting mechanisms, and inhibition of antithrombotic pathways. 2.
Homocystein levels can usually be normalized by administration of pyridoxine (B6) and
folate. vit b12 should be added if b12 deficiency is documented.
4359
4384
Pediatrics
Medicine
4412
Medicine
the lupus anticoagulant, an anti-phospholipid antibody, is a prothrombotic

immunoglobulin that causes spurriously prolonged partial thromboplastin time in vitro.
APS is characterized by: venous thromboembolism or recurrent early miscarriages,
presence of antiphospholi[id antibody such as the lupus anticoagulant (LA),
anticardiolipin antibody, or beta 2 glycoprotein 1 antibody.
4416
Medicine
pancytopenia (decreased red bld cells, white bld cells, and platelets) is common in pts
with systemic lupus erythematosus. it usually indicates concurren peripheral immune
mediated destruction of all 3 cell lines.
4436
Medicine
Hyposthenuria (impairment in kidneys ability to concentrate urine) is common in pts

with sickle cell anemia and sickle cell trait. pts with sickle cell anemia may develop
membranoproliferative glomerulonephritis or end-stage renal disease due to focal
segmental glomerulosclerosis. These diseases typically manifest with significant
abnormalities in the urinary sediment, such as red bld cell casts.
4440
Medicine
hydroxyurea is used to decrease the frequency and severity of pain crisis in patients
with sickle cell anemia by increasing hemoglobin F levels.
4446
Medicine
CO poisoning-> polycythemia, nausea, dizziness, and headaches.
4447
Medicine
pts with hereditary telangiectasia (osler weber rendu syndrome) can deleope
pulmonary avms associated with hemoptysis and right to left shunt physiology... the
diagnosis must be entertained in this pt with recurrent nose bleeds and oral lesions.
multiple myeloma _monoclonal proliferation of plasma cells. the classic tetrad of

multiple myeloma can be CRAB: calcium(hypercalcemia), renal impairment, anemia,
and bones (bone pain ,lytic lesions, fractures). IgG antibodies or paraproteins,
produced by myeloma cells can colect in the glomeruli, causing renal failure or
"myeloma kidney"... also theirs increased risk for infection due to a total decrease in
functional antibodies and leukopenia secondary to bonr marrow crowdin
polycythemia is defined as a hematocrit >65% in term neonates. Risk factors inculde

delayed cord clamping, maternal hypertension, and maternal diabetes mellitus.
Symptomatic neonates generally have a combination of repiratory distress,
hypoglycemia, and neurologic manifestations.
4466
4819
Medicine
Pediatrics
4875
Pediatrics
thalasemia train, also known as thalassemia minor, presents with microcytic anemia
with target cells and teardrop cells on peripheral smear. The red cell distribution width
and total red bld cell count are typically normal. TX is nor usually needed.
2161
Medicine
Infectious Diseases
CEllulitis in nthe majority of patients is caused by beta-hemolytic streptococci and

staphylococcus aureus. Clinical features can be systemic as well as local (tx oral
dicloxacillin) . systemic signs of toxicity are high -grade fever with rigors and chills,
malaise, fatigue, and confusion. when such systemic signs are present, IV nafcillin or
cefazolin is the preferred tx... in areas with high prevalence of MRSA, vancomycin can
be used as a first like agent.
2262
Medicine
Infectious Diseases
all pts who are started on anti-tubercular therapy should also be started on vitamin
supplements, especially pyridoxine (10 mg a day), to avoid peripheral neuropathy and
other neurological complications. HEPATITIS is another known side effect of isoniazid.
2264
Medicine
Infectious Diseases
TMP-SMX is used for prophylaxis of toxoplasmosis, while sulfadiazine and

pyrimethamine are used for treatment purposes.
Infectious Diseases
suspect bacterial pneumonia in HIV- infected patient who presents with acute onset,
high- grade fever and pleural effusion. pneumococcus is the most causative
organisms in general, so other encapsulated bacteria shouls also be considered in te
differential. 2. mycobacterioum tuberculosis infection presents as chronic cough, fever
and weight loss. 3. disseminated fungal infection results in a miliary pattern or nodular
infiltrate on chest xray. 4. pcp presents as dry cou
Infectious Diseases
prophylaxis against mycobacterium avium complex with azithromycin is given to pts

with HIV when the cd cell count is <50. disseminated mycobacterium avium complex
MAC infection= non speficif systemic symptoms ( fever, cough, abdominal pain,
diarrea, night sweats, weight loss) in the presence of splenomegaly and an elevated
alkaline phosphatase level should raise suspicion for disseminated mycobacterium
avium complex MAC in pts with HIV and cd4 cell count <50. dx-bld culture
2267
2268
Medicine
Medicine
2296
Medicine
Infectious Diseases
causes of atypical pneumonia include mycoplasma pneumoniae, chlamydia

pneumoniae, legionella, coxiella, and influenze... mycoplasma pneumonia is the most
common cause of atypical pneumonia in the ambulatory setting. pneumococcus is the
most frequent cause of community aquired pneumonia requiring hospitalization. and
has a more virulent course with fewer extrapulmonary manifestations compared to the
atypical pneumonia
2384
Medicine
Infectious Diseases
Reassurance is the most appropraite course of action for a pt with known immunity to
hep B who is exposed to the dz. - The Hep B immunoglobulin and the hep B
vaccination series should be given to pts with unknown immunity after exposure.
Infectious Diseases
bulging fontanelle can be a sign on neonatal sepsis inlucing meningitis. procalcitonin is

an acute phase reactant similar to c-reactive protein and is released in response to
bacterial toxins, in contrast, levels are reduced in viral infection. infants, even those
with increased intracranial pressure, have a very low risk f herniation after lumbar
puncture due to their open fontanelles.
2428
Pediatrics
2616
Medicine
Infectious Diseases
pts with febrile neutropenia should be started on empiric broad spectrum antibiotics
asap after bld cultures are obtained. Epiric monotherapy with an antipseudomonal
agent (cefepime, meropenem, piperacillin-tazobactam For initial management. 2.
vacomycin has no gram neg activity. it is add to empiric drug therapy for pts with
known MRSA, probable catheter-related infection,skin.soft tissue infection, pneumonia,
or hemodynamic instability. FYI-NEUTROPENIA->gingival erythema
2749
Medicine
Infectious Diseases
for necrotizing fasciitis,(fever and hypotension) the most frequently recovered

pathogen= group a streptococci. , although necrotizing fasiitis is usually polymicrobial.
gas production by microbials.
Infectious Diseases
HEP B VIRUS TX: ~interferon- usually for younger pts with compensated liver dz; short
term tx ~lamivudine- diminished role due to high drug resistance, may have role in HIV
pt's ~entecavie- can be used in decompensated cirrhosis; lowers rate of drug
resistance that lamivudine ~Tenofovir- most potent with limited drug resistance;
preferred drug (in countries where approved)
Infectious Diseases
Entaboeba histolytica is a protozian, which can cause amebic liver abscess.

Remember the Mexico trip! - The hx of travel to an endemic area followed by dysentry
and RUQ pain with a single cyst in the right lobe of the liver is indicative of amebic liver
abscess. An abscess on the superior surface of liver can cause a pleuritic-like type of
pain and the radiation to the shoulder. 2. pyogenic liver abscess is generally
secondary to surgery, a GI infection, or acute appendiciti
2961
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Medicine
Medicine
2970
2984
2993
2995
2997
Medicine
Medicine
Medicine
Medicine
Medicine
Infectious Diseases
"Egg shell" calcifications of a hepatic cyst on a CT scan is highly suggestive of hydatid.

hydatid dz is due to infection with echinoccis granulosis. HUmns contract the infection
from the close and intimate contacts with dogs... aspiration of the cyst is generally not
indicated due to the risk of anaphylactic shock secondary to spilling of cyst contents.
TX: is surgical resection under the cover of albendazole.
Infectious Diseases
some pts can eventually clear HBV wih resolution of chronic infection. They will have a
positive anti-HBs antibody and no viral antigens, including HBsAg, However, the pt first
must show normal ALT and HBeAg clearance before anti HBs would be meaningful.
such pts with the presence of HBeAg wich indicated active replication , even in pts with
normal ALT. Such pts need serial measurememts of both ALT and HBeAg every 3-6
months until they achieve viral clearance.
Infectious Diseases
1. staphylococcus aureus is a common cause of cellulitis 2. pseudomonas is a cause

of malignant otitis externa in diabetic pts; it may cause black necrotic lesions in the
ear. 3. h influenza and moraxella catarrhalis are common causes of bacterial sinusitis.
4. candida can cause thrush and vaginitis in diabetic pts
Infectious Diseases
histoplasma capsulatum )present as mold in soil and in bird and bat droppings).
pulmonary histoplasmosis should be considered wen pulmonary symptoms are
accompanied by mediastinal or hilar lymph nodes (or masses) or by arthralgias and
erythema nodosum. 2. disseminated histoplasmosis in immunecimpromised pts can
present with lymphadenopathy, pancytopenia, and hepatosplenomegaly as the
organism targets histiocytes and the reticuloendothelial system.
Infectious Diseases
Invasive aspergillosis occurs in immunocompromised pts who may present with fever,
cough, dyspnea, or hemoptysis. Chest xray may show a cavitary lesion, and ct scan
shows pulmonary nodules with a halo sign or lesions with an air crescent. 2.
Blastomycosis usually affects the lungs, skin, bones, joints, and prostate. 3.
coccidiomycosis-> primary pulmonary infection has non specific features, such as
fever, fatigue, dry cough, weight loss, pleuritic chest pain & arthralgias
2999
Medicine
Infectious Diseases
blastomycosis affects midwest & upper midwest regions of the US, xtending into
mississippi. primary infection occurs through inhalation, and blostomycosis most often
causes a mild to moderate pulmonary infection. extrapulmonary dz due to
hematogenous spread most commonly affects the skin. Bone, prostate, and the cns
are frequently involved. skin lesions have heaped up verrucous or nodular lesions that
may evolve into microabscesses.
3007
Medicine
Infectious Diseases
pts with infectious mononucleosis are at risk for splenic rupture. sports should be
avoided for >3 weeks.
3011
Medicine
Infectious Diseases
amoxil-clavulanate is the abx of choice for prophylaxis/tx of infections caused by a

