USMLE WORLD: MEDICINE

y Primary Adrenal Insufficiency: hypotension, pigmentation, hyponatremia, hyperkalemia, eosinophilia, elevated ACTH, low cortisol. MCC in developed countries is autoimmune adrentalitis with Ab against steroidogenic enzymes. History of other AI diseases (especially endocrine). Endocarditis: fever, generalized weakness, new right sided heart murmur (increase with inspiration). History if IVDA and cellulitis. Staph if IVDA, strep and entero if not. Vancomycin is most commonly used as empiric therapy in IVDA due to MRSA coverage. Folic Acid Deficiency: present with megaloblastic anemia. MCC is poor diet and alcoholism. Phenytoin, primidone, phenobarbital inhibit folate absorption. TMP and methotrexate inhibit DHFR causing folate deficiency. Huntington s Disease: autosomal dominant that presents 30-50 years. Mood disturbances (depression, apathy), dementia, choreiform movements, positive family history. Symptoms are progressive -> severe disability. UTI: lower abdominal discomfort, burning, increased frequency, suprapubic tenderness, significant bacteriuria. Predisposing factors: antibiotics, genital infections, contraceptives (diaphragm, spermicide), poor hygiene. Occur via ascending route. Systemic Sclerosis: affects all organ systems. Cutaneous findings are that of scleroderma. Thickening of the skin, edema -> obliteration of hair follicles and sweat glands and flexion contractures. Mask like appearance to face. Myofibroblast proliferation -> increased collagen and ground substance production. Kidney involvement -> hypertension. Pulmonary hypertension -> right heart failure. Esophageal and gastric dysmotility -> GERD. Find ANA and anti-topoisomerase I antibodies. Clostritidum difficile Diarrhea: antibiotic treatment predisposes. Diffuse watery, non bloody, diarrhea with abdominal cramps and fever. Nausea, vomiting, elevated WBC. Toxin to intestinal epithelial cells. Detect toxin in the stool. Treat with IV/oral metronidazole. Oral vancomycin can also be used. Acute Limb Ischemia: sudden decrease in perfusion that threatens limb vitality and presents 2 weeks of symptom onset. Pain, pulselessness, pallor, parasthesias, paralysis. Due to embolism (MCC), thrombosis, trauma. Atrial fibrillation -> embolism. Prevent with warfarin. Essential Tremor: action/intention tremor in the absence of other neurological signs. Difficulty holding newspaper, writing legibly, drinking coffee, feeding themselves. Treat with beta blocker (propranolol). Primidone or topiramate also work. BZDs can be helpful but run risk of addiction. Creutzfeldt Jakob Disease: rapidly progressive dementia, myoclonus, sharp periodic bi/triphasic synchronous discharges on EEG. Caused by a prion -> spongiform encephalopathy. CSF is usually normal. Most patients die within 1 year. Rotator Cuff Tendonitis: shoulder pain with reaching or lifting arm overhead. Due to repetitive activity at shoulder height (painters), MC in middle aged/older. Confirmed on PE by Neer test with pain and guarding. Confirmed with lidocaine injection -> improvement. MRI for definitive diagnosis. HIV Infection: increased risk of viral, bacterial, fungal, protozoan infections. Need vaccinations at diagnosis, especially influenza, hepatitis, Strep pneumo. MMR is necessary

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(measles can be fatal in HIV). Can give with CD4 > 200, and no history of AIDS defining illness. y Lung Adenocarcinoma: least association with smoking. MC type of lung cancer, even in non smokers. Located peripherally. Columnar cells growing along septa. Presents as solitary nodule. Bronchoalveolar type is most important. Related to pulmonary scars as in fibrosis. Metastisizes early to adrenals, bone, CNS. HIV: presents with nonspecific symptoms such as weight loss, malaise, neurological changes, anorexia, weight loss. Usually present early, can present late with PJP or Candida esophagitis. HIV Dementia: waxing and waning, difficulty with complex tasks, poor memory, apathy. Mixed Cryoglobulinemia:palpable purpura, proteinuria, hematuria, non-specific systemic symptoms, arthralgias, hepatosplenomegaly, hypocomplementemia, peripheral neuropathy. Demonatrate circulating cryoglobulins to confirm. Usually have underlying HCV infection. Acute Cord Compression: back pain with associated tenderness at the site of metastasis (usually prostate). Progressive or sudden compression with neurological deficit can ensue. Medical emergency that needs prompt treatment. First do neurological exam for signs of myelopathy (if so, give steroids). Then do MRI or CT myelogram if no MRI. Radiotherapy to treat. Respiratory Acidosis: decreased pH, primary increase in PCO2. Along with low PO2 levels, suggest alveolar hypoventilation (MCC). Causes: pulmonary/thoracic (COPD, OSA, CF, obesity, scoliosis, ankylosis), neuromuscular (MG, LE, poliomyelitis, muscular dystrophy, GBS, ALS), drug induced (anesthesia, narcotics, sedatives), primary CNS (brainstem lesion, infection, stroke). Bronchodilator Response Test: used to demonstrate reversibility if airway obstruction. Differentiates COPD from asthma, but subset of COPD will have airway reactivity (diseases are on a continuum). Measure FEV1 before and after bronchodilator (beta agonist). Increase of 15% needed for reversibility. Low DLCO and CT findings support COPD. Iron Deficiency Anemia: hypochromic/microcytic anemia, low iron/ferritin. MCC is chronic blood loss. Can be caused by dietary deficiency or malabsorption. Adult male or post menopausal female -> test for occult blood in stool. PUD, angiodysplasia, diverticulosis are other causes. Niacin: used to treat lipid abnormalities. Frequently produces flushing and pruritis due to vasodilation. Caused by drug induced release of histamine and PG. Low dose ASA can help alleviate if taken 30 minutes prior. Usually improve after 2-4 weeks of therapy. TCA Overdose: CNS depression, hypotension, hyperthermia, anticholinergic effects (dilated pupils, blocks SLUD). Decreases myocardial conduction velocity -> wide QRS (best indication of extent of OD) -> ventricular arrhythmia. Treat with NaHCO3 (narrows QRS). Renovascular Hypertension: headache, elevated BP, renal bruit due to RAS (fibromuscular dysplasia in young women, atherosclerotic in older). Interventional therapy is better than medical alone. Attempt angioplasty and stent. If patient is older, not good candidate or refuses surgery, can use medications alone (ACE and diuretics). Generalized Resistance to Thyroid Hormones: hypothyroid can be caused by thyroid (primary), pituitary (secondary), hypothalamus (tertiary), or GRTH. Results from receptor defects on peripheral tissues. Present early with growth and mental retardation. Elevated thyroid hormones and normal/elevated TSH. Features of hypothyroid with elevated T3/T4.

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Lambert Eaton Syndrome: caused by Ab against voltage gated calcium channels in presynaptic motor nerve -> decreased Ach release -> proximal muscle weakness and loss of DTR. History of features of SCC of the lung. Muscle response increases with repetitive simulation. Treat with plasmapheresis and immunosuppressants. Myasthenia Gravis: caused by Ab to postsynaptic receptors -> reduction of Ach receptors -> muscle weakness and preservedor brisk DTRs. History of features of SCC of the lung. Muscle response decreases with repetitive stimulation. Microangiopathic Hemolytic Anemia: elevated serum LDH and schistocytes. Have decreased haptoglobin, reticulocytosis, elevated indirect BRN. One cause are artificial valves. Pulseless Electrical Activity: presence of rhythm with no palpable pulses. Any patient with arrest with nonshockable rhythm (anything other than VF/VT) -> give CPR, establish airway, give 100% O2. Atrial fibrillation is not a shockable rhythm during arrest with no pulses. IV access for epinephrine, vasopressin, atropine. Caused by 6H s (hypovolemia, hypoxia, hydrogen/acidosis, hypoglycemia, hyper/hypokalemia) or 6T s (tamponade, tension pneumothorax, thrombosis/MI/PE, trauma/hypovolemia, tablets/drugs, toxins). Vitamin B12 Deficiency: common after total or partial gastrectomy (gastric derived IF binds B12 and facilitates absorption in the stomach). Necessary cofactor for demethylation of methyl-THF -> THF needed for purine synthesis. Other causes: pernicious anemia, gastritis, intestinal disorders, old age. Presents as megaloblastic anemia with glossitis and neurologic changes. Aortic Dissection: three clinical findings: abrupt onset tearing pain in chest or back, variation in pulse/BP between arms, wide mediastinum on CXR. Tear in intima -> subintimal hematoma. HTN, smoking, family history of CAD. May extend into pericardium, CA, carotids > tamponade, MI, stroke. Nephritic Syndrome: dependent edema, hypertension, hematuria with or without dysmorphic RBC or RBC casts. Decreased GFR -> fluid overload -> weight gain, hypertension, exertional dyspnea. Rash, low grade fever possibly due to systemic disease. UA -> RBC with or without casts. May have proteinuria. Biopsy to determine exact type of GN. Testicular Cancer: AFP, beta-HCG, placental ALP are useful for diagnosis, staging, monitoring patients. Seminoma: PLAP, embryonal carcinoma: AFP + beta-HCG (50%), choriocarcinoma: beta-HCG. LDH and CEA have some use but are non-specific. Pneumocystis Jiroveci Pneunonia: an important cause of progressive dyspnea and hypoxia in HIV/AIDS patients. Hypoxia in pneumonia results from alveolar and interstitial inflammation -> V/Q mismatch -> increased A-a oxygen gradient. Polymyositis: inflammatory muscle disease. Slowly progressive proximal muscle weakness > difficulty standing or climbing stairs, difficulty combing hair or working overhead. Muscles of mastication and facial expression are spared. May develop dysphagia due to involvement of upper pharyngeal muscles. Weakness is primary, may have mild tenderness. Muscle biopsy is diagnostic. Shows mononuclear infiltrate surrounding necrotic/regenerating fibers or overt fibrosis. COPD: recurrent pulmonary infections, chronic cough, smoking history, increased AP diameter, wheezing. Chronic hypoxemia -> constriction of pulmonary arterial system -> pulmonary hypertension -> RVH -> RVF -> elevated JVP, hepatosplenomegaly, hepatojugular reflex, lower extremity edema. NO PULMONARY EDEMA.

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homonomous hemianopia. diseased arteries are maximally dilated and cannot increase blood flow and is redistributed to non-diseased segments. CO binds with high affinity to Hgb -> displaces O2 -> decreases O2 content and causes left shift of Hgb O2 dissociation curve -> decreased unloading of O2 -> increased anaerobic metabolism -> lactic and anion gap metabolic acidosis. CD4 < 50. Managed conservatively with analgesics (meperidine or fentanyl). Increases endometrial cancer and uterine sarcoma. Also have increased risk of venous thrombosis. acute respiratory distress syndrome. elevated serum amylase and lipase. decreased BRN excretion (tubular necrosis). altered mental status. If CD4 < 50. MC site is the putamen (35%). private. First line is methotrexate. Lab tests show rheumatoid factor and anti-cyclic citrullinated peptide. decreased liver function (hypotension). Atypical Mycobacterium: HIV infected. juxta-articular osteoporosis. malaise. comfortable environment o Ask patient how much they know or what they think o Ask patient how much they want to know o Give warning shot saying you have bad news o Break the news if they want you to o Give prognosis. Can develop HA. massive blood replacement. ulnar deviation. Can have hemi-sensory loss. Radiographs show joint erosions. Reduces risk of recurrence and new cancer in the other breast. Can cause chronic interstitial pneumonitis. NPO. flatulence. DMARDs are used early to promote remission. stupor. Postoperative Cholestasis:hypotension. IVF. Internal capsule is adjacent -> hemiparesis. vomiting. cough. Causes acute abdomen. Breaking Bad News: o Quiet. coma. Fever. Shock and CO poisoning are causes. Onset is not abrupt like SAH or embolism. y y y y y y y y y y . azathioprine. Eyes deviate away from paralytic side. organizing pneumonia. extensive blood loss into tissues. boutonniere. Redistribution of coronary blood flow to non-diseased segments is called coronary steal. Rheumatoid Arthritis: symmetric polyarthritis. PIP and MCP joints are affected. Dipyridamole: is a coronary vasodilator along with adenosine. Side effects are dose dependent. sulfasalazine. unexplained fever. Dermatitis herpetiformis is also associated (chronic intensely burning pruritic papulovesicular rash) with granular IgA deposits in upper dermis. infliximab. leflunomide. Jaundice due to increased pigment (transfusions). Hypertensive Hemorrhage: focal neurological signs that gradually worsen over minutes to hours. Acute Pancreatitis: pain radiating to the back. Celiac Disease: intermittent abdominal distension. keep aware of options available o Explain everything as clearly and simple as possible Tamoxifen: mixed agonist and antagonist on estrogen. leukocytosis. Can use NG if necessary to decrease gastrin release. narrowing of joint spaces. Used during myocardial perfusion scanning to reveal areas of restricted perfusion. Avoid in patients with pre-existing lung disease. Can also use hydroxychloroquine. greasy stool. morning stiffness > 1 hour. swan neck. Amiodarone: causes pulmonary toxicity.y Lactic Acidosis: if results from poor O2 delivery to tissues is called type A. etanercept. Iron deficiency is one of the most common presentations (iron absorbed in duodenum). no history of or exposure to tuberculosis. weight loss. give azithromycin as prophylaxis. With CAD.

Mycobacterium avium complex. people with recent influenza. odynophagia. iron deficiency anemia in addition to typical symptoms.y Migraine: suspected with unilateral headache with a pulsatile quality. crystal induced. y y y y y y y y y y y y . Surgical debridement is necessary and antibiotics (ampicillin+sulbactam and clindamyacin). Extraocular symptoms are the most common. overt or occult bleeding. Sudden onset pain and swelling. Immunosuppression increases risk. Frequently reassess. Campylobacter. Inflammatory Monoarthritis: septic. Treat with antibiotics. especially with Staph aureus. and test for C diff toxin. outpatient follow up. extremity weakness. Acute Pain: all patients should receive same standard pain management regardless of drug history. No concerning features are present. Do fluid analysis. Triptans can also be effective if used early in course of migraines. Systemic signs of toxicity can be present. Endoscopy is also indicated if medications fail. Skin and mucous membranes can be affected. contralateral vibration and proprioception loss. patients with CF. gram stain. Tar derivatives. Smoking cessation and home O2 therapy are the only two things shown to decrease mortality. G(+) clusters on gram stain. CMV. culture. Fluctuating weakness in voluntary muscles -> diplopia. Occurs after trauma or foreign bodies. especially if accompanied by vomiting and photophobia. O&P. trauma. Give IV antiemetics (chlorpromazine. A disease of the NMJ. History of DM. Vanishing Bile Duct Syndrome: progressive destruction of intrahepatic bile ducts with ductopenia on biopsy. prochlorperazine. GAS or Staph aureus are usual cause. radiation predispose. Serious complication of influenza. Toxic Adenoma: clinical features and lab findings of hyperthyroid with iodine scan showing uptake in one area and suppression of rest of gland. suspect SCC in a chronic wound -> non-healing. weight loss. Purple discoloration and gangrene. Necrotizing Fasciitis: infection involving fascia of deep muscles. painless. Staph Aureus Pneumonia: most often affects hospitalized patients. pH monitor if (-) endoscopy. nursing home residents. referral to pain specialist if abuse is suspected. Emphysema: permanent airway destruction without obvious fibrosis. Medial Medullary Syndrome: contralateral spastic hemiplegia. Myasthenia Gravis: decreasing muscular strength with continued contraction. Complicated GERD: dysphagia. injection drug users. metoclopramide) acutely solo or with NSAIDS. Septic should be considered until proven otherwise. Shigella. Diarrhea in HIV: Salmonella. Cryptosporidium. ptosis. Rough scaly nodules -> ulcerate -> metastasize. Punch biopsy confirms. Chronic Wounds: until proven otherwise. Giardia. C diff. Treat with antibiotics and joint drainage. Never undertreat pain even with risk of abuse. Sometimes have an aura of neurological symptoms. Endoscopy is indicated and possible biopsy. Use IV morphine. History of RA predisposes to septic arthritis. SCC is cancerous changes in the mid epidermis -> extension into dermis. carcinogens. Evaluate with stool culture. Do not have infiltrative ophthalmopathy. PBC is MCC of ductopenia in adults. tongue deviation towards injured side. Occlusion of vertebral artery or one of branches. bleeding ulcer. Sun-exposed or burn areas are involved.

Lynch I is hereditary site specific CoCa. y y y y y y y y y y y y . Complicated by hypercoagulation due to loss of antithrombin 3. Atrial Fibrillation: causes LV diliation and decreased EF due to tachycardia. Hartnup s disease. PCP: bilateral interstitial opacification. Lynch II is cancer family syndrome and high rate of extracolonic tumors. common in people on corn based diets. tremors. no hilar LA. Thyrotoxicosis: weight loss. Pulsus Paradoxus: usual drop in systolic pressure during inspiration is < 10 mm Hg due to increased venous return to right -> impeding LV filling. Triad of D s: diarrhea. < 30 seconds. carcinoid syndrome. Due to increased myocardial SR Ca-dependent ATPase. rupture. tachycardia. Treat with intubation and withdrawl of anti-AChE for several days. iron resistant microcytic hypochromic anemia due to transferrin loss. Myasthenia Crisis: weakness of respiratory/pharyngeal muscles that is life threatening. Also in alcoholics. tension pneumothorax. also use antibiotics. severe asthma (elevated intrathoracic pressures -> impedence of LV pumping). Renal vein thrombosis. PE can occur. Can cause protein malnutrition. pleural effusion. Hyperdynamic state -> HTN. Immediate defibrillaion in the first 4-5 mins improves survival. HNPCC: Amsterdam Criteria I: at least 3 relatives with CoCa with one being first degree of other 2. cavitation. no atrial kick. Match case and control based on confounding factor or stratify based on confounding factor. FAP excluded. If smaller. MC is endometrial cancer (43% of affected females). Monitor PFT s bedside when suspected. Isoniazid: causes hepatits picture via idiosyncratic liver injury with histological features similar to viral hepatitis. irritability. AAA: surgery if > 5 cm. Atherosclerosis is precipitant. enlargement. Untreated -> death. MPGN. 2 mins CPR prior to shock improves survival. For unwitnessed or when defibrillator is not available. Mycoplasma or Chlamydia also suspected. Control rate and/or rhythm to improve LV function. do periodic imaging. Cardiac Arrest: leading cause for witnessed. Also give azithromycin until PCP confirmed and evaluate for HIV infection. Diagnosed by EEG with activation procedures. Caused by tamponade. one before 50 y/o. Increased sensitivity to catecholamines by increasing adrenergic receptors. arterial thrombosis. Altered permeability of GBM due to MCD. symptoms present. Confounding: bias that results in exposure-disease relationship with effect of extraneous factors. decreased thyroxine levels due to loss of thyroxine binding globulin. AV dissociation. Nephrotic Syndrome: proteinuria (>3-3. lid retraction.y Pellagra: dietary deficiency of niacin. Cessation is best intervention to slow progression. outside hospital events is ventricular arrhythmia. cardiomegaly. MCC is intercurrent infection. membranous. edema. vit D deficiency due to loss of cholecalciferol binding protein. Return is also abrupt. > 2 generations. Systolic HTN and increased PP. Can cause high output failure. Smoking is major RF for formation. hyperlipidemia. mesangial proliferative. FSGN. dermatitis in sun exposed areas. rapid rate of growth. hypoalbuminemia. Absence Seizures: sudden cessation of ongoing mental activity.5 g/day). increased susceptibility to infection. DOC is TMP-SMX or pentamidine. PP when drop in systolic > 12 mm Hg with inspiration. lipiduria. No post ictal state or confusion. Influence both exposure and outcome. or decrease in Ca-inhibiting protein and phospholamban. dementia.

urinary retention due to failure of contration of detrussor (worse in patients with BPH). Treat underlying cause. Have hum or bruit at CVA due to collateral circulation. throat pain. heart disease. acute inflammation. Tylenol. Also seen in premenopausal women. SE and CI increase. Acute. Larger CI indicates wider range of effects. hydroxizine) have anti-Ach effects -> dry eyes. eosinophilia. chlorpromazine. wheezing. volume depletion. respiratory tract. See tachycardia. neurofibromas. Pleural fluid has high amylase. contrast extravasation from swallowing. Acute Bronchitis: common cause of blood tinged sputum due to virus. baroreceptor -> vasodilation).y Drug Induced Liver Injury:rash. can contain food. tachypnea. Hyperkalemia can ensue. subcutaneous ephysema. Howell Jolly Bodies: nuclear remnants in RBCs usually removed by spleen. As SD increases. Confidence Interval: mean + standard score (z) * Standard Error of Mean (SD/root n). Observe and follow. and dysuria. Progresses to macroproteinuria (> 300 mg/d) and decreased GFR. mouth. widened mediastinum. Anemia of Chronic Disease: usually normocytic. dyspnea. Lisch nodules of iris. doxepin. 4) Toxic/fulminant liver failure. arthralgias. FN increase. severe chest pain or epigastric pain after retching. Weight loss or more blood suggest TB or malignancy. congestion. No hematemesis. arrhythmia. diuretic abuse. Fever and dyspnea common. Decreased iron. Occurs via direct cytotoxic effects or idiosyncratic reaction. chromosome 22. Antihistamines: first generation anti-H1 (diphenhydramine. Lack of history or physical indicating more severe disease. Diabetic Nephropathy: starts with hyperfiltration (increased GFR) and microalbuminuria. Ferritin can be normal or high. Catagorized by morphology: 1) Cholestatic. < 130/80. Boerhaave Syndrome: spontaneous esophageal rupture. Left ventricular hypertrophy is present. Hypertrophic Cardiomyopathy: crescendo-decrescendo systolic murmur along LSB without carotid radiation. Fibromuscular Dysplasia: MCC secondary HTN in children. Treat with isotonic saline infusion. Usually due to physical or functional asplenia due to infarction. bony lesions. axillary freckles. Autosomal dominant. 2) Fatty liver. False Negatives: patients with negative test who have the disease. No fever (rules out pneumonia). Intensive BP control reduces decline in GFR. infiltration. Right more affected than left. Single. As n increases. Saline Responsive Metabolic Alkalosis: urine chloride < 20 mEq/L and due to GI proton loss (ex vomiting in bulimia). Angiography shows string of beads pattern. antiretrovirals). Location and no radiation differ from AS. Associated with chronic inflammatory conditions. leukocytosis. ischemia. transferrin. halothane. DM. chest pain. Involves iron trapping by macrophages. y y y y y y y y y y y y . blue inclusions on Wright stain. fever. Have malaise. Direct is dose dependent with short latent periods (tetrachloride. low pH. TIBC. tetracycline). Symptoms of syncope (due to outflow obstruction. ACE and ARB are preferred and decrease decline GFR in patients with significant azotemia and proteinuria > 1 g/d. round. Type I has café-au-lait spots. chlorpheniramine. Idiosyncratic is not dose dependent with variable latent periods (INH. When cutoff levels are raised. Neurofibromatosis: neurocutaneous syndrome. SE decreases. 3) Hepatitis. 5) Granulomatous.

Varicoceles (usually left) fail to empty when patient lies down. Obstructive Uropathy: flank pain (capsular distension).Type II has brain tumors especially BL acoustic neuromas (diagnostic). renin secreting tumor. renovascular disease (2 most common). renovascular disease has high plasma renin activity. Develop CNS. Attempt iron first. then erythropoietin injections (Hgb < 10. suggests advanced/metastatic disease. Silent (same sense) mutations do not affect the protein structure. visceral tumors. have excessive daytime sleepiness. Ask patients to fill in clock. skin. Parenchymal disease (infections. responsible for spatial organization. neuroectodermal tumors can ectopically produce PTH. HTN. trauma. Penicillin V to treat. kidney angiomyolipomas. Hypoxia -> erythropoietin -> polycythemia. only seen in 10%. correlation coefficient can be calculated. will only fill in one side. (+) rapid strep do not need culture confirmation. glucocorticoid suppressible hyperaldosteronism. rhinorrhea. ignore people on one side. y y y y y y y y y y y y . impotence. exudative pharyngitis. UA shows RBC and WBC but no casts. Hct < 30 if iron deficiency is ruled out). painful cervical LA. Increased erythropoietin -> polycythemia. PTHrP. diffuse alveolar hemorrhage). y Sturge Weber: neurocutaneous syndrome. mental retardation. Bacterial Pharyngitis: MCC is GAS. Hodgkin s disease has increased calcitriol. Lots of overlap -> confirm with rapid strep test. lung. Treatment improves polychythemia. With non metastatic solid tumors produce PTHrP -> low PTH levels. May only shave. 15% have headaches. ectopic PTH. Hypertension and Hypokalemia: caused by primary hyperaldosteronism. remove fluid by dialysis and give beta blockers or vasodilators). (-) do. Patients are overweight. some forms of CAH. exanthum. PNS. angiomatous malformations of the brain. Port wine stains in V1 distribution. Ash leaf hypopigmentation. morning headaches. and vascular (AV malformations. Metastases to bone cause osteolysis due to IL-1 and TNF (usually lung and breast). normochromic due to erythropoietin deficiency. hemiparesis. intermittent high volume (obstruction overcome). 5% have flu like symptoms (in IV route. comb. Hemoptysis: can be blood streaked sputum to massive with respiratory failure. bronchiectasis. seizures. thrombocytosis. Hemi Neglect: patient neglects one side and only senses the other. Viral pharyngitis: conjunctivitis. Classic triad: flank pain. Do CXR to check for cancer. Anemia in ESRD: normocytic. Airway disease (bronchitis. OSA: recurrent transient obstruction of upper airway due to pharyngeal collapse. With significant smoking -> think chronic bronchitis. Mutations: nonsense and frame shift mutations are typically more severe than missense or splice site mutations. snoring. Primary HA has low plasma renin activity. hematuria. Hematuria is frequent (40%). Renal Cell Carcinoma: usually asymptomatic. 30% have worsening HTN (10 mm Hg in SQ route. tumors) are MCC. If linear. Abdominal CT to diagnose. Caused by lesion in right (non-dominant) parietal lobe. poor urine output (obstruction). Fever. PE). cardiac rhabdomyomas. Can demonstrate association (linear or non-linear) if one is present. Tuberous Sclerosis: neurocutaneous syndrome. syndrome of apparent mineralocorticoid excess. Hypercalcemia: malignancy is a common cause via cytokines. Rare red cell aplasia. calcitriol. seizures. Ovarian. use antiinflammatories). Scatter Plots: useful for crude analysis. palpable abdominal renal mass.