human bite. this is also the drug of choice for dog bites. 2. clindamycin is typically used
for tx of lung abscesses and infections of the female genital tract.
Infectious Diseases
babesiosis tick bite- parasite enters pts rbc;s and causes hemolysis.labs show mild
leukopenia, atypical lymphocytosis, elevated ESR, abnormal liver function test and
decreased serum complement levels. the two most widely used drugs->
quinine-clindamycin and atovaquone-azithromycin. 2. ehrlichiosis or rocky mountain
spotted fever features include fever, malaise, headache, nausea and vomiting. labs
show leukopenia and thrombocytopenia. 3. qfever aka coxiella burnetti- cattl
3104
Medicine
3104
Medicine
Infectious Diseases
suspect babesiosis in any pt from an endemic area (eg, ny) who presents with a tick
bite, especially if their is evidence of hemolysis and the pt has been splenectomized.
rash is normally not seen. 2. Qfever- is a zoonosis caused by coxiells burnetii. The
main source of human infection are infected cattle, goat, and sheep. ppl at risk: meat
processing workers and vets. manifes: flulike syndrome, hepatitis, or pneumonia.
3172
Medicine
Infectious Diseases
parvovirus is among the most common causes of acute viral arthritis( others include
hep b and c, hiv and rubella). parvovirus infection most commonly affects adults who
have frequent contact with children. .... it will typically present as RA, but its not!
Infectious Diseases
Vancomycin plus ampicillin plus cefepime is the drug regimen of choice for
immunocompromised pts with suspected bacterial meningitis. corticosteroids must be
started at the same time as antibiotics and hsould be discontinued if cultures show an
organism other that streptococcus pneumoniae. 2. ceftazidime (or meropenem) and
vancomycin are indicated for patients with neurosurgery/shunt or penetrating trauma
to the skull who present with symptoms of meningitis.
Infectious Diseases
HIV patients are at high risk for tuberculosis. A positive PPD test ( skin unduration of
greater than 5 mm in HIV patients) requires pprophylaxis with isoniazid ( and
pyridoxine) for 9 months. pyridoxine is added to the regimen to prevent possible
neuropathy caused by isoniazid.
3245
3246
Medicine
Medicine
3248
3249
3250
3260
3267
3326
Medicine
Medicine
Medicine
Medicine
Medicine
Pediatrics
Infectious Diseases
enterohemorrhagic Escherichia coli (EHEC) is a food-borne pathogen that causes

acute watery to bldy diarrhea. diagnosis can be confirmed with a stool assay for shiga
toxin. If EHEC is suspected, empiric antibiotic therapy should be avoided as it may
increase the risk of hemolytic uremic syndrome. 2. rotavirus is a frequent cause of
acute gastroenteritis with nonbldy diarrhea and vomiting. it typically occurs in
outbreaks among children, although adults may be affected as w
Infectious Diseases
cryptosporidium is an emerging and important cause of travelers diarrhea and should

be considered in pts with persistant, non bloody, watery diarrhea for >2 weeks. 2.
shigella is a common bacterial cause of acute diarrhea. shigellosis is notable for fever,
abdominal pain, and bldy diahrrea. 3. strongyloids stercoralis is a parasite found
primarily in tropical and subtropical regions and can cause skin, gi and pulmonary
manifestations... gi symptoms are nausea % pai vomiting
Infectious Diseases
staph aueus & bacillus cerus both produce preformed toxins that after eating the toxic,
results r rapid nausea and vomiting. 1 staph auerus-> poultry, egss, meat, salads
made with MAYPOnaise (e.g tuna,egg,chicken,potatoe,marcaroni), cream filled
pastries, and milk and dairy products. 2. bacillus cereus-> contaminates starchy foods
such as rice (classically reheated fried rice). 1. campylobacter jejuni is associated with
diarrheal illness but onset of symptons is 2-5 days
Infectious Diseases
suspect malignant otitis externa in any diabetic pt with severe ear pain. the pain often
radiates to the temporal manidibular joint and consequentally causes pain that is
exacerbated by chewing., otorrhea, and evidence of granulation tissue in the ear
canal. Pseudomonas aeruginosa is the most frequent cause of malignant otitis
externa. - diabetes and or other immunosupressive conditions are important risk
facttors.
Infectious Diseases
trichinellosis ingestion of undercooked meat (usually pork). more endemic in mexico,

cina, thailland, parts of central europe and argentina. typically presents with gi
complaints (eg abdominal pain, nausea, vomiting) followed by the characteristic triad
of periorbital edema, myositis, and eosinophiliia ( hallmark of the diease). other
findings include fever, subungual splinter hemorrhages, and conjuntial or retinal
hemorrhages.
Infectious Diseases
1. orbital cellulitis is a serious bacterial infection with alarming symptoms such as pain
with extraocular movements, visual impariments, and opthalmoplegia. 2. optic neuritis
is an inflammatory, demyelinating condition that causes acute vision loss and pupillary
defects. it most commonly affects 1 eye and is associated with multiple sclerosis. 3.
anterior uveitis is an inflamation of the anterior chamber of the eye caused by trauma,
infection or autoimmune dosorders...
3423
Pediatrics
Infectious Diseases
carriers of the sickle cell trait are inherently protected from (malaria) as the misshapen
rbcs make a suboptimal environment for parasitic proliferation. pts with a past history
of malarial infection are also at relatively low risk for severe disease on reinfection due
to partial immunity. 1. cyclic fevers (every 2 or 3 days) with other non specific systemic
symptoms are the key features o malarial illness.
3441
Pediatrics
Infectious Diseases
group b strep = most common meningitis in infants. aquired from mother during
childbirth.
3442
Pediatrics
Infectious Diseases
in an infant with meningococcemia, watch out for waterhouse-friderichsen syndrome,

which is characterized by a sudden vasomotor collapse and skin rash due to adrewnal
hemorrhage.
Infectious Diseases
infectious mono is most commonly caused by the epstein bar virus and presents with
fever, fatigue, exudative pharyngitis, and diffuse cervical lymphadenopathy, a
polymorphous, maculopapular rash frequently develops after administration of
amoxicillin. pts should avoid sports >- 3 weeks due to risk of splenic rupture.
Infectious Diseases
clinical features of cervical actinomycosis: chronic, slowly progressive, non tender

indurated mass; extends through tissue planes to form abscess, fistula, and draining
sinus tract; mandible is the most commonly involved site... Risk factors: dental caries,
extractions, or infectedtooth; gingivitis or trauma; diabetes or immunosupression;
malnutrition; local tossue damage from malignany or irradiation. TX: penicillin
3444
3561
Pediatrics
Medicine
3613
Medicine
Infectious Diseases
CMV pneumonitis should be considered in the differential of any bone marrow

transplant recipient with both lung and intestinal involvement. the median time if
development of CMXV pneumonitis after BMT is about 45 days ( 2wks-4 months).
bronchoaleolar lavage is diagnostic in most cases. CMV in post BMT pts also
manifests upper and lower gi ulcers (the cause of diarrhea and abdominal pain), bone
marrow suppresion, arthralgias, myalgias, and esophagitis.
3633
Pediatrics
Infectious Diseases
Bacterial meningitis in fants and children presents with lethargy, fever, poor oral
intake, and vomiting. It is crucial to administer empiric antibiotics (CEFTRIAXONE AND
VANCOMYCIN) first then perform lumbar puncture asap.
3636
Pediatrics
Infectious Diseases
LYme disease is normaly treated with doxycycline, but is contraindicated in children <8
yrs old and pregnant woman. so in thise special cases, Tx is amoxixillin
3639
Obstetrics &
Infectious Diseases
Gynecology
neiserria gonorrhoeae is the 2nd most common cause of cervicitis in the us after
chlamydia. it is also the major cause oof urethritis and PID. cervicitis is the most
common manifestation. classic findings include mucopurulent discharge & a friable
cervix with easy blding. TX: ceftraxone plus azithromycin or doxycycline. 1.
clindamycin & gentamicin are indicated for polymicrobial infection with an anaerobic
component, such as tubo-ovarian abscess or post partum endometritis.
3670
Pediatrics
Infectious Diseases
for hiv, it can take 3 months to develope detectable antibody... diagnosis in infants
consists of polymerase chain reaction testing.
Infectious Diseases
cutaneous larva migrans ( a helminthic disease"is common in travelers in tropical

regions, and is characterized by puritic, elevated, serpiginous lesions on the skin...
infection is often aquired through contact with sand. scabies on the other hand, is a
parasitic infection caused by sarcoptes scabie. it presents as a pruritic infection on the
volar wrist, interdigital web spaces, elbows, and/ or penis... it is transmitted by close
contact with another infected individual
3674
Medicine
3678
Obstetrics &
Infectious Diseases
Gynecology
Maternal combination antiretroviral therapy during preg and neonatal zidovudine

therapy can reduce perinatal HIV transmission to <1%. if the dx is made late in
pregnancy, intrapartum zidocudine and infant tx should still be offered.
3888
Medicine
Infectious Diseases
vaccines recommended for adults with HIV 1. pneumococcus (PCV13 once, then
PPCV23 8 weeks later, then every 5 years. 2. tetanus, diphtheria and pertussis ( Tdap
once, repeat Tdap for women during each pregnancy infected or not infected women,
Td every 10 years following Tdap. 3. men who have sex with other men should also
revieve hep A vaccine. 3. live vaccine (MMR, varicella, zoster, live-attenuated
influenza) are contraindicated in CD4 cell count <200.
3906
Pediatrics
Infectious Diseases
macrolides (azithromycin, erythromycin, or clarithromycin) are the abx of choice for

pertussis tx and post exposure prophylaxis. all close contacts should be given a
macrolide antibiotic regardless of age, immunization status, or symptoms.
Infectious Diseases
any hiv positive pt with bloody diarrehea and a normal stool examination should have
a colonoscopy with biopsy to look for CMV colitis. CMV colitis is characterized by bldy
diarrhea with abdominal pain. colonoscopy shows multiple ulcers and mucosal
erosions. biopsy demonstrates characteristic cytomegalic cells with inclusion bodies.
Infectious Diseases
CF pts suffer from life threatening recurrent sinopulmonary infections due to

accumulation of viscouse aiway secretions. staph aureus is the most common cause
of bacterial pneumonia in young children with CF, especially with coexisting influenza
infection. IV vancomycin is the drug of choice for severe pneumonia in this setting.
3917
Medicine
4030
Pediatrics
4158
Obstetrics &
Infectious Diseases
Gynecology
chlamydia trachomatis tx-> azithromycin neiserreria gonorrhoeae tx->ceftriaxone - the

2 organisms cannot reliably be distinguished by examination, and nucleic acid
amplification testing is recommended to differentiate between them.
Medicine
Infectious Diseases
pneumonia is the leading cause of death in nursing homes, and streptococcus

pneumoniae is the most common cause of pneumonia in nursing home residents. s.
pneumoniae is also the most common cause of community - acquired pneumonia in
adults. Vaccination with pneumovax can help prevent this condition. patients with
neurlogic disorders ( e.g., advanced dementia, parkinson's disease, and stroke) are at
increased risk of aspiration pneumonia caused by anaerobes.
Infectious Diseases
all immunocompetent pts who are asymptomatic and nonimmune should recieve the
varicella vaccine for post-exposure prophylaxis within 3-5 days of exposure.
Immunocompromised hosts who are asymptomatic and nonimmune should recieve
varicella zoster immune globulin.
Infectious Diseases
although staphylococcus aureus is the most common cause of osteomyelitis in

children and adults, Psuedomonas aeruginosa is a frequent cause of osteomyelitis in
adults with a hostory of a nail puncture wound (especially when the puncture occurs
thru rubbery-soled footwear). tx is with oral or parenteral quinolones and aggressive
surgical debridement.
4166
4186
4257
Pediatrics
Medicine
4418
Medicine
Infectious Diseases
1. oseltamavir treats influenza 2. Ganciclovir is an IV antiviral used to treat CMV

infections. CMV pneumonia is a serious infection that affects severly
immunosuppressed patients. 3. tenofovir is a nucleotide analg used to treat HIV 4.
Ritonavir is a protease inhibitor used to treat HIV 5. Clindamycin is an antibiotic used
to treat anaerobic infections. in particular, it is often used to treat lung abscesses and
bacterial infections on the mouth and neck.
4470
Medicine
Infectious Diseases
For Tuberculin skin test, an induration of <15 mm is considered negative in healthy pts
with a low liklihood of TB infection.
4472
4611
Obstetrics &
Infectious Diseases
Gynecology
UTI ANTIBIOTICS IN PREGNANCY 1. nitrofurantoin, amoxicillin,

amoxicillin-clavulanate, cephalexin... CONTRAINDICATED 1, tetracyclines,
fluoroquinolones, TMP-SMX 2. TMP-SMX class C med in preg, it may be used with
caution during the SECOND trimester but it is contraindicated during 1st trimester as it
interferes with metabolism. it should also be avoided during 3rd trimester/near term as
it increases the risk of kerniterus in the newborn.
Medicine
Infectious Diseases
TMP-SMX is used in HIV positive pts to PREVENT opportunistic infections caused by

opportunistic infections caused by Pneumocystis jiroveci and toxoplasma gondii. 2.
isoniazid is indicated for prophylaxis agaisnt M tuberculosis infection in HIV pts with a
positive tb skin test >5mm, or who has contact with individual with active tb. 3.
azithromycin is recommended prophylaxis agaisnt Mycobacterium avium complex in
HIV pts cd4 <50 4. fluconazole-> prophylaxis against cryptocc
4833
Pediatrics
Infectious Diseases
viral meningitis is a usually self-limited inflammation of the leptomeninges caused by a

viral infection. almost 90% of cases are caused by non-polio enteroviruses, such as
echovirus, and coxsackievirus. the incidence of viral meningitis decreases with
increased age. infants are the most commonly affected, and disease morbidity and
mortality is highest in this group.
4850
Pediatrics
Infectious Diseases
the most common predisposing factor for acute bacterial sunisitis is a viral upper
respiratory infection.
Infectious Diseases
congenital syphilis presents early on with hepatosplenomegaly, cutaneous lesions on

the palms and soles, jaundice, anemia and rhinorrhea. Metaphyseal dystrophy and
periositis may be seen on radiography... parenteral oenicillin G is the treatment of
choice for syphillis. 2. congenital CMV is characterized by intrauterine groth
retardation, hepatosplenomegaly, petechiae or purpura, microcephaly, chorioretinitis,
sensorineural hearing loss, and periventricular calcifications.
4852
Pediatrics
4891
Pediatrics
Infectious Diseases
The combination of fever, odynophagia/dysphagia, drooling, inability to extend the

neck, muffled voice and trismus(inability to open the mouth completely) is very
concerning for infection of the larynx, pharynx, or deep neck space. The inability to
extend the neck and the widened prevertebral spacessuggest a diagnosis of
retropharyngeal abscess (RPA). in pts with no signs of resp compromise, a CT scan
with contrast should be performed to confirm the presence and size of the a
8880
Medicine
Infectious Diseases
1. pts with ulcerative lesions of the colon due to colonic neoplasia or inflammatory
bowel disease have an increased predilection to develop IE due to streptococcus
gallolyticus (s bovis biotype l)
Infectious Diseases
the pathophysiology of toxic shock syndrome involves widespread activation of T cells

by exotoxins acting as superantigens, leading to the massive release of cytokines
-toxic shock syndrome is primarily due to exotoxin effects (although contributions from
endotoxins are also possible), not massive bacterial lysis and circulating endotoxin
(which would be the main mechanism of septic sh 2. bacterial overgrowth and
dissemination are characteristic of bacterial endocarditis.
Male Reproductive System
Acute bacterial prostatitis presents in a manner similar to other uti's, but with the
addition of perineal pain, pronounced systemic symptoms (fever, chills, acute illness),
and a tender, boggy prostate on examination. Urine culture should be obtained to help
direct antibiotic therapy. 2. a CT scan can be useful to diagnose a prostatic abscess,
which would be suspected if a pt with acute bacterial prostatitis continues to have fever
despite appropriate abx therapy.
10935
2246
Medicine
Medicine
2373
Pediatrics
Hydroceles, both communicating and non communicating will resolve spontaneously

by the age of 12 months and can be safetly observed during that period... if hydrocele
is present after 12 months, then surgical intervention is done due to the risk of inguinal
hernia.
3369
Medicine
anabolic steroids supresses the production of GnRH, LH and FSH myotonic dystrophy
is characterized by testicular atrophy as well as widespread muscular atrophy,
weakness, lower than normal testosteronen level, and high FSH and LH levels.
Pediatrics
Henoch-schonlein purpura (HSP) is an immune-mediated vasculitis that is most

common in children age <15. typical features include palpable purpura, hematuria,
Miscellaneous (Multisystem)
abdominal pain, arthrlagias and occasional scrotal swelling. children with HSP are at
increased risk for ileo-ileal intussusception.
3821
Pediatrics
Loss of the paternal copy of 15q11-q13-> The main features of Prader-Willi syndrome
are hypotonia, hyperphagia, and obesity. Patients are at risk for sleep apnea, type 2
diabetes mellitus, and gastric rupture.. - Management revolves around obesity and its
complications. so put locks on frigerator!
3871
Pediatrics
3554
Remember the 3 P's of McCUne-Albright syndrome_[recocious puberty, pigmentation

(cafe au lait spots) and polyostotic fibrous sysplasia.
3912
Pediatrics
pts with androgen insensitivity or 5-a-reductase deficiency will have a female

phenotype with a normal male genotype (46XY). pts with these disorders will not have
ovaries. 2. pts with 47XXY have klinefelter syndrome- they have a male phenotype
that includes small testes.
4764
Pediatrics
in turner syndrome, they have a dysfunctional lymphatic system wich causes

accumulation of protein rich interstitial fluid in the hands, feet, and neck (webbed neck)
4765
Pediatrics
patients ith turner syndrom have a higher risk of osteoporosis due to lower estrogen
levels and only having one copy of x chromosome genes involved in bone metabolism.
2276
Medicine
Nervous System
suspect primary CNS lymphoma in an HIV infected pt with an altered mental status,
EBV DNA in the CSF, and a solitary, weakly ring-enhancing periventricular mass on
MRI. 2. Toxoplasmosis is a good diff diagnosis, hwever, it is unlikely in a pt recieving
TMP-SMX. MRI reveals multiple ring ehancing spherical lesions in the basal ganglia. a
positive toxoplasma serology is quite common in normal subjects in the USA, and is
theirfore not specific for toxoplasmosis.
2279
Pediatrics
Nervous System
preferred tx for absent petit mal seizures is either ethosuximide or valproic acid.
Nervous System
benign essential tremor ( the amplitude of the tremors typically increases at the very
end of goal directed activities. the head and upper extremeties usually affected, while
legs are spared. TX: propanolol 2. parkinsons tremor is a resting tremor and usually
associated with rigidity and bradykinesia. TX:benztropine 3. haloperidol is use for
huntingtons chorea (chorea and dementia) 4. sodium valproic acid and clonazepam
are used for myoclonus.
2287
Medicine
2290
Medicine
Nervous System
Guillain-Barre syndrome is characterized by ascending weakness, bulbar symptoms