Decubitus Ulcer: common in patients with diseases that impair normal sensation or movement. Acetazolamide if no weight reduction. with normal imaging. double contrast barium enema. May develop during hospitilization for acute issue. Syphilis: chronic systemic infection. diagnose. moist skin or mucous membrane papules. tachycardia. Young. AAA. does not have thick or irregular walls. Median survival is 1 month without treatment. blind as bat. Steroids are symptom control. Then are observed for development of disease. To determine. With known CAD or CAD equivalent (diabetes. Treat with weight reduction. ectopic ACTH. May also be chronic infectious. Will have invasive cords of squamous cells with keratin pearls. subjects without disease must be followed for a period of time to see if they develop it. Interval to repeat depends on test. Involves trunk. not healed for a long time. A prospective observational study where group is chosen based on presence or absence of certain factors. With 2. With 0-1. headache. Benign and incidentally discovered. Will have history of occupational sun exposure. colonoscopy. when pressure > 32 mm Hg (normal arteriolar pressure). do not increase survival. goal LDL < 100. thickened septae. chronic autoimmune. most significant complication. psych problems. HTN. heels. Trihexylphenidyl and benztropine are used for Parkinsons and EPSEs. improve local control. Change position every 2 hours. low HDL. ACTH adenoma (Cushing s disease). 10 year risk > 20%). VI nerve palsy. OCP also associated. full as flask. If multiple. elbows. or contrast enhancement. dry as bone. Result from adrenal cortical hyperplasia. Also enhance insulin resistance (hyperglycemia) and mineralocorticoid activity (hypokalemia). thin skin. symptomatic CVD. 45 in women. Simple Renal Cyst: most commonly seen in patients > 50. headaches. Colon Cancer Screening: regular screening at 50 years old. palms. y y y y y y y y y y . mad as hatter. hot as hare. Secondary -> systemic infection with malaise. flexible sigmoidoscopy. visual field defects. Simply observe and no follow up needed. Can have history of steroid use or vitamin A. smoking. If single with stable extracranial disease. Risk factors are (+) FH. anorexia. generalized MP rash. Proximal weakness. Serology is positive. just do whole brain radiation. Cohort study is best option. Make sure its not multiloculated. Squamous Cell Carcinoma: ulcer that is solitary. goal LDL < 130. Develop condyloma lata: broad exophytic formations in anogenital region or upper thighs that ulcerate. Primary -> chancre. Major of lip cancers are well differentiated SCC. Develop rapidly when preventative measures not taken. soles. surgery is done first to relieve mass effect. Can have papilledema. ears). age. central obesity. If fail or visual field deficits progress -> shunt or optic nerve sheath fenestration to prevent blindness. goal LDL < 160. located in keratinized epithelium of the vermillion zone of lower lip. single or multiple. steroid administration. Constant unrelieved pressure -> necrosis of overlying skin and muscle. Can have dizziness. elevated CSF pressure. Usually asymptomatic. Can precipitate acute glaucoma due to mydriasis. obsese female with headache suggestive of brain tumor. Can do FOBT. Cushing s Syndrome: high cortisol -> vasoconstriction -> secondary HTN. Lipid Screening: start at age 35 in men.y Incidence: frequency of new cases over a period of time. There is impaired CSF absorption. Then do whole brain radiotherapy to destroy residual. Pseudotumor Cerebri: benign intracranial HTN. seen frequently in NSCLC. Occur over bony prominences (sacrum. extremities. Sometimes can become infected. Usually at gray-white junction. Brain Metastases: most common type of intracranial brain tumor. Anticholinergic Toxicity: red as beet.

non productive cough. Kussmaul s sign (decrease of JVP on inspiration) can be present but not specific. Disseminated Gonorrhea: gonococcal bacteremia due to untreated mucosal gonorrhea infections. With neurological defecit and perianal anesthesia -> cauda equina syndrome. Use NSAIDs and muscle relaxants. Decreased lung volumes. Secure ABCs. Manage conservatively. Look at population with outcome and subjects are either cases or controls. y y y y y y y y y y y y . Dyspnea. Epidemiological Studies: goals are to be descriptive and analytical. ratios. Has least bias and shows strong causal relationship. Blood cultures often negative. do imaging MRI or CT with or without contrast. Randomized Control Trial: gold standard for studying efficacy of treatment or procedure. Decreases myocardial conduction velocity -> QRS widening -> risk of ventricular arrhythmia. Occurs with large parenteral doses. May develop permanent hypothyroidism. Exercise and PT are not shown to be effective. Looks for presence of risk factors. TCA Overdose: hyperthermia. Diffusion capacity is reduced due to V/Q mismatch -> A-a gradient. Chronic inflammation of alveolar walls -> widespread fibrosis -> destruction of architecture. ascites. QRS prolongation. Reviews past records. honeycomb pattern. end-inspiratory crackles. In cohort studies. purpuric or pustular with hemorrhagic necrosis. Treat with diuretics or pericardiectomy. If longer 4-6 weeks. May cause supperative arthritis (different from early arthralgias). since whole gland is hyperfunctional -> general uptake -> complete ablation. Descriptive deals with rates. Movement from effect to cause. Analytical tests hypothesis created by descriptive and consists of observational and experimental studies. Acyclovir: can cause nephrotoxicity. Prospective Cohort Study: or longitudinal. subjects are free of outcome at onset of study. CT/MRI -> thickened pericardium. Followed prospectively until onset of disease. Causes crystalluria and renal tubular obstruction -> renal failure. Stronger than case control or cross sectional. In cohort studies. anticholinergic effects (dilated pupils. MCC are cardiac surgery. Taken up by thyroid -> destruction via beta emission. arrhythmia. hepatic congestion.y Radioiodine: most popular treatment of hyperthyroid. Cross Sectional Study: exposure and outcome are studied at one cross section of time. normal FEV1/FVC. Not possible to determine temporal association between exposure and outcome. Idiopathic Pulmonary Fibrosis: restrictive lung disease. Randomly assigned to treatment or control group. Increased pressures on cardiac cath. dyspnea. vascular congestion at hilum. Retrospective Cohort Study: starts between exposure and outcome. digital clubbing. With hypotension. CXR -> calcified pericardium. especially with inadequate hydration. Dry. Divides group into exposed and not exposed. classifies into exposed or not exposed. viral pericarditis. weakness. and follows until outcome. distribution. High fevers. subjects are free of outcome at onset of study. greatest in patients with Grave s disease. tenosynovitis. Case Control Study: retrospective study. migratory polyarthralgias. Skin lesions on extremities from 5-40. Return to activities ASAP. Constrictive Pericarditis: thickened or scarred -> impaired diastolic filling -> decreased CO -> JVP. Majority of mortality due to hypotension. CXR -> decreased lung volume. Usually during menstrual periods. ileus). Acute Back Pain: with positive straight leg raise -> herniated disk. radiation. give sodium bicarbonate.

No hemodynamic abnormalities or renal dysfunction indicating hemolytic reaction or bacterial contamination. Chalazion: painful swelling -> nodular rubbery lesion. IV septum rupture. elevated ESR/CRP. Impaired humoral immunity -> susceptibility to encapsulated organisms. Pansystolic murmur. Cell washing. loudest at the apex. using frozen deglycerolized cells. Pneumococcous is the MCC. Ventricular Remodeling: after MI. ACEs inhibit ventricular remodeling and should be started within 24 hours of MI if no contraindication. Usually involve MCP. Acid exposure has likely full recovery. or leukocyte depletion RBC filters. but is easily treated with synthroid. can also be due to meibomian gland carcinoma. Febrile Transfusion Reaction: fever and chills that respond to NSAIDS and acetaminophen. distinct borders. Amiloride prevents Li accumulation. other dermatophytes can also cause. Rotator Cuff Tear: present with shoulder pain and weakness. MRI is diagnostic. Remains after lidocaine injection. obtain medical care first. pulling. PIP. Do histopathology to rule out cancer. Meibomian gland obstruction -> chronic graulomatous inflammation.y Amaurosis Fugax: painless loss of vision from emboli. HIV Pneumonia: acute onset. Complications of MI: mitral regurgitation due to papillary muscle rupture. Limited arc abduction and external rotation. KOH preparation shows hyphae. HIV). Eye disease may worsen at beginning of therapy. increased plasma osmolarity. Viral Arthritis: acute onset polyarticular symmetric arthritis that resolves in 2 months. If extensive. doctor after washing. usually HLA specific. increased plasma osmolarity -> CNS dysfunction. Call ER. Become euthyroid in 2-6 months. Tendonitis resolves with lidocaine injection. Leukocyte depletion can reduce possibility. y y y y y y y y y y y . Basal cell carcinoma presents similarly. When intravascular volume improves. MC SE is hypothyroid (especially in Grave s disease) due to follicle destruction. soft S1. Radioiodine Therapy: treatment of hyperthyroid in non-pregnancy. lifting overhead. LV free wall rupture. Lithium accumulates in kidneys -> tubular damage. DI: presents as polyuria & polydipsia due to ADH deficiency or resistance. pulmonary edema & LVF -> SOB & crackles = acute mitral regurgitation. 911. then use hypotonic solutions. Cholesterol particles (Hollenhorst bodies) may be seen. Trichophyton rubrum is MCC. Chemicals in the Eye: first priority is immediate flushing under running water for at least 15 minutes. Excrete dilute urine. Treat with topical terbinafine if local. Give NS with CNS dysfunction and dehydration. Caused by patient Ab to donor WBCs. MC symptom is itching. MCC is Parvovirus. If persistent. Present as hemodynamic compromise at 3-7 days when infracted myocardium is softest. high grade fever. Aggravated by pushing. no resolution in 2 months. give systemic griseofulvin and investigate for immunosuppresion (DM. lying on affected shoulder. RA has chronic onset. Alkaline will more likely have permanent corneal damage. ventricle slowly dilates and walls thin -> CHF which occurs over months to weeks. For foreign bodies or cuts/scratches. usually with those that work with children. wrist. Occur as end result of rotator cuff tendonitis or trauma (FOOSH). Water deprivation -> fluid loss dehydration. pleural effusion. with radiation to the axilla. Warning of impending stroke due to emboli -> mostly occur from carotid bifurcation -> do US of neck. Tinea Corporis: ring shaped scaly patches with central clearing.

autoimmune disease resulting in parietal cell destruction -> measure intrinsic factor Ab and B12 levels. Caused by JC virus Involves white matter of cortex. 25-90% have underlying IBD (usually UC). nocturia. polydipsia.y Aspergillosis: fungal infection with coarse fragmented septae.5. Hospital Infection: common source of confusion. Point mutation in one of beta globin genes -> reduced synthesis. Complicated will have positive gram stain & culture. hyphae usually seen. Hyperkalemia:> 5 mEq/L. Beta Thalassemia: microcytic anemia not responsive to iron. Present with fatigue or pruritis. Onion skin fibrosis -> ESLD & portal HTN. transplant. Measure fasting blood glucose (recommended screening test). Between 100 and 125 is insulin resistance or pre-diabetes. BPH: increased frequency. pH < 7. obesity. ARBs. cholangiocarcinoma. fibrosis. PML: opportunistic infection in immunocompromised patients. ACEs. BPH is likely. Immediate anticoagulation with heparin and embolectomy are needed. No mass effect. Treat with UDCA. and pernicious anemia. dilatation & stenting. TMP and pentamidine also cause. IBD causes hypoalbuminemia. biliary stricture. structuring of intra and extrahepatic biliary tree. Major is due to 2 defective -> severe. DM: RF are AA race. glucose < 60 and needs chest tube. paralysis. cholelithiasis. place FC. If acute renal failure (one of MCC). and ARBs also improve mortality. cholangitis. MRI shows multiple demyelinating non-enhancing lesions. diarrhea. Check blood and urine cultures with new fever or WBC elevation. Started on low dose and titrated up (mortality improvement is dose dependent). positive FH in first degree relatives. weak stream. Tissue death and amputation if not treated within hours. Present with polyuria. Present with weakness. ACE Inhibitors: shown to prolong life in asymptomatic to severe heart failure. MCC is medications.2. Pleural Effusion: use Light s criteria: exudate will have fluid to serum protein ratio > 0. fluid to serum LDH ratio > 0.6. colon cancer. PSC: inflammation. Cholangiography -> beading pattern. especially with Mediterranean origin. Starts in the center of the prostate (cancer in peripheral). respiratory insufficiency. Beta blockers. y y y y y y y y y y y . spironolactone. urgency. Limb Embolus:normal neurological exam with paresthesias. Destruction of parenchyma -> cavitation -> debris and hyphae coalesce into ball. Use binding resin. Mobile mass with intermittent hemoptysis. Reduce preload and afterload. cardiac toxicity -> sine wave or ventricular fibrillation. non detectable pulse. Can see positive p-ANCA. Vitamin B12 Deficiency: causes are strict vegetarian diet (more than 3-4 years). can have permanent kidney damage. It is a multifactorial disorder. With recent abx. CXR may show cresecent radiolucency next to rounded mass. Cholestatic pattern on labs -> elevated alk phos and BRN. Minor is due to 1 defective gene with Hct between 28-40 and MCV 55-75. Empyema is frank pus. or fluid [LDH] > 2/3 the upper limit for serum LDH. If large volume is obtained. > 126 on 2 occasions is diagnostic. tender abdomen -> C diff colitis. change in temperature. Multiple stool samples are necessary. US can show hydronephrosis. disturbances in vision/gait/speech. Gradual onset of hemiparesis. Stool toxin assay and empiric metronidazole. so review them. If progresses for 2 weeks. sense of incomplete voiding. spironolactone block aldosterone.

normal ionized calcium. y y y y y y y y y y y y . Treat with BZD (decreases anxiety & sympathetic effects). 5% of patients. Consolidation will have dullness. low K. Warfarin: inhibits vit K dependent clotting factors II. do secretin stimulation test. Use BZD or phenytoin as second line. If blocked. Histoplasmosis: dimorphic fungus found as mold in soil. First 48 hours > seizures. Nephropathy:preceded by protein excretion in urine. auscultation. CNIII is affected most often of CN. low PO4). agitation. OCP: common cause of secondary hypertension. hallucinations. HIT: combination of AV thrombosis and thrombocytopenia in patients receiving heparin. fevers. Common in patients with congenital protein C deficiency. nitrates (for constriction). CXR -> hilar LA. sweating. 24 hour urine is more inconvenient. Hypocalcemia: hypoalbuminemia -> decreased serum. Present in bat and bird droppings in Mississippi and Ohio river areas. no symptoms. Disseminates in IC patients. History of bat or bird exposure. Excess alcohol -> chronic pancreatitis -> vitamin D deficiency -> hypocalcemia and hypophospatemia due to malabsorption. Prominent gastric folds. hallucinations. Lung Exam: inspection. Hypomagnesemia causes refractory hypokalemia. tachycardia. If compression causes it. but preferred. Palatal ulcers. Acute pancreatitis can also be a cause. VII. Measure serum gastrin levels. Cocaine Intoxication: present with venous track marks. palpation. hepatosplenomegaly. louder expiratory component if airways are open. > 1000 is diagnostic. protein C. Status Epilepticus: ongoing seizures activity for > 5-10 minutes or lack of interictal return to baseline. IX. EKG changes of myocardial ischemia/infarction due to sympathetic effects -> tachycardia and hypertension. Protein C has half life of 9 hours -> early signs of protein C deficiency -> hypercoagulabilty -> thrombus formation -> skin necrosis. Treat with BZD like chlordiazepoxide (Librium). X. percussion. interstitial pneumonitis. Alcohol Withdrawl: first 6-24 hours -> anxiety. Normal will be resonant with vesicular sounds (quiet inspiratory. Ab to heparin-platelet-factor 4. will decrease. First step is appropriate oxygenation and blood pressure. Delerium tremens -> after 48-96 hours -> HTN. If not. ASA (for clots). Starts with microalbuminuria -> 30300 mg/d. S. Spot urine and timed urine collection for microalbumin to Cr ratio are good screening methods. tremors. Nonspecific symptoms. inaudible expiratory).y Zollinger Ellison: also called gastrinoma. Discontinuation can correct the problem. both fibers will be affected. Resistant to medications. Will also hear egophany and crackles. May manifest as acute ischemic stroke. insomnia. pancytopenia. Check Mg to correct low K. ulcer located beyond duodenal bulb on endoscopy. Caused by estrogen mediated increase in synthesis of angiotensinogen. Antibodies activate platelets -> premature removal and thrombotic complications. Chronic Alcoholism: multiple electrolyte abnormalities (low Mg. Targets histiocytes and RE system -> LA. Ischemia of somatic fibers and sparing of PS fibers -> ptosis and down-and-out gaze. Pupil response and accommodation are intact. Mg is an important cofactor for K uptake and maintenance if IC K levels. Diuretics also causes low Mg. Diabetic Mononeuropathy: can be cranial or somatic. with endotracheal intubation.

May improve survival in patients with multiple myeloma or breast cancer. vascular malformations. Acute Lymphoblastic Leukemia: predominance of lymphoblasts that are PAS+. syncope. Typically red. RVH. They are DM. do renal CT or US to look for other pathologies (obstruction) or complications (abscess). Susceptibility increases < 1000. Ability to control own flora decreases < 500. HDL < 40. Paget s Disease:persistent dermatitis. HTN. Dramatic onset. Can cause cor pulmonale. Zoledronic acid recommended in all women with metastatic breast cancer and radiographic lytic bone disease.9. CXR -> pulmonary artery enlargement. Positive alphanaphthyl esterase test. cefepine.4 for over an hour. fever. women > 55. bacteriuria. Causes RVH and failure. fistula. weight loss. Start antibiotics that are broad spectrum and cover Pseudomonas. Ceftazidime. PPV = TP/TP+FP. PPV will decrease and false negatives will also decrease. HDL > 60 negates one risk factor. imipenem. Bacteria from skin and flora are MC. receiving hormone or chemotherapy. oozing. weakness. Caused by respiratory disorders. Treat initially with antibiotics. May reduce bone pain and fractures. Test Cut Off Points: lowering cut-off point increases sensitivity. Acute Myeloblastic Leukemia: M2. venous/cardiac. y y y y y . > 30 mm Hg with exercise. unresponsive to steroids or antibiotics. fatigue.y Acute Pyelonephritis: acute febrile illness. hemoptysis. Gingival hyperplasia and skin lesions. or combination of aminoglycoside and anti-pseudomonal beta-lactam. Non toxic and more potent than IV saline. Pulmonary Hypertension:> 25 mm Hg at rest. Increase true positives and false positives. 10 year risk > 20%. Febrile Neutropenia: ANC < 1500. CAD: risk factors -> men > 45. Acute Monocytic Leukemia: M5. chest pain. Fever in these patients classified as one temperature > 100. LLQ pain and fever. Give IV antibiotics until symptoms resolve. Bisphosphanates: drugs of choice for mild to moderate hypercalcemia. If fail to response. Predominance of myeloblasts. hoarseness. tapering of distal vessels. gum or nose bleeding. With no response in 72 hours. crusted. abscess. symptomatic CVD. Leukocytosis with blasts. mostly G(+). arterial (primary/ idiopathic). pyuria. chronic thromboemboli. or > 100. Risk equivalents impart equal risk for MI as having a previous MI. Dyspnea. Could be DCIS or infiltrating ductal. women < 65). High incidence of DIC. CVA tenderness. do CT to evaluate for perforation. PVD. smoking. headaches. Acute Promyelocytic Leukemia: M3. Usually underlying breast cancer. AAA. meropenem. family history of early CAD (men < 55. Predominance of hypergranular promyelocytes with Auer rods. Biopsy -> proliferation of malignant epithelial cells scattered as well as cells with lots of pale staining cytoplasm surrounding hyperchromatic nuclei with prominent nucleoli. LDL Goal < 100 < 130 < 160 When lifestyle changes start > 100 > 130 > 160 When starts > 130 > 160 > 190 drug therapy y y y y y Risk Category CAD or Equivalent 2+ RF 0-1 RF y Diverticulitis: history of constipation with little fiber.

50% of diabetics. Individuals trying to lose weight should be counciled about weight loss as vitamin and mineral toxicities are common. limited ROM. use of beta agonists < 2x/wk. Mucomist also helps. (+) AD family history. Best choice for stable patients is a beta blocker. splenomegaly. Graves Disease: insomnia. Secondary to microangiopathy. Vitamin D Overdose: seen in patients trying to lose weight. ankle edema. progresses to CRF and ESRD in 4-5 years. Spherocytes with central pallor. Spike of Cr within 24 hours. abdominal pain. fatigablilty. Possible oral steroids. polydipsia. SLE Nephropathy: classic presentation of young woman with joint pain. moderate levels of proteinuria. extremely limited activity. long acting inhaled beta 2 agonist. Treat with as needed albuterol inhaler. lid lag. Radioactive Iodine:preferred treatment for Graves disease. Contrast Nephropathy: caused by renal vasoconstriction and tubular injury. Controls atrial fibrillation and other symptoms of hyperthyroidism. Can cause hypercalcemia -> constipation. Pallor. jaundice. no limitations of daily activities. Also detects metastases. baseline FEV1/FVR ratio is normal. fatigue. Can do micro-Coombs. Severe persisent -> symptoms throughout the day. nighttime awakenings 3-4x/mo. weekly nighttime awakenings. Septic Arthritis: acute onset painful swollen joint. Contraindicated in pregnancy and very severe ophthalmopathy. Staph aureus is MCC in prosthetic joint septic arthritis. polyuria. (+) fragility test. high dose inhaled corticosteroids. fever > 104. frequently nighttime awakenings. tremor. Moderate persistent -> daily symptoms. Annual influenza vaccination is also recommended. IV bicarbonate or NS. Gastric Cancer:early detection is critical since surgery and excision of affected tissues is mainstay therapy. Prosthetic joint increases risk. (+) Coombs (not required). FEV1 < 60% predicted. especially liver metastases. History of diabetes and chronic renal insufficiency are increased risk. Crystal induced presents similarly but WBCs between 10-50k and lower fever. Asthma:intermittent -> daytime symptoms < 2x/wk. Microalbuminuria can be detected within 4-5 years of onset. Add low-dose inhaled steroid as a controller. Adequate hydration is most important. FEV1 < 60-80% predicted. y y y y y y y y y y y y . Add long-acting inhaled beta 2 agonist. Mechanism is immune complex mediated kidney damage -> circulate and deposit in renal glomeruli -> complement activation and C3 level decrease. facial rash. Takes about 6-8 weeks for improvement. minor limitation. Do CT scan to assess extent of disease after diagnosis is made. Treat with short acting bronchodilator as needed. HIV Immunizations: polyvalent pneumococcal vaccine recommended for all HIV patients whose CD4 count > 200.y Acute Erythroleukemia: M6. Evident after 12-22 years of diabetes. weight loss. normal PFTs. elevated indirect BRN. Hereditary spherocytosis has spherocytes with no central pallor. fluid WBC 50150k. Diabetic Glomerulosclerosis: renal insufficiency. nighttime awakenings < 2x/mo. Most are diagnosed at stage III-IV. Predominance of erythroblasts which have irregular outline and high N/C ratio. AI Hemolytic Anemia: acquired disorder that causes extravascular hemolysis. No higher incidence of cancer. reticulocyte count and LDH. HCV: chronic hepatitis C with persistently normal LFTs on multiple occasions have minimal histological abnormalities and do not need to be treated with interferon or antivirals. Mild persistent -> symptoms > 2x/wk but < daily. Knee is most commonly affected by hematogenous distribution. Atrial fibillation is common due to increased sensitivity of beta receptors.

commonly involves knee. Ampicillin and amoxicillin associated with urticaria. hypertrophic vertebral bodies. y y y y y y y y y y y y . Labs show decreased haptoglobin. Give BZD for severe psychomotor agitation. Amoxicillin-clavulanate (beta lactamase inhibitor) is antibiotic of choice. Present with microcytic hypochromic anemia but can see normochromic cells (dimorphic population). stones. Arthritis happens in late disease. diverticulosis. Visuospatial functions intact. bad when coupled with HTN. Warmth. Pseudogout: hyperparathyroidism -> elevated calcium & low phosphorus -> constipation. Possible family history. osteoporosis. narrowed disc spaces. anaerobic coverage needed. ADPKD: hypertension. Osteophytes -> radiculopathy -> sensory abnormalities. Fronto-temporal Dementia:characteristic are personality changes (euphoria. microhematuria. are fragmented RBCs. screening not recommended). Cervical Spondylosis: chronic neck pain. Causes violent behavior. abdominal wall & inguinal hernias. disinhibition. Couples with acute painful monoarthritis due to CPP crystals -> rhomboid. Hepatic cysts are MC extrarenal manifestation. MVP or AR. These findings are of low specificity. Hyperkalemia: in fall with weakness. Give B6 to treat. nystagmus (only drug that causes vertical. Mechanical are more traumatic than porcine. mental status changes. (+) birefringent. G(-). Usually polymicrobial wounds and G(+). Bone marrow biopsy will show ringed sideroblasts. Drug Hypersensitivity: if mild (urticaria and pruritis without systemic symptoms). Lyme Arthritis: caused by untreated Lyme infection by Borrelia burgdorferi. Endoscopy -> multiple ulcerations. 99. treat with antihistamines and discontinuation. 95% within 2 SD of mean. palpable abdominal masses. Also have primary hyperparathyroidism. Tall T waves on EKG indicates cardiotoxicity -> treat with IV calcium gluconate -> cardiac myocyte membrane stabilization. dissociative feelings. other neuroendocrine pancreatic tumors. Schistocytes: also called helmet cells. Limited neck rotation and bending due to osteoarthritis and muscle spasm. X ray -> bony spurs. papillary dilatation. polyuria. Isoniazid and alcoholism can be a cause. prominent gastric folds. Also berry aneurysm (5-10%.7% within 3 SD of mean. diarrhea. First episode within 6 months of erythema migrans and travel to endemic area. sclerotic facet joints. or prosthetic valves. MC due to pyridoxine-dependent impairment in early steps of protoporphyrin synthesis. Will have high iron and low TIBC. PCP Intoxication: causes hallucinations. abdominal pain. compulsive behaviors (peculiar eating habits. morbilliform rash. seizures. HUS. apathy). tachycardia.y Human Bite: clenched fist injury. late maculopapular rash. TTP). long time on floor -> due to rhabdomyolysis. increased LDH & BRN. swelling. Normal Distribution: 68% within 1 SD of mean. Due to mechanical destruction: MAHA (DIC. confusion. agitation. hyperthermia. pituitary tumors. Also drug of choice for dog bites. hyperorality). History of intermittent inflammatory arthritis. Cause severe HTN. Sideroblastic Anemia: defective heme synthesis. impaired memory. restriction of movements differ from arthralgias in early disease. fatigue. can be horizontal or rotary). MEN I: non-beta cell pancreatic tumor like gastrinoma -> abdominal pain.

Present with dyspnea. decreases work of breathing). Self limited. Pyrantel pamoate is an alternative. Memory impairment in the long term. HTN. Due to enlarging osteophytes at facet joints and hypertrophy of ligamentum flavum. cataracts. weight gain. Central America. neuroleptic sensitivity. Symptoms resolve in 2 months. HIV. Albendazole or mebendazole is first line. MRI confirms diagnosis. bleeding. hypercalcemia. increased ESR. better with flexion. can be transmitted vertically. hyperglycemia. especially in 3rd TM. burns. acidophilic hepatic degradation. syncope. visuospatial ability. Viral Arthritis: symmetric small joint inflammatory arthritis of acute onset and short duration. ballooned hepatocytes. Diagnosed by detection of HEV RNA by PCR in serum or feces or IgM Ab. mumps. May have crepitus or clicks in the TMJ with movement. Africa. > 60 y/o. Can result from exogenous steroids or own overproduction. 1/3 of patients have leukopenia. infiltrates on CXR. back pain that radiates into buttocks and thighs. Can see hypernatremia. Do EKG to rule out arrhythmia. normal albumin. Antivirals are unnecessary. Pinworms: enterobiasis caused by Enterobius vermicularis. Bence Jones proteins. but not in pregnant patients. acne. ARDS: inflammatory mediators due to tissue injury -> leaky alveolar capillaries -> pulmonary edema. Serum immunoelectrophoresis shows M spike. TMJ Dysfunction: history of teeth grinding. Female crawls out at night and deposits skin -> nocturnal anal pruritis. Free T4 is usually elevated. interpret as ear pain. Exclude all other ear conditions.y Lewy Body Dementia: fluctuating cognitive impairment. Hyperthyroid: plasma TSH is best initial test -> usually low unless TSH secreting adenoma. Normocytic anemia. executive functions. Diagnosed by scotch tape test which demonstrates eggs. parkinsonism resistant to therapy. Presents in old age with back pain. HEV: RNA virus. hepatitis. Initial treatment is conservative. Saccular aneurysms occur in 3-4% of population. Pain is worse with chewing. Hypokalemia is most common electrolyte abnormality due to some mineralocorticoid activity. Use NSAIDS. no chronic carrier state. osteoporosis. Present with fatigue. rupture is rare. Commonly found in India. easy bruising. PEEP may go upto 15 in ARDS. infection. like nighttime mouth guard. susceptibility to infections. worse with walking and extension. Lumbar Spinal Stenosis: degenerative condition where spinal canal is narrowed -> compression of one or more spinal roots. osteopenia. Do 24 hour radioiodine uptake to differentiate Graves from other disease. Caused by parvovirus. Use propranolol for symptomatic relief. Can see positive RF and weakly positive ANA. y y y y y y y y y y . high risk when > 7 mm. toxins. Falls. tachypnea. Common in anterior circle of Willis. systematized delusions. renal failure. Treat with spironolactone. Progressive decline that impedes functioning. Multiple Myeloma: malignant plasma cell disease -> monoclonal protein and increased plasma volume. Adult lives in cecum and appendix. Histology -> focal necrosis. proximal muscle weakness. Asia. recurrent infections. transient loss of consciousness. Surgery sometimes needed. hypoxemia. SAH: rupture of saccular aneurysms is the MCC (2/3 of cases) of nontraumatic SAH. Fulminant hepatitis can occur. central adiposity. hallucinations. rubella. elevated protein. Caused by sepsis. Transmitted through fecally contaminated water. Diagnose with cerebral angiography and treat surgically. Joint swelling and low grade fever suggest inflammation. can improve oxygenation. Cushing s Syndrome: excessive systemic cortisol levels. Ventilation with low TV and PEEP (increases FRC. Deficits in attention. more common in pregnant women.

Conservative treatment (sleeping upright) is recommended. diaphoresis. Headache. Ambient heat and humidity prevent sweat production. cyanosis. Derived from vitamin A -> similar to vitamin A OD. vision loss. Tachypnea.y Myeloproliferative Disorder: polycythemia vera -> splenomegaly and pruritis with hot baths due to histamine release from increased basophils. ARDS. Prominent in AS. tachycardia. Minor criteria -> predisposing condition. Heat Stroke: core temperature > 40 and altered mental status. papilledema. conjunctival hemorrhages. MC seen with recurrent tendon or ligament stress and HLA-B27 associated arthropathies like AS. Familial Hypocalciuric Hypercalcemia: benign AD condition. cannot get fluids or move from heat). CN palsies (especially CNVI). 1 major & 3 minor. renal abscesses. Can be exertional (factory workers. can be switched to oral antibiotic after 48-72 hours of IV therapy. Tibial tuberosities and iliac crests also involved. Diagnosed with 2 major. Osler s nodes (painful fingertip nodules) and GN due to immunologic phenomenon. Pull back on ET tube slightly. presence of new murmur. urinary retention. Can be due to isotretinoin in acne treatment. fever > 38. vascular phenomenon (septic emboli). Hyper PTH have high urine calcium. Increased serum calcium and increased/normal PTH levels. military. y y y y y y y y y y y . Severe Asthma Attack: normal or increased PCO2. endocardial involvement on echo. Lung inflation and tachycardia are also normal. athletes) or non-exertional (at extremes of age. Oral is more convenient and less expensive. immunologic phenomenon (glomerulonephritis). Asymmetric breath sounds. blurry vision. coagulopathy. renal failure. Cauda equina -> saddle anesthesia. Average duration of therapy is 2 weeks. reactive arthritis. Pseudotumor Cerebri: benign/idiopathic intracranial hypertension. Needs immediate ophthalmology consult. Right bronchus intubation is a common complication due to acute angle -> overinflation of the right and underinflation of the left. PCO2 should be decreased due to hyperventilation. Complications are rhabdomyolysis. increased work of breathing. epistaxis. Infective Endocarditis: major criteria ->> 2 blood cultures positive. Fundus is hard to visualize or details obscured. Mycotic aneurysms. abdominal abscesses. Also seen in primary hyperPTH. Switch based on sensitivities. Back tenderness due to spasm of paraspinous muscles. MCC is diabetic retinopathy. Obtain 24 hour urine calcium and creatinine. no sphincter tone. Herniated Disk: unilateral radicular pain in dermatomal distribution. Manifests with heel pain where Achilles inserts. Severe pain with mild obstruction (like BPH) inhibits ability to valsalva -> urinary retention. Vitreous Hemorrhage: sudden loss of vision and onset of floaters. LP shows increased pressure. CXR confirms. Arthritis can be due to immune complex deposition. speech difficulty. Janeway lesions all related to septic emboli. Enthesitis: inflammation and pain at sites where tendons and ligaments attach to bones. Endotracheal Intubation: to provide a secure airway. 5 minor. Pyelonephritis: if uncomplicated. Severe obstruction -> increased PCO2. Present as confusion. 40% develop gout due to overproduction of uric acid because of increased catabolism and turnover of purines. Cut Off Point: raising -> increased specificity. FHH have decreased urine calcium. psoriatic arthritis. decreased sensitivity. hyperthermia. septic PE. low PO2. altered sensorium. silent lungs. Symptoms worse during straight leg raise. Should sit at the carina for safety and efficacy.