(eg, dysarthria, dysphasia) and respiratory compromise after antecedent illness such
as repiratory or GI infectio (especially campylobacter jejuni). csf analysis shows
albuminocytologic dissociation. TREATMENT of GBS includes intravenous
immunoglobulin or plasmapheresis. 2. Riluzole is used in the treatment of ALS wich
presents with both upper and lower neuron signs. acute presentation is uncomm
2439
Pediatrics
Nervous System
friedreich ataxia is an autosomal recessive condition and genetic counceling is

recommended for prenatal diagnosis for parents with one affected child.
2445
Pediatrics
Nervous System
1. nieman pick dz type A presents at age 2-6 months with areflexia,

hepatosplenomegaly, and cherry red macula and developmental milestone regression.
although tay sachs dz presents in a similar manner, hepatosplenome 2. hurler
syndrome (one of the mucopolysaccharidoses) is a lysosomal storage disorder due to
lysosomal hydrolase deficiency. it presents at age 6 months-2 years with coarse facial
features, inguinal or umbilical hernias, corneal clouding, and hepatosplenomegaly.
2472
Pediatrics
Nervous System
cepphalohematoma is a subperiosteal hemorrhage, and presents a few hours after

birth as scalp swelling limited toone cranial bone. Most cases do not require any tx and
resorb spontaneously within 2 weeks.
2572
Obstetrics &
Nervous System
Gynecology
fetal hydantion syndrome is characterized by midfacial hypoplasia, microcephaly, cleft

lip and palate, digital hypoplasia, hirtutism and developmental delay... It is caused by
the medications phenytoin and carbamazapine.
2669
Pediatrics
Nervous System
the characteristic features of neurofibromatosis 1 include cafe-au-lait spots,

macrocehaly, feeding problems, short stature, and learning disabilities. patients later
develope fibromas or different tumors. the characteristics of neurofibromatosis 2 is
bilateral acoustic neuromas and cataracts.
Nervous System
Deep intracranial hemorrhage (eg, basal ganglia, cerebellum, thalamus, pons) is

typically due to hypertensive vasculopathy; lobar hemorrhage is more often associated
with amyloid angiopathy (especially in the elderly) and usually involves the parietal or
occipital lobe. Eyes may deviate toward the side of hemiparesis and present with
non-reactive miotic pupils in pts with thalamic hemorrhage, helping to differentiate it
from other sites of intracranial hemorrhage.
Nervous System
central cord syndrome may result from hyperextenion injuries, particulary in elderly pts
with spondylosis. it is characterized by weakness moreso in the upper extremity that
the lower ext and may be accompanied by a localized deficit in pain and temp
sensation. the unique motor deficitoccurs bc the motor fibers serving the arms are
closer to the central part of the corticospinal tract. 2. posterior(dorsal) cord
syndrom->bil loss of vibratory and proprioceptive sensation, oft
Nervous System
central cord syndrom typically occurs with hyperextension injuries in elderly pts with
pre-existing degenerative changes (spondylosis) in the cervical spine. it is
characterized by weaknes that is more pronounced in the upper extremeties than the
lower and may be acompanied by a localized deficit in pain and temp sensation.
2672
3072
3072
Medicine
Medicine
Medicine
3162
3192
Medicine
Pediatrics
Nervous System
Idiopathetic intracranial hypertension risk factors-> overweight women of child bearing

age, possible link to certain medications (tetracyclines, hypervitaminosis A)...
symptoms include headache, transient vision loss, pulsatile tinnitus, and diplopia.
physical findings include papilledema, peripheral visual field defect, CN Vl palsy.
diagnosis->MRI lumbar puncture (CSF pressure >250... tx is to stop the offending
medication, weight loss & acetazolamide for idiopathic cases
Nervous System
G6PD deficiency is also known as type 1 glycogen storage dz and von gierkes dz.
caused by a deficient g6pd in the liver, kidney and intestinal mucosa. typical pt 3-4
months of age with hypoglycemia, lactic acidosis, hyperuricemia, and hyperlipidemia.
hypoglycemic seizures may occur. The characteristic features include doll-like face
(e.g fat cheeks), thin extremeties, short stature, and a protruberant abd (due to
enlarged liver and kidnes). the spleen and heart are normal.
3193
Pediatrics
Nervous System
infant or newborn with failure to thrive, bilateral cataracts, jaundice, and hypoglygemia.
such an infant most likely has galactosemia, which is a metabolic disorder caused by
galactose-1-phosphtae uridyl transferase defiency, thereby leading to elevated bld
levels of galactose. ... other common manifestations include aminoaciduria, hepatic
cirrhosis, hypoglycemia, and mental retardation. such pts are at an increased risk for
ecoli neonatal sepsis.
3218
Pediatrics
Nervous System
pts with serious tramatic brain injury (e..g neurologic deficit, signs of basilar skull
fractures) require neuroimaging, close inpatient monitering (neurologic exams every 2
hours), and neurosurgical consultation. These pts typically have significant intracranial
injury (e.g epidural hematoma).
3300
Medicine
Nervous System
anterior cord syndrome is commonly asspciated with burst fracture of the vertebra and
is characterized by total loss of motor function below te level of lesion with loss of pain
and temperature on both sides below the lesion with intact propioception. 2. central
cord syndrome is characterized by nurning pain and paralysis in upper extremeties
with relative sparing of lower extremeties. 4. cauda equina is characterized by
paraplegia, variable sensory loss, urinary/fecal incon
3373
Medicine
Nervous System
Reversible acetylcholinesterase inhibitors such as donezepil, rivastigmine, and

galantamine are of benefit in slowing the cognitive decline associated with Alzheimers
dz.
3396
Pediatrics
Nervous System
shaken baby syndrom can give bilateral retinal hemorrhage.
3513
Medicine
Nervous System
Essential tremor usually begins in adulthood. pts who require medication are given
either beta blockers or primidone. Primidone is an anticonvulsant. The administration
of primidone may precipitate acute intermittent porphyria, which manifests as
abdominal pain, neurologic and psychiatric abnormalities. -primidone can be used to
treat essental tremors. its administration can precipiate acute intermittent porphyria,
which can be dx by checking for urine porphobilinogen.
3667
Pediatrics
Nervous System
medulloblastoma is the second most common infratentorial tumor in children and

arises from the vermis.
3727
Medicine
Nervous System
the management os myasthenia crisis with respiratory failure consists initially of

endotracheal intubation followed by tx with corticosteroids as well as intravenous
immunoglobulins or plasma exchange (preferred)
3728
Medicine
Nervous System
the most common (30%) site of hypertensive hemorrhages is the putamen. the
internal capsule that lies adjacent to the putamen is almost always involved, leading to
contralateral dense hemiparesis.
3771
Medicine
Nervous System
riluzole is a glutamate inhibitor that is currently approved for use in patients with
amyotrophic lateral sclerosis.
3837
Medicine
Nervous System
Eaton-lambert syndrome is associated with small cell carcinoma of the lung, and
results from autantibodies directed against the voltage gated calcium channels in the
presynaptic motor nerve terminal. TX: consists of plasmapheresis and
immunosuppressive drug therapy.
3852
Medicine
Nervous System
CT poorly detects lesions of the brain stem, spinal cord and cerebellum, while MRI can
detect these well. MRI is the test of choice to support the clinical diagnosis of multiple
sclerosis.
Nervous System
cortical laminar necrosis is the hallmark of prolonged seizures and can lead to
persistent neurologic deficits and recurrent seizures. .... the definition of status
eplipticus has therefore been amended to be any single seizure lasting >5 minutes or
a cluster of seizures with the patients not recovering a normal mental status
inbetween.
4089
Medicine
4170
Medicine
Nervous System
Right hand clumsiness suggest ulnar nerve syndrome: decreased sensations over the
4th and 5th fingers and weak grip due to involvement of interosseous muscles of the
hand are characteristic. the most common site of ulnar nerve entrapment is the elbow
where the ulnar nerve lies at the medial epicondylar groove. EXTREMELY HIGH
YIELD!
4179
Medicine
Nervous System
Beta blockers are not cosidered first line therapy for htn as they are associated with
less protection against stroke and a possible increase in mortality in pts ahe >60 - they
can also increase the risk of developing new onset-diabetes messlitus.
Nervous System
Hemi-neglect syndrome is characterized by ignoring the left side of a space, and

involves the right (non-dominant) parietal lobe. 2. a frontal cortex lesion results in
hemiparesis ( with motor aphasia if the dominant lobe is involved) 3. left temporal lobe
involvement leads to receptive aphasia 4. occipital lobe damage results in visual
disturbances.
4206
Medicine
4248
Pediatrics
Nervous System
Morning vomiting and Nocturnal headaches are red flags for intracranial pathology. 2.
coextisting otitis and mastoiditis are serious risk factors for direct spread of infection
into a temporal brain abscess. Headaches are the most common sympton of brain
abcess. Because intracranial pressure naturally increases in the supine position due to
gravity, pts may expierence headache exacerbation at night or early morning. next
best step if brain CT with contrast and MRI
4271
Pediatrics
Nervous System
spirometry is the gold standard in evaluating pulmonary function (e.g FVC, forced
expiratory colume in 1 sec)
Nervous System
metoclopromide is a dopamine receptor antagonist used to treat nausea, vomiting,

and gastroparesis. common side effects is agitation and loose stools. metoclopromide
can induce a dystonic reaction (stiffining of muscles), and drug induced extrapyramidal
symptoms. treatment for dystonic reaction involves discontinuation of the medication
and administration of benzotropine of diphenydramine.
Nervous System
pronator drift is a finding thats sensitive and specific for upper motor neuron dz. It is
considered a sensitive test for subtle deficits that a pt may not otherwise notice. uppor
motor lesions cause a weakness in supination that results in the pronator muscles
becoming dominant. as a result when these pts close their eyes and extend their arms
with the palms up, the affected arm will tend to pronate. the concern of this pts arm
weakness is due to a stroke.
4366
4381
Medicine
Medicine
4391
Medicine
Nervous System
spinal cord compression is characterized by signs and symptoms of upper motor

neuron dysfunction distal to the site of compression. these include weakness,
hyperflexia, and an extensor plantar response. Cord compression is a medical
emergency requiring prompt diagnosis by spinal MRI. An epidural abscess (even
without fever) is of particular concern in an IV drug abuser.
4397
Medicine
Nervous System
absence of a postictal state (confusion, disorientation) in a syncope pt, makes seizures

less likely.
4399
Medicine
Nervous System
Torticollis is a common form of focal dystonia involving the sternocleidomastoid

muscle. 1. dystonia is defined as sustained muscle contraction resulting in twisting,
repetitive movements, or abnormal postures. Torticollis can be congenital, idiopathetic,
secondary to trauma or local inflammation, or drug induced. -Medications commonly
responsible include the typical antipsychotics, metoclopramide, and prochlorperazine.
4400
Medicine
Nervous System
resting tremor is often the presenting symptom of parkinsons disease. it is usually a

"pill rolling" tremor that starts in one hand and can progress to involve oter
extremeties, jaw, face, tongue, and lips.
4408
Medicine
Nervous System
Diabetic mononeuropathy often involves CNlll. Nerve damage is ischemic and only
somatic nerve finers are affected. Parasympathetic fibers of CNlll retain function.
Ptosis and a "down and out" gaze in conjunction with normal light and accommodation
reflexes indicate diabetic CNlll neuropathy.
4461
Medicine
Nervous System
abrasions can also occur without obvious corneal trauma. pts typically develop severe
eye pain, photophobia with reluctance to open the eye and a sensation of a foreign
body in the eye. Absence of eye pain suggests trugeminal nerve dysfunction as the
ophthalmic branch V1 of the trigeminal nerve (cranial nerve V) controls corneal
sensation.
4464
Medicine
Nervous System
1. statin induced myopathy can present with proximal muscle weakness and myalgias.
Nervous System
lacunar strokes (25%) of ischemic strokes) are due to microatheroma and

lipohyalinosis in small penetraing arteries of the brain. they often affect the internal
capsule and result in pure motor dysfunction. hypertension, hyperlipidemia, smoking,
and diabetes are major risk factors. also, lacunes are not often seen on ct scan
because its too small.
4482
Medicine
4483
4513
Medicine
Medicine
Nervous System
1. Todds palsy is usually preceded by a focal motor seizure. 2. carotid artery

thrombosis is a common cause of atherothromboembolic stroke. pts can expierence
AMAUROSIS FUGX ( retinal transient ischemic attack) or stroke... occurs most
commonly in the middle cerebral artery and presents with contralateral hemiparesis
and hemianesthesia. Carotid dz is more common in older pts with multiple vascular
risk factors.
Nervous System
1. viridan a solitary ring enhancing lesion on brain CT and a fluid collection in the
ethmoid or sinusisits or any head.neck infection with headaches and a focal
neuroligcal deficit are findings for a brain abcess. only 50% of people with brain abces
have fever. 2.cerebral toxoplasmosis also presents with ring enhancing lesions in
patients with AIDS. The lesions in toxoplasmosis are usually multiple and tend to occur
in the basal ganglia and at the cortical grey-white matter
4619
Medicine
Nervous System
lewy body dementiais characterized by alterations in consciousness, disorganized

speech, visual halucinations, extrapyramidal symptoms, and relatively early
compromise of executive functions. at autopsy lewy bodies or eosinophilic
intracytoplasmic inclusions may be seen in neurons of the substantia nigra, locus
ceruleus, dorsal raphe, and substantia innominata. tx: for motor->anticholinesterase
inhi, for halluc->atyp antipsyotics akithesia (restlessness, cant sit still)
4620
Medicine
Nervous System
alzheimers dz is the most common type of dementia in the united states and is
characterized by early memory and viduospatial impairments. Gait impairments is the
most prominent early clinical feature of normal-pressure hydrocephalus but is a later
finding in alzheimers dementia.
4700
Medicine
Nervous System
Potentially reversible causes of confusion: empiric administration of thiamine for

werneckes encephalopathy, dextrose for hypoglycemia, supplemental oxygen for
hypoxia, and naloxone for opiate overdoase. 2. all all alcoholics of malnourished pts
should recieve thiamine before any dextrose, as sugars can worsen or precipitate
wernickes. 1. Haloperidol is an antipsychotic medication used to treat schizophrenia
and acute psychotic states such as delirium.
10348
Medicine
Nervous System
lewy body dementia is deifferntiated from other dementia by cognotive fluctuations,

vidual hallucinations, and parkinsonism.
2760
Medicine
Ophthalmology
basal cell carcinoma is the most common malignancy of the eyelid margin, and may
apear clinically to a chalazion ( painfully swelling that progresses to a nodular rubbery
lesion
Ophthalmology
Open angle glaucoma is more common in african americans and has an increased
prevalence in those with a family hx of glaucoma and diabetes. it is generally
asymptomatic in the initial stages, followed by a gradula loss of peripheral vision over
a period of years, and eventual tunnel vision. 2. diabetic retinopathy can be classified
into 2 types.1. Non-proliferative-> dilation of veins, microaneurysms, retinal
hemorrhages, edema, & hard exudates. 2. proliferative->neuvascular
Ophthalmology
suspect optic neuritis in a patient with central scotoma, afferent pupillary defect,
changes in color perception and decreased visual acuity. Remember the association
between optic neuritis and multiple sclerosis. 2. in anterior uneitis, the eye is usually
painful and red with blurry vision. typically the eye has perilimbal injection. examination
reveals keratic precipitaes. corneal stromal edema may be present.
Ophthalmology
Retinal detachment usually presents with a sudden onset of photopsia (flashes of light)
and floaters (spots in the visual field) it usually occurs in people aged 40-70 yrs. The
most classic description is that os " a curtain coming down over my eyes" laser therapy
and cryotherapy are done to make permanent adhesions between the neurosensory
retina, retinal pigment epithelium, and the choroid.
Ophthalmology
1. central retinal vein occlusion-> subacute monocular visual loss. findings-> "vld and
thunder" appearance on funduscopic exam consisting of optic disk swelling, retinal
hemorrhage, dialted veins, and cotton wool spots 2. central retinal artery occlusion->
sudden, painless loss of vision in one eye, and the funduscopic exam reveals pallor of
the optic disk, a cherry red fovea, and boxcar segmentation of bld in the retinal veins.
3. amaurosis fugas-> atherosclerotic dz
Ophthalmology
copius purulent ocular drainage and eyelid swelling in a 2-5 day old infant newborn are
most consistent with gonococcal conjunctivitis .tx: single dose of intramuscular or IV
ceftriaxone or cefotaxime, and hospitalization to assess for tx response. 1. Gonococcal
conjunctivitis can be prevented with application of topical erythromycin ointment within
1 hour of birth. 2. conjunctivits caused by chlamydua trachomatis is usually milder and
presents 5-14 days after birth.
2852
2856
2862
3328
3329
Medicine
Medicine
Medicine
Medicine
Pediatrics
3711
Pediatrics
Ophthalmology
White eye reflex (missing red eye during pic "my words!) can result from opacities of
the lens (cataract) or tumor (retinoblastoma) 2 new onset strabismis can be a sign of
retinoblastoma if accompanied by a white reflex. 3 strabismus after age 4 months is
usually abnormal & requires tx to prevent amblyopia. asymmetric corneal light
reflections and deviation on cover test r concerning findings.The standard tx is
occlusion (pathing) or penalization (blurring) of the normal eye
2662
Medicine
Poisoning & Environmental

Exposure
diphenhydramine overdose leads to antihistamine effects including drowsiness,

confusio and anticholinergic effects including dry mouth, dilated pupils, blurred vision,
rediced bowel sounds, and urinary retention. TX: Physostigmine, a cholinesterase
inhibitor can counteract these anti-cholinergic effects

Exposure
the combination of recent onset confusion, fever, muscle rigidity and diaphoresis are
consistent with the diagnosis of neuroleptic malignant syndrome, a drug induced
idiosyncratic reaction. - symptoms of NMS begin within 2 weeks of the precipitating
drug. The rigidity and hyperthermia of NMS may result in muscle necrosis, reflected by
elevated creatine kinase.
3135
Medicine
3139
Medicine

Exposure
Fluphenazine is a "typical antipsychotic" that is injected every 2-3 weeks in

schizophrenics with poor compliance. More potent that haloperidol, fluphenazine can
cause hypothermia but inhibiting the bodys shivering mechanism and/or autonomic
thermoregulation. for this reason, pts taking this med should be advised to avoid
prolonged exposure to cold temp. 1. ibuprofen, when takin in excess can lead to
hypotenion. 2. amitriptaline s/e are weight change, dizziness, and insomia
3827
Pediatrics

Exposure
acute iron poisoning presents as abdominal pain, hematemesis, and metabolic

acidosis. iron is radiopaque, and ingested tablets can be seen on x-ray. chelation
therapy with deferoxamine should be provided for moderately to severely ill patients.
4487
Medicine

Exposure
TCA overdose-> sodium bicarb to improve bld pressure, shorten the QRS interval and
prevent arrhythmia. 1. calcium gluconate is cardio-protective in cases of hyperkalemia.
2. magnesium sulfate is used in pts suffering from torsades de points induced by
prolonged qt interval. 3. atropine and pralidoxime are the proper antidotes for
anticholinesterase toxicity, as seen in organophosphate poisoning. these pts present
with cholinergic toxicity characterized by bradycardia, mio
4509
Medicine

Exposure
cellulitis tx-> clindamycin clindamycin use can be associated with diarrhea, along with
nausea, vomiting, anorexia, and metallic taste.
4837
Pediatrics

Exposure
Abnormal lead values must be confirmed by venous bld draw.
10145
Medicine

Exposure
Cyanide is a potent inhibitor of cytochrome oxidase a3 in the mitochondrial electron

transport chain. This activity blocks oxidative phosphorylation and promotes anaerobic
metabolism, causing lactic acidosis.

Exposure
to prevent cardiorespiratory arrest and permanent neurologic disability, victims of

smoke inhalation injury should be treated empirically for cyanide toxicity with n
antidote, such as hydroxocomalamin or sodium thiosulfate, or with nitrites to induce
methemoglobinemia. 2. Methanol is found in antifreeze solutions (eg, windshield wiper
fluid, fuels, solvents). 3. Methemoglobinemia occurs after exposure to oxidizing agents
(dapsone, nitrates, topical/local anesthetics).
10146
Medicine
2299
Medicine
Pregnancy, Childbirth &

Puerperium
choriocarcino is a metastatic form of gestational trophoblastic disease. it may occur

after molar preg or normal gestation, and the lungs are the most frequent site of
metastatic spread. suspect choriocarcinoma in any postpartum woman with pumonary
symptoms and multiple nodules on chest xray. en elevated beta HCG helps to confirm
the diagnosis.
3269
Obstetrics & Pregnancy, Childbirth &

Gynecology Puerperium
preterm labor refers to regular contractions causing cervical dilation and/or effacement
at <37 weeks gestation. pts in preterm labor at <34 weeks should recieve a tocolytic
agent (eg calcium channel blocker), magnesium sulfate for neuroprotection, and
corticosteroids for acceleration of fetal lung maturity.
3337

in the immediate postpartum period, a low grade fever, leukocytosis, and vaginal
discharge are normal findings. The vaginal discharge (lochia) is initially bldy, then
serous and finally white to yellow in color days following surgery 1. if a foul smelling
lochia is noted, endometritis should be suspected.