Infectious Mononucleosis: splenic rupture is a potential complication and patients with splenomegaly should avoid excessive physical activity and contact sports until spleen is not palpable (usually 1-3 months). bronchoscopy. hypercoagulable state. Localized tenderness. Discontinue drug. If cough persists. IgA deficiency and CVID (suppressed cellular immunity and increased risk of malignancy). Also treats coexistant ehrlichiosis. IgA or IgG can be deficient. avoid sleeping on stomach. Chest Pain: methods for diagnosing CAD are only helpful for those at intermediate risk. Food allergies and autoimmune diseases may be present. allergies. tearing. Volume loss -> contraction metabolic alkalosis due to RAAS activation (maintenance phase). good response to conservative therapy). no radicular signs. barium swallow. secondary increase in PCO2. Humoral Immunodeficiency: history of recurrent bacterial infections. Allergic Conjunctivitis: environmental exposure -> acute hypersensitivity. Family history of asthma. Accumulation of kinins and some activation of the arachadonic acid pathway are the cause. Prevention of Back Injury: usually present with lumbar strain (relation to heavy lifting. Age and steroid use are RF. treatment choice is amoxicillin. Lyme Disease: doxycycline is first line for early lyme. don t rub eyes. cool compresses to treat. atopic dermatitis are common. PFT. Penicillin G is alternate for early localized during pregnancy or disseminated. Common complication of osteoporosis. Diagnose with flow cytometry for CD55 and CD59. Recommended to get vaccinated against HAV and HBV (safe during pregnancy). No twisting and bending exercises. In pregnant/lactating women and children. do CXR. Vomiting -> decreased HCl -> metabolic alkalosis (generation phase). Diagnose with quantitative immunoglobulin levels. Do warm ups. Hyperemesis Gravidarum: causes metabolic alkalosis with respiratory compensation via hypercapnea. Bend at knees. portal veins. Itching. learning proper bending and lifting. Loss of urinary iron -> iron deficiency anemia. Compression Fracture: acute onset of back pain without trauma. Absent ankle reflex is common in elderly people. Budd Chiari. primary increase in HCO3. TPN: GI tract is bypassed stimulus for GI hormone release is gone. No CCK -> no GB contraction -> stasis -> bile sludge and gallstones -> cholecystitis. Possible photophobia and burning. Hemolysis is complement mediated. HCV: major cause of chronic hepatitis (~80%) and MC acquired via infected blood. Paroxysmal Nocturnal Hemoglobinuria: intravascular hemolytic anemia.45. A (-) non invasive test in a high risk patient is likely false (-). If selective. Elevated LDH and low haptoglobin. y y y y y y y y y y y . not at waist. High incidence of thrombosis in hepatic. Pancytopenia -> reticulocytosis. anxiety and psychosocial issues are a common cause. Keep back straight. In young women. otherwise neurological exam is normal. artificial tears. bone marrow aplasia. hyperemia. ABG shows pH > 7. Reduce exposure. A (+) test in a low risk patient is likely false (+). Strengthen supporting muscles (abdominals). topical antihistamines. IV ceftriaxone or cefotaxine (3rd generation) are used for early disseminated or late. Kinins are degraded by ACE.y ACE Cough: non productive cough occurs in 5-20%. Low evidence of sexual transmission. edema. CCK is stimulated by proteins and FA in duodenum.

high TG. Solitary Pulmonary Nodule:< 3 cm circular lesion in middle or lateral 1/3 of lung surrounded by normal tissue. With GB hypomotility or excess cholesterol compared to bile salts -> precipitaiton. ACE I:reduces urinary albumin excretion and decline in Cr clearance. pure sensory. FNA. Cholesterol and mixed > 80%. Mostly benign. ovarian). Virilization in females. Diagnose with biopsies and vial serology. questionable ulcer needs biopsy to rule out cancer and distinguish UC from Crohn s since treatment is different for both. coffee ingestion. MCC is viral infection. pedal edema due to decreased oncotic pressure due to decreased albumin. Caused by bacterial infections. ST elevation that is concave up and PR depression in aVR and friction rub. psychological disturbance. biliary tract infections and parasite infections. Locally invasive. or GI bleed (bacterial breakdown of hemoglobin with urea reabsorption). clofibrate. Do CT chest. retrosternal pain relieved by sitting forward. Resect to treat. Cirrhosis: gynecomastia and spider angiomata due to decreased estrogen metabolism. Pearly lesions with rolled border. Not usually seen on CT. erythrocytosis. Better prognosis. pancreatic. Surgery or UDCA for treatment. long sun exposure are risks. fasting. Indication for Dialysis: refractory hyperkalemia. rapid weight loss. gynecomastia. GB hypomotility (pregnancy. hair loss. octreotide. or mixed. TPN). uremia (which is an indication for dialysis). HTN and DM are risks. age. Can have ataxia. B12 Deficiency: megaloblastic macrocytic anemia. volume overload/pulmonary edema not responsive to diuretics. ileal disease -> bile salt malabsorption. Eyelid Lesion: squamous papilloma is frond like or lobular and MC benign tumor. Usually due to decreased IF -> malabsorption -> peripheral neurophaty. Gallstones: cholesterol. old age. Palmar erythema. Due to genetic defect in young or malignancy in elderly (gastric. female hormones/OCP. increased coagulation. possible excisional biopsy. elevated PT/PTT and fibrin split products indicate activation of systemic cascade. Fair skinned.y Colon Ulcer: on scope. pelvis in old. MC site is posterior internal capsule -> pure motor stroke. posterior column defects due to defective myelin y y y y y y y y y y y y . can -> enucleation. glucose intolerance. Slows the progression of diabetic nephropathy (reduces intraglomerular pressure). pigment (calcium bilirubinate). Follow by CXR every 3 months for 1 year. Basal cell is MC malignant tumor and most common malignancy in humans. caput medusa. low HDL/high LDL. Anabolic Steroids: SE are suppressed testicular function. RF for pigment stones: chronic hemolysis. Bulls eye calcification is granuloma. uremic pericarditis. uremic encephalopathy/neuropathy. Elevated BUN/Cr Ratio: prerenal azotemia (elevated BUN with mild elevated Cr). Lacunar Stroke: due to occlusion of single deep artery in brain due to microatheroma or hyalinosis. US for diagnosis. Calcification favors benign. Used in patients with microalbuminuria. coagulopathy due to renal failure. Popcorn calcification is hamartoma. or mixed. If no change in 12 months -> benign. aspirin/NSAIDS are protective. exercise. lupus. refractory metabolic acidosis (< 7. hepatotoxicity. Low carbs. parotid swelling. steroid administration. premature epiphyseal closure.2). telangiectasias that can bleed or ulcerate and cause loss of eyelashes. Percarditis: non radiating. obesity. if no change -> benign. ceftriaxone. abdominal distension due to ascites. Look at old x-ray in low risk patients. even with normal BP. abdomen. RF for cholesterol stones: Caucasian. Recurrent Thrombosis: thrombophlebitis with multiple DVTs. High risk patients need CT. cardiac disease. nail changes. MC cause is alcohol or viral hepatitis.

Herpes Zoster: reactivation of varicella zoster virus. x ray can show thumb printing . and not improved with lifestyle. Arms do not swing while walking. y Megaloblastic Anemia: due to folate or B12 deficiency. Ischemic Colitis: suspect with evidence of atherosclerotic disease. VII. Elevated lymphocytes in fluid: TB. both watershed areas supplied by terminal SMA/IMA. Exudates are caused by increased capillary permeability. D Parkinsonism: mask like immobile face. IX. Post herpetic neuralgia prevented with TCA with anti virals. Important cofactor in gamma-glutamyl carboxylase -> factor II. reduce salt in diet. lymphadenopathy. bradykinesia. Have elevated homocysteine (can t convert to methionine).synthesis. Most common histologic finding is diffuse glomerulosclerosis. ALL: disease of children. treatment of HTN. abdominal pain. Have 4x higher risk of strokes than non-hypertensives. Smear shows large RBC and hypersegmented neutrophils. Present with infections. Increased lactic acid. Carboxyl groups increase affinity for phospholipids on platelet surface. Pleural Effusion: diagnosed by Lights Criteria: fluid is exudative if fluid/serum protein > 0. age. JNC guidelines are to put on medication. tremors. phenytoin.5. Smoking and DM are also risk factors. lymphoma. and hypokinetic gait. rigidity. Virus is latent in DRG after primary infection. Folate can improve B12 deficiency but worsen neurological defects. Due to immune complex mediated hypersensitivity due to sulfonamides. sarcoid. sensible alcohol. fluid/serum LDH > 0. Diabetic Nephropathy: diabetes is leading cause of ESRD in US. neoplasm. Have lymphoblasts. fluid LDH > 2/3 ULN. have PAS(+) material. Hypercholesterolemia more associated with CAD. Vitamin K Deficiency: antibiotics and cystic fibrosis. Stress. Stevens Johnson Syndrome: also called erythema multiforme major. RA. Exacerbated by hypotension. NSAIDs. Valacyclovir or acyclovir to treat. transudates caused by high hydrostatic/low oncotic pressure. Nodular glomerulosclerosis (Kimmelsteil Wilson lesion) is pathognomonic. (+) test has a poor PPV and is not definitive. B12 converts methylmalonyl CoA to succinyl CoA. or rectosigmoid junction. D Dimer: a fibrin degradation product elevated with blood clots and other inflammatory conditions. Lymphoblasts have no peroxidase (+) granules. bloody diarrhea. HIV. lymphoma -> impaired cellular immunity -> reactivation along sensory nerve. Stooped over. Most commonly involves splenic flexure. feet that shuffle and scrape the floor. splenomegaly. Lifestyle modification is necessary: smoking cessation. ACE I. protein C & S deficiency. Hypertension: has the strongest association with strokes. series of short accelerating steps. autoimmune. Degeneration of neurons in substantia nigra -> decreased DA and increased Ach activities. Sudden onset y y y y y y y y y y y . HTN Management: pharmacologic and non-pharmacologic. Are also TdT(+) (only in pre B and pre T). Increases the risk of all types of strokes. B12 and folate convert homocysteine to methionine. usually T3-L3. With multiple readings of > 140/90.6. Slow by strict glycemic control. B12 deficiency -> elevated MMA. minimal exam findings. Best first line is a thiazide. Treat with dopaminergic or anticholinergic drugs. Pain prior to rash. weight loss. with anemia/neutropenia/thrombocytopenia. X. Exudates caused by infection. (-) test is good for ruling out a DVT or PE. Asthma is a contraindication for beta blockers.

Better ventilation and less exhaustion of respiratory muscles. hypotensive. Tinea Corporis: also called ringworm is a superficial fungal infection with erythematous. chest pain. fibrosis. Achalasia: decreased esophageal body peristalsis and poor relaxation of the LES is typical. RF: surgery in last 3 months. systemic signs of toxicity. Prepyloric inflammation -> edema. malaise. Avoid mydriatic agents such as atropine (dilates the pupil and worsens the problem. Multiple Myeloma: proliferation of single transformed plasma cell producing IgG with lytic bone lesions. recurrent infections. Present with dyspnea. Use narcotics to control pain. septic. Prodrome of fever. or can be the cause).mucutaneous lesions over two sites. timolol. hypercalcemia. dysrhythmic patients. Vertebral Fracture: patients suffering from ankylosing spondylitis for > 20 years are at risk due to decreased bone density and can result from minimal trauma and clinical suspicion should be high especially with history and onset of severe back pain. history of DVT. hypoxemia by ABG. 4) Urology referral: if anuric. marrow plasmacytosis. hydration of NaCl. Metabolic evaluation not necessary with first stone. have back pain. assessment of hemodynamic stability. IV potassium initially. CI in patients that are septic. tachypnea.35 or PaCO2>45 or RR>25. Recommended with pH<7. acute hepatitis is evaluated by LFTs and viral serology. Treat with supportive management. y COPD Exacerbation: if refractory to steroids and bronchodilators. cough. but patient is not crashing -> use NIPPV before intubation. hyperviscosity. HBsAg confirms HBV as cause. Has decreased incidence of complications such as infection. urine and serum monoclonal proteins. Gastric Outlet Obstruction: rare complication of PUD. malignancy. Rubella: erythematous and maculopapular rash that starts of face and progresses to trunk and extremities. Nephrolithiasis: 1) Imaging: CT scan without contrast. Usually in elderly. pilocarpine. Chronic Hepatitis: evaluation of liver damage is based on liver biopsy. decreased PCWP (indirect measure of LAP) -> activation of SANS -> vasoconstriction. renal failure. Chronic hepatitis persists for 6 months. Symptomatic Hypercalcemia: vigorous hydration with IV normal saline is first step in management. Treat with mannitol. Hypovolemic Shock: blood loss -> loss of intravascular volume -> decreased CO. Seen in hot/humid clients. Exposure to infected y y y y y y y y y y y y . pruritic rash with central clearing. tachycardia. Presents with progressive dysphagia. characteristic target appearance. arthritis. mild coryza. 3) Size: < 5mm typically pass with fluid intake > 2L (dilutes urine). food regurgitation. loud S2. pleuritic chest pain. immobilization. NG suction. increased HR. 2) Narcotics and NSAIDs: relieve pain of renal colic. occipital/posterior LA. NSAIDs do not exacerbate nausea and vomiting. Pulmonary Embolus: anticoagulation with heparin should be initiated immediately in any patient with high likelihood PE and respiratory distress before diagnosis. conjunctivitis. scaly. DVT symptoms. ARF. acetazolamide. scarring of the pylorus -> early satiety and intractable vomiting -> dehydration and hypokalemic hypochloremic metabolic alkalosis due to hyperaldosteronism from volume contration and renal potassium wasting to retain hydrogen. then treatment of the ulcer with possible surgery. Barium swallow shows dilated esophagus and birds beak deformity. and aspiration. fluids. Acute Glaucoma: emergency.

Dry heat is not effective. atherosclerosis. Myocarditis: otherwise healthy young people with acute onset CHF and lack of CAD risk factors. vivax. hypoglycemia. sick sinus syndrome. hypotension and tachycardia. Usually viral due to coxsackie B virus. CSF albumino-cytologic dissociation is specific. Vitiligo: autoimmune disease with areas of depigmentation due to lack of melanocytes. malariae every 72 hours. Causes hyponatremia. SAH: causes cerebral salt wasting syndrome due to inappropriate secretion of vasopressin -> water retention. Cause peripheral vasodilation. syncope. people. areflexia. May get lightheaded and dizzy. not seen with falciparum. Also maximize nutrition. Associating abdominal pain with extraintestinal manifestations can help diagnose. Treat with oral erythromycin. RBC parasite transmitted by Anopheles mosquito. renal disease. vivax and ovale cause relapses. Due to uninterrupted pressure on tissue over bony prominences like elbows. Facial nerve paralysis and autonomic dysfunction can occur. hips. Give IV atropine -> decreases vagal tone. critically ill. sensory changes 3-4 weeks after a URI or GE. Can be falciparum. AI thyroid disease. Can see SIADH which causes hyponatremia and is treated with water restriction. Endemic to Africa. GBS: ascending paralysis. Asia. normal aldosterone levels (not under CRH control). hypopituitarism. primary adrenal insufficiency. See anemia and splenomegaly. discontinue. Do not attempt to debride initially. medications (CCB. heels. Crohn s Disease: involves entire GI tract and has skip areas. Caused by Bartonella. Topic antifungals to treat. Cyclic fever is hallmark that coincides with RBC lysis. malariae. Bruit is due to turbulent blood flow and found in 85% of RAS vs. Caused by physical training. RAS: systolic-diastolic abdominal bruit in patient with HTN. public places are RF. immobile. Decubitus Ulcers: elderly. If significant. regular rhythm.animals. Labs will be normal. MCC of adrenal insufficiency. sensory impairment are all risks. 25% of patients with HTN. Not an allergy! Bacillary Angiomatosis: bright red. type 1 DM. BB. Falciparum causes most deaths. Sinus Bradycardia: HR < 60. Frostbite: best initial treatment is rapid rewarming with warm water (40-44). exophytic nodules in HIV patient. firm. ovale. Immerse in room water that is continuously circulated. excess vagal tone. Can have apthous ulcers in the mouth (non specific) and can see granulomas. Treat with IVIG and plasmapheresis. Repositioning patients every 2 hours (point at which pressure begins to induce tissue damange) and pressure reducing devices prevent. venous insufficiency. alopecia areata. digoxin). coccyx. y Malaria: protozoan disease caused by plasmodium. Can have weight loss and anemia. Vivax and ovale has fever every 48 hours. y y y y y y y y y y y y . Diagnosed with skin scraping and KOH. May have preceding viral type symptoms. Dihydropyridine CCB: cause peripheral edema along with CHF. Results in less tissue damage than slow rewarming at room temperature. friable. increased ANP/BNP -> salt excretion. Central/Tertiary Adrenal Insufficiency: low CRH due to chronic supratherapeutic doses of steroids -> low ACTH and cortisol. poor nutrition. Associated with other AI: pernicious anemia. constant PR interval. a G(-) rod. Causes secondary HTN and CKD.

Cut Off Point: lowering cut off point will increase sensitivity. or restrictive cardiomyopathy. New-onset hearing loss or chronic ear drainage despite antibiotics. Associated with LVH from long standing HTN. (-) Coombs. MCHC > 36%. brain abscesses. hemoptysis. Metabolic & Respiratory Acidosis: low pH (<7. ASA desensitization therapy. folic acid deficiency.y Hereditary Spherocytosis: AD and MC cause of hereditary hemolytic anemia in caucasians. anti-metabolites). normal MCHC. poikilocytosis. Pulmonary Tuberculosis: productive cough. Sounds like Tennessee. Have persistent nasal blockage. ASA blocks COX -> increased lipoxygenase -> accumulation of LT. other (hypothyroid. TMP-SMX for prophylaxis. Can be prevented with adequate hydration and slowing rate of infusion. then do brain biopsy. Is excreted by glomerular filtration and tubular secretion. increased BRN. recurrent fevers. Results from atrial kick hitting stiff LV. topical steroids. Can be severely anemic with jaundice and splenomegaly on presentation. MC contracted due to contaminated blood. Osmotic fragility test is next best test.5(HCO3)+8+2. In US. Granulation tissue and skin debris with retration pockets of TM. Cardiac Disease: detailed history and physical is most effective way to screen for cardiac disease and underlying hypertrophic cardiomyopathy. Imaging shows upper lobe cavitary lesions with surrounding alveolar infiltration. Brain irradiation is for CNS lymphoma (afebrile and weakly enhancing). meningitis. Caused by B12 deficiency. Use Winter s formula to calculate what PaCO2 should be: PaCO2 = 1. renal tubular damage. All school and collegiate athletes should be offered pre-participation by skilled healthcare workers. Treat with leukotriene inhibitors. Cholesteatoma: congenital or acquired secondary to chronic middle ear disease. sulfadiazine & pyrimethamine for treatment. Have increased reticulocytes. Need otologic exam. Morning Hyperglycemia: due to Somogyi effect (high NPH dosing with peaks 4-10 hours after injection -> overnight hypoglycemia -> epi. HBV Vaccination: decreases incidence of HCC especially areas with high HBV like Africa and Asia (chronic HBV secondary to vertical transmission major cause of HCC). inappropriately normal PaCO2 = primary respiratory acidosis. Also causes CN palsies. glucagon release -> glycogenolysis and gluconeogenesis -> morning hyperglycemia) or Dawn phenomenon (decreased insulin sensitivity between 3 and 8 AM -> hyperglycemia at 3 AM and 7 AM due to spikes of GH release which occurs shortly after falling asleep) or waning circulating insulin (usually coexists with Dawn phenomenon. NE. Large RBC. and CT or surgical visualization. vertigo. elevated MCH. S4: low frequency heart sound at the end of diastole just before S1. anisocytosis. 3 AM glucose is usually normal). basophilic stippling. y y y y y y y y y y y y . decreased HCO3 = metabolic acidosis. MCV is normal or high. liver disease. possible weight loss. Acyclovir: causes acute elevation of Cr. Suspect in patients from endemic areas with subacute/chronic pulmonary complaints. ASA Sensitivity Syndrome: pseudoallergic reaction due to ASA induced PG/LT misbalance in susceptible individuals. Congenital RBC membrane defect. 7th& 9th MCC cancer death in men and women. hypersegmented neutrophils.35) = acidosis. crystalluria. episodes of bronchoconstriction. When concentrations -> crystallization. If don t respond. Brain Lesion in HIV: MCC is toxoplasmosis. spherocytes. Megaloblastic Anemia: elevated MCV.

Most commonly see hypercholesterolemia (increased LDL) or combined with high TG. breast. rimantadine and amantadine are only effective against influenza A. Need eye exams every 6 months. Neuraminidase inhibitors (oseltamivir and zanamivir) are used. Kidneys work property excreting dilute urine. History of malignancy makes diagnosis likely. bullous/pustulous lesions around orifices or extremities. but do not help survival. ARBs. crackles. HBV associated membranous GN more common in children than adults. Diagnosed via: acute dyspnea. kidney can all metastasize. Isoniazid: can cause B6 deficiency -> peripheral neuropathy -> tingling in extremities. Diabetes and amyloidosis are common causes. elevated urine protein (3g/day). toxic injury. COPD: often have CO2 retention -> respiratory acidosis. Thyroid Function Tests: hyperlipidemia. Start antivirals within 48 hours. bilateral infiltrates. heads and UE are often affected. y y y y y y y y y y y y . ataxia. and phenothiazines given to them cause dry mouth increasing thirst. thyroid. malaise. impaired wound healing. Digoxin and furosemide can reduce symptoms and hospitilzations. Nephrotic Syndrome: edema. chills. prostate. spironolactone all confer survival benefit. Minimal change disease is the MCC in children. severe bleeding. elevated serum muscle enzymes are indications for TFTs. course breath sounds. Due to decreased LDL receptors. Survival in CHF:ACE I. Causes alopecia. Common association with HBeAg (+) due to deposition of Ag or Ab. hypoalbuminemia. 100 mg/day for treatment. Hepatitis is another known side effect. beta blockers. cough. Common in patients with schizophrenia. Start on 10 mg/day prophylaxis. Lung. abnormal taste. PCWP < 18 (> 18 indicates impaired LV function). Confirm by withholding water -> increases urine osmolality and specific gravity. ARDS: non cardiogenic pulmonary edema due to inflammation of alveoli. trauma. May be difficult to control cholesterol even with thyroid control. Influenza: acute onset fever. Normally digested in the jejunum. Most serious SE is retinopathy & corneal damage. Occurs in winter. Caution: increased risk of myopathy with statin use. FSGS and membranous are most common in adults. Treat with propranolol. Urinary Retention: abdominal pain and suprapubic fullness after taking TCAs (anticholinergic -> reduces detrussor contraction and sphincter relaxation). CXR may be normal or have interstitial pattern. Catheterize -> document PVRV > 50 mL (diagnostic for urinary retention) and provides symptomatic relief. Essential Tremor: AD. Active HBV infection causes membranous GN > nephrosis. Hyponatremia -> seizures. myalgias. Sepsis. Hydroxychloroquine: good for treatment of SLE with isolated skin and joint involvement. PaO2/FiO2 < 200. Primary Polydipsia: problem of excessive water ingestion. burns can be causes. degenerative which is worse with exercise and better with rest. Metastatic Disease of the Vertebrae: metastases are the MC malignancy of bone. numbness. Use diuretics to treat cor pulmonale but caution is needed because they have a reduction in CO with subsequent development of renal failure. Febrile with wheezes.y Zinc Deficiency: result from chronic TPN (lacks zinc) or malabsorption due to SB resection due to IBD. worse when arms outstretched at the very end of goal directed activities (intention tremor). inciting condition. Pain is usually constant and worse at night with rest vs. Nasal swabs confirm. unexplained hyponatremia.

Type IV hypersensitivity: initial sensiztization -> 10-14 d -> re exposure -> reaction in 12-48 hours. RF are small bowel disease. topical antihistamines. pleuritic chest pain. Lead Time Bias: always consider in evaluation of a screening test. Decrease in transaminases = recovery or few functional hepatocytes (look at other tests). >10 mm is (+) in immigrants from endemic area. café-au-lait spots. surgical resection. Treat via drainage and antibiotics. preservatives. Think of this with new screening test for poor prognosis diseases. Alcohol. organ transplant. usually those < 6. NF Type I: intensive axillary freckling. patients on immunosuppression. Can use calamine lotion. obesity. round alveolar infiltrates. atrophic. coffee intake are not RF. RF: male sex. residents/employees of highrisk settings. ginko. with swollen. MCC strep pneumo. Allergic Contact Dermatitis: MC sensitizer is plant urushiol (poison ivy/oak/sumac. Elevated transaminases = cellular injury. PPD: detect patients with latent TB infection. skin. Degree of induration required for (+) test depends on pre-test probability. Tricuspid regurgitation is common -> systolic murmur that increase on inspiration. hemoptysis. prostate. joints. Pancreatic Cancer:5th MCC of cancer related mortality. rubber are also common. Have fever. Due to bacterial seeding of a parapneumonic effusion or inoculation of bacteria during surgery. Avoid contact. optic gliomas in ~ 15% of patients. Slow progressive unilateral vision loss and dyschromatopsia. Nickel. heaped up. chest pain. If tricuspid or pulmonic valves are involved -> septic emboli to the lung -> cough. or normal optic disk. SBE and IV Drugs: increased risk in both right and left heart. LFTs: PT is the most important test of functionality. children < 4 or teens exposed to high risk adults. non-anion gap metabolic acidosis (decreased bicarbonate and normal AG). steroids. Proteinuria due to septic emboli or immune complex in the kidney. IVDA. y y y y y y y y y y . CXR shows free flowing (early) or loculated (late) effusion. >15 mm is (+) for healthy patients with no known TB risk factors. Failure to secrete acid as NH4+ and potassium retention. black race. fragrances. May occur due to diabetic nephropathy and can be worsened by ACEs and ARBs that inhibit aldosterone. mango skin) in NA. bones. Caused by aldosterone deficiency or tubular insensitivity to aldosterone. >5 mm is (+) in HIV. familial pancreatitis.y Empyema: intrapleural collection of pus. Blastomycosis: broad based budding yeast endemic to north central and south central US. long standing diabetes. warty. sharp borders. Can have verrucous (crusted. Primary pulmonary infection is asymptomatic or presents with flu-like symptoms. Affects lungs. smoking (most consistent reversible RF). violaceous hue. formaldehyde. MC are calcium oxalate that are envelope shaped. Rise in PT with decreased transaminases = low functionality = fulminant hepatic failure. SOB. detected earlier so patients seem to live longer. Opacity typically has abnormal contour. cough. >50 years. Type 4 RTA: hyperkalemia. recent contact with TB. patients with diabetes/CKD/hematologic malignancies/fibrotic lung disease. Kidney Stones: colicky flank pain with radiation to the groin. Actually. Incorrect assumption of prolonged survival time and better prognosis. Wet mount shows organism. and pancreatic cancer in close relative. klebsiella. gallstones. signs of TB on CXR. surrounded by micro abscesses) or ulcerative skin disease. chronic diarrhea -> bile salt and FA malabsorption -> calcium chelation -> reabsorption of oxalate. renal insufficiency. Can see exophthalmos. chronic pancreatitis. staph aureus.

y

DVT: presents with calf pain, swelling, discoloration (other DDx is Bakers cyst, muscle strain, venous insufficiency, cellulitis). Decision to anticoagulate based on history, physical, and non-invasive testing: compression ultrasound. If low risk, do D-dimer. If negative, no anticoagulation. If positive, do ultrasound. Osteomyelitis: if coupled with chronic foot ulcer in a diabetic (due to neuropathy and arterial insufficiency) or other causes of arterial insufficiency, caused by contiguous spread. Aspiration Pneumonia: fever, cough with foul smelling sputum after endoscopy or other instrumentation. Poor dentition also RF. Add antibiotic with anaerobic coverage like clindamycin. Thoracic Aortic Aneurysm: MC site is ascending due to cystic medial necrosis. 2nd MC is descending distal to L SCA, fusiform, due to atherosclerosis. May also have AAA. Usually have comorbid CAD or pulmonary disease. Atrial Myxoma:MC primary intracardiac tumor, usually in LA. Can cause fever, weight loss, neurologic symptoms due to embolization, and mass on echo. Usually in elderly patients. Horner s Syndrome: suspect lung cancer in a smoker. Cancer can cause cough, chest pain, weight loss, decreased appetite, weakness, swallowing difficulty, hoarseness, shoulder pain due to direct extension. Do simple CXR to start. Histoplasmosis: common and asymptomatic infection in Mississippi and Ohio River Valley and Central America. Commonly found in bird and bat droppings -> inhalation. Not common to get symptomatic disease. Will have fever, chills, non productive cough, with patchy infiltrates. Cavitary lesions can form in older adults with COPD which can be fatal. Can disseminate in immunocompromised and children. Can present as solitary nodule. Chronic Liver Disease: all patients should be vaccinated against HAV and HBV unless already immune (look at Ab levels), due to high risk for acute hepatic failure or cirrhosis. Post Splenectomy Sepsis: normally pathogens are phagocytosed by dendritic cells in white pulp -> MHC II presentation to TH2 cells -> marginal zone -> B bells in primary follicles -> secondary follicles and plasma cells -> Ab formation -> binding Ag -> phagocytosis by opsonization. No spleen -> impaired Ab mediated opsonization for phagocytosis -> risk for sepsis due to Strep pneumo, N meningitidis, H flu. NPH: abnormal gait (slow broad based shuffle), incontinence (urinary, fecal in late disease), dementia due to increased ventricular size without increased pressure. Treat with large volume LP and, if successful, VP shunt. Caustic Ingestion: no alteration of consciousness, dysphagia, pain, heavy salivation, mouth burns. Causes necrosis of GI tissue and can cause perforation of stomach or esophagus -> peritonitis and mediastinitis. Central Line Thrombosis: prolonged placement -> thrombosis -> swelling (arm if SCV). Remove catheter and duplex to document thrombus and need for anticoagulation. Common with TPN lines which should be in RA. Hyperosmolar fluid -> irritation of vein. Have swollen arm with present pulses. Swelling may extend into head and neck with distended veins. Pheochromocytoma: do not give beta blockers without alpha blockers. Beta block -> unopposed alpha activity. Give alpha first and then beta to treat tachycardia, otherwise can cause dangerous increase in BP. Labetalol has alpha and beta activity and can be given.