Clinically, endometritis is characterized by fever, uterine tenderness, foul smelling

lochia (persistent vaginal discharge) and leukocytosis. Broad spectrum antibiotics are
required to treat this typicallly polymicrobial infection. Risk factors include prolonged
rupture of membranes, prolonged labor, operative vaginal delivery and caesarian
section amond others. en
4799
4800

endometritis os the most common cause or puerperal fever on the 2nd and 3rd day
postpartum. endometritis is a polymicrobial infection caused by a combination of gram
positive and gram negative organisms, aerobic and anaerobic organisms and
occasionally other organisms such as mycoplasma and chlamydia.
4801

the treatment of choice for postpartum endometritis, which is a polymicrobial infection,

is intravenous clindamyciin and gentamicin.
10441

cell free fetal dna testing is a non invasive and highly senisitve andd specific screening
test for fetal aneuploidy. it can be odered >- 10 weeks gestation. abnormal results can
be confirmed by chorionic villus sampling at 10-12 weeks or amniocentesis at 15-20
weeks.
Pediatrics
Psychiatric/Behavioral &
Substance Abuse
pts with anorexia nervosa require hospitalization when they have unstable vital signs,
severe bradycardia, or cardiac dysrhythmias, and electrolyte derangements. Goals of
tx include nutritional rehabilitation and weight gain. Pts should be monitered closely for
refeeding syndrome. - starvation and malnutrition can decrease serum
thyroxine-binding globulin and albumin concentrations 2. SSRI can be used to achieve
remission from binging and purging in bulemia nervosa.
Psychiatry
Substance Abuse
when treating a single episode of major depression, the antidepressant should be

continued for a period of 6 months following the patients response. is mulitpe episodes
of depression have occured, maintenance therapy will likely need to be continued for a
longer period. nausea= s/e of most antidepressants including buproprion.
Substance Abuse
1. cognitive-behavioral therapy focuses on reducing automatic negative thoughts and

avoidance behaviors that cause distress. 2. biofeedback is a tx modality in which the
goal is for pts to improve their own health by using signals from the body ( ex pts can
learn to control their response to a stressful situation theirby decreasing their bld
pressure. 3 motivational interviewing is a psychotherapeutic technique used in
substance abuse.
Pulmonary & Critical Care
Massive pulmonary embolism is likely in a postoperative pt with hypotension, jugular

venous distension, and a new- onset right bundle branch block. - the right strain
progresses rapidly to right ventricular dysfunction, decreased return to the left side of t
heart, decreased cardiac output, left heart pump failure, and resultant bradycardia.
this results in cardiogenic shock and causes CNS effects, such as dilated pupils and
unresponsiveness.
Congenital diaphragmatic hernia (CDH) is rare but is life threatening. results in

pulmonary hypoplasia and pulmonary hypertension. Approx 85% present on the left
and 15 on R. polyhydramn d/t esoph comp. 1st ste in management of a newborn with
respiratory compromise and suspected congenital diaphragment hernia is
endotracheal intubation. Bag-&-mask ventilation can exacerbate respiratory decline. A
gastric tube should be placed immediately to decompress the stomach and bowel.
superior sulcus tumors ( Pancoast tumors e.g non-small cell lung cancer) may present
with shoulder pain as the initial symptom due to tumor invasion of the brachial plexus
or extension into adjacent structures. The pain may radiate up to the head and neck or
down to the ipsilateral arm (ulnar nerve distribution)...orners syndrom occurs due to
the tumor invasion of the paravertebral sympathetic chain and inferior cervical
ganglion. Initial evaluation= cxray.
Beta 2 agonists like albuterol reduce serum potassium levels but driving potassium
into cells. in some pts, clinically significant hypokalemia can result, causing muscle
weakness, arrythmias, and ekg changes. obtaining a serum electrolyte panel would be
helpful to assess the severity of a pts hypokalemia. 2. chest xray on an acute asthma
exacerbation may reveal lung hyperinflation... chest xrays are most useful where
foreign body aspiration or underlying pneumonia are suspe
Recurrent pneumonia in the same anatomic location is a red flag for bronchial
obstruction. Smoking is the primary risk factor for bronchogenic carcinoma. CT is
indicated to visualize underlying parenchymal abnormalities. - Bronchoscopy is an
invasive procedure and is generally reserved for pts with masses documented by CT
scan. Bronchoscopy would also be the next step in pts with neg CT scan and high
suspicion for endobronchial obstruction.
COPD is not entirely reversible. COPD encompasses chronic bronchitis and

emphysema and is one of the leading cause of death worldwide... TX: long term
supplemental oxygen therapy has been proven to prolong survival and improve quality
of life in hypoxemic pts with COPD. indications for o2 therapy in COPD include Pa02
<55, sa02<88, hematocrit>55, or evidence of cor pulmonale 1. beta blockers are
generally avoided in moderate/severe asthma and COPD bc of their bronchocontricti
2353
3843
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2435
2602
3026
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3042
Psychiatry
Medicine
Pediatrics
Medicine
Medicine
Medicine
Medicine
3045
Medicine
idiopathic pulmonary fibrosis is due to excessive collagen deposition in peri-alveolar

tissues. This leads to decreased lung volumes ( low total lung capacity, functional
residual capacity, and residual volume) with preserved or increased forced expiratory
volume in 1 second/forced vital capacity ratio. Patients have imparied gas exchange
resulting in reduced diffusion capacity of carbon monoxide and increased
alveolar-arterial gradiant.
3285
Pediatrics
viral upper respiratory tract infections are the most common predisposing factor of
acute bacterial rhinosinusiis. persistent or worsening symptoms should raise conern
for progression to bacterial sinusitis. uncomplicated acute bacterial rhinosinusitis
should be treated with oral amoxicillin-clavulanic acid.
ARDS is a form of non-cardiogenic pulmonary edema caused by leaky alceolar

capillaires. causes include sepsis, severe infection, severe blding, toxic ingestions and
burns. In ARDS, mechanical ventilation with low tidal volumes and PEEP can improve
oxygenation by preventing alveolar collapse at end of expiration which increases the
functional residual capacity and decreases work of breathing. so increase PEEP! PEEP
(positive end expiratory pressure) improves
3433
Medicine
3531
Pediatrics
Acute lymphoblastic leukemia is the most common cause of childhood cancer. affected
children b=can present with numerous infections and weight loss.
hepatosplenomegaly, lymphadenopathy, and petechia are often seen on examination.
2. cystic fibrosis is autosomal recessive!
3553
Pediatrics
infants age <2 months are at high risk of developing apnea and respiratory failure from
bronchiolitis. in addition, they tend to develop recurrent wheezing throughout
childhood.
3580
Medicine
granulomatosis with polyangitis (wegeners) is a vasculitis affecting small and medium

sized arteries. pts present with a combination of glomerulonephritis and upper and
lower respiratory tract disease. diagnosis is made by c-ANCA positively and tissue
biopsy. TREATMENT involves high-dose corticosteroids and cytotoxic agents.
3597
Medicine
10 % of venous thromboemboli originate in the deep veins of the upper extremeties.

pts with indwellint catheters are at increased risk.
3775
Medicine
a large mediastinal mass with elevated levels of beta-human chorionic gonadotropin

and alfa fetoprotein, consistent and virtually diagnotic with a nonseminomatous germ
cell tumor.
3776
Medicine
an apical lung tumor in the right superior sulcus of the lung can cause compression of
the sympathetic trunk(horners syndrom), the brachial plexus(pancoast syndrom), the
right recurrent laryngeal nerve (hoarse voice) and the superior vena cava(SVC
syndrome) 2. aspergilloma can grow in the apex of the lung. pt may present with
hemoptysis, fever, weight loss, and chronic cough. the mass is usually mobile and
moves with position. dx is made by finding hyphae in the specimen.
3846
Medicine
the most commin adverse effect of inhaled corticosteroid therapy is oropharyngeal

thrush (oral candidiasis)
3999
Medicine
factor v leiden is the most common inherited disorder causing hypercoagulability and
predisposition to thromoses, especially DVT of lower extremeties.
ventilation/perfusion scanning is a useful tool in dx pulmonary thromboembolism.

Mismatched perfusion defect is characeristic, but is found in less that 50% of the pts.
-dyspnea, tachypnea, normal lung exam, and a right axis deviation on ECG are
suggestive of the pulmonary embolism. In most pt;s, CT angiography is the test of
choice. However, in pts with contrast allergy or renal insuff, contrast canot be given,
making the ventilation/perfusion scan as the test of choice.
dyspnea, productive cough, fever, and chest xray showing a right lower lung infiltrate
suggest community aquired pneumonia... most common causes of CAP include streo
pneumoniae, haemophulus, and atypical organisms (e.g mycoplasma)... empiric outpt
tx of healthy pts include doxycycline pr macrolides... hospitalized pts require extended
spectrum fluoroquinolone (e levofloxacin), moxifloxacin) or a beta-lactam combined
with a macrolide.
4009
4024
Medicine
Medicine
4039
Medicine
chest physiotherapy with percussion and vibration, and other mechanical techniques
to aid sputum clearance (intermittent positive-pressure breathing) is indicated for pts
with bronchiectasis. 2. intravenous magnesium sulfate caues bronchodilation and is
used for severe, lifethreatening asthma exacerbations.
4052
Medicine
Bronchogenic cysts are usually found in the midde mediastinum. Thymoma is usually
found in the anterior mediastinum. All neurogenic tumors are located in the posterior
mediastinum.
4073
Medicine
parapneumonic effusions usually occur from pneumonia. the fluid may be apirated to
determine if empyema has set in yet. a low PH (<7.2) is almost always indicative of an
empyema and indicates removal of the fluid by thoracostomy. glucose of less that
60mg is also an indication for tube thoracostomy.
4087
Medicine
diagnostic thoracocentesis is the preliminary investigation of choice in the

management of pleural effusion, except in patients with classic signs and symptoms of
congestive heart failure, where a trial of a diuretic is warranted.
4105
Medicine
indicators of a severe asthma attack include normal to increased pc02 values, speech
difficulty, diaphoresis, altered sensorium, cyanosis, and silent lungs.
4177
Medicine
pulmonary hypertension is defined as a meanpulmonary arterial pressure greater than