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Hereditary Spherocytosis: AD disorder of spectrin -> increased RBC fragility. Not deformable and gets trapped in red pulp fenestrations. (+) family history, splenectomy, spherocytosis, can cause cholecystitis due to pigmented stones -> treat with folate and splenectomy. Whipple s Disease: multi system infection caused by Tropheryma whippelli. Presents with arthralgias, weight loss, fever, diarrhea, abdominal pain. Can have chronic cough and myocardial/valvular involvement -> CHF or regurgitation. Have PAS(+) material in lamina propria on biopsy. Can have hyperpigmentation, LA, supranuclear ophthalmoplegia, myoclonus. Chronic Hepatitis C: waxing and waning of transaminase levels with few symptoms. May have arthralgias/myalgias. Can have cryoglobulins, porphyria cutanea tarda, GN. 20% develop cirrhosis. Hepatic function worsens in times of stress. Dehydration: altered MS, dry mucosa, high electrolytes/Hct, BUN/Cr > 20. Elderly patients are predisposed due to decreased thirst response, impaired sodium retention, impaired renal concentration. Treat with NS, but caution: Na loading unmasks subclinical CHF. Aortic Stenosis: causes exertional syncope along with ventricular tachycardia and HOCM. AS will have symptoms of CHF (fatigue, dyspnea on exertion). Symptomatic with valve area < 1. Have systolic murmur at R 2nd ICS with carotid radiation, pulsus parvus et tardus, and prolonged PMI. Neurocysticercosis: MC parastitic infection of the brain caused by larval Taenia solium. Adult lives in intestine -> eggs -> animal consumed -> larvae encyst in tissue -> eat animal -> adult tapeworm in intestine. If person consumes eggs -> embryos in intestine -> invade wall -> disseminate to brain, muscle, SQ tissue, eye. Multiple, small, fluid filled cysts with invaginated scolex on neuroimaging. Usually asymptomatic and found on autopsy. Hypercalcemia: abdominal pain/constipation, polyuria, psychiatric disturbances (usually calcium > 12). Treat with normal saline and then loop diuretic. Can be seen in MM with back pain and pancytopenia, due to osteoclast activating factor -> lytic lesions and hypercalcemia. Serum Sickness Like Reaction: can occur 1-2 weeks after administration of penicillin, amoxicillin, TMP-SMX, or cefaclor after viral illness. Fever, urticarial rash, polyarthralgia, LA. Distinct from immediate hypersensitivity reactions. Discontinue offending agent. Hematuria: initial hematuria = urethral damage. Terminal hematuria = prostate or bladder damage. Total hematuria = kidney or ureter damage. Clots not usually seen with kidney damage. Painless terminal hematuria -> investigate bladder cancer. Cavernous Sinus Thrombosis: occur in patients with infections of the skin adjacent to the eye or nose, ethmoid/sphenoid sinusitis. HA (neuropathic due to V1/V2) is MC early symptom. Fever, periorbital edema due to obstructed flow. Lateral gaze palsy due to CN VI involvement. CN III, IV, V1, V2 can be affected. Do MRI/CT of orbits. Use IV antibiotics. Hyperandrogenism: rapidly developing suggests androgen secreting neoplasm in adrenal or ovary. Look at testosterone and DHEAS. High testosterone with normal DHEAS = ovary. Normal testosterone with high DHEAS = adrenal. Lumbosacral Strain: MCC of acute back pain usually after physical exertion, absence of radiation, presence of paravertebral tenderness/contraction, (-) straight leg raise, normal neurological exam. Treat with NSAIDS and early mobilization.

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Minor Thalassemia: alpha or beta will have impressive microcytosis with modest anemia (Hgb level, adult diagnosis, lack of severe symptoms), target cells, with no GI bleeding. Common in Mediterranean descent. Reassure and followup. ABCs: start in management of ANY patient coming into ER. Poor circulation evidenced by hypotension, pallor, tachycardia, delayed capillary refill -> volume resuscitate -> hemodynamically stable -> start with diagnosis. Anal Fissure: slit like tears of anal canal usually on anterior or posterior anal verge due to passage of large, hard constipated stools. Crypt abscesses, explosive diarrhea, perianal dermatitis/infection, IBD, trauma, sexual abuse can all be causes. Severe pain and bright red bleeding. Treat acute and chronic with high fiber, lots of fluids, stool softener, local anesthetic. GERD:patient with asthma like symptoms that occur only at night (especially those who eat late or go straight to bed), sore throat, horseness, wheezing. Start with lifestyle modification (avoid eating late, elevated head of bed), PPI. Ichthyosis Vulgaris: history of normal skin at birth with gradual progression to dry, scaly skin. Hereditary or acquired. Usually dry and rough with horny plates over extensor surfaces. Sparing of diaper/face in children. Worse in winter. Sometimes called lizard skin . Subacromial Bursitis: result of repetitive overhead motions -> chronic microtrauma to the supraspinatus tendon by compression between acromian and humeral head. Pain with active ROM, passive internal rotation/forward flexion (Neers). Atrial Flutter: sawtooth pattern of atrial impulses on EKG with large P waves that do not conduct all QRS complexes. Caused by re-entrant rhythm. Present with palpitations, CP, SOB, lightheadedness. Ventricular rate determined by AV node conduction. MC is 2:1 block, can have 3:1 or 4:1 (variable AV node conduction). Hyatid Cysts:due to infection with Echinococcus granulosus from close contact with dogs (definitive host). Causes unilocular cystic lesion in liver, lung, muscle, bone. Usually asymptomatic, or symptoms are due to compression. Have eggshell calcifications and can cause anaphylaxis. Treat with resection under cover of albendazole. OA: narrowed joint space, osteophytes, subchondral sclerosis or cysts, < 30 minutes morning stiffness, joint pain. Obesity is most readily modifiable RF for OA and can slow progression and improve joint pain and function. Herpes Zoster: reactivation of VZV in DRG in patient with previous chickenpox. Can be due to immunocompromise (HIV, chemo, diabetes), stress, old age. Pain and vesicular rash in dermatome. Pain may precede rash. CO Poisoning: colorless, odorless gas emitted automobiles, charcoal grills, furnaces. Acute exposure presents with HA, nausea, vomiting, abdominal discomfort, confusion, coma, with pinkish skin hue. Diagnosed by carboxyhemoglobin levels. Treat with hyperbaric O2. History is helpful. Hypercalcemia of Malignancy: due to production of PTH-rP by malignant cells. MC paraneoplastic syndrome usually associated with SCC of lung. Causes increased bone resorption, increased tubular calcium resorption, phosphate secretion. Outlier: extreme and unusual value observed in dataset. Means are extremely sensitive and shift towards them.

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diaphoresis. Involved in 10-50% of car accidents. fibrosis. tachycardia.y FAP: AD caused by mutations of APC gene. hypovolemia. electric-shock like. History of slowed reaction time. Do a UA to rule out more worrisome conditions. hypochloremia. hyaluronic acid deposition. Seen where sheep are raised. Weakness and wasting is characteristic of UMN and LMN lesions. confusion. Graves Ophthalmopathy: MCC of exophthalmos in adults. Primary Syphilis: treatment is single intramuscular injection of benzathine penicillin. bone marrow. history of diuretic use. foreign body. Hyperkalemia: removal of K from the body only done via dialysis. edema. and lung in 1/4. burning. Bilateral diffuse infiltrates on CXR in perihilar region. or exchange resins like Kayexalate acts in GIT to exchange Na for K. 3) Bartter/Gitelman s: same as diuretic abuse. Otherwise is a benign drug effect. hypochlouria. tachypnea. transmission when dogs live close to humans and are fed viscera of slaughtered animals. beta agonists. sheep are intermediate hosts. liver. diuretics. PJP Pneumonia: opportunistic pathogen and important cause of pneumonia in IC adults. Cut Off Point: raising decreases sensitivity. positive urine assay for medication. insulin with glucose/dextrose. MC due to obstruction due to mucus plugging. Carbamazepine is the drug of choice for treatment. fever. Dogs are definitive hosts. Liver is MC affected in 2/3. Will have dry eye due to keratitis and exposure. Causes hundreds of adenomatous polyps in colon and has 100% risk of cancer if not treated with elective proctocolectomy. Can have involvement of LN. exaggerated DTR) and LMN (fasciculations). dry mouth. White Out Lung: have opacification with mediastinal shift towards affected lung due to atelectatic volume loss. intense. tumor. Urgent bronchoscopy for diagnosis and possible relief of obstruction. Caused by autoimmune periorbital lymphocytic infiltration of extraocular muscles -> fibroblast proliferation. Treatment also uses calcium gluconate. humans are deadend accidental hosts. increases specificity. impaired short term memory. Causes dyspnea. dental erosions. external compression. Echinococcus Granulosus: majority are asymptomatic infections. Have conjunctival injection. use single dose azithromycin or 2 weeks of doxycycline or tetracycline. Cysts are have germinal layer (can give rise to daughter cysts) and laminated layer. spleen. With penicillin allergic. Human ingestion -> intestinal penetration -> dissemination. bulbar symptoms. Have dyspnea. y y y y y y y y y y y y y . Hypokalemic Alkalosis: 1) Vomiting: scars on dorsum of hand. hypertension. ALS: characterized by involvement of UMN (spasticity. lightning-like pain on the face which is severe. 2) Diuretic Abuse: same presentation but elevated urine chloride. bicarb. MJ Intoxication: MC used illicit drug in US. Sclera seen above and below iris which is pronounced by sympathetic stimulation of lid retraction. cyanosis. increased appetite. such as renal TB or TB associated glomerulopathy. Case Control Study: pateitns with disease of interest (cases) and people without disease (control) are asked about previous exposure and exposure odds ratio is measured compared case rate to control rate. Trigeminal Neuralgia: paroxysmal. Rifampin: causes red/orange discoloration to bodily fluids and can cause discoloration of soft contacts. non productive cough.

suprapubic discomfort. fatigue. Iron Deficiency Anemia: MCC of anemia in the elderly. Cardiac Tamponade: hypotension. diverticulosis). ARDS: endothelial injury -> fluid leakage from capillaries -> fills interstitium and alveoli -> intrapulmonary shunting -> hypoxia refractory to O2. Use Winter s formula: PaCO2 = 1. no unusual vaginal discharge. ASA Intoxication: mixed respiratory alkalosis (due to increased drive) and anion gap metabolic acidosis (accumulation of salicylate and decreased excretion of organic acids like lactic acid and ketoacid). Wilson s Disease: AR. Acute onset. Have low ceruloplasmin. apathy. ECG shows electrical alternans: amplitude of QRS changes. gait ataxia. increased copper excretion. Evidence of other atherosclerotic diseases and non-specific physical findings. cholesterol. Oral TMP-SMX is best empiric threatment. confabulation. bacteriuria. Nitrates: venodilation -> improves cardiac chest pain by reducing preload -> decreased myocardial O2 demand. Can be induced by giving glucose without thiamine. Cardiovascular Disease: MCC of death in patients on dialysis (50% of deaths. Usually secondary to a nutritional deficiency. Kayser-Fleisher rings. 20% due to MI. drainage. oculomotor dysfunction.5(HCO3)+8+2 to determine if its mixed or not. Staph aureus for < 25%. Patients taking antipsychotics should be advised to avoid prolonged exposure to extreme temperatures. 50% patients may have a bruit. IgM. Can be due to chronic blood loss (gastritis. Wernicke: encephalopathy. frequency. neuropsychiatric. PU. Seen in elderly with uncontrolled diabetes. steatorrhea. Malignant Otitis Externa: serious infection of the outer ear caused by Pseudomonas. Cystitis: dysuria. cornea. Needs massive fluid resuscitation and emergent pericardiocentesis. JVD. Also cause some arterial dilation -> some decreased afterload and myocardial O2 consumption. bilateral infiltrates. pyuria = acute uncomplicated cystitis. Elevated ALP. xanthomas. (+) anti-mitochondrial Ab. osteopenia. granulation tissue in ear canal. Korsakoff: irreversible amnesia. Cause pallor and fatigue. food aversion. jaundice. Diagnosis requires angiography or Dopper US. 60% to sudden death) and MCC of death in renal transplant patients. Cultures are not needed. no high risk sexual behavior. hepatomegaly. basal ganglia. Swan Ganz < 18/absense of JVD/cardiomegaly (which indicates CHF). UDCA is treatment of choice: relieves symptoms and lengthens transplant free survival time. Can y y y y y y y y y y y y y . Mesenteric Ischemia: unexplained chronic abdominal pain especially after eating. Increased risk of hepatobiliary malignancy. Osteomyelitis in SCD: Salmonella is the MCC (upto 70% of cases). Wernicke Korsakoff: caused by thiamine (B1) deficiency. Starts with pruritis especially at night. abnormal copper deposits in liver. weight loss. Fluphenazine: high potency typical antipsychotic that is injected every 2-3 weeks that can cause hypothermia by disrupting thermoregulation and shivering mechanism. PaO2/FiO2 < 200. portal hypertension. Reduces ventricular volume and wall stress. tachycardia. Liver disease (asymptomatic to fulminant). ear pain.y PBC: autoimmune destruction of intrahepatic bile ducts and cholestasis.

TEE is preferred diagnosis to MRI (takes too long) or CT. Due to chemo/radiation. the greater probability that a patient from the population with a positive test actually has the disease. TMJ (worse with chewing). bowel/bladder dysfunction).4. Linked to contaminated water faucets. Use CT to look for thymoma after diagnosis is established. abscess. Adrenal Deficiency: hyperpigmentation of skin and mucous membranes is characteristic of primary deficiency due to increased ACTH. Ventilation: RR x Vt. Can also have other manifestations of pituitary insufficiency. toxic megacolon. Not seen in secondary deficiency which is due to hypothalamic-pituitary failure. Respiratory alkalosis (pH > 7. Aortic Dissection: suspect with acute retrosternal pain and normal EKG. facilitates measurement of size. lower RR (decreased Vt -> increased RR -> worsens situation). Life threatening complication -> rupture. weight loss. lung. New Drugs: consider natural history of a disease in evaluating effectiveness of a new drug in a trial. Give IV ciprofloxacin. Complications are PSC. Normal Vt is 6 mL/kg ideal body weight. can develop secondary malignancies (usually lung or breast). spondyloarthropathy. decreased sensation. Usually asymptomatic and present with symptoms of primary malignancy. Spinal Cord Compression: signs and symptoms of UMN dysfunction distal to site of compression (weakness. Pseudomonas Pneumonia: G(-) bacilli in sputum in intubated ICU patient with fever and leukocytosis.2% of patients within 20 years. Liver Mass: isolated mass is more likely to be metastatic than primary. y Hodgkin s Disease: curable lymphoma of young patients. MC considered G(-) aerobic bacilli and common cause of nosocomial pneumonia. Sjogren s Syndrome: subjective and objective evidence of dry eyes (keratoconjunctivitis sicca) and mouth (xerostomia. decreased CO2) results from hyperventilation. hyperreflexia. The more common a disease. uveitis. increased caries) exists with histologic evidence of lymphocytic infiltration of salivary glands or SSA (Ro)/SSB (La) Ab. Opposite is true for NPV. EMG and Ach receptor test are diagnostic. anemia. HTN should be controlled before TEE. Does not produce pain or numbness. Could be herniation. Occurs in 3. CN involvement. therapy y y y y y y y y y y y y . AAA:usually asymptomatic and discovered incidentally. With chronic abdominal pain -> colonoscopy. malignancy. colon cancer. trauma. tenesmus. erythema nodosum. PPV: depends on prevalence of disease of interest in population and increases with increases in prevalence. Check BP in both arms and listen for diastolic murmur of AR. In setting of appropriate Vt. Ultrasound has nearly 100% sensitivity and specificity.develop osteomyelitis of the skull base. shows presence of thrombus. Myasthenia Gravis: MC manifestation is weakness of muscles that lift lid (ptosis) or move eyes (double vision). Medical emergency requires prompt diagnosis with MRI. Control groups help prevent this. cramping. respiratory therapy equipment. SOB and dysphagia are worrisome. Ulcerative Colitis: bloody diarrhea. Routine colonoscopies beginning 8 to 10 years after diagnosis. Primary tumors of GIT. breast are MC.

Occurs with valve replacement or severely calcified aortic valves. azotreonam. Suspect in patient with sudden onset SOB. focal neurological deficits. Intraocular Foreign Body: suspect in patients with high velocity injuries (drilling. Dubin Johnson Syndrome:conjugated chronic hyperbilirubinemia not associated with hemolysis. increased LDH. MC in African Americans and usually have no prior symptoms. MI. Helmet cells or fragmented RBC s on smear. non-specific complaints. GBS and other demyelinating syndromes. Usually some kind of precipitant event (infection. Hyperglycemia (>600). MCC is MVP (can hear mid systolic click). stroke). dysuria. If initial pen light exam does not reveal anything. tachypnea. elevated CK. y imipenem/cilastatin. absent ketonemia. grinding). tobramycin. Due to myxomatous degeneration of the valve. tumor lysis syndrome. muscle rigidity. do fluorescein exam with Wood s lamp or slit lamp. Non-depolarizing blockers are better. y y y y y y y y y y . RR can equal odds ratio. Have normal amounts of total urinary coproporphyrin but have > 80% type I (vs. Insulin is enough to prevent ketosis but not hyperglycemia. Calf swelling and Virchow s triad not always present. HOCM: sudden cardiac death in young individual. If population is small.pools. risk in unexposed). weakness. Liver is usually black due to dense pigment of epinephrine metabolites in lysosomes. Low O2 and atrial fibrillation = poor prognosis. jaundice. Should not be used in patients with high risk for hyperkalemia: crush or burn injuries > 8 hours old (rhabdomyolysis). amikacin. Cefepime. Asymptomatic. Macrovascular Hemolysis: elevated reticulocyte count. autonomic instability. Succinylcholine: depolarizing neuromuscular blocker that can cause life threatening hyperkalemia and arrhythmias. NMS: fever. hypoxia. history of multiple sexual partners. low grade fever. low haptoglobin -> iron loss -> microcytic anemia. Mitral Regurgitation: holosystolic murmur that radiates to the axilla. Chlamydial Urethritis: presence of mucopurulent urethral discharge. gentamycin. frequency. Stop medication. UA has no bacteriuria. usually during exertion. Can also have heart failure and stroke but would not cause sudden death. pleuritic chest pain. Dantrolene (a muscle relaxant) is used to treat followed by bromocriptine (DA agonist) and amantadine (antiviral with dopaminergic properties). PE: signs and symptoms are non specific and variable. Non Ketotic Hyperosmolar State: occurs in T2DM. Can cause left atrial dilation and atrial fibrillation (intermittent palpitations). coma. piperacillin/tazobactam. normal individuals with majority type III). High osmolarity -> lethargy. Case Control Study: exposure-odds ratio is the measure of association (odds of exposure in cases to odds of exposure in control) and is not the same as relative risk (risk in exposed vs. tachycardia. ciprofloxacin. Usually seen with typical antipsychotics and usually start within 2 weeks of starting medication. hemoptysis. Have glucosuria and severe dehydration. Can have ventricular tachycardia or ventricular fibrillation due to abnormal myocytes and myocardial scarring. hyperosmolarity (>320). plant products. altered mental status. Icterus can be worse during stress. UCx < 100 colonies/mL. mental status change.

hyperviscosity. bicarbonate is retained -> decreased choride absorption. SOB. Bullous Pemphigoid: tense blisters in flexural areas. Diabetic Ketoacidosis: when treating. Safe for use in patients with renal/liver failure. serum/urine ketones falls behind changes in pH or anion gap and are more reliable indicators of recovery. If patient < 50 with no risk factors. Obesity Hypoventilation: long term consequence of severe obesity and untreated OSA -> chronic hypercapneic/hypoxic respiratory failure. cor pulmonale. Treat with steroids. metabolic (hyperthyroidism). Diagnose by serum measurement and genetic testing. Nonketotic Hyperglycemic State: fluid replacement is the most important step. Atrial Fibrillation: irregularly irregular. increased TLC/residual capacity and FEV1 is disproportionately decreased. Start with NS. cherry red fovea. Central Retinal Vein Occlusion: subacute monocular vision loss with blood and thunder appearance on fundoscopy of optic disc swelling. Rapid irregular rhythm -> atrial fibrillation -> cardiogenic source of embolus (could be caused by MI due to CAD). decreased VC. retinal hemorrhage. MCA Infarct: with aphasia. palpitations. acute phase reactant. no P waves. not intermixed. secondary erythrocytosis. Minimal BRBPR: on toilet paper. pulmonary HTN. resist digestion by diastase.y PE: patients with recent orthopedic surgery are at higher risk for DVT and PE and anticoagulation will be needed. Statin Side Effects:elevated liver enzymes and myopathy. Will have elevated A-a O2 gradient due to impaired gas exchange (also seen in interstitial disease. polyps. Treat with purified A1AT or lung/liver transplant. May need 8-10 liters. Atracurium: neuromuscular blocking agent that is metabolized by serum esterases and degrades spontaneously. CoQ10 (reason for myopathy). Usually northern European. Develop panacinar emphysema (MCC death) and liver disease (2nd MCC death). To keep pH. or drugs. drops in toilet bowl. Inhibition of HM-CoA reductase. and other processes that alter V/Q). Alpha 1 Antitrypsin Deficiency: inhibits many different proteolytic enzymes. anal fissure. chronic glaucoma. narrow QRS. 5% dextrose given when blood glucose < 250 to prevent cerebral edema. painless loss of vision in one eye with optic disc pallor. Due to UVR. BP 180. Accompanied destruction of alveolar-capillary membrane. especially when hypovolemia is present. Auto Ab formed against basmement membrane proteins BP230. then colonoscopy if no etiology found. cotton wool spots. usually cerebral cortex on the left. boxcar segmentation of blood in retinal veins. Can present with chest pain. urticaria. Usually done in patients with early onset emphysema. pulmonary. y y y y y y y y y y y y y . Central Retinal Artery Occlusion: sudden. Due to cardiac. proctitis. dilated veins. then ½ NS. weakness. See IgG and C3 and dermal epidermal junction. Cannot make mevalonate -> dolichol. do anoscopy or proctoscopy. highly pleomorphic gene on chromosome 14. antibiotics. some on outside of stool. NSAIDs. Broca s is common and patients will have word finding difficulties. Elderly patients with pruritis. atherosclerosis. COPD: progressive expiratory airflow limitation -> air trapping. rectal ulcers/cancer. Liver cells will have PAS(+) granules. Caused by coagulopathy. MCC hemorrhoids.

Used for 30 days with bare metal stents and 1 year for drug eluting stents (epithelialization occurs slowly). otitis. sinusitis) and vasculitic cutaneous lesions (tender nodules. Vascular lesions can develop as well. Type B (descending) need medication only. 50% sensitivity). toxins. HIV LA or obstructive lymphomas -> auditory tube dysfunction. Can use sputum induction with hypertonic saline (high specificity. Interferon and lamivudine used for hepatitis B. CD4 < 200) and less useful for diagnosis of interstitial disease. tenosynovitis. LA usually in posterior chain. ulcerations). Good in place of ASA in those who cannot tolerate. epistaxis. Increased risk of aspiration due to esophageal dysmotility. trauma. Wegener s Granulomatosis: triad of systemic vasculitis. Type A (ascending) need medication and surgery. MC middle ear pathology in AIDS. ARDS: develops in setting of sepsis. dull TM that is hypomobile. TEE for those who cannot tolerate contrast. HTN is leading risk factor. Nasal cartilage destruction (saddle nose. airway resistance calculated by PAP. Use chloroquine for sensitive areas. Positive c-ANCA to proteinase 3 and elevated CRP. inguinal. higher with decreased compliance). tonsillitis with exudates. palpable purpura. Systemic Sclerosis: MC underlying mechanism of pulmonary disease is interstitialfibrosis. burns. Start 1 week before. Treat with cyclophosphamide. pharyngitis. proteinuria. Gonnococcemia: triad of polyarthralgia. purpulent rhinorrhea. Can have fever and chills. Non Inflammatory Chronic Prostatitis: afebrile with irritative voiding symptoms. sore throat. Indian subcontinent). Expressed secretions show no bacteria and normal WBCs. GN (RBC casts. detectable HCV RNA.y Infectious Mononucleosis: fever. mefloquine is the drug of choice. >90% sensitive and specific for PJP (HIV. Usually no symptoms of symptomatic venereal disease. but voiding problems may have been present in past. painless vesiculopustular skin lesions. MC symptom is conductive hearing loss. CT is good for diagnosis. Can develop hemolytic anemia and thrombocytopenia due to anti-I Ab and usually Coomb s (+). but uncommon to be without fibrosis. Aortic Dissections: beta blockade is most appropriate initial intervention (lower HR and BP > decreased wall stress). upper and lower airway granulomatous inflammation. Increased risk of lung cancer. beta blocker. Bronchoalveolar Lavage: useful with suspected malignancy or opportunistic infection. y y y y y y y y y y y y . Antagonize ADP as antiplatelet. Serous Otitis Media: middle ear effusion without active signs of infection. Treatment of Hepatitis: for hepatitis C: elevated ALT. pneumonia. Malaria Prophylaxis: for chloroquine resistant (sub Saharan Africa. statins. No history of UTI. and continue for 4 weeks after returning. Clopidogrel: secondary prevent in UA/NSTEMI for at least 12 months along with ASA. PCWP < 18 (normal) indicates non-cardiogenic pulmonary edema. axial. sterile pyuria). ACE. PEEP calculated by end-expiratory hold maneuver. Pumonary Mechanics: compliance calculated by doing end inspiratory hold maneuver (elastic pressure is pressure at end of inspiration. toxic symptoms. Alcoholism is further RF. History of recent unprotected sex with new partner. histologic evidence of chronic hepatitis are candidates for treatment interferon and ribavirin. Can have jaundice and hepatitis.

May also have abdominal pain. wheezing. bronchi. with signs of sepsis. vasculitis. sterility. glottis. urinary tract cancer. PE: proximal deep leg veins (iliac. restrictive lung pattern. endinspiratory crackles. colon. Pain shifts to RLQ with involvement of parietal peritoneum and becomes somatic in nature. popliteal) are MC source of symptomatic PE. Male Incontinence: MCC in older men is bladder outlet obstruction due to BPH or carcinoma of the prostate. Have anemia and reactive thrombocytosis. Progressive dyspnea. bloody diarrhea. Associated with fistulae. void frequently. CREST Syndome: calcinosis cutis (deposition of calcium in skin that manifests as nodules that may ulcerate and drain chalky material). renal. normal FEV1/FVC. Will have enlarged prostate with high PVRV. nocturia. Cyclophosphamide: immunosuppressant used in SLE. weight loss. lips. Limited form of systemic sclerosis. blue. urinary retention. Occurs due to accumulation of bradykinin. tenesmus. pelvic. femoral. larynx. clubbing. Analgesic Nephropathy: MCC of drug induced chronic renal failure. Bradyarrhythmia: SSS or conduction abnormality -> recurrent syncope (when HR < 30). microscopic hematuria. anal disease. y y y y y y y y y y y y y . mild proteinuria. hesitancy. HTN. urgency. Carcinoid Syndrome: classic triad of flushing. Present with post void dribbling. taking MESNA help prevent all complications. sclerodactyly (fibrosis of skin distal to MCP joint -> shiny appearance. Usually seen after 2-3 kg of drug ingestion. Develop premature aging. cancers. poor stream. impaired urinary concentrating ability in late disease. Ulcerative Colitis: most likely in a patient with subacute to chronic presentation of abdominal pain. Asbestosis: pneumoconiosis from inhalation of particles. Serotonin causes vasodilation. renal colic. bladder carcinoma. joint pain). prolonged QT -> tachyarrhythmia). decreased lung volumes. appendix. toxic megacolon should be investigated with x ray. Tumors are in SI. vascular disease. Check for airway compromise and vasomotor instability -> epinephrine. Drink fluids. and some eventually need insulin. SE are hemorrhagic cystitis. abdominal pain. diarrhea.y Angioedema: ACE I are the MCC of acquired. Prolonged QRS suggests this (vs. Edema in the face. useful when trying to increase BP of hypotensive patients. Raynaud s (white. Vasoconstriction -> ischemia/necrosis of distal fingers/toes that is symmetric. Also helps some weight loss. telangiectasias (mat like patches on face/palms). flexion contractures. If symptoms are worsening. esophageal dysmotility (food stuck. decreased DLCO. red). Metformin plus sulfonylurea (glyburide) is good combination. Assess renal status. Calf. usually one week after stopping drug. NE Induced Vasospasm: alpha 1 agonist -> vasoconstriction. upper extremity. Crohn s Disease: suspect in young patient with diarrhea. T2DM: most patients require more than one oral agent. metformin causes lactic acidosis. Acute Appendicitis: initial peri-umbilical pain is referred and visceral in nature. Can occur in intestines (mesenteric ischemia) or kidneys (renal failure). Papillary necrosis and tubulointerstitial nephritis. GERD). structures. Involves entire GIT. tongue. myelosuppression. Polyuria and WBC casts. and right heart are also possible locations.

Prinzmetal s angina. Commonly due to hyperventilation due to pneumonia. MCC is pneumococcus. CT shows nodules with halo sign or lesions with air cresecent. fatigue. enlarging are worrisome. y Nasal Polyps: chronic rhinosinusitis. Lymphadenopathy. Surgery to treat. Only PMN in sputum. Do esophageal manometry to show repetitive. constipation. Malignant/granulomatous disease are hard and immobile. Diagnosis made by acid fast bacilli on skin biopsy. small over mature lymphocytes. Erythema multiforme (dusky red target lesions over extremities). Respiratory Alkalosis: increased pH with primary decrease in PaCO2. Diagnosed by MRI. chills. nonperistaltic. Older patients with incidental lymphocytosis. Fevers. uncontrolled HTN. Spinal Stenosis: MC caused by degenerative disk disease with low back and leg pain. Due to rich blood supply. thyrotroph. high amplitude contractions spontaneously or after ergonovine stimulation. AERD). It is a CI. Asymptomatic soft LN can be observed. Treated conservatively or with laminectomy.heart palpitations. y y y y y y y y y y y y . Community Acquired Pneumonia: levofloxacin or moxifloxacin are first choice for inpatient treatment. Mycoplasma Pneumonia: atypical with indolent course. Also called neurogenic claudication. Other CI: familial hemiplegic migraine. CXR out of proportion to PE. ASA/NSAID induced bronchospasm (aspirin exacerbated respiratory disease. Pain worse with walking. MC due to URI. > 2 cm. Azithromycin or doxycycline for outpatient. CAD. Diffuse Esophageal Spasm: spontaneous pain. anosmia. Claudication is exertion dependent. craniopharyngioma. hoarseness. Leprosy: suspect in Asian patient with insensate hypopigmented patch of skin caused by Mycobacterium leprae. Accompanied with weight gain. use octreotide. corticotroph. it is susceptible to metastases. Do LN biopsy to confirm. Bilateral gray glistening mucoid masses in nose. Aspergillosis: occurs in immunocompromised patients with fever. In older smoker -> metastatic or oropharyngeal cancer. cough. If cannot be removed. Nitrates and CCB also alleviate chest pain. hypotension. smudge cells. and higher likelihood of extrapulmonary manifestations. CXR shows cavitary lesion. outpatient. high altitude. CLL: MC type of leukemia in western countries. Lymphadenopathy: small (< 1 cm) cervical LN are common in children and young adults. salicylate intoxication. Others: somatotroph. Symptoms of bilateral nasal obstruction. MCC of atypical pneumonia. gonadotroph. Also H flu and Moraxella. Peripheral nerve damage -> muscle atrophy. Triptans: pregnancy testing should always be done in women of reproductive age. hemoptysis. infections (low IgG). ischemic stroke. non productive cough. No cell wall = no stain. dyspnea. nasal discharge. Pneumonia Severity Index determines inpatient vs. Bicarbonate will decrease slowly due to renal compensation. basilar migraine. Pituitary Tumor:prolactinoma is the MC and present with galactorrhea and hypogonadism. but leg pain is position dependent and persists when standing still. Plaques of fibrous tissue can deposit on endocardium of right heart. asthma. Hypothyroidism: important cause of reversible change in memory and mentation. odynophagia for hot and cold foods. weight loss.

5 ASA). MAHA can occur in DIC (abnormal coagulation) and malignant hypertension (high BP and retinopathy). especially in low BMI or alcoholism. PIP. pKa of CO2/HCO3 pair is 6. Mitral Stenosis: atrial fibrillation. Primidone: anticonvulsant used to treat essential tremor. AIDS (didanosine. hearing loss (CN VIII trapping). CHF: low CO -> increased pulmonary vascular pressure -> transduction of fluid into air spaces -> edema and effusion -> absence of lung sounds. MCC of primary insufficiency in developing countries. Can precipitate acute intermittent porphyria -> abdominal pain. optic disc cupping. Rheumatic fever is MCC. situations with needles and urination can precipitate. Parvovirus B19: arthritis of MCP. and anticholinergic effects like dry mouth. seizures or bipolar (valproic acid). Paget s Disease: osteoclast dysfunction & compensatory bone formation -> mosaic bone pattern.1. naloxone for opiate overdose. CT is diagnostic. pallor. Due to strep pyogenes infection. Pain. Autoimmune is MCC in y y y y y y y y y y y y y y . Have diastolic rumble and opening snap. hepatitis. also HIV. Can have fractures and osteosarcoma. skeletal deformities. Use timolol drops initially. Then can do laser or surgical trabeculectomy. MI: ischemia -> diastolic dysfunction and stiff LV -> atrial gallop (S4). HIV increases risk (but causes FSGS independently). femoral bowing. rubella. ankle joints. confusion. Diagnosed by checking urine porphobilinogen. TTP HUS: unexplained normocytic hemolytic anemia with reticulocyte response and thrombocytopenia in patient with renal failure and neurological symptoms. MC presents 3-7 days after (along with papillary muscle rupture). L-asparaginase). increasing hat size are common. dullness to percussion. Gradual loss of peripheral vision -> tunnel vision. Do annual eye exams. due to excessive vagal tone. Frequent contact with children is diagnostic. Vasovagal Syncope: also called neurocardiogenic. Fever does not have to be present. high ALP. Presents during pregnancy due to increased intravascular volume. common in countries without antibiotics. Open Angle Glaucoma:more common in AA and is asymptomatic in the beginning. Acid Base Status: pH and PaCO2 are best values to determine status. stress. antibiotics (metronidazole. Adrenal Tuberculosis:clinical features of adrenal insufficiency and calcifications in adrenal glands. blurred vision. May not have other symptoms. High IOP. neurologic. Drug Induced Pancreatitis: usually mild. psychiatric abnormalities. dilated pupils. upto 2 weeks. tachycardia. resolve in 2 months. Common in young women. Wernicke s Encephalopathy: patients with acute delerium or acute ataxia. pentamidine). Diuretics (furosemide. Other treatments for acute delerium: dextrose for hypoglycemia (thiamine before). urinary retention. Preceded by nausea. thiazides).y Diphenhydramine Overdose: antihistamine effects of drowsiness. HCO3 is calculated from Henderson-Hasselbalch equation. decreased bowel sounds. MCC of viral arthritis (polyarticular and symmetric). IBD (sulfazalazine. Rapid onset PEA is a result of tamponade -> shock -> sinus tachycardia. Bone. Ventricular Free Wall Rupture: occurs during remodeling post MI. wrist. immunosuppressants (azathioprine. Diagnosed with tilt table test. signs of pulmonary edema. Physostigmine (cholinesterase inhibitor) can help reverse. tetracycline). diaphoresis. Anti-B19 IgM is diagnostic. joint pain. Do pericardiocentesis. oxygen for hypoxia.

Bartter s Syndrome: hypokalemia. decreased NE content of nerve endings. urine chloride > 20. Treatment of TB does not help adrenal. NSAIDs. Atrial Fibrillation: MC chronic arrhythmia in adults. More common in women. rifampin. infection. capillary leak (will have hemosideran depisition). normal BP. Interstitial Nephritis: cephalosporins. sulfonamides. NSAIDs which blunt response to low volume. low volume state. may have history of food allergies. Arterial stiffness. Diagnosing underlying cause is important in decreasing risk of future fractures. metabolic alkalosis. PAC: premature activation of atria from ectopic source. medications. irregularly irregular with rapid heart rate. and glycerol-3-phosphate. phenytoin. Gluconeogenesis: main substrates are alanine. History of radiation and family history are important risk factors. hepatotoxicity (12-96hrs). Can result in SVT. Due to inefficient constriction of resistance and capacitance vessels in LE due to defect in reflexes. diuretics. Defective sodium and chloride reabsorption in LOH -> hypovolemia and activation of RAAS -> K and H excretion. Beta blockers are CI because they can worsen heart failure. Reversible with fluids. May have stridor and harsh respiratory sounds. Papillary. Have polyuria. oxygen. Serum iron to diagnose (usually > 350 mcg/dL). Fungal. and anaplastic all arise from follicular/epithelial cells. In malnourished patient. CMV are other causes. Lower Extremity Edema: venous hypertension (not likely in dehydrated patient). Treatment needed if cause distress or SVT. PTCA/thrombolysis. Use diuretic such as furosemide -> decreases preload and venodilates. Need lifelong glucocorticoid and mineralocorticoid treatment. anticoagulation. Also give morphine. single or bigeminy. Need rhythm/rate control and anticoagulation. lymphadenopathy. and decreased myocardial sensitivity contribute. allopurinol. Worse with ACE. Thyroid Cancer: MC is papillary carcinoma and has best prognosis. stress can all precipitate. y Acute Iron Intoxication: 5 phases: GI phase (30min-6hrs) of direct mucosal damage. follicular. Beta blockers are helpful in symptomatic patients. y y y y y y y y y y y y y . Early P wave. latent phase (6-24hrs) is asymptomatic. sepsis. decreased oncotic pressure -> edema. Pyruvate is an intermediate of alanine during the process (via ALT). laryngeal edema. growth & mental retardation. Prerenal ARF: due to insufficienct arterial perfusion (dehydration).developed countries. Discontinue offending agent. alcohol. urticaria. lactate. trauma. Can have fever and rash. Airway Obstruction: always rule out first with sudden onset SOB. obstruction (several weeks) due to scarring. Will have dyspnea. Compression Fracture: occur with decreased bone mineralization and density. lymphangitis). Metformin: causes lactic acidosis (which is potentiated by renal failure) and should be discontinued in setting of renal failure. but prolonged hypoperfusion -> renal failure due to ischemia. shock and acidosis (6-72hrs). Tobacco. Can cause palpitations. polydipsia. Orthostatic Hypotension: postural decrease in BP by 20 mmHg systolic or 10 mmHg diastolic. caffeine. PCNs. nitrates. difficulty swallowing. lymphatic obstruction (with history of lymphadenectomy. hepatic failure. Elderly at greatest risk. Flash Pulmonary Edema: usually due to acute heart failure (MI).

amiodarone. Corrected Calcium: 0. Impaired responsiveness of fat cells to insulin -> steatosis -> steatohepatitis -> fibrosis due to lipid peroxidation and oxidative stress. Infection often acquired by contact with sand. splenomegaly. abdominal pain. water bottle shaped cardiac silhouette. Low serum/urine erythropoietin. Non Alcoholic Steatohepatitis: RF are obesity. elevated urine osmolarity (> serum). Whipple Triad: episodic hypoglycemia. Fibrinolysis should be done within 30 minutes. prevalence increases.8 (4 measured albumin) + measured calcium. Causes nephrotic and palpable kidneys. brown-red lesions on the skin which elongate. Secondary Amyloidosis (AA): result of chronic systemic inflammation with AI. excretion of dilute urine with elevated serum osmolarity. tamoxifen. Can be caused by abnormal gait. elevated LAP. Treat with deferoxamine which binds iron and allows urinary excretion. temporary CNS dysfunction. PTCA is choice treatment and should be done within 90 minutes. SIADH: euvolemic hyponatremia. cardiomyopathy. both plasma and urine are dilute. Water Disturbances: DI: polyuria. elevated. Iron Poisoning: disrupts basic cell processes (free radial and lipid peroxiation) -> hematemesis. peripheral neuropathy. TPN. Reversible moderate HTN. y y y y y y y y y y y y . hepatomegaly. MC pancreatic tumor. Diminished heart sounds. chronic infections. Suspect in patients with liver disease. metabolic acidosis. Polycythemia Vera: increased RBC mass and totcal circulating volume. use of certain medications (steroids. ice. serpiginous. incidence does not change. Anserine Bursitis: localized pain over the anterior medial tibial plateau just below the medial joint line. polydipsia. Occurs in children of pregnant mothers (supplements are brightly colored). Cutaneous Larva Migrans: common in travelers to tropical regions. psoriasis. shock. Thrombosis and bleeding due to elevated platelet count and low functionality. Rest. diltiazem. AST/ALT < 1. IVDA. New Drugs: if prolongs survival. hypercelluar bone marrow. Granulocytosis. Pericardial Effusion: enlarged. pseudohypertrophy. reversal of CNS abnormalities by glucose administration. Hyperviscosity symptoms. SIADH: hyponatremia. Mild ALP elevation. normal O2 saturation. failure to correct with NS. Have high insulin and high C peptide. MI: strongest influence on long term prognosis of STEMI is duration that passes before blood flow is restored via PTCA or fibrinolysis. Valgus stress and x rays are normal. Have pruritic. UDCA helps decrease transaminase levels. Pain may present overnight. steroid injections. Primary polydipsia: excessive water drinking.y Insulinoma: classic symptoms of hypoglycemia. decreased serum osmolarity. difficult to palpate PMI. Control underlying condition. overuse. trauma. high urine sodium. Old male with pruritis after bathing. HAART). hyperlipidemia. IBD. serum dilute. Proteins deposit as beta pleated sheets in tissue. urine very concentrated. DM. Caused by dog and cat hookworm and infection occurs by contact with feces.

Diuretics -> electrolyte abnormalities -> arrhythmia. Also called Friedlander s pneumonia usually affects upper lobe and has currant jelly sputum. Smear reveals bite cells. G(+) soil bacterium that is partially acid fast and causes pulmonary or disseminated disease in immunocompromised hosts. infections. deformity. dactylitis (sausage digit). Hypotension. treat with glucagon -> increased cAMP and higher calcium levels -> cardiac contractility augmentation. Pulsus paradoxus: disappearance of pulse on inspiration. Lateral Epicondylitis: pain with supination or extension of the wrist and point tenderness just distal to the lateral epicondyle. bradycardia.y Arrhythmia: sudden onset syncope without warning. hypotension. erosion with weeping drainage. Young person with tachycardia. Morning stiffness. Allergic Contact Dermatitis: can be due to exposure to toxic plants. Can have SQ or brain abscesses. G(-) bacillus that can cause pneumonia in subjects with debilitating conditions such as alcoholics. Grows as mucoid colonies. Normal MVo2 due to hyperdynamic circulation and improper distribution of CO. Treat with atropine and IVF. screwdriver) from degeneration of extensor carpi radialis tendon. Nocardia: filamentous. elderly. Indicates not normal tissue perfusion! Also have low RAP and PCWP. nail involement. Occurs during recent surgery or medical illness. aerobic. tachycardia. Can also see classic psoriasis lesions on hands (red plaques with silvery scale). Can have alveolar infiltrates with nodules and cavitation. G6PD activity is normal during acute hemolytic episode. Beta Blocker Overdose: AV block. Will have subsequent minor or massive infarction. Blood impairs filling -> decreased preload and CO. Otherwise denatures into Heinz bodies -> disrupts RBC membranes -> hemolysis. methotrexate. Can have splenomegaly. vesiculation. anemia. immunocompromised. Usually due to microaspiration. Also have radiographic evidence of chondrocalcinosis (calcified cartilage releases crystals). heart failure. Can be confused with TB or Actinomyces. G6PD needed to make NADPH to make glutathione to prevent Hgb oxidation. presence of heart disease (post infarction. y y y y y y y y y y y y y . potential cardiogenic shock. ectopic beats. G6PD Deficiency: XLR common in AA men. Due to repeated forceful wrist extension and supination (tennis. anti-TNF. Clonic jerks can occur due to brain hypoxia. Syncope from decreased cerebral blood flow. Episodic hemolysis in response to oxidant drugs. wheezing. NSAIDs. CLL: see smudge cells on smear with small mature lymphocytes. Klebsiella: encapsulated. fava beans. if not. appear in linear fashion > edema. G6PD Deficiency: acute hemolysis after ingesting primaquine or sulfa drugs. Steroids are CI. Psoriatic Arthritis: usually involves DIP joints. alcoholics. dyspnea particularly if on OCP. thrombocytopenia (associated with poor prognosis). Treat with TMP-SMX. PE: common cause of pleuritic chest pain. Hyperdynamic circulation and elevated CO. Have cough with purulent sputum. Heinz bodies seen on blood smear. Cardiac Tamponade: deadly consequence of aortic dissection. Pseudogout: acute inflammatory arthritis due to CPPD crystals which are rhomboid shaped and (+) birefringent. G(-) pneumonia more common in infants. Type IV cell mediated hypersensitivity. Septic Shock: distributive shock due to vasodilation.

3rd Degree Heart Block: complete independence of P waves from QRS. fixed dilated pupils. Conjunctivitis can occur if lid margins are involved. Occurs due to formation of autoantibodies against blood cells (Type II hypersensitivity).3 or > 38/100. antimalarials. PE: CXR is normal in most cases. tremor. ANC < 500. Tophaceous Gout: urate crystals can deposit in skin resulting in formation of chalky white tumors. QRS usually > 120 msec. Parkinson s Disease: resting tremor that improves with activity is often presenting symptom. Opportunistic skin infection in HIV infected patients but can occur in normal individuals. Addison s Disease: aldosterone deficiency -> non anion gap hyperkalemic hyponatremic metabolic acidosis. Sinus tachycardia is MC EKG finding. Health care workers that come into contact with orotracheal secretions (dentists) are increased risk. Brain Death: total loss of brain function and legally acceptable as definition of death. Take blood cultures and start 3rd or 4th generation cephalosporin (ceftazidime or cefepime). (+) exposure history. Central Hypogonadism: low testosterone and low or inappropriately normal FSH/LH. no spontaneous breaths. holds on to K/H. unlike essential and cerebellar tremors. SLE: pancytopenia is common. Tophi can ulcerate and drain chalky material. Herpetic Whitlow: common viral infection of the hand caused by HSV 1 or 2. coccidio. Needs pacemaker placement due to risk of VT or VF. If deficienct. nitrofurantoin. multinucleated giant cells on Tzank smear. Diuretics are RF due to hypovolemia associated uric acid reabsorption. Molluscum Contagiosum: multiple dome shaped lesions with central umbilication caused by pox virus. nephrolithiasis of uric acid stones. Treat with antidepressants. Seen also in women with genital herpes or children with herpetic gingivostomatitis. postural instability. Seen in GIT and are usually G(-) and Pseudomonas. podagra (great toe).4 for 4 hours in neutropenic patient. aldosterone reabsorbs Na for K/H. V rate is usually low -> dizziness and hypotension. measure prolactin which inhibits GnRH release (possible pituitary adenoma). Uncontrolled diabetes -> low GnRH. Thrombocytopenia is ITP like. sarcoid can also cause. Neutropenia is less common. Pseudodementia: suspect in elderly patients with dementia in setting of severe depression. Confirm with another physician first. Histo. Normally. With well controlled diabetes. Can be seen in RA and calcinosis. bradykinesia.3/101. Absent CN reflexes. Anemia due to autoimmune hemolysis due to warm IgG Ab against RBCs. Usually starts in one hand and then involves all extremities. Can be caused by TB -> adrenals. G6PD Deficiency: can have positive Prussian blue stain in urine due to hemosiderin due to hemolysis. Self limiting. Tremor will not involve entire head. Occurs with CD4 < 100. Chemotherapy -> impaired immune function & disruption of skin/mucosal barrier. y y y y y y y y y y y y . Attacks precipitated by sulfa drugs. crypto. Throbbing pain in pulp space. Starts with asymptomatic hyperuricemia -> monoarticular arthritis.y Febrile Neutropenia: medical emergency with single temperature > 38. Loss of DA neurons in basal ganglia that causes tetrad of rigidity.

With no other RF. MCD is a common association with Hodgkin s lymphoma. avoid supine sleeping as first step. Sysetmic can be due to low testosterone or high prolactin. 45 in women in those with average risk. ECG changes due to involvement of ostia (usually RCA) -> inferior ischemia. y y y y y y y y y y y y . Require hospitilization and IV antibiotics for complicated cases like with hypotension. associated with HLA-B27. Usually found in nose or nasopharynx. If thrombosis is suspected. Always do head CT to distinguish ischemia from bleed. usually caused by parasympathetic nerve injury and altered arteral supply. Hypercalcemia of Malignancy: due to osteolytic metastases. increased IL-6. ED: in the setting of pelvic fractures with urethral injuries. but can also see FSGS. May have a history of travel -> possible multiple sexual partners. Sleep Apnea: morbidly obese middle aged man with daytime sleepiness. obstructing the airway. Warfarin good for cardiogenic emboli. Acute Pyelonephritis: present with fever. localized mass. MCC of hypercalcemia in inpatients. negative RF. CPAP and UPPP also help. Usually have low PTH levels. must be controlled before any other studies are done. increased production of PTHrP. Treatment is important due to high risk of another. TIA: cerebral ischemia -> focal neurological dysfunction < 24 hours. SBE is no longer emphasized. Classically back pain is worse in morning and gets better during day. Sometimes no treatment is needed. Failure to achieve erections during sleep (REM) and morning is pathognomonic. avoid sedatives/alcohol. valvular disease. If HTN is present. Also have arthritis of peripheral joints and uveitis. but high recurrence.y Aortic Dissection: pregnancy is associated due to connective tissue changes. Treat with weight reduction. vomiting. Anti-TNF used for treatment. Mammogram: perform every 2 years starting at age 50 with average risk. Marfans. morning HA. Asymptomatic Thrombocytopenia: presenting symptom of HIV in upto 10% of people. Cholesterol Screening: age 35 in men. nausea. and not beyond 75. increased fatigability and snoring. coarctation are also risks. Bicuspid valve. Atrial Fibrillation: patients are at risk for strokes and need anticoagulation. Elevated ESR. Venogenic can occur after penile fracture. use ASA. X ray shows SI inflammation. Will resolve with lymphoma treatment. flank/suprapubic/ costovertebral angle tenderness. frequent epistaxis -> removal. Higher calcium than in hyperparathyroid. Can see mild HTN which improves with treatment. give antiplatelet agent (ASA). Only treated by specialists. use warfarin. age > 75. Low back pain and stiffness that limits back motion and chest expansion. chills. Nephrotic Syndrome: membranous is the most common associated with malignancy. previous stroke/TIA. Angiofibroma: male adolescent with epistaxis. increased Vit D production. Ankylosing Spondylitis: seronegative spondyloarthropathy that affects men < 40. HTN. With CHF. DM. Check every 5 years in patients with normal risk and previously normal lipids. bony erosion on back of nose. Yield decreases in the elderly. If enlarging.

High association with erythema nodosum (painful skin lesions on the shins). ketoacidosis. lichen planus. Metabolic Acidosis: always calculate AG [Na (Cl+HCO3)] to narrow DD. Focal demyelination usually in periventricular or subpial white matter of cerebrum. Do MRI to diagnose. Chronic Hepatitis C: can cause membranoproliferative (or membranous) GN characterized by proteinuria. Multiple Sclerosis: female with recurrent attacks of focal neurological dysfunction with nonpredictable time intervals. and Kayser-Fleisher rings are diagnostic. Steatorrhea: diarrhea secondary to fat malabsorption -> pale. TOC is paracentesis (before antibiotics) with (+) culture and > 250 PMNs. Have low phosphate due to renal wasting. Likely in patient < 30 with unexplained chronic hepatitis. plasmacytomas. AI disease. Develop severe osteopenia. Causes free radical formation. Cataract: vision impairing disease characterized by blurred vision and glare (night driving) due to lens thickening. ALP. change in alertness. 25 vitamin D. Low ceruloplasmin. methanol ingestion (formic acid). especially through rubber sole. SBP: can have subtle presentation and should be considered in cirrhotic patients with ascites and fever/mental status changes. May be deficit in 1 hydroxylase and can have low calcitriol. Renal failure usually -> hypocalcemia due to binding of phopsphate. Personality and behavior changes may occur as disease goes on. Have neuropsychiatric symptoms due to deposition in basal ganglia. porphyria cutanea tarda. upto weeks. Non caseating granulomas on biopsy. serum Ca and ACE are elevated. Wilson s Disease: AR. Zinc also prevents copper absorption. Do blood culture or bone biopsy. If accompanied with epigastric pain -> chronic pancreatitis y y y y y y y y y y y y . ITP. Can cause cryoglobulins. Treat with IV quinolones and surgical debridement. Increase means there is an accumulation of non chloride acids -> lactic acidosis. malodorous. Give 3rd generation cephalosporin. E coli and Klebsiella are common. B-cell lymphoma. likely Pseudomonas. uremia (NH4). trientene to chelate copper. Tetanus does not cause osteomyelitis. X Linked Hypophosphatemic Rickets: suspect in patients with rickets with normal calcium. Hallucinations. ethylene glycol (oxalic and glycolic acid). optic nerves. Will have loss of transparency of the lens. Nail Puncture Wound: if results in osteomyelitis in an adult. also called hepatolenticular degeneration. Normal is 6-12.y Sarcoid: presents in black females with hilar LA presenting with dyspnea. and bisphosphanates decrease osteoclast activity and reduce risk of osteopenia. gait impairment. spinal cord. salicylates. Thyroid Nodule: first step in management is TSH level. Alzheimer s Disease: MCC of dementia in US. PTH. Hypercalcemia of Immobilization: prolonged rest -> accelerated bone resorption likely due to osteoclastic activation. Treat with d-penicillamine. Early signs are visuospatial defetcs (getting lost in neighborhood) and anterograde memory loss. urinary incontinence are late findings. Abdominal pain is often less prominent. Treat with steroids. increased copper excretion. voluminous stools that are difficult to flush. weight loss. Treat with lens extraction. Staph aureus is MCC of regular osteomyelitis in children and adults. fever. brain stem. Oxidative damage occurs with aging. Can have liver transplantation. Low formation and secretion of ceruloplasmin and low secretion of copper in biliary system. Usually occurs within days.

Autonomic neuropathy is worse with dialysis. HTN persist with dialysis. Affects skin (maculopapular rash on palms. Associated with lung cancer. Cerebellar Tumors: ipsilateral ataxia. Do 72 hour quantitative fecal fat to diagnose. May have retinal whitening or cherry red spots. Dietery deficiency: oral radiolabeled B12 is absorbed in gut and excreted in urine in normal amounts. bronchiectasis. vomiting. Treat with high flow O2 and ocular massage. nystagmus. bacterial overgrowth. DKA: causes anion gap metabolic acidosis. Survival 95% at 1 year. Factitious Thyrotoxicosis: ingestion of exogenous thyroid hormone. Foul smelling sputum and RLL pneumonia. Dacryocystitis:inflammatory changes at medial canthus. high T3 and T4. sedation. intestine (bloody diarrhea). CT can show calcifications and ductal dilation. Responds to systemic antibiotics. Living related > living non-related > cadaver. abdominal pain that may present like surgical abdomen. Fall towards side of lesion. polydipsia. Have polyuria. ipsilateral muscular hypotonia.(alcohol is MCC). Hypertrophic Pulmonary Osteoarthropathy: clubbing and sudden onset arthropathy in a chronic smoker or other pulmonary disease (cancer. ESRD: treatment options are transplant or dialysis. Aspiration Pneumonia: consider in patient with recurrent pneumonias. 88% at 2 years. Ophthalmic artery is first intracranial branch of ICA -> CRA and ciliary branches to the anterior globe and choroid. Associated with amaurosis fugax before occlusion. H1 Antihistamines: decrease nasal inflammation and PND (dry cough) in patients with allergic rhinitis by blocking nasal secretions. Steroids: cause neutrophilia by increasing bone marrow release and demarginating neutrophil pool. emphysema). Transplant patients have better return to normal function. Can occur in immunocompetent and HIV with CD4 > 180 but is self-limited. usually due to excessive alcohol intake. Occurs in infants or > 40. Modified acid fast stain of stool shows oocysts. Graft vs Host Disease: common after bone marrow transplant. bone disease. soles. Give next dose with IF. Obstruction of CSF -> HA. Anemia. liver (abnormal LFT s and jaundice). intention tremor. Eosinophils and lymphocytes are decreased. nausea. Have signs or symptoms of hyperthyroid but no goiter or exophthalmos. Central Retinal Artery Occlusion: painless loss of monocular vision due to embolism. loss of coordination. neurological disorders. Chlophenirimine blocks H1 receptors and is anti-inflammatory blocking histamine release from mast cells. dysphagia. Also occurs in altered consciousness. Can have glucose intolerance. vomiting. Diminished excretion -> impaired absoroption. Renal transplant has better survival rates and QoL. Cryptosporidium: major cause of chronic diarrhea in HIV patients with CD4 < 180. face). do a CXR to rule out or look for other pathology. y Schilling Test: differentiates dietary deficiency from pernicious anemia. Low excretion = short gut. Normal excretion = pernicious anemia. TB. papilledema. difficulty performing rapid alternating movements. y y y y y y y y y y y y . nausea. pancreatic insufficiency. Staph aureus and beta hemolytic strep are MCC. infection of the lacrimal sac. Caused by recognition of major and minor MHC by donor T lymphocytes and cell mediated immune response. TFT shows low TSH. Sway to affected side.

peripheral neuropathy. but cyst aspiration is not recommended. Treat with TMP-SMX (prophylaxis too). Synovial fluid analysis shows WBC < 2000. osmotic diuresis -> loss of potassium stores even with normal/high serum K. skin infections. HBeAg. y DKA: teenager presenting with metabolic acidosis. ALT 2x normal is likely to respond versus normal ALT. dehydration. Minocycline is alternative. Usually starts as subacute pneumonia. pulmonary involvement. Usually solitary adenoma. CNS. cardiac. OA: non-inflammatory arthritis presenting with pain worse with activity improved with rest X rays show joint space narrowing and osteophytes. glossitis.Diffusely decreased radioiodine uptake. tachycardia. hypotension. Lamivudine is oral and has less SE. detectable HBsAg. can be exacerabated by medications with anticholinergic activity. Chronic Hepatitis B: elevated ALT. Amebic Liver Abscess: contain debris described as anchovy paste. partially acid fast filaments on microscopy. Recent immigration. Exertional type occurs in healthy individuals exercising in extreme heat. Pernicious Anemia: MCC B12 deficiency -> macrocytic anemia. also develop chronic atrophic gastritis -> increased risk of intestinal type cancer and carcinoid tumors by 2-3x. Caused by Entamoeba histolytica. Dehydration. G(+). Higher with HBeAg(+). tender solitary abscess. Common in infections during 3rd TM. Seizures. chemotherapy. Loop Diuretics: cause reversible or permanent hearing loss or tinnitus. Neonatal Hepatitis: newborns of mothers with active HIV infection should be passively immunized with HBIG followed by active immunization with the recombinant HBV vaccine. hepatic/renal failure may also occur. ARDS. decreased consciousness. Deficiency cell immunity at high risk. branching. and HBV DNA should be treated with interferon and lamivudine. Contralateral hemianesthesia with transient hemiparesis. RUQ pain. psychiatric disease. abdominal pain in setting of ongoing infection (releases cortisol and catecholamines which are anti-insulin). low BMI. y y y y y y y y y y y . Also serum testing. Degree of ALT elevation indicates response to medication. or patients taking other ototoxic drugs (aminoglycosides. Biopsy shows follicular atrophy. multiple adenomas. Could be hyperplasia. athetosis. DM: fasting blood glucose is MC screening test. Usually VPL thalamus which transmits sensory information from contralateral side of body. can cause dysentery. Usually asymptomatic and found on routine screening. Severe dysesthesia (thalamic pain) is common. ketonemia. DIC. Increasing age is leading RF. Present in soil. causes pulmonary. May have stones and low bone density. Heat Stroke: defined as temperature > 105. cancer. Nocardia: crooked. ballistic movements. Treatment is oral metronidazole. Morning stiffness < 30 minutes. Dejerine Roussy Syndrome: thalamic stroke. high chance of chronic hepatitis. Primary Hyperparathyroidism: MCC hypercalcemia in ambulatory patients. polyuria. Diagnosis requires 2 separate FBG measurements > 126. those with renal failure. no crystals. no organisms. Typically occur in those taking high dose. CT or MRI plus leukocytosis and elevated ALP. Acidosis and low insulin pushes K into extracellular fluid. brain. Period FOBT for cancer is needed. ASA). High humidity may prevent sweating. Excess glucagon -> hyperglycemia. beaded. Anti-intrinsic factor decreases absorption. tachypnea. Consider in patient trying to lose weight.

Friction rub may be heard. As it progresses. Cough. surgery (cryosurgery. Lungs are MC affected. Diffuse ST elevations with PR depression is common. Hypoventilation is a major cause. Useful in diagnosis of iron deficiency as the cause. Primary Hyperaldosteronism: persistently elevated BP. infants/young children. Prothrombotic Ab that causes a long PTT.5 is osteopenia. normal or high ferritin). Increased salt and water retetion with aldosterone escape and natriuresis. Gonococcal is purulent copious drainage 3-5 days after birth. absent edema. < 65 with heart failure. hypokalemia. Neonatal Conjunctivitis: chemical is usually mild and due to prophylactic silver nitrate drops. interferon alpha). sideroblastic (normal to high iron and ferritin) are also causes. Russell viper venom test is prolonged. Hilar LA and reticular opacities on CXR. Small fiber is more pain and allodynia. podophyllin). Treat with chemical/physical agents (tricholoacetic acid. mild hypernatremia. Dysphagia for liquids and solids suggets a motility disorder whereas obstruction presents with solid dysphagia -> progresses. T score compared to younger individual of same gender and race.5 is osteoporosis. laser). Pneumococcal Vaccine: 23 valent capsule polysaccharide pneumococcal vaccine induces a T cell independent B cell response. especially in the post-ictal state (could be due to aspiration). Barium study is safer in those with upper esophageal lesions or stricture. arthritis. High risk in post menopausal women. Can do stain and culture on Thayer Martin agar. < 2. no ankle jerk. chronic lung disease. Gabapentin is the alternative.5 to -2. low renin. -1. ACD (low TIBC. Will not correct on mixing study. DEXA scan: USPSTF recommends one time screening for all women > 65. excision. previous miscarriages. Sarcoidosis: MC in AA women during 3rd or 4th decades. Lupus Anticoagulant: also called anti-phospholipid antibody. Can also have hypoxia. Acute Pericarditis: typically occurs in first several days after an MI. 5FU epinephrine gel. Microcytic Anemia: iron studies are always indicated. Chlamydial is milder and is > 5 days after birth. Present with VTE and lupus symptoms. erythema nodosum. Thalssemia (normal to high iron and ferritin). only peptides. immune therapy (imiquimod. Can worsen urinary symptoms and cause orthostatic hypotension. IgM or IgG that binds to phospholipids used in assay (laboratory effect). low proproceiption. Usually present at rest and worse at night. Sharp pleuritic pain worse when lying down and better when sitting up and leaning forward. large fiber is more sensory loss.y Correlation Coefficient: shows the strength and direction of a linear association between two variables and does not imply causality. > 60 with RF. metabolic alkalosis. Diabetic Neuropathy: TCA s are DOC. anterior uveitis (red eye with leukocytes in anterior chamber). renal failure. Dysphagia: do a barium esophagram first before endoscopy. whereas sensory deficit stays. Polysaccharides cannot be presented to T cells. Recommended over 65. papilliform anogentical lesions that are skin colored or pink versus condyloma lata which are flat and velvety. y y y y y y y y y y y y . pain subsides and disappears. Gonococcal -> contact with infected secretions -> ulceration and blindness. Condyloma Acuminata: verrucous. Respiratory Acidosis: acidosis with hypercarbia and normal/elevated bicarbonate. cirrhosis.

occasional forgetfulness. Causes liver disease (may present as neonatal hepatitis. Dementia not diagnosed until there are functional impairments. Hypernatremia: MCC is hypovolemia. SAH: vasospasm is major cause of M&M. Craniopharyngiomas: benign tumors of Rathke s pouch. liver failure). immunosuppression. sodium bicarbonate and beta-2 agonists (albuterol) to drive K intracellularly. migratory non deforming arthritis. treat with IV nafcillin or cefazolin. Postictal Lactic Acidosis: transient anion gap metabolic acidosis that resolves without treatment after 60 to 90 minutes after cessation of seizure activity. Vancomycin for MRSA. Presents with hypopituitarism -> retarded growth in children (GH and TH deficiency) and sexual dysfunction in adults (amenorrhea). Use insulin. use beta blocker as prophylaxis to reduce hemorrhage risk. Nitrates are sometimes added. Vomiting: produces metabolic alkalosis due to unbalanced loss of H+ ions and due to contraction alkalosis. Chronic malabsoptive diarrhea. low grade fever. Normal Aging: tiredness. Produces a compensatory respiratory acidosis with hypoventiation. myocardium. Chronic fungal foot infections serve as a nidus for celluitis and eradicate in patients with recurrance. SB biopsy with PAS(+) macrophages. Treat with fluids. electrolytes. Primary treatment is DA agonists such as bromocriptime or cabergoline (better drug). Have bitemporal hemianopsia and HA. Excess production of lactic acid and decreased hepatic uptake. Typically older males. Air fluid levels in GB. Complications are gangrene and perforation. If detected. Correct at 1 mEq/L/h. trouble falling asleep. Cellulitis: caused by beta hemolytic strep and Staph aureus. RF are vascular compromise. fatigue. Severe cases should be treated with NS switched to ½ NS. Tropheryma whippelli. and antibiotics. Emphysematous Cholecystitis: secondary infection of the GB wall with gas-forming bacteria. cirrhosis. Treat with surgery or radiotherapy. Presents as amenorrhea and galactorrhea. y y y y y y y y y y y y y . damage to eye. Hyperkalemia:give IV calcium gluconate to stabilize cardiac membrane. chills. Measure serum A1AT. With systemic signs of fever. gallstones. Prolactinoma:< 10 mm is a microadenoma.y Bacillary Angiomatosis: Bartonella is the cause in immunocompromised individuals. malaise. Present with cutaneous and visceral angioma like blood vessel growths. More common in children and older adults. early surgery. Esophageal Varices: do screening endoscopy in all new diagnoses of cirrhosis to detect varices. Greater can cause cerebral edema. Signs of ischemia appear 7 days after bleed. hypogonadism in males. LA. Whipple s Disease:multisystem disorder caused by G(+) bacillus. CCB (nifedipine) are used to prevent vasospasm. Mild cases can be treated with D5W ½ NS. CNS. Antibiotics lead to regression. glucose. Observe and repeat chemistry panel in 2 hours. occasional word finding difficulty. Alpha 1 Antitrypsin Deficiency: non smoking adults < 45 years old with pan lobular emphysema (centrilobular in smoking).

optic neuritis (painful loss of vision in one eye with central visual defect. Present initially with focal symptoms that deteriorate into symptoms of increased ICP. Diabetic Neuropathy: MC is symmetric distal polyneuropathy with classic stocking glove distribution of sensory loss. > 5 weeks. also causes caries) is MCC of endocarditis after dental procedures. MEN Type I: hypercalcemia/hypophosphatemia due to hyperparathyroidism. Do noncontrast CT. MS: patchy neurological problems. Prescribe adequate amounts. CBC. and resolves on its own. Do MRI to see cerebral or cerebellar plaques. and GI malignancy in older adults. bowel and bladder dysfunction. DKA: suspect in stuperous patients with rapid breathing. and autonomic neuropathy. Cauda Equina Syndrome: serious neurological disorder characterized by saddle anesthesia. Consists of spinal nerves before they leave spinal canal. Sheehan s Syndrome: postpartum failure to lactate and other features of hormone deficiency. Associated with DM in younger adults. polydipsia. Measure glucose first. Other viridans are mitis. y y y y y y y y y y y y y . Precision: measurement of random error. salivarius. diagnosed by US. Can be triggered by infection. tissue. Tighter the CI. Pancreatic Pseudocyst: encapsulated area of enzyme rich fluid. neck. Also mononeuropathies of CN and peripheral nerves. MC benign vascular tumor of adults. thalamus. Cherry Hemangioma: small red cutaneous papules. Kussmaul s respiration (rapid deep breathing) due to acidosis. proximal neuropathy. After NSAIDs. Then chemistry. Also associated with Addison s Disease. Acanthosis Nigricans: symmetrical hyperpigmented velvety plaques in axilla. malignancy. lumbar disc. sanguis.y Cancer Pain Management: try non-narcotic measures first unless patient is in severe pain. try short acting morphine until under control. May have parathyroid tumors. Occurs in acute < chronic. cerebellum. the more precise. Pre existing MS is RF. groin. low back pain. Can be caused by trauma. polyuria. becomes infected. Have polygonal cells with atypical nuclei at all levels of epidermis with zones of keratinization. SCC: second most common non-melanoma skin cancer. Increasing sample size increases precision. Do not regress spontaneously and increase in number with age. abscess. Light microscopy shows proliferation of capillaries and PCV in papillary dermis. Do not be afraid to give narcotics. Hypertensive Intraparenchymal Hemorrhage: MC in basal ganglia. pons. Amylase can be high due to leakage. Emergent MRI. Other cause is lymphocytic hypophysitis. Nerves have poorly developed epineurium. ABG. then use long acting patches or narcotics. Single most important factor in development is sunlight. Usually a few weeks after attack. debris that accumulates in pancreas -> inflammation. Staph epidermidis causes prosthetic valve endocarditis. variety of LE findings. Can erode into blood vessels. Drain if > 6 weeks. and intractable ulcers due to ZE. history of weight loss. Endocarditis: viridans type strep (MC is strep mutans.

Nephrotic Syndrome: heavy proteinuria (>3g/24h). PVD. captopril. Also consider HOCM. septicemia from Vibrio vulnificans. trimethoprim. External Hordeolum: also called stye. Diabetic Foot Ulcers: RF are diabetic neuropathy (80%). Central vertigo lasts longer. Will have loss of monofilament sensation. Have arthralgias. Elevated CK. allopurinol. Amebic Liver Abscess: history of travel with dysentery (bloody diarrhea) and RUQ pain due to cyst in RIGHT lobe of liver. Indicates intact vascular and nervous supply. smoking. Flagyl. (+) in psychogenic. can have anginal CP due to increased myocardial O2 demand. rifampin. peripheral edema. Primary colon infection -> portal circulation. can do surgical gangliolysis or suboccipital craniectomy. Isolated Systolic Hypertension: important cause in elderly. Dermatomyositis: proximal symmetric muscle weakness with skin rash. obesity. heroin use. follow with CBC. NSAIDs. myopathic EMG to diagnose. Use warm compresses. High FiO2 could be used. Abnormal accumulation of endolymph in the ear. Staph abscess of eyelid. renal failure. Often have hearing loss and tinnitus. diuretics. hypoalbuminemia. I&D is done if no resolution in 48 hours. bony abnormalities. (-) in organic. penicillins. AS: if severe. membranous. Localized small swelling along margin of eyelid. Classically caused by URI (cough and fever). Hemochromatosis:vulnerable to Listeria infections. sulfonamides. but can cause pulmonary oxygen toxicity (below 40% required). Prolonged contraction and impaired filling due to LVH reduces CA blood flow. Drug Induced Interstitial Nephritis: caused by cephalosporins. PVCs:common in post MI patients. Decreased dumping by arteries -> widened pulse pressure (important CV RF). y y y y y y y y y y y y y y . poor glycemic control. Bilateral wheezes. Even though they may indicate worse prognosis. High iron is also a RF for infection with Yersinia enterolitica. should not be treated unless causing symptoms (can worsen survival). Always treat. FSGS (more common in AA. Many cases due to systemic disease (diabetes. history of previous ulcer or amputation. If medication fails. MCC of non traumatic amputations. rash. prolonged expiratory phase. Adequate oxygenation requires PEEP (prevents collapse and reopens collapsed alveoli). Can be on superior surface -> shoulder pain. > 10 years. male sex. Peripheral cause. respiratory acidosis and hypoxia. Aplastic anemia can occur. Meniere s Disease: cause of vertigo (sensation of spinning with nausea) if patient also has sensation of ear fullness. Aspirate is sterile. In young. Exertional CP with systolic murmur and 2nd R ICS. phenytoin. Often manifests as muscle weakness at different levels. MCC intrinsic are MCD. Normal sensation and reflexes.y COPD Exacerbation: acute worsening of symptoms in a patient with COPD. Carbamazepine: used to treat atypical bipolar and trigeminal neuralgia. accessory muscle use. HCTZ is DOC. ARDS: hypoxemia refractory to high O2 administration. Caused by decreased elasticity of arterial walls (may cause decreased diastolic BP). UA will show eosinophils. ED: nocturnal penile tumescence helps differentiate psychogenic from organic ED. determine by H&P. Do sleep study or use RigiScan device. Can be paraneoplastic from lung cancer. Caused by Entamoeba histolytica. HIV). amyloidosis). due to bicuspid valve. Beta blockers are first line.

y Osteomalacia: low to low normal calcium. Do iron studies to confirm. low 25 Vit D. retinal edema). sodium restriction. y y y y y y y y y y y y . high PTH (makes calcium near normal in beginning and worsens hypophosphatemia). no treatment needed. Wenckebach: or mobitz type I. hemorrhages. Diabetic Retinopathy: background/simple (microaneurysms. proliferative/malignant (new blood vessel formation). CSF: low glucose. Can occur idiopathically. Self limited and resolves spontaneously in immunocompetent individuals. B12 Deficiency: suspect in vegetarians with anemia and neurological complications. AA with family history of blood disorder. If colonoscopy is (-). Found in patients with SCD and less commonly. CO2 retention is bad. Respiratory wall weakness is not major cause. progestins (respiratory stimulants). Hyposthenuria: impairment in kidney s ability to concentrate. N-nitroso foods. Abrupt onset. Dystonia = sustained muscle contraction -> twisting repetitive movements or abnormal posturing. and start IV acyclovir immediately. metoclopramide. alveolar hypoventilation during wakefulness. 1 (-) FOBT is not enough to rule out occult blood loss. fever. constipation. Have symmetrical looser zones . O2 therapy. decreased appetite. Do a colonoscopy. Have hypercapnea. FA will correct anemia. high lymphocytes). Major RF for SCC are smoking and alcohol along with hot food and drink. Iron Deficiency Anemia: MCC in elderly patients is GI blood loss. Genital lesions should be treated to prevent spread. Respiratory failure (with hypercapnea and hypoxia) and somnolence need intubation and ventilation. poor quality CXR = obesity. Macular edema -> vision loss. do capsule endoscopy. Treatment of first stone is hydration and observation. hypoxia. pseudofractures. Calcium restriction is not advised. Considered an STD. Barrett s has 1% per year risk of carcinoma. Weight loss. Esophageal Adenocarcinoma: chronic GERD and Barrett s are RF along with obesity. pre-proliferative (cotton wool spots). Pacing may be needed. Benign and transient. SCT. Herpes Encephalitis: MC affects temporal lobe -> bizarre behavior and hallucinations. inferior wall MI. weight loss. exudates. Use photocoagulation to prevent complications. high calorie/fat intake. low voltage QRS on EKG. thiazide diuretic. increase in PR until beat is dropped. IV steroids. low phosphorus. H pylori). congenital. Torticollis: focal dystonia involving SCM. Unless patient is symptomatic. Narrow QRS. Thick neck. but not neurological dysfunction. smoking. Thought to be due to RBC sickling in vasa rectae which impairs countercurrent exchange and free water absorption. Also have fatigue. MS changes. but can be medication related (typical antipsychotics. No meningeal signs. distant heart sounds. blurring of the spine. respiratory acidosis due to decreased lung and chest wall compliance. Curretage and apply liquid nitrogen. procholperizine). Seen in digitalis toxicity. increased vagal tone. ventilator support. Asthma Exacerbations: use inhaled B2 agonists/anticholinergics. Obesity Hypoventilation Syndrome: severe obesity (> 150% ideal body weight). Kidney Stones: patients with recurrent hypercalciuric stones should be treated with increased fluid intake. Do PCR for herpes. Seen in AIDS with CD4 < 100. If (-). Leading cause of blindness in USA. secondary to trauma or inflammation. do endoscopy (NSAID history. Molluscum Contagiosum: single or multiple rounded dome shaped papules with central umbilication caused by poxvirus.

Retroorbital -> hemicranium spread. pregnancy.y Cluster Headache: men>women. diplopia. SCC Lung: suspect in patient with smoking history. Signs of fluid overload. plasmapheresis. Acute Limb Ischemia: consider in patient with 5 P s. Tracheal tumors. Sarcoidosis: history. Neurogenictumors and esophageal leiomyomas are in posterior and thymomas and retrosternal thyroids are in anterior. CXR with hilar LA with or without reticulonodular infiltrates. Start IV heparin. IVIG. Necrotic turbinates. severe. History of CAD. congenital (DJ or Rotors). Partial Seizures: auras are common manifestation of partial seizures. stuffy nose. Pulmonary Renal Syndromes: Goodpasture s is due to anti-GBM Ab. NPH: caused by decreased CSF absorption or chronic increases in ICP -> enlargement without chronically increasing ICP. Post ictal state usually indicates a generalized seizure as well. Needs surgical embolectomy or intra-arterial fibrinolysis/mechanical embolectomy. Angiography will show abrupt cutoff in blood supply. aortic aneurysms cause middle mediastinal masses. y y y y y y y y y y y y . hypercalcemia (may have symptoms). sudden. LOC means generalization. Complex partial seizures have repetitive motion with no LOC/aura. drugs. obstruction. Horner s. Poorly controlled diabetes is risk. Repetative episodes. S3/S4. Elevated transaminases = liver problem. autoimmune. lymphoma. smoking. effusion. pallor. cardiomegaly. Campylobacter is MCC. Defined as >50% BRN is conjugated (vs. Unilateral. cavernous sinus thrombosis. explosive. HTN. proptosis. Mucormycosis: MC agent is Rhizopus species. cyclophosphamide. Emergent removal by plasmapheresis minimizes kidney damage and improves prognosis. noncaseating granulomas on biopsy. Acute MS: usually treated with steroids. coma. Mycoplasma. gait disturbances. Causes hypocapnea and respiratory alkalosis. LN enlargement. congestion. MC in patients with lymphoma. post op). red eye. unconjugated when > 90% indirect). Not used for mild sensory symptoms. rhinorrhea. Can be due to intrahepatic obstruction (viral. Elevated ALP = obstructive. pericardial cysts. hilar mass. Can have cardiac asthma (wheezing). Herpes. Hypothalamic dysfunction -> alterations in circadean pacemaker. Due to production of PTHrP -> increased bone and renal resorption of calcium. continuous. CHF Exacerbation: causes tachypnea as LV dysfunction -> pulmonary edema. Do US or CT first. Plasmapheresis is used as adjunct. sarcoid. excruciating. Wegener s is treated with cyclophosphamide and steroids. Conjugated Hyperbilirubinemia: mainly because of intra or extrahepatic obstruction or congenital impaired hepatic excretion of BRN. Diagnosis made with CT scan. Treat with steroids for symptomatic disease. chemosis. Can test for BNP and PCWP to confirm. Fever. Elevated ACE. Recent HIV infection and immunization also. lupus. Usually used when patients have disabling symptoms. incontinence. Dementia. GBS:2/3 have antecedant respiratory or GI infection. Can cause blindness. 100% O2 is the best treatment. Wake from sleep. alcohol. use interferon. Bronchogenic Cyst: usually found in middle mediastium on CXR. Haemophilus are other causes. May be due to bone involvement in late cancer (serious implication). bibasilar crackles. To reduce frequency of exacerbations. deep. Associated with lacrimation. glatiramer acetate. IV streptokinase is used for STEMI. hypoxemia due to decreased ventilation. bloody nose.

Older age and weight loss are common. Back is MC area in men. but have high Ig levels. If stress is normal. autonomic instability. anemia. CNS infections or viral syndromes. > 10% will have internal malignancy (MC ovarian). RF are fair skin. Angina: can sometimes be mistaken for epigastric pain. dysplastic/atypical nevi. place catheter. Do US (dilated ducts) in patients with jaundice. OA: acetaminophen should be first line treatment in mild to moderate pain. It is a drug induced idiosyncratic reaction. history of sunburns. BPH: eventually can progress to obstruction and renal failure. Gottrons sign on knuckles. Malaise. Hepatitis A: prodromal phase. fever. knees. Due to autonomic dysregulation which can be explained by straining and rapid bladder emptying. Hepatomegaly. NMS: initiation of DA antagonists. elbows. Diameter > 6 mm. mental status change. usually IgG but also IgM and IgA. Proven efficacy and good SE profile. hepatotoxicity. legs in women. but CT is better for diagnosis of cancer. Consider diagnosis in 40 y/o with knee pain aggravated by activity and relieved with rest. Can have cardioinhibitory and vasodepressor mechanisms involved.y Dermatomyositis: classic cutaneous findings with proximal muscle weakness. family history. icteric phase. Ab against anti-Mi-2 against helicase. TURP for long term correction). PE: sudden-onset pleuritic CP. Have proximal extensor myositis and rash (heliotrope). Rest of CSF is normal. increases right to left shunting -> drop in O2 saturation. Can have transudative or exudative effusions. Enlargement. Situational Syncope: typical is middle aged or older male who has LOC after urination (may have BPH symptoms and nocturia) or during coughing fits. Oligoclonal bands present in > 85-90%. Recent travel to endemic country and sick contacts. dyspnea. Give with folic acid to reduce SE. Pancreatic Cancer: primary differential in patients with chronic pancreatitis. Pneumonia: placing consolidated lobe in dependent position (down) increases blood flow. Regular age-appropriate cancer screening is crucial. aversion to smoking. Do US as initial test to look for hydronephrosis (if so. Melanoma: suspect in older individual with changing mole and ABCDE. Will have smooth firm enlargement. anorexia. RNA picornavirus that has fecal oral transmission. think about GI problems. 10 minutes morning stiffness. Chest CT will show wedge shaped infarction (CXR = Hamptons Hump). electrolyte abnormalities. Treat supportively. Alveoli are filled with exudate and are perfused but not ventilated. leukocytosis. Not diagnostic for MS. Gottron papules on joints are pathognomonic. Elevated BRN and ALP due to compression. muscle rigiditiy. Methotrexate: an antimetabolite agent withside effects are stomatitis. Can be symptomatic. Those at risk should be vaccinated. Keep high on differential especially worsening with activity. Crepitus due to incongruent joint surfaces. convalescent phase. Give Ig to individuals in contact. Have shawl sign on chest and lateral neck. increases in AST/ALT followed by increases in ALP/BRN. MS: total protein is usually normal. Increasing in prevalence. nausea. Elevated Cr = renal failure. y y y y y y y y y y y y . Do exercise stress without imaging if EKG is normal. Elevated CK. nausea. Usually 2 weeks after starting. cough. Elevated Ig also seen in neuropathies. fatigue. Typical antipsychotics are MCC. vomiting. mild abdominal pain. myelosuppression. SLE and steroid use = accelerated CAD. hemoptysis.

low erythropoietin. PCV: myeloproliferative disease of pluripotent stem cell. painful lesions (Oslers nodes). stasis dermatitis. decrease AT2. hypotension. Venous Insufficiency:due to incompetent venous valves.5 in patients with prosthetic valves. anti-staph antibodies. Increased RBC mass. new murmur. ACE in lung converts AT1 to AT2 -> vasoconstrictor. ceftriaxone to cover Strep pneumo. After 1-2 weeks. Endocarditis: cystoscopy can cause enterococcal bacteremia in patients with chronic GU infections. death. Vancomycin. Direct renin inhibitors will promote natriuresis. taking steroids). Hydrate. somnolence. coma. erythematous rash. TSS: possibly fatal condition caused by toxins produced by certain strains of staph. tremor. Mycophenolate causes marrow suppresion. elevated platelets. granulocytosis. Viral URI incites COPD exacerbation. Will have varicose veins. leukopenia. Viridans usually from upper airway and staph from skin. Eosinophilia is seen. Increased ulcers (histamine release from basophils). Vancomycin needed for resisitant pneumococcus and does not penetrate brain well. Leg elevation. Immunosuppressants: cyclosporine and tacrolimus are both calcineurin inhibitors (inhibit IL-2). aldosterone production. Primary Adrenal Insufficiency: best screening test is cosyntropin stimulation test. Steroids are used to treat especially for adrenal crisis while waiting for tests. VTE (3 month treatment) and atrial fibrillation should be between 2 and 3 for good anticoagulation without bleeding risk. gum hypertrophy. y y y y y y y y y y y y . Underlying valvular lesions are increased risk. hepatotoxicity. gouty arthritis (increased cell turnover). promotes ADH release. Tacrolimus does not have gum hypertrophy and hirsutism. Aldosterone promotes Na and H2O absorption in DCT and CD. hirsutism. including epidermal exfoliating toxin and is related to tampons and other intravaginal articles. skin of palms and soles will peel. Hypercellular bone marrow. Neisseria. signs of meningitis. Fever. are at risk for rapid bone loss due to increased osteoclastic activity in bone cells. Will have hypercalcemia and hypercalciuria. Hyperthyroidism: untreated. high fever. Warfarin: dose should be adjusted based on INR for condition. tremor (action tremor). HTN.y Acute Bacterial Meningitis: sick. RAAS: renin made by JG cells when hypoperfused. Renin converts angiotensinogen to AT1. Carbon Dioxide Narcosis: alveolar hypoventilation (COPD) causes CO2 retention -> lethargy. Flu. debride wound. Azathioprine has done related diarrhea. HTN due to increased volume. compression stockings. malaise. Plethoric face and splenomegaly. elevated neutrophils. Increase in levels above 20 30-60 minutes after 250 mcg cosyntropin rules out Addisons. Scleroderma: absence of peristaltic waves in lower 2/3 and low LES tone are characteristic for esophageal dysmotility due to scleroderma. remove source of infection. Chronic edema. Also at risk for arrhythmias (atrial fibrillaion). wound care are best treatment. immunocompromised. Look for other symptoms of thyroid dysfunction like fatigue. patients with malignancies. hyperkalemia. Sedatives should be avoided. Cyclosporine causes nephrotoxicity. Ampicillin for Listeria (> 55. Both hyper/hypothyroid can cause proximal muscle weakness. Improve with thyroid. ulceration are complications. anxiety. Sticking sensation and dysphagia with heartburn. Muscle Weakness: usually caused by muscle problem. seizures. H flu. 2.5 to 3. decrease aldosterone. Keep Hcrt < 45. weight loss for hyperthyroid.

Promote Na. so drug levels and renal function should be monitored. occipial HA worrisome for bleed (hyperdense). ERCP with sphincterotomy is most appropriate treatment. PE: CT angio is test of choice but V/Q scan is useful tool for those with contrast allergy or renal disease. MGUS: asymptomatic elevation of monoclonal protein on electrophoresis. FA oxidation -> increased oxidative stress -> inflammatory cytokines -> inflammation. Do bone scan after labs to look for lytic lesions. cirrhosis. pre-renal renal failure. Risk for disease is less if removed within 24 hours. Sometimes AD inheritance. Can progress to MM. Warfarin. Second Degree Heart Block: identified by prolongation of PR interval with dropped beats. fibrosis. Needs IV antibiotics and needle drainage. Nephrotoxic. Will have large perfusion defect without ventilation defect. HTN. hypercalcemia. Inhibited by alcohol. SE are hypokalemia. Hypernatremia: severe symptomatic hypernatremia requires 3% saline. anemia. Synovial analysis is crucial. Inhibit Na/K/2Cl transporter. Elevated sphincter pressure. Stroke: new neurological defecits. Rate should be 0. called mismatched defect. Non Alcoholic Steatohepatitis: insulin resistance plays central role -> fat accumulation by increasing rate of lipolysis and elevating circulating insulin levels. Confounder: extraneous factor which has properties linking it with exposure and outcome of interest. Acute Arthritis: gouty vs pseudogout vs septic cannot be accurately distinguished from each other based on clinical presentation. history of vascular disease. reassure. < 50% have this. Loop Diuretic: given to cirrhotic patients with volume overload and ascites. metabolic alkalosis. Congenital Rubella Syndrome: if women becomes pregnant within 3 months after rubella immunization. K excretion. Diabetic Nephropathy:glomerularhyperfiltration is the earliest abnormality and major pathophysiologic mechanism of disease.5 to 1 mEq/L/hr. RUQ pain. Propranolol: DOC in patients with HTN and benign essential tremor (intention tremor). Rapid correction -> CPM. HTN. No cases reported with vaccines early in pregnancy. Volume depletion -> renal failure. Differs from MM: absence of renal insufficiency. Do non contrast CT to decide of ischemic (thrombolysis) or hemorrhagic (surgery). Tick Removal: should be removed promptly to reduce risk of tick borne diseases. ACE I reduce intraglomerular pressure. Due to AV node dysfunction. Aminoglycosides: antibiotics to treat serious G(-) infections (like complicated UTI). Grasp the tick s mouthparts with tweezers and remove using slow constant pressure. elevated LFTs. Thick GBM is first change that can be quantitated. Aldosterone -> alkalosis. occipital headache. atrial fibrillation. Normal ERCP and US rule out CBD stones.y Sphincter of Oddi Dysfunction: causes post cholecystectomy pain (also caused by CBD stones). lytic bone lesions. Peritonsillar Abscess: muffled voice makes for more than uncomplicated pharyngitis or tonsillitis. Deviation of the uvula and cervical LA y y y y y y y y y y y y y y y . Intraglomerular HTN -> damage and functional loss. usually < 3 g/dL.

Use special shoes. Measure TSH. lupus. Continue hydroxyurea to increase Hgb F. TB.help differentiate from epiglottitis. PEP for any exposure around head or neck. but shows no signs of rabies. especially in males. MCC is rheumatic fever. Affects weight bearing joints and manifests with functional limitation deformity. annual intramuscular influenza. Due to neuropathy and repetitive joint trauma. Ventricles cannot expand to receive fluid and preload decreases. hypertrophy. CT can be negative. opening snap. Can deplete in 4-5 months. If develops signs. can result in shock. loose joints on imaging. Tamponade: pulsus paradoxus (inspiration -> more blood to RV -> IV septum to bow to left > reduces LV filling) and Beck s triad: hypotension. normal PAP is 25/15. Fibers cross early in the cord. y Folic Acid Deficiency: tea and toast diet predisposes. B12 deficiency. tabes dorsalis. Charcot s Joint: also called neuropathic arthropathy. Folic acid is head sensitive (don t get from cooked foods). Also have bleeding at mucosal sites. degenerative joint disease. HAV and HBV. Thyroid Myopathy: consider hypothyroidism in patients with elevated CK and myopathy. nerve damage. observe for 10 days. Hematoma after minor injury is suggestive. Contraction alkalosis also occurs. Loud S1. Can cause airway obstruction or spread into parapharyngeal space. Can cause persistant cough and elevation of left main stem bronchus. invasive pneumococcal disease. Caused by diabetes. 30-50 is malignancy. If captured. Can have hepatojugular reflex. Brown Sequard Syndrome: damage to the lateral STT -> contralateral loss of pain and temperature beginning two levels below the lesion. muffled heart sounds. Exudative Effusion: low glucose is due to high metabolic activity of leukocytes and bacteria within fluid. use PEP. Measure factor VIII and IX levels. Do exchange transfusion to decrease percentage of sickled cells and prevent secondary infarct. ECG will have atrial fibrillation or LAE. Chronic Liver Disease: should be up to date on childhood vaccinations. diastolic murmur. Will have history of joint swelling. Causes macrocytic anemia. syringomyelia. and rhabdomyolysis. Will have sluggish tendon reflexes. Surgery if aspiration cannot relieve. and analyze brain. Normal RAP is 4-6. Vomiting: causes hypokalemic hypochloremic metabolic alkalosis. COPD and L heart disease also cause pulmonary HTN. JVD. Echo confirms. Loss of H+ plus no use of HCO3 by the pancreas (due to no acid) retains it in the blood. < 30 suggest empyema or rheumatic effusion. Treat by replacing missing coagulation factor. Can cause myalgia. Left Atrial Enlargement: due to mitral stenosis. Surgery to treat. Will have sudden onset. Stroke: can be a common manifestation of sickle cell disease due to sludging and occlusion. spinal cord injury. And should get Td booster every 10 years. Rabies: if animal is not captured. esophageal rupture. PE: result in pulmonary hypertension with elevated RAP and PAP. Restore ECF with NS and potassium to treat. Hemophilia: hemarthroses are MC manifestation. y y y y y y y y y y y y . it is assumed rabid and post exposure prophylaxis is needed (active and passive).

Androgens:women produce androstenedione. hypercalcemia. diarrhea. increased LDL/TG. Choriocarcinoma: metastatic gestational trophoblastic disease. Suspect in y y y y y y y y y y y y y y . constipation. Exacerbated by stress. small % can be invasive. Toxoplasmosis: HIV patient with fever. hypokalemia. warrants cardiac workup. smoking. Stop drug and check WBC count. pulmonary fibrosis. Chest Pain: in a young person with RF. those with scars. family history. Occurs < 100 CD4. and pleural plaques. Aminoglycosides: cause nephrotoxicity and ototoxicity. Can have seizures and focal neurological deficits due to mass effects. T are produced by the ovaries. Murmur increases on Valsalva. Lungs are most frequent site of metastasis. Topical retinoids are for non inflammatory comedones. confusion.y Asbestosis: increases risk of malignancy. MG:fatigable muscle weakness involving the ocular and bulbar muscles. Disease is MC in AA. Antithyroid Drugs: fever and sore throat while taking suggests agranulocytosis. > 1500 means drug not cause. hypokalemia (muscle cramps. Also causes hyperurecemia. Overproduction -> hirsutism. DHEA/S are not true androgens. Primary Hyperaldosteronism: hypertension. Thiazides: cause hyperglycemia. glucocorticoid/licorice ingestion also causes HTN. Influenza Vaccine: all individuals > age 50 should get it yearly. More in women than men. Due to reactivation. COPD needs pneumococcal as well. acne resistant to other therapy. frequent exposure to small children. 15% have a thymoma which can be seen on CT chest. No pathologic or lab hallmark. Do morning PA/PRA. Damages hair cells of inner ear. IBS: functional bowel disorder of GI tract characterized by pain. HOCM: outflow obstruction due to septal hypertrophy and systolic anterior motion (SAM) of mitral valve (may be of more consequence). ataxia. ring enhancing lesion. continuous. Murmurs: diastolic. >35. Also cause hyponatremia. CAH. Start with dyspnea with cough or sputum production. Do not do routine CBC in patients on these drugs. Younger adults with medical problems. First drug to give is ASA during suspicion of coronary event to prevent platelet aggregation. healthcare workers should also get it annually. low K. look for Ab at diagnosis. Treat prophylactically with TMP/SMX if have Ab. high glucose (due to impaired insulin secretion). Due to immune destruction of WBC. but not annually. Still have desirable affects on CV mortality even in diabetics. MCC is aldosterone producing adenoma. polyuria due to ADH resistance). DHEA-S. pregnant women. > 30 is suggestive. HA. < 1000 warrants permanent cessation. testosterone. Bronchogenic carcinoma and mesothelioma are both caused but bronchogenic is more common. Midsystolic soft murmurs (I to II/VI) do not need to be investigated if asymptomatic. DHEA. AS. Occurs after molar pregnancy or normal gestation. DHEA. or loud systolic murmurs should be evaluated with Echo. Nodulocystic Acne: give oral isotretinoin with moderate to severe acne that is nodulocystic. estrogen therapy increase risk of thrombosis. syndrome of apparent mineralocorticoid excess. low plasma renin. DHEA-S is produced by the adrenals (elevated with tumors). but can be converted. Causes severe vestibulotoxicity (especially gentamycin) -> potentially permanent vertigo and ataxia. Benzoyl peroxide and topical antibiotic is for mild inflammatory acne.

Increasing age is cause. bleeding > 8 weeks post partum. BPV. prohibits accomadation. Presents with HA. lightheadedness. Worse in morning. Warfarin should be continued for 6 months for first clot and lifetime for second. Memory loss. Cushing s reflex (hypertension and bradycardia). family history. CT shows atrophy. Alzheimer s Disease: MCC dementia in western world. Flow volume shows pancake . Vertigo: senseation of excessive motion compared to reality. focal neurological defecits. See drusen deposits in the macula. Meniere s. Cholecystectomy: indicated in all patients with symptomatic gallstones who are stable enough to undergo surgery. Tongue biting and sore muscles indicate seizure. Sun avoidance is best method of protection. Driving or reading are first activities affected. Has higher rate of seroconversion than HCV and HIV. drug screen.postpartum woman with lung symptoms and multiple nodules on CXR. Stress and poor sleep trigger seizures. nausea. MC due to vestibular dysfunction. Laryngeal Edema: causes fixed upper airway obstruction which decreases airflow during inspiration. Middle aged individual who holds books at arms length is classic. y Hepatitis B: (+) HBsAg & (-) HBsAb means active infection. Gallstones are MC responsible in non-alcoholics. y y y y y y y y y y y y . active expiration. Activities that require fine vision affected first. apraxia -> impaired judgement and personality changes. Citrate from transfusions binds. acoustic neuromas. Age. Causes nausea and vomiting. Occurs due to hypoalbuminemia and dilution. Avoid outdoor activities between 10 AM and 4 PM. pelvic pain. Elevated b-HCG. smoking maybe. Intracranial HTN: diagnosed when ICP > 20. Down s. vomiting. Trauma. space occupying lesions. Macular Degeneration: common cause of blindness in US. Sunscreens should be applied 15-60 minutes before. EEG. Psychotic features appear later. Needle stick in unvaccinated individual -> give HPV vaccine and Ig. perilymphatic fistulas. and passive expiration. brain MRI. language difficulties. Hypomagnesemia presents with hypocalcemia and causes decreased PTH secretion and decreased peripheral response to PTH. hydrocephalus. heparin is discontinued after 5 days. syncope. HBeAg indicates high infectivity. VTE: treat initially with heparin & warfarin combination. Hyperactive DTR s may be initial manifestation. labyrinthitis. impaired CNS venous outflow. changes in awareness. unsteadiness. Rapidly return to baseline with syncopal event. Presbyopia: common age related decrease in lens elasticity that leads to difficulty with near vision. Distinguish from imbalance. Asthma causes intrapulmonary obstruction and has scooped out patter on exhalation. Photo Protection: important in high risk groups. vision changes. If INR is therapeutic. female. Ovarian Cancer: no evidence that regular abdominal US help decrease mortality. Needs CBC. Straight grid lines may appear wavy. Do CT or MRI. Seizure: if results in LOC (complex partial or generalized) will be followed by post-ictal state. Hypocalcemia: occurs during or immediately after surgery in patients undergoing major surgery and transfusions. Will have enlarged uterus. head trauma.

Dense intramembranous deposits of C3 are present. Also called dense deposit disease. PUD: hemorrhage is the MC complication. sore throat. Fluid and blood resuscitation. Marfan s Syndrome: most dangerous complication is aortic dissection. medical therapy. generalized maculopapular rash. Usually acetominophen which can be compounded by alcohol. but (-) in early illness. IgG Ab (C3 nephritic factor) against C3 convertase -> constant active. MCC are neuropathy. Smoking is most important RF. L5 radiculopathy (or radiculopathy of any of the common peroneal roots L4-S2). CNS Lymphoma: HIV infected patient with altered mental status. Herpes Zoster Ophthalmicus: characterized by dendriform corneal ulcers and vesicular rash in CNV distribution. Transmitted by oropharyngeal secretions. fever. stop the statin. Blood or coffee grounds on NG aspirate. EBV DNA in the CSF. polycythemia. Causes aortic regurgitation -> early diastolic murmur. y y y y y y y y y y y y y y . Charcot Marie Tooth disease has congenital foot drop. Treatment within 72 hours of high dose acyclovir reduces complications.y Osteomalacia: defective mineralization of bones. Foot Drop: steppage gait. Vitamin K will not work because of liver disease. Carboxyhemoglobinemia: consider in patients with RF and headaches. Disordered skeletal remodeling in specific bones is Paget s disease. Vit D deficiency -> decreased availability of calcium and phosphorus at mineralization sites -> softening. Can progress to rhabdomyolysis (kidney failure). burning itching sensation in distribution. malaise. dizziness. malaise. traumatic damage to common peroneal nerve. May have fever. Heterophile Ab are good test. Extreme LFTs: marked AST/ALT consistent with hepatocellular injury. Splenomegaly. and solitary weakly ring enhancing periventricular lesion on MRI. nausea. unique glomerulopathy caused by persistent activation of the compliment pathway. Seen with SCC of the lung. Susceptible when working in closed space with exposure to car fumes. If highly elevated. Rickets is defective mineralization of bone bone and growth plate cartilage. megacolon (both due to neural destruction) cardiac disease (CHF type due to prolonged myocarditis). CXR may have wide mediastinum. FFP: given to patients with bleeding disorders and liver failure. but normally mineralized per unit volume. SIADH: hyponatremia. AST/ALT can be > 5000. Usually due to alcohol (2:1 AST:ALT) or medication induced. endoscopic when appropriate. Due to VZV. Metastasizes early. Null Hypothesis: always a statement of no relationship between exposure and outcome. Also causes increased LFT s. Statin Induced Myopathy: CPK levels of anyone on statin with muscle pain. Causes megaesophagus. May have melena or hematochezia. Repeat test. Membranoproliferative GN: Type II. Tearing chest pain that radiates to the back and neck. Posterior cervical LA and palatal petechiae. Infectious Mononucleosis: fatigue. Osteoporosis is low bone mass. elevated urine osmolarity in presence of decreased plasma osmolarity. Disease is due to fibrillin defect. Chagas Disease: caused by Trypanosoma cruzei protozoan.

multiple nodules on CT. levothyroxine OD. If not available. tetany. accidents. Diagnosed with c-ANCA and tissue biopsy (affected nasal mucosa). vomiting. CMV: consider in patients after BMT with pneumonitis (after 2 weeks to 4 months. diarrhea. Cancer Associated Anorexia: treat with megestrol acetate. arthralgias. esophagitis. C-telopeptide levels. Have morning headaches. Shingles: vesicular eruption that occurs in dermatomal distribution. Endocarditis: first draw blood for culture then give empiric antibiotics. excessive soft tissue. Prednisone may be added.y OSA: common in obese population. Usually in elderly or immunosuppressed during periods of stress. Use nocturnal polysomnography to diagnose. Accelerated and disordered osteoclastic resorption -> disorganized woven and lamellar bone. hyporeflexia. All efforts to make patient eat. When culture is available. Zanamivir and oseltamivir (neuraminidase inhibitors) active against both. muscle cramps. hyperaldosteronism are all causes. At rish for HTN. Calcium in Alkalosis: increased pH increases serum albumin affinity for calcium. neck and arms. IVDA and valvular abnormalities are RF. swelling of head. or biopsy. High -> surgical removal. Hypokalemia: causes weakness. Treat with steroids and cytotoxic agents. Intermediate -> PET. subacute granulomatous thyroiditis. ST depression. Lung cancer (SC) and NHL are usual causes. iodine induced thyroid toxicosis. arrhythmia. Fibrosing mediastinitis due to histoplasmosis or Tb infection or thrombosis due to central catheters. Used as appetite stimulant in advanced malignancies. synthetic progestin. multifocal diffuse pathy infiltrates. apneic episodes. decide if high or low risk (age. Caused by VZV which also caused chicken pox. Skull hypertrophy -> increased hat size and deafness. Randomization: said to be successful when similar baseline characteristics are seen in treatment and placebo individuals. Associated with normal calcium and phosphate levels and increased ALP and urine hydroxyproline. Severe -> paralysis. Comination of GN and upper/lower airway disease. Disseminates in very immunocompromised. y y y y y y y y y y y y y . Paget s Disease of the Bone: osteitis deformans. CXR may have multiple nodular densities and alveolar/pleural opacities. Snoring. daytime sleepiness. SVC Syndrome: malignancy is MCC (smoking. diagnosed on BAL) and colitis (upper and lower GI ulcers) bone marrow suppression. Wegener s Granulomatosis: vasculitis affecting small and medium sized arteries. fatigue. Influenza: treat with bed rest and analgesia. Increases albumin bound and decreases ionized calcium -> clinical manifestations of hypocalcemia. deoxypyridinoline. heart disease. poor concentration. micrognathia. Amantadine and rimantadine are only active against Influenza A. myalgias. Due to tonsillar hypertrophy. weight loss). flat broad T waves. Often preceded by pain for 48 hours. Do CXR to diagnose. Dyspnea. Diuretics. venous congestion. Ntelopeptide. Weight bearing bones have pain and bowing. smoking). PVCs. Low -> serial CT. cor pulmonale. antibiotics can be changed. Antivirals decrease symptoms by 2-3 days but only effective if given within 48 hours. EKG may show U waves. Better to have oral than TPN. Absence of growth over time rules out malignancy. rhabdomyolysis. Thyrotoxicosis with low I Uptake: subacute painless thyroiditis. Solitary Pulmonary Nodule: first step is to find old x rays. struma ovarii.

Inferior MI: right ventricular infarction -> right heart failure. Patients may be involved in high risk sexual activity so HIV counseling and screening with ELISA should be offered. dysphagia/odynophagia. Seen in children in old houses or lead based paint. vomiting. Coingestions can have normal pupil size or even mydriasis.y HIV Esophagitis: start first with oral fluconazole directed against candidiasis. drowsiness -> BZD or opioid. valvular disease. Pain radiates to TMJ and worse with chewing. antithyroid drugs. MMI can cause cholestatic jaundice. NFII: young patient with acoustic neuroma and café au lait spots. MRI with gadolinium is best way to diagnose. Lithium has tremor. obtundation. behavior changes. Elevated PTT is therapeutic. nausea. Failure to respond in 3-5 days needs endoscopy. HSV and CMV are both causes as well. thrombocytopenia is adverse effect. effects are most pronounced in the esophagus -> liquefactive necrosis. Cr > 8 (> 6 in diabetes) or severe symtoms. clear lung fields. ANCA vasculitis. Pseudomonas is MCC. hyperreflexia. but does not prevent hepatitis) for 9 months. decreased bowel sounds. thyroidectomy. Pericardial fluid is usually hemorrhagic. unsteady gait. MC SE is allergic reaction. Can have paradoxical thrombosis. Primary Syphilis:dark field microscopy is good for evaluation. Gradual tinnitus and hearing loss. X ray may show lead lines at metaphyses. Hypotension. Decreased RR. PTU can cause hepatitis picture. HIT: seen in about 5-15% of patients with onset in 3-15 days and resolution 4-5 days after stopping. Do fingerstick in all suspcions. Agranulocytosis is major SE of antithyroid drug therapy. refractory metabolic acidosis. BZD do not have severe respiratory depression and no pupillary constriction. Monitor LFTs. JVD. Needle marks on extremities. Sometimes if GFR < 10 (< 15 in diabetes). Grave s Disease: treatment is radioactive thyroid ablation. Alcohol and phenytoin intoxication are similar but have nystagmus. ataxia. Niacin deficiency -> pellagra. Positive PPD (> 5 mm in HIV) needs INH and pyridoxine (to cover INH neuropathy. Can have anorexia. Preload dependent -> treat with IVF y y y y y y y y y y y y y . > 10 is abnormal. Administer naloxone. Gastrograffin study if rupture is suspected. Uremic Pericarditis: absolute indication for dialysis. clumsiness. Opioid Intoxication: does not always present with miosis. BZD OD: slurred speech. Have retrosternal pain. hypersalivation. Early upper GI contrast studies and endoscopy are critical for evaluating damage and deciding on treatment. Otitis Externa: any diabetic patient with severe ear pain. Lye Ingestion:effects are instantaneous. otorrhea. hypotension. Usually BUN > 60 and anemia. Painful swallowing and substernal burning. hypothermia. Lead Poisoning:microcytic anemia and basophilic stipping. Frequently bilateral. Classic triad is flushing. 5-HIAA present in blood and urine. Meperidine and propoxyphene do not cause miosis. TB and HIV: Tb has a very high rate of progression. seizures. evidence of granulation tissue in ear canal. Carcinoid Syndrome: at risk of niacin deficiency due to increased formation of serotonin from tryptophan. Usually CD4 < 50. Worsening with antibiotics -> malignant. Give IVH and receive serial abdominal and chest x rays. Kussmauls sign (increased JVD with inspiration). Other dialysis indications: fluid overload or hyperkalemia that is not responsive. diarrhea. Tryptophan is precursor of serotonin and niacin.

aVL. Low HR -> possible SA node involvement. Back pain and signs of hemodynamic compromise. Can be missed on colonoscopy. Common in cecum. Greater risk of bleed on warfarin in diabetics. tinnitus. depression. Priapism: always check medications first. inhibit carbohydrate and lipid metabolism -> accumulation of lactate etc. Causes are post-surgical. Dilated Cardiomyopathy: viral myocarditis (post partum) usually due to Coxsackie B. Mixed respiratory alkalsosis (stimulates respiratory center) and anion gap metabolic acidosis (uncouples oxidative phosphorylation > increased O2 consumption/hyperpyrexia. Pancreatic Cancer: painless jaundice in a patient with conjugated hyperbilirubinemia and elevated ALP. Primary Hyperparathyroid: MCC of hypercalcemia in ambulatory patients. primary decrease in HCO3. Reliable Tests: gives similar results on repeat measurements. STE in II. Controversial association with AS. Will have antecedent URI. congenital absence. aVF and STD in I. Have elevated or inappropriately normal PTH levels. ARDS: acute pancreatitis may be a cause (15%). US can confirm GB pathology. Antidepressant used for sleep disturbances. Pseudohypoparathyroid = PTH resistance. improves with naloxone). depression. impairs renal function -> accumulation of sulfuric/phosphoric acid). Decrease FiO2 to nontoxic levels (< 60). neurogenic lesions. RR and TV determine PaCO2. Opioid Intoxication: miosis. Major association with trazodone. decreased bowel sounds. viral illness can be cause.and avoid nitrates and diuretics to decrease preload. Women 20-50 years old. Other causes are SCD and leukemia. Can be due to direct viral damage or immune response. PEEP may need to be increased to maintain oxygenation after FiO2 is decreased. age > 60. Painful and long erection without stimulation. Sleep disorder. autoimmune destruction (APECED = autoimmune polyglandular endocrinopathy candidiasis ectodermal dysplasia). Angiodysplasia: common cause of intermittent and occult lower GI bleeding in patients > 65. Normal labs. PTH is higher and calcium is normal (hypocalcemia is the stimulus).. hypertension. displacing kidney. hypotension (histamine release). Anemia with normal MCV = episodic (not chronic) bleeding. Near normal pH. PEEP and FiO2 determine PaO2. y y y y y y y y y y y . Have multiple trigger points of tenderness. MCC is prazosin. Can use right sided EKG leads. Improve with TCA and exercise. ASA Intoxication: triad of fever. bradycardia. alcoholism. Echo shows dilated ventricles and diffuse hypokinesia -> systolic dysfunction (low EF). CT will show isodense collection anterior to psoas. Do CT of abdomen to confirm. Toxins also cause. decreased RR (best indicator. III. y Retroperitoneal Hematoma: can occur even with normal INR. cause of mortality. tachypnea. defective calcium sensing receptor. Hypoparathyroidism: characterized by low calcium and elevated phosphorus levels with normal renal function. Reliability is maximal when error is minimal. primary decrease in PaCO2. No pain rules out acute obstruction such as choledocholithiasis. perineal/genital trauma. Chronic renal failure -> secondary hyperparathyroidism. poor sleep. depressed mental status. Fibromyalgia: chronic widespread pain disorder associated with fatigue.

Can be transient during period of stress or febrile illness. Typically prolonged leaning on elbows at desk job. Usually caused by rhabdomyolysis -> ARF (high BUN. high HCO3. difficulty with rapid alternating movements. Ear pain and drainage. lung. vomiting. metabolic alkalosis. Malignant Otitis Externa: seen in eldery and uncontrolled diabetics. specificity is 69%. Can cause osteomyelitis of skull base and destruction of facial nerve. Transfusion Reactions: relatively common and life threatening. Can occur in patients with acquired alloantibodies. Have positive Coomb s test. K). brain. HTN. gaze y y y y y y y y y y y y y . Decreased sensation in 4th and 5th digit. Have gain instability/ataxia/broad based gait. hemolysis. no radiation). especially in adults. May be in liver. Will have low renin. Acute hemolytic reaction due to transfusing mismatched blood and Ab reaction (ABO mismatch). occipital HA. hypokalemia. Muscle hypotonia can result -> pendular knee reflex.5 cm. and mostly in diabetics. Brain Hemorrhage: usually due to HTN. bony enlargement. DIC. increased Hgb/Hcrt. chills. Fever. non-black person. non-invasive. AAA: USPSTF recommends screening male active/former smokers between 65 and 75 years old one time with abdominal US (low cost. If > 3. high aldosterone. sore throat. Can be seen in adult immigrants with improper vaccination. Topical treatment with selenium sulfide lotion and ketoconazole shampoo. OA: lack of physical exam findings and lab changes. Putamen is MC place.y Osler Weber Rendu: hereditary hemorrhagic telangiectasia (AD). Seizures can be a cause. Supportive treatment. ARF. Repair aneurysms > 5. stridor (harsh thrill). Can have massive hemoptysis. No recommendations for or against men 65-75 who have never smoked. Based on clinical impression and radiographic evidence. drooling. flank pain. plasma free Hgb is pink with Hgb > 25. granulation tissue in ear canal. Ulnar Nerve Syndrome:MC site of ulnar nerve entrapment is at the elbow where ulnar nerve lies at medial epicondylar groove. dysmetria. Muscle weakness and exercise intolerance are due to hypokalemia. MCC is Pseudomonas. Medical emergency and rapid treatment is needed to secure airway. lack of warmth/morning stiffness. Age > 50. bony tenderness. CT or MRI. Cr. Develop pulmonary AVMs > AV shunting -> hypoxia -> erythrocytosis. Suspect in young nonobese. shock. Myoglobinuria: suspect with large amount of blood on dipstick but few RBC s on UA. Caused by Malassezia furfur (spaghetti and meatballs). Tinea Versicolor: pale velvety pink/white appearing hypopigmented macules that do not tan and do not appear scaly but scale on scraping. Occurs at forearm rarely. mild hypernatremia. Use systemic cipro. Strep Bovis Endocarditis: associated with colorectal cancer or upper GI malignany. Isolated Proteinuria: evaluation should begin by testing urine on at least two other occasions. nystagmus. Cerebellum is 2nd MC place -> ataxia. Cerebellar Dysfunction: common in chronic alcoholics. intention tremor. Weak grip due to intrinsic hand muscle denervation. Suspect with recurrent nosebleeds and oral lesions. Epiglottitis: MC organisms are H flu and Strep pyogenes. crepitus. Can occur at the wrist. Conn s Syndrome: primary hyperaldosteronism. and internal capsule is often involved -> hemiparesis. Not responsive to topicals. Fever. Colonoscopy should be pursued for further evaluation and after do radiographic surgey for UGI cancer. Color change requires months to return to normal. Also can cause septicemia. hematuria.

MC pattern is fall in total T3. cimetidine). Pons is 3rd MC place -> deep coma. pinpoint pupils reactive to light. medications are usual causes. PUD: melena is a common manifestation of UGI bleeding. Due to caloric deprivation and cytokine release. no horzontal eye movements. IVDA -> cirrhosis due to possibility of HBV/HCV infection. Hypertriglyceridemia: can cause acute pancreatitis when levels > 1000. Longer sick -> T4 and TSH drop. Symtoms are SAD (syncope. (-) heterophile Ab in the first few weeks does not rule out. Diagnose with fasting lipid profile.6. Rubella: maculopapular rash. Euthyroid Sick: any patient with acute severe illness can have TFT abnormalities. precaution in conditions with priapism. Barrett s and adenocarcinoma.palsy. LA after 2-3 weeks -> rash 1-5 days later (starts on face and speads. May have horseness and chronic cough especially when recumbent. malaise. asymptomatic with severe AS and either poor LV function. Refractory -> fundoplication or endoscopic treatment. give drugs 4 hours apart to decrease risk of hypotension. improve with exercise. neuropathy. Pain from duodenal ulcers gets better with food. infection. Prognosis : severity of lab abnormalities. recent ERCP. normal T4 and TSH (low T3 syndrome). EBV specific Ab test is for patients with suspected IM and (-) heterophile Ab test. dyspnea). abnormal response to exercise. Limited spine mobility and progression of back pain > 3 months. Ab titer for Toxoplasma are all indicated. Exposure -> fever. myxedema psychosis. y y New HIV Patient: VDRL. Hypothyroidism: accumulation of matrix substances all over body causes many manifestations of hypothyroidism. y y y y y y y y y y . May be trigger for asthma (upto 75% of cases). LVH > 15 mm. May have eruptive xanthomas on PE. MC extraarticular manifestation is anterior uveitis. pain from gastric ulcers gets worse. First line is PDE inhibitors. Bilateral sacroiliitis on x ray. hematenesis. nausea. Hypercalcemia. usually for < 3 days). myxedema coma. IM: heterophile Ab test (Monospot) is sensitive and specific for diagnosis (appear within a week and may be positive upto a year). Pain and stiffness worse in morning. Vascular complications. H pylori and NSAIDs. Untreated -> generalized myxedema. trauma. Diabetics are at high risk for ED. AS: indications for AV replacement: symptomatic. valve area < 0. Atypical lymphocytes are seen but not specific. GERD: retrosternal burning after eating and lying down. facial weakness. CI in people taking nitrates. Ankylosing Spondylitis: occurs in adults 20-30 years. UGI proximal to hepatic flexure can cause melena. Usually due to cirrhosis from chronic liver disease (alcoholic or viral). May have wheezing (all patients with asthma symptoms should be asked about GERD symptoms as well). Treat with acetaminophen. angina. PPD. Initial treatment is H2 receptor antagonist (ranitidine) or PPI. HAV/HBV serology. Have abdominal pain. no hemiparesis. severe AS undergoing CABG or other valve surgery. ED: in treating patient with sildenafil and an alpha blocker (usually zosin). medications also causes. paraplegia. concurrent use with drugs that may increase ½ life (erythromycin. decrerebrate rigidity. Matrix accumulation in median nerve and tendons of carpal tunnel may cause carpal tunnel syndrome. vomiting. Portal HTN: MCC of ascites. More severe -> lower T3. posterior cervical and posterior auricular LA and polyarthralgia.

BUN/Cr ratio is useful indicator (sensitive but not specific). y y y y y y y y y y y y y . Decreased consciousness is MC symptom. High levels of B2 agonists are used along with steroids in acute asthma. Blurred vision is caused by myopic increase in legs thickness and intraocular hypotension due to hyperglycemic hyperosmolarity. Can present as seizures. Present with lymphocytic pleocytosis. Amyloidosis: restrictive CM with thickened ventricles and preserved dimensions (diastolic dysfunction without systolic changes) as well as involvement of liver (easy bruisibility) and kidneys (proteinuria). cidofovir. coughing fits. Usually triggered by infection. worsens with inspiration and movement. Viridans Group Strep: frequent cause of SBE in patients with pre-existing vascular disease. Power: the power of a study is its ability to detect the difference between two groups. Mild hypovolemia can predispose them to orthostatic syncope. coagulopathy. Costochondritis: chest pain that is reproducible with palpation suggests musculoskeletal.y SBP: suspect in any patient with cirrhosis and ascites who presents with low grade fever (cirrhotics may be hypothermic). Sharp. Staph aureus is cause of acute infective endocarditis and is seen in IVDA. rigidity (lead pipe or cogwheel). Behcet s Syndrome: multisystemic inflammatory condition with recurrent genital/oral ulcers. Caused by MM (AL). Complete DI -> urine osmolarity < 300. Herpes Encephalitis: temporal lobe affected. Non Ketotic Hyperosmolar Syndrome: T2DM. long lasting. Treated with salt restriction and discontinuation. elevated protein. Accumulation of alpha synuclein in substantia nigra. foscarnet. chronic inflammation like RA (AA). anterior uveitis. bradykinesia. especially on waking. Usually HSV-1 beyond neonatal period. Increasing the sample size -> more power ->makes CI of the point of interest tighter. If HTN. hypertension. skin lesions (erythema nodosum). Asian. Stress -> increased cortisol and catecholamines -> insulin resistance. May be due to trauma from rubbing eyes. SAAG > 1. Treat with steroids -> do not prevent progression to dementia and blindness. focal. IV acyclovir. increased number of erythrocytes. 2/3 signs on physical exam grounds for clinical diagnosis. headaches. seen in Turkish. Demeclocycline. Paracentesis with PMN > 250 and positive culture is diagnostic. Lithium: common cause of nephrogenic DI. Dehydration: elderly patients are particularly sensitive to fluid loss. partial DI -> urine osmolarity 300-600. try lowering BP. Middle Eastern. palpitations. abdominal discomfort. amphotericin also cause DI. Hypokalemia: high levels of B2 agonists present with muscle weakness. Subconjunctival Hemorrhage: if spontaneous. Do electrolyte panel. Exercise EKG: recommended for patients with an intermediate pre-test probability of angina based on clinical features and RF. arrhythmias. is a benign finding and does not require treatment.1 = portal HTN as cause. EEG -> intermittent high amplitude slow waves. altered mental status. Parkinson s: three cardinal signs are resting tremor (resting pill rolling usually focal to one hand and generalizes). EKG abnormalities. postural instability. Do HSV PCR is gold standard for diagnosis. Anti-ischemics should be withheld (digoxin and meds that slow heart rate like beta blockers). B2 agonists can also cause tremors. may present acutely (< 1 week) with focal neurological signs.

fluconazole). Flushing caused by hot drinks. Class IC (blocks Na channels). coryza. S4. Do not use in Lewy Body dementia. Bicuspid valve considered in anyone < 70. Papillary Necrosis: presentation of woman with hematuria and headaches = analgesic nephropathy. enthesitis. Flecanide: used to treat ventricular arrhythmias and SVT like atrial fibrillation. FSGS: most common type of glomerulopathy associated with HIV. Class IV also has use dependence but doesn t elongate QRS. urethritis. heat. rheumatic heart disease. NSAIDs are first line therapy. Can manifest even if rest of HIV markers are normal. More prevalent in blacks. Later by immunosuppression and SSPE. Aortic Dissection: tearing pain with radiation to the back and difference in BP of > 30 mm Hg between the arms. antiarrhythmics (amiodarone. watery. bronchiectasis. Analgesics -> vasoconstriction. Torsades des Points: polymorphic ventricular tachycardia that occurs in setting of prolonged QT: familial long QT. Cells keep making enzymes when no secretion -> leakage. Papilledema: transient loss of vision for a few seconds with changes in head position. chin. Rosacea: suspect in 30 to 60 year olds with telangiectasias over cheeks. Sometimes clots form -> renal colic. sotalol). TEE or CT with contrast to diagnose. Collagen abnormalities also predispose to MVP. nocturnal diarrhea. Characteristic finding of dark brown discoloration of the colon with lymph follicles shining through as pale patches (melanosis coli). Early on there is dysfunction between synthesis-secretion. elongates depolarization -> slow conduction through AV node and bundle of His. conjunctivitis after 10 days ->Kopliks spots that appear 48 hours before rash and fade as soon as rash appears -> erythematous maculopapular rash initially over face and then spreads. confirmed by ophthalmologic examination. Have nephrotic range proteinuria. Years of analgesics -> chronic tubulointerstitial damange. asymmetric oligoarthritis.y Acute Pancreatitis: serum amylase and lipase are considered most sensitive and specific tests for diagnosis. drugs (TCAs). Enlarging blind spot. bicuspid aortic valve. Have rapid development of renal failure. Have use dependence where effect increases (QRS increases) as HR increases (not as much time to dissociate). May have papules and pustules. hypomagnesemia (malnourished alcoholics). nose. Usually seen in those abusing anthraquinone containing (bisacodyl). Measles: paramyxovirus. Exposure -> prodrome of cough. May have CHF signs. Topical metronidazole is usually prescribed as initial therapy. other causes of rapid body temperature change. BZD s are not good. Seronegative spondyloarthropathy from enteric or GU infection. vitamin A deficiency. normal sized kidneys. Antipsychotics can be deadly in elderly but good for acute agitation. When ICP increased -> transmitted to optic nerve head -> swelling. Complicated by pneumonia. emotion. Lipase is more sensitive and specific. Treat with stopping cause and starting magnesium sulfate. antiinfectives (moxifloxacin. Can also use quetiapine and risperidone. Also have conjunctivitis. azotemia. Laxative Abuse: frequent. changes in HA intensity with position). Haloperidol: good for treating agitation in elderly regardless of underlying cause of dementia. AS: three most common causes are senile calcific aortic stenosis. Caused by increased ICP (morning HA. Reactive Arthritis: Reiter s syndrome. mucocutaneous lesions. y y y y y y y y y y y y .

cardioversion is appropriate. History of recent angiography. Tropical Sprue: malabsorption (B12.8 mg/dL decrease in calcium. erythematous. Antibiotics with some resolution. Cholesterol Emboli: acute renal failure. (+) = heart. diabetes. Need two means.05. folate). Persistant cough. bethanacol. MM: hypercalcemia is a common finding -> constipation. reject the null hypothesis. decreased compliment levels. If p < 0. Hyperactive bowel sounds and borborygmi. Can occur in any patient where there is a pulmonary infection accompanied by either decreased airway drainage or impaired immune defense. early satiety. previous pancreatitis attacks. skin changes in lower extremities (bluish discoloration or livedo reticularis). obesity. diarrhea. erythromycin are used for gastroparesis (difficult to control glucose). renal tubular dysfunction. thrombophlebitis. Bacterial overgrowth occurs in SI. Atrial Fibrillation: irregularly irregular R-R interval with absent P waves and narrow QRS complexes. Bronchiectasis: identified on CT by presence of dilated bronchi with thickened walls. Erysipelas: sudden onset of sharply demarcated. elevated eosinophils in blood/urine. Metoclopramide (DOC). Can develop pancreatitis. 3-4 weeks of rate control and anticoagulation before. characterized by blunted villi with infiltration of chronic inflammatory cells. Lung Consolidation: bronchial breath sounds. Always measure albumin in order to correct for it. Use beta blocker or CCB. dullness to percussion. the sample size. Recent onset diabetes. Pertains to the applicability of the results to the study of other populations. increased fremitus. Pancreatic Cancer: RF are family history. the sample variances. do immediate cardioversion. involves SI. Most frequently implicated organism is group A beta hemolytic strep. neurologic symptoms. Constipation in LI. If stable who have been in atrial fibrillation < 48 hours. Restriction of the study to a certain population. Bronchial sounds have full expiratory phase. bronchophony. (-) = liver. history of living in endemic area for > 1 month. lymphocytes. Hypocalcemia: can be due to low albumin. Elderly patients with pneumonia may not have elevated temp or WBC. Measured calcium + 0. Two Sampled T Test: statistical method that is commonly employed to compare means of two groups of subjects. chronic pancreatitis. anemia. Legs are most frequently involved. egophany. anorexia. Hepatojugular Reflex: useful tool to differentiate between heart and liver disease related cause of lower extremity edema.y GI Manifestations of Autonomic Neuropathy: postprandial bloating.8 (4 measured albumin). elevated ESR. Generaliziability: external validity. whispered pectoriloquy on PE. > 48 hours. Combination back pain. smoking. Inflammation of the superficial dermis. constipation. weakness. eosinophils. Alcoholism is not a risk factor. Higher in males and blacks. Hemoptysis is a potential complication. Presents similarly to COPD where abnormal aiways cause obstruction. In unstable patients. edematous. tender skin lesions with raised borders. Jaundice and weight loss. renal dysfunction. y y y y y y y y y y y y . Every gm/dL decrease in albumin is 0. GI symptoms. high fat diet. plasma cells.

sensorineural deafness with a family history of renal failure. EM shows alternating areas of thinned and thickened capillary loops with splitting of the GBM. vascular obstruction. Can have macrocytic anemia. US. fluid-filled loops of bowel).3 indicates pleural inflammation. or RA. NG decompression. bronchoscopy) to find primary tumor. Bone pain (osteomalacia). Pleural fluid will be consistent with transudate. Anemia: if in CKD. diverticulitis. fluid management. thrombocytopenia. < 7. SCC: of the head and neck in alcoholic smoker who presents with palpable cervical LN. Symptoms may be nonspecific and include abdominal pain.y Hawthorne Effect: tendency of a study population to affect the outcome because these people are always aware that they are being studied. Glucose < 60 favors parapneumonic effusion. dyspepsia. neuropathy (B12 deficiency). otherwise can precipitate iron deficient state. ELISA for IgA Ab to gliadin. NPV: probability of being free of a disease if test is negative. Celiac Disease: malabsorption and iron deficiency anemia. give IV iron dextran. floating stool. Abdominal distension with succussion splash (palpable. due to erythropoietin deficiency (normocytic. Can do radioisotype scanning. Acanthosis Nigricans: thickening and hyperpigmentation of skin in flexural areas with velvety texture. Hypotensive patients need fluids and maybe pressors. weight loss. cyclosporine toxicity. CT or US only if diagnosis is not clear or acute episode does not respond. Give cipro or ceftriaxone. Only 10% have family history.35 would be transudative. Medical emergency. hyperkeratosis (vit A deficiency). May have tetany (hypocalcemia due to Vitamin D deficiency). y y y y y y y y y y y y y . Breast Cancer: single most important RF is age. soft. renal biopsy to diagnose. infection. schistocytes and giant platelets on peripheral smear. Normal pleural fluid pH is 7. dermatitis. and anti-endomysial antibodies. Ischemic colitis. MRI. Pleural Effusion: CHF is the MCC. obstructive colon cancer can also cause. GI bleeding is common. Try to keep subjects unaware that they are being studied. night blindness (Vit A deficiency). Acute rejection is best treated with IV steroids. laryngoscopy. foul smelling. High probability = low NPV and vice versa. Elevated LDH and indirect BRN and reticulocyte. Alport s Syndrome: recurrent episodes of hematuria/proteinuria. TTG. Emergency surgery may be needed. Give IV steroids. Toxic Megacolon: UC is MCC. Urine and blood cultures before giving antibiotics. NPV will vary with pretest probability. watery diarrhea. TB. Rare before age 30. Purpura and HTN. obesity) and GI malgnancies (MCC is gastric adenocarcinoma). 7. arthritis. normochromic). acute rejection. Acute Pyelonephritis: potentially results in G(-) sepsis. Renal Transplant Dysfunction: in early post operative period = ureteral obstruction. Bacterial Overgrowth: a malabsorption syndrome associated with a history of abdominal surgery. Common in insulin resistant states (DM. Women > 40-50 years of age need regular annual mammograms. Be sure iron stores are adequate prior to erythropoietin replacement. ATN. volvulus. In dialysis patients. MAHA. Panendoscopy (esophagoscopy. fever. acromegaly.64. Bulky. easy bruising (vit K deficiency). pallor (anemia). HUS: child who has recently recovered from diarrheal illness and presents with ARF. hepatic injury.

Gradual decreasing flow rates. Recurrent episodes of gross hematuria several days after URI. AD neurodegenerative disorder. Bradycardia and hypotension suggesting SA node involvement. Dehydration. May be combined with short acting beta agonists. Atrophy of caudate nucleus is characteristic (enlargement of lateral ventricles). y y y y y y y y y y y y y y . III. Temporal relationship is not always clear. Huntington s Chorea: present in 40 s or 50 s with chorea and/or behavioral disturbance. Ventricular Tachycardia: in presence of stable BP does not need cardioversion. Cross Sectional Study: exposure and outcome are measured simultaneously at particular point in time (snapshot study). Hyperparathyroidism: indications for surgery are serum calcium at least 1 mg/dL above upper limit of normal. 24 hour urinary calcium > 400 mg. Major radiographic features are joint space narrowing. MC type of testicular sex cord stromal tumors. PE: MC S&S are dyspnea. Usually macroadenomas. Diuretic Abuse: increased excretion of water and electrolytes by the kidneys. hyponatremia. Inferior Wall MI: most likely cause is RCA occlusion (could be left circumflex). Helical CT angiogram is investigation of choice in patients with normal creatinine. Serum compliment is normal. Chorea is sudden jerky irregular movements. Elevated T3 and T4 levels with inappropriately elevated TSH levels. orthostatic hypotension.y Dipstick: test for nitrites and esterase in suspected cases of UTI. PSGN is 10 days for pharyngitis. Bladder Cancer: screening is not recommended even in those who are at risk of developing the disease. Pleural Effusion: undiagnosed effusion is best evaluated with thoracocentesis except in patients with clear cut evidence of CHF. < 50. Smoking and exposure to industrial chemicals are common causes. MC presentation of gynecomastia or precocious puberty. (+) LE signifies significant pyuria and (+) nitrites indicate Enterobacteraceae. Common in eating disorders. Can determine of transudate or exudate. subchondral sclerosis. tachycardia. ST elevation in inferior leads (II. hypokalemia.5. COPD: inhaled muscarinic antagonists like ipratroprium are mainstay therapy. subchondral cysts. tachypnea. Elevated alpha subunit. Men > women. Principle source of testosterone and capable of estrogen production. 2nd MC urologic cancer. lung reduction only for increased survival. reduced renal function. GN after URI: IgA nephropathy is MCC of GN in adults. V/Q scan for those with kidney problems or allergic to dye. 21 days for impetigo. breast. Do not have infiltrative ophthalmopathy or pretibial myxedema. Smoking cessation. pleuritic CP. High urine sodium and potassium. lymphoma cause 75% of malignant effusions (exudative). increasing lung compliance and volumes. TSH Adenoma: excessive TSH levels -> hyperthyroid state. weight loss. OA: predominantly involves DIP joints. BMD < -2. Leydig Cell Tumor: estrogen production can be increased with secondary inhibition of LH and FSH. Lung. Best treatment is amiodarone (DOC) or lidocaine. O2. osteophytes. aVF).

Can be symptom of sarcoidosis. arm. volcano like (small and deep appearance) -> treat with acyclovir. Complication of MI. arthritis. Defibrillation: in VF and pulseless VT. well circumscribed. early fibrosis can be reversible with cessation of alcohol intake. pretibial nodules. Follicular Carcinoma: invasion of the capsule and blood vessels required for differentiating follicular carcinoma from adenoma. subcutaneous. splenomegaly. liver cell necrosis. IBD. nasolabial folds. Transparent yellow papules. y y y y y y y y y y y y y . Time to defibrillation is strongly correlated with survival. Oral antibiotics are used if papular and inflammatory acne. Erythema Nodosum: condition of painful. leg without any higher cortical dysfunction or visual field abnormalities. alcoholic hepatitis (Mallory bodies. petechiae. topical steroids. do endoscopy. and scalp. uveitis. antidandruff shampoo. Topical antibiotics are used if mild to moderate inflammation. perivenular inflammation distribution). steroid therapy. Oral isotretinoin for nodulocystic or scarring. Papillary Thyroid Carcinoma: MC thyroid malignancy. RA: patients with rheumatoid arthritis are at increased risk of developing osteoporosis and osteopenia.y Acne: if patient has mild acne (non inflammatory comedones) use topical retinoids. History of intermittent dyspnea and coughing. Presents in 3rd or 4th decade with recurrent focal neurological dysfunction. Metoprolol: selective beta 1 antagonist that. Alcoholic Liver Disease: fatty liver (steatosis). infiltration by neutrophils. one has to get an echo to rule out a thrombus in the LV. inability to perform weight bearing exercise. in high doses. shallow. it is of primary importance. mucosal bleeding without S&S of TTP/HUS. Presence of psammoma bodies. Seborrheic Dermatitis: also called cradle cap. HSV ulcers are multiple. Association is strong in AA women. Tend to invade blood vessels and metastasize to different organs. Severe cases may be due to immunodeficiency. Acute Limb Ischemia: in a patient with an MI who develops a cold leg. MS: suspect in young female patient with bilateral trigeminal neuralgia. Do CXR. Cough. Slow infiltrative local spread and spreads to LN. do cycle of CPR before defibrillation. histoplasmosis. Treat with moisturizers. Papular scaly rash tends to affect eyebrows. If unwitnessed or > 5 minutes. Cells with ground glass cytoplasm with inclusion bodies and central grooving. hilar adenopathy are also common. If symptoms persist. female sex. ITP: autoimmune platelet destruction is common cause of thrombocytopenia and suspect in patients with ecchymoses. can block bronchodilatory beta 2 receptors and cause bronchoconstriction in susceptible individuals. Likely due to combined effects of disease itself. Lacunar Stroke: can cause lesion in posterior limb of internal capsule characgterized by unilateral motor hemiparesis of the face. superficial and intracytoplasmic/intranuclear inclusions -> treat with ganciclovir. 200-320 joules. antifungals. pancytopenia. True cirrhosis is irreversible regardless of alcohol abstinence. HIV and Dysphagia: give 1-2 weeks of fluconazle therapy since candidal esophagitis is most likely. CMV ulcers are large. streptococcal infection. TB. marrow failure. possible history of eczema -> possible asthma. Unencapsulated.

Have low B12. PEP with 2-3 antiretroviral drugs should be stated without delay. association between FAP/HNPCC and brain tumors (primary medulloblastomas and gliomas in FAP. and extremely elevated LDH. Rapid onset of symptoms with associated bronchospasm and hypotension plus absensce of fever helps to distinguish from other types of transfusion reactions. start epinephrine. Can be acquired due to Tb or pneumonia. Zollinger Ellison Syndrome: MC cause is a gastrinoma in pancreas -> parietal cell hyperplasia -> increased stomach acid -> multiple duodenal ulcers. Right sided lesions -> septic pulmonary emboli. and nephrolithiasis. When people are feigning. All its measures of central tendency are equal. UTI. Scabies: highly contagious disease with presents with generalized itching and pruritic papules over the penis and scrotum in males and on areolas and breasts in females. linear atelectasis. possibly pressors. PCKD: heritable form of renal disease with multiple renal cysts and intermittent flank pain. Echo can be used to diagnose. High resolution CT scan is used for definitive diagnosis. 6 months. CHF. hematuria. high grade gliomas in HNPCC). Associated with intracerebral aneurysms. Vetricular Aneurysm: late complication of MI. Stop transfusion. Antibodies to parietal cells have been reported -> achlorhydria. Liver might be enlarged due to cystic involvement. liver. Healthcare HIV Exposure: whenever healthcare worker is exposed to HIV.y Polycystic Kidney Disease: relatively common autosomal dominant disease. Cough. possible jejunal ulcers. Pronator Drift: relatively sensitive and specific for UMN damage affecting upper extremities. peripheral opacities. they will tend to drop the affected arm without pronating. Normal Distribution: symmetric and bell shaped. thrombus formation with mitral regurgitation. positive IF Ab. Inherited can be due to CF. mucopurulent sputum. persistent ST elevations on EKG. Supinators are naturally stronger but exaggerated with UMN lesion. arrhythmias. Infectious Endocarditis: in high risk patients presenting with fever. hemoptysis. chills. Enlarged right kidney is easier to palpate than enlarged left because its lower. IV fluids. spleen septic emboli. Use 2 NRTI and 1 protease if adding a third. Treat with 5% permethrin cream which is applied from neck down and left overnight. y y y y y y y y y y y y y . Can have LUQ pain and splenic fluid collection. 3 months. Turcot s Syndome: AR. Presents with hematuria and HTN but can cause abdominal masses and pain. Anaphylactic Reactions: rare to occur to transfused blood products. kidneys. do baseline HIV testing immediately. Steatorrhea can develop due to inactivation of pancreatic enzymes by stomach acids. evidence of septic emboli or abscesses. Repeat testing at 6 weeks. Pernicious Anemia: MC megaloblastic anemia -> B12 deficiency due to decreased IF. Hypercapnea: if respiratory acidosis is compicating metabolic acidosis -> lethargy due to hypoventilation. More common in patients with IgA deficiency. Occurs in teens. Bronchiectasis: bronchial dilatation -> impaired clearance of secretions -> obstruction. Skewed distributions do not have the same tendency. Do abdominal US. Left sided lesions -> brain. mean=median=mode. CXR -> prominent bronchioles.

poor growth. Non-ionic are better than hyperosmolar ionic agents. Inflammatory Diarrhea: inflammatory changes in the blood (anemia. endemic area (SE. CT used to define extent or presence of abscess. protein in urine. juvenile nasopharyngeal angiofibromas. congenital marrow failure. California). BNP: measurement of serum BNP can help distinguish between CHF and other causes of dyspnea. Cronkhite Canada Syndrome: juvenile type polyps and ectodermal abnormalities like alopecia. If higher. hypogonadism). other morphological abnormalities (microcephaly. colonic polyps with desmid tumors. Fanconi s Anemia: AR. Usually < 500. Hypersensitivity Pneumonitis: inflammation of the lung parenchyma caused by antigen exposure. Treat with doxycycline without delay. elevated LFTs. Alcoholic Hepatitis: AST:ALT > 2. NOT a feature of simple COPD. Treat with broad spectrum antibiotics. lipomas. First Degree Heart Block: characterized by PR > 0. Dyslipidemia puts patients at increased risk of for accelerated atherosclerosis. Anasarca: results from organ failure or hypoalbuminemia. supernumery teeth. HA. Avoid antigen. areas of skin hypopigmentation. Added to increased risk of thrombosis (usually venous. upper MW. Preseptal cellulitis presents similarly with swollen. honeycombing. reactive thrombocytosis). decreased visual acuity. clubbing. mid-atlantic. No rash present. SC. painful eye and fever. Will have RBCs. Cough. Anemia is usually macrocytic. Contrast: potential to cause nephropathy in patients with chronic renal insufficiency (Cr > 1. leukopenia/thrombocytopenia. abnormal thumbs. Usually levels > 100 for CHF. Completely benign and requires no treatment. Orbital Cellulitis: pain with eye movement. Consider alternative studies. Nephrotic Syndrome: results in alterations in lipid metabolism. or Tylenol use. Thickening of the nail bed. osteomas (especially of the mandible). elevated ESR. Released from ventricles in response to volume overload. y y y y y y y y y y y y y y . proptosis. malaise. is due to decreased GFR with some proteinuria and hypoalbuminemia in some cases. Have high LDL and low HDL. RBC casts. With GN. GIT hamartomas with breast. Blood and leukocyte positive stool. Chronic -> weight loss. thought to be due to hepatic deficiency of pyridoxal-6phosphate (needed for ALT activity). shock liver. myalgias. consider viral. systemic symptoms (fever. fever. breathlessness. sebaceous or epidermoid cysts.y Gardner s Syndrome: AD. Sinusitis can cause orbital. Also use hydration and acetylcysteine prior to giving. nausea. hyperpigmentation. Can be secondary to increased vagal tone or digoxin. Treat aplastic anemia with BMT. gastric polyps. Ehrlichiosis: history of tick bite. Can be bird fanciers lung or farmers lung. Cowden Syndrome: multiple hamartoma syndrome. especially renal) -> risk for MI and stroke. WBCs. thyroid cancer and nodular gingival hyperplasia. vomiting). Clubbing: new clubbing in patients with COPD can indicate cancer. malaise occurring within 4-6 hours of exposure. Aplastic anemia (fatigue and pounding in ears). loss of angle between nail bed and nail fold.5) or diabetes. elevated acute phase reactants.2 seconds. nail loss (oncholysis).

If evidence of fluid overload. diarrhea. Pancreatic Cancer: enlarged. Choledochal Cysts: congenital abnormalities of the biliary tree characterized by dilatation of the intra and/or extra hepatic biliary tracts. Bacillus Cereus: causes nausea and vomiting after eating rice. PPI). VIPoma: pancreatic cholera. Dermatitis Herpetiformis: presence of pruritic papules and vesicles over extensor surfaces and presence of anti-endomysial antibodies. LFT s are normal. NSAIDs. vesicles over sun-exposed areas. anticholinercics. Symptom onset is 1-6 hours. arthralgias. Greater risk of dyskinesia. Young -> DA agonist. Use PPI and antibiotics as long term treatment (amoxicillin. Produces a heat stable toxin in inadequately refrigerated cooked rice. Produce reactive oxygen products with exposure to UV radiation. Most cases related to anomalous pancreaticobiliary junction. Lithium or demeclocycline for chronic treatment. Treat acute attack with colchicine. Can have mucosal ulcerations and skin rash. Ethanol -> lactate which competes with urate for excretion. achlorhydria. Can occur from lung cancer. 90% are due to H pylori. Also have GI symptoms of malabsorption. Make the diagnosis in an early stage. hypokalemia (leg cramps). Test for VIP in blood. Tetracyclines: important cause of phototoxic drug eruptions. Manifest as exaggerated sunburn reactions with erythema. LA. CHF. Better for older patients. evidence of biliary obstruction (elevated direct BRN and ALP). MC in AA. flushing. night sweats. Consider in patient being treated for mild-moderate acne. have abdominal pain. If Na < 120 or if patient is having seizures. use 3% NaCl to raise to 125. Women > men. Present with jaundice and passage of acholic stools. US can show dilated ducts. vomiting. HOCM: heart murmur at LLSB that decreases with increased preload (standing to squatting) or intensifies with decreased preload (Valsalva). Diarrhea. Chemical irritants also cause abrupt onset nausea and vomiting. weight loss. No treatment necessary. CT or MRI to confirm. edema. Increased risk of GI lymphomas (reduced with gluten free diet). but does not stop progression. y y y y y y y y y y y y . Can degenerate into cholangiocarcinoma. Gout: cessation of alcohol and low purine diet are important measures to prevent future attacks. Abdominal pain. Abdominal CT to diagnose. jaundice. clarithromycin. Can become dehydrated. amantadine. hypotension. use loop diuretics. cramping. Also avoid drugs like diuretics and pyrazinamide. or steroids. non tender gallbladder. Do US followed by CT/MRI.y Primary HIV Infection: present with mononucleosis type syndrome with fever. Usually 2-4 weeks after the exposure. SIADH: water restriction is first step in managing their hyponatremia. SE are nausea. attacks of acute pancreatitis (elevated amylase and lipase). Parkinsonism: most effective symptomatic therapy is L-dopa. Prolonged