25 mmHg at rest or 30 mmHg with exercise. - primary pulmonary hypertension can be
seen in middle aged pts and it presents with exertional breathlessness. Lungs will be
clear to auscultation. CXrays would show enlargement of the pulmonary arteries with
rapid tapering of the distal vellels (pruning) and enlargement of the right ventricle.
4210
Medicine
a mobile cavitary mass in the lung, which presents with intermittent hemoptysis, is
usually indicative of ASPERGILLOMA.
4523
Medicine
a pt with food allergies and urticaria presenting with dyspnea, difficulty swallowing and
physical findings suggestive of uper repiratory obstruction, laryngeal edema is likely
the cause of the respiratory symptoms. 2. in a pt presenting with sudden onset of
severe shortness of breathm upper airway obstruction should be immediately ruled
out. fyi! offnote! chest percussion on the side of a pneumothorax will reveal a tympanic
note.
4562
Medicine
PEEP prevents alveolar collapse, directly counteracting the means by which ARDS
causes hypoxemia. It may also reopen some alveoli that have already collapsed.
empyema most commonly occurs in the seting of untreated pneumonia due to

bacterial seeding of a pleural effusion. inflammation and collection of pus in the pleural
cavity leads to the formation of a loculated, abnormally contoured effusion with
adjacent pulmonary consolidation. namely strep pneumoniae, staph areurs, and
klebsiells pneimonaie
Chronic low back pain in an otherwise young healthy young man, pain at night,
improvement of pain with activity, and elevated ESR are suggestive of (AS). some pts
also can develop anterior uveitis, IBD, and aortic regurg. pts with ankylosing
spondylitis can develop restrictive lung dz due to diminished chest wall and spinal
mobility. Pulmonary function tests show a mildly restrictive pattern with reduced vital
capacity and total lung capacity but normal FEC/FVC.
4568
4575
Medicine
Medicine
4663
Medicine
consequences of obesity hypoventilation syndrome include pulmonary hypertension

with cor pulmonale, secondary erythrocytosis, hypoxia, chronic hypercapnea, and resp
acidosis. in a compensatory effort to maintain normal pH, the kidney increases
bicarbonate retention and decreases chloride reabsorption.
4664
Medicine
the body compensated for chronic hypercapnea by increasing renal bicarbonate

retention. 2, there is increased dead space ventilation in COPD, which worsens the
respiratory acidosis.
Severe asthma exacerbation... an elevated or even normal paco2 suggest decreased

respiratory drive (likely due to respi muscle fatigue) and impending resp failure. other
clinical signs or symptoms of pooe respo drive include : decreased breath sounds,
absent wheezing, dec mental status, hypoxia wih cyanosis... pts wuch as this require
ICU admision with endotracheal intubation to maintain adequate oxygenation and
ventilation.
4706
Medicine
4718
Medicine
COPD pts with acute-on-chronic respiratory failure treated with high-flow supplemental
oxygen are at risk for developing worsening hypercapnia and CO2 narcosis. This is die
to a combination of reduced alveolar ventilation, increased dead space ventilation
causing ventilation-perfusion mismatch, and decreased hemoglobin affinity for CO2.
The goal oxyhemoglobin saturation in these pts is 90-94 % (not >95%)
4730
Medicine
for COPD, intravenouse glucocorticoids (eg, methylprednisolone) are recommended

for severe exacerbations and for pts unable to take oral medications.
4770
Medicine
acute pneumonia presentation: decreased breath sounds and increased fremitus

indicate an area of consolidation within the (location) lobe. pneumonic consolidation
results when alveoli in the affected lung segments become filled with exudative fluid
and cellular debris. ventilation(V) within these consolidated regions is essentially zero.
However, alveolar bld flow (Q) remains intact, resulting in a (mismatched) VQ ratio of
0.
4831
Pediatrics
maternal diabetes increases the incidence of frespiratory distress syndome by

delaying the maturation of pulmonary surfactant production.
2169
Medicine
Renal, Urinary Systems &

Electrolytes
IV saline hydration is the immediate tx of choice for pts with symptomatic moderate
(calcium 12-14) or severe (>14) hypercalcemia. Saline hydration helps to restore
intravascular volue and promote urinary calcium excretion. Calcitonin also reduces
serum calcium concentration within 4-6 hours and should be administered alon with IV
saline hydration. Bisphosphonates are recomended for long term managemnt in
addition to tx of the underlying cause.
2182
Medicine

Electrolytes
IV normal 0.9% saline is preferred for treating hypovolemic hypernatremia. the fluid
can be switched to a hypotonic fluid ( 5% dextrose in water preferred over .45% saline)
for free water supplementation once the pt is euvolemic.
2186
Medicine

Electrolytes
Fluid replacement is the most important step in the management of non-ketotic

hyperglycemic coma.
2189
Medicine

Electrolytes
arterial pH or anion gap is the most reliable indicator of metabolic recovery in pts with
diabetic ketoacidosis.
2226
Pediatrics

Electrolytes
chronic constipation is a risk factor for recurrent cystitis in toddlers. Impacted stool can
cause rectal distion, which in turn compresses the bladder, prevents complete voiding,
and leads to urinary stasis. the residual urine is a potential breeding ground for
bacteria that ascend to the urethra from the perineum 2. renal u/s is performed to R/O
hydronephrosis 3. voiding cystoureterogram is the imaging of choice to detect
structural abnormalities (e.g vesicoureteral reflux)
2228
Medicine

Electrolytes
small bowel disease, surgical resection or chronic diarrhea can lead to malabsorption
of fatty acids and bile salts... this is turn predisposed to the formation calcium oxalate
stones.
2233
Pediatrics

Electrolytes
suspect alports syndrom in pts with recurrent episodes of hematuria, sensorineural

deafness and a family hx of renal failure... Electron microscopy findings include
alternating areas of thinned and thickened capillary loops with splitting of the
glomerular basement membrane (GBM)
2235
Medicine

Electrolytes
intramuscular ceftriaxone with oral doxycycline is often used emperically for treating
suspected chlamydial and or gonococcal infections.
Medicine

Electrolytes
drug induced interstitial nephritis occurs with many drugs such as penicillins,
cephalosporins and sulfonamides, sulfonamide containing diuretics, nsaids, rifampin,
phenytoin and allopurinol. clinical features include fever, rash and arthralgias. other
features are peripheral eosinophilia, hematura, sterile pyruria, and eosinophiluria.
WBC casts may be present in the urine but red cell casts are rare. Discontinuing the
offending agent is the treatment.
Medicine

Electrolytes
the nephrotic syndrome can result in alterations in lipid metabolism. This dyslipidemia
puts affected pts at risk for accelerated atherosclerosis. This atherosclerotic tendency,
along with intrinsic hypercoagulability, places pts with nephrotic syndrome at risk dor
complications such as stroke and myocardial infarction.

Electrolytes
abnormal lipid metabolism is found in many patients with nepthrotic syndrome,

including an elevated LDL and/or a low HDL, predispoding to accelerated
atherosclerosis. -patoents with nephrotic syndrome are also hypercoagulable. 2.
monoclonal gammapathy can lead to amyloidosis, which can be a cause of nephrotic
syndrome, however, nephrotic syndrome itself does not lead to monoclonal
gammapathy.

Electrolytes
needle shaped crystals on urinalysis indicate uric acid stones which are rasiolucent
and theirfore have to be evaluated by CT of the abdomen or intravenous pyelography.
abdominal ultrasonography may also deteect radiolucent stones... CT is also useful for
diagnosing other pathology such as appendicular abscess or bowel obstruction...
stones <1 cm may pass spontaneously with hydration and analgesia; otherwise,
surgical intervention is needed.

Electrolytes
vigorous hydration with iv normal saline is the 1st step in managing severe
symptomatic hypercalcemia. in addition, concurrent tx with calcitonin and
bisphosphonates (e.g, zoledronic acid) is also recommended to rapidly reduce the
serum calcium levels. Bisphosphonates are subsequently continued for the long-term
management of hypercalcemia of malignancy. 1. hypercalcemia induces urinary salt
wasting= volume depletion 2. Glucocorticoids are effective in tx vit D related hype

Electrolytes
1. methyl alcohol poisoning can cause visual changes (snowfield vision) and acute
pancreatitis. 2. uremia (renal failure) causes an anion gap metabolic acidosis due to
failure to excrete acids as NH4+ 3. lactic acidosis can result from poor delivery of
oxygen to the tissues and poor oxygen utilization by the tissues. 4. Calcium oxalate
crystals (rectangular, enveloped shaped crytals) are seen in pts with ethylene glycol
poisoning (antifreeze).
2242
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2633
2799
Medicine
Medicine
Medicine
Medicine
2803
Medicine

Electrolytes
tinnitus, fever, techypnea, nausea and GI irritation after an overdose of ASA (salicytate
toxicity)... normally causes an anion gap metabolic acidosis and resp alkylosis, BUT a
near normal pH. soo resp alkalosis, metabolic acidosis and near normal pH = ASA
toxicity.
2810
Medicine

Electrolytes
Causes of normal anion gap metabolic acidosis: diarrhea, fistulas (pancreatic,

ileocutaneous,ect), carbonic anhydrase inhibitors, renal tubular acidosis, ureteral
division (e.g, ileal loop), iatrogenic. ANION GAP= serum NA - (serum cl+hco3) normal
anion gap = 8-12 renal tubular acidosis (RTA) is a group of disorders characterized by
nonanion gap metabolic acidosis in the oresence of reserved kidney function. 1.
furosemide (loop) causes hypokalemia & metabolic alkalosis.
3061
Medicine

Electrolytes
drug induced interstitial nephritis is usually caused by cephalisporins, prnicillins,

sulfonamides, NSAIDS, rifampin, phenytoin and allopurinol. ptaients present with
arthralgias, rash, renal failure, and the urinalysis wil show eosinophiluria.

Electrolytes
placement of a urinary catheter in patients with hydronephrosis can provide quick relief
of urinary obstruction. medical management with alpha blockers (tamsulosin) or
5-alpha-reductase inhibitors (finasteride) can hekp improve BPH urinary symptoms.
surgical intervention (e.g, transurethral resection of the prostate) may be required in
some patients with refractory symptoms.

Electrolytes
pts with chrons disease or any other snall intestine disorder resulting in fat
malabsortion are predisposed to hyperoxaluria wich presents with sysmptoms of
nephrolithiasis wich classically presents with flank pain and hematuria frequently
accompanied by nausea and vomiting. symptomati hyperoxaluria is the result on
increased oxalate absorption in the gut. normally calcium binds to oxalate in the gut
and prevents its absorption, but in pts with fat malabsorption, calcium is
3336
3435
Medicine
Medicine
3481
Medicine

Electrolytes
current recommendations suggest obtaining a urinalysis in oatients with BPH to

evaluate for hematuria ( for bladder cancer and kidney stones) and infection. PSA
should also be obtained to screen for prostate cancer 1. cystoscopy is not generally
required in the evaluation of BPH unless there is hematuria on the urinalysis,
suggesting bladder cancer, ureteral calculi, or urethral stricture.
3648
Medicine

Electrolytes
intravenous calcium gluconorate which acts within minutes to antagonize the effects of
hyperkalemia on th cell membranes of the heart. sodium polystyrene sulfonate
removes potassium via the gastrointestinal tract.

Electrolytes
clinical features of Hyperkalemia! ECG CHANGES 1. tall peaked T waves with

shortened QT interval 2. PR prolongation & QRS widening 3. disappearance of P wave
4. conduction blocks, ectopy, or sine wave pattern. Extracariac effects-> weakness,
flaccid paralysis, metabolic acidoosis. Rapidly tx options-> calcium infusion, insulin with
glucose, beta 2 adrenergic agonist(albuterol), sodium bicarbonate. Removal of K (slow
acting) ->diuretics, cation exchange resin, hemodialysis

Electrolytes
cytinuria is an inherited disease causing recurrent renal stone formation. look for a
personal hisptory of recurrent kidney stones from childhood and a positive family
history. The characteristic stones are hard and radioopaque. urinalysis shows typical
hexagonal crystals. the urinary cyanide nitriprusside test is widely used as a qualitative
screening procedure. HIGHYIELD

Electrolytes
abnormal hemostasis, platelet dysfunction is a common manifestation seen in pts with

chronic renal failure. abnormal blding and bruising are characteristic of uremic
coagulopathy. 1. a number of agents such as desmopressin (DDAVP), cryoprecipitate,
and conjugated estrogens have been used to correct the coagulopathy in uremic pts.
DDAVP increases the release of factor Vlll: von williebrand factor multimers from
endothelial sotrage sites.
Medicine

Electrolytes
Platelet dysfunction is the most common cause of abnormal hemostasis is a common

manifest in pts with (uremic pts)chronic renal faiulre. PT, PTT, and platelet count are
normal. BT is prolonged. desmopresin (DDAVP) is usually the tx of choice, if needed.
DDAVP increases the release of factor Vlll (Von Williebran factor multimers from
endothelial storage sites. Platelt transfusion is not indicated because the transused
platelets quickly become inactive. EXTREMELY HIGH YIELD!!!
Medicine

Electrolytes
Pulmonary-renal syndromes include a variety of disorders with simultaneous

involvement of the lung and kidney. EMergencyplasmapheresis is required in patients
with godpastures syndrome. 2. Granulomatosis with polyangitis (egeners) is treated
with a combination of cyclophosphamide and steroids.
Pediatrics

Electrolytes
renal complications of sickle cell trait include hematuria, renal medullary carcinoma,
and uti. painless hematuria is likely due to renal papillary ischemia or necrosis. the
relatively low partial pressure of oxygen in the vasa rectae predisposes the affected
red bld cells to sickling. papillary necrosis can occue with massive hematuria, but the
episodes are usually mild and resolve spontaeously.
3654
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Medicine
Medicine
Medicine
3984
Medicine

Electrolytes
Focal and segmental glomerulosclerosis: most common form of glomerulopathy

associated with HIV. Typical presentation of focal segmental glomerulosclerosis
includes nephrotic range proteinuria, rapid development of renal failure (azotemia),
&normal sized kidney. 1. other forms of HIV related glomerulopathies that can present
with nephrotic range proteinuria are membranous glomerulonephritis, often seen if
they also have Hep B infection, mesangioproliferative & diffuse prolif
3997
Medicine

Electrolytes
multiple myeloma is the most common cause of AL amyloidodsis, and rheumatoid

arthritis is the most common cause of AA amyloidosis

Electrolytes
analgesic nephropathy-> painless hematuria, sterile pyruira, wbc casts, trace

proteinuria) suggests a non-glomerular disorder affecting the tubulointerstitium or
lining of the urinary tract. - chronic analgesic use can cause chronic kidney dz due to
chronic tubulointerstitial nephritis. pts r typically asymptomatic with an elevated
creatinine found incidentally. pts can also develop painless and prominent hematuria
due to papillart ischemia. significant pap nec=renal colic

Electrolytes
analgesic nephropathy is the most common form of drug-induced chronic renal failure.
Papillary necrosis and chronic tubulointerstitial nephritis are the most common
pathologies seen. pts with chronic analgesic abuse are also more likely to develop
premature aging, atherosclerotc vascular dz and urinary tract cancer. 2. acute tubular
necrosis causes acute renal failure... seen in ischemic or neohrotoxic acute renal
failure, muddy brown granular casts are characteristic.

Electrolytes
simple renal cysts are most commonly seen in pts >50. they are benign and often
discovered incidentally by radiologic examination. most of the time, cysts do not cause
htn, flank pain, hematuria, or proteinuria. infections occur rarely... incidentally
discovered cysts with benign features require no additional f/u evaluation or imaging,
and the pt may be reassured. 2. ureteral stent placement is indicated when there is
urinary obstruction at the ureter or renal pelvis.

Electrolytes
the most common causes of hyperkalemia include acute or chronic kidney disease,
medications, or disorders impairing the renin-angiotensin axis. common affending
medications include nonselective beta-adrenergic blockers, k sparring diuretics
(amiloride), ace inhibitors, arbs, and nsaids. 1. pateints may develop ascending
muscle weakness with flaccid paralysis and ECG changes (peaked T waves followed
by short QT interval, widening QRS and sinus wave v-fib.
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Medicine
Medicine
Medicine
Medicine
4361
Medicine

Electrolytes
ureteral calculi may cause flank or abdominal pain radiating to the perineum, often
with nausea and vomiting. iltrasonography or non contrast spiral CT scan of the
abdomen and pelvis are the imaging modalities of choice to confirm the diagnosis. 2.
HIDA scan is indicated in pts with acute cholecystitis when u/s cannot definately
demonstrate obstruction at the neck of the gallbladder. in acute cholecystitis, pain is
located upper abdomen radiating to tip of right scapula/shou
4423
Medicine

Electrolytes
mg is an important cofactor for potassium uptake and maintenance of intreacellular

potassium levels.
Medicine

Electrolytes
HYpernatremia reflects a water deficit in relation to sodium, and it most often occurs in
people who are debilitated or have altered levels of consciousness and cannot access
free water. 1. the most common cause of hypernatremia is hypovolemia.mild cases
can be treated with 5% dextrose in .45% saline. Severe cases should be initially
treated with .9% saline. 1. 5% dextrose in water (D%W) is the tx of choice for pts with
euvolemic and hypervolemic hypernatremia.
4428
Medicine

Electrolytes
succinylcholine is a depolarizing neuromuscular blocker, however it can cause

significant k release and life threatening arrythmias, and so it should not be used with
pts who are high risk for hyperkalemia.... non polarizing agents such as vecuronium or
rocuronium are better choice in these patients.
4432
Medicine

Electrolytes
amitriptyline is a tricyclic antidepressant with anticholinergic properties.
4435
Medicine

Electrolytes
Diruetics are often used in the tx of COPD pts who have developed cor pulmonale
must be cautiosly used bc these patients are at risk of having a reduction in cardiac
output, with subsequent development of prerenal renal firlure.
4535
Medicine

Electrolytes
the underlying cause or acidemia results in lethargy and altered mental status.
4548
Pediatrics

Electrolytes
posterior urethral valves are the most common cause of urinary obstruction in
newborn boys. classic findings on prenatal ultrasonography include bladder distension,
bilateral hydroureters, and bilateral hydronephrosis... oligohydramnios from low urine
production can cause pulmonary hypoplasia and postnatal respiratory distress.
4567
Medicine

Electrolytes
low renal bld flow causes release of prostaglandins that dilate the afferent arteriole to
maintain GFR, aspirin inhibits the effects of prostaglandins.
4424
nephritic glomerulonephritis usually presents with urinary sediment containing red bld
cells, occasional white bld cells, and red cell or mixed cellular casts. edema in these
patients is due to decreased glomerular filtration rate and retentionof sodium and
water byt he kidneys.
4591
Medicine

Electrolytes
4733
Medicine

Electrolytes
urinary retention caused by anticholinergic agents results from failure of detrusor

contraction. Detrusor activity is controlled by parasympathetic input from the pelvic
splanchnic nerves.

Electrolytes
MEDICATIONS THAT CAN CAUSE HYPERKALEMIA - cyclosporine blocks aldosterone

production - nsaids deacreases renal perfusion resulting in decreased k deliveryto the
collecting ducts - succinylcholine causes extreacellular leakage of patassium though
acetylcholine receptors. - digitalis- inhibition of the na-k-atpase pump - trimethoprim
can cause hyperkalemia. it may also cause artificial increase in serum creatinine
without affecting the GFR
8331
Medicine
10287
Medicine

Electrolytes
hematuria (gross or microscopic) can be due to glomerular or non glomerular causes.

the sourse of hematuria is more likely to be glomerular if the urine studies reveal
proteinuria, dysmorphic RBC;s or RBC casts. 2. Acute tublar necrosis is characterized
by acute azotemia following a hypotensive or nephrotoxic injury. pts may have a coca
cola colored urine but significant hematuria is uncommon.
2450
Pediatrics
Rheumatology/Orthopedics
& Sports
confirmatory/specific tests for SLE are antismith antibody and anti double stranded
DNA test.

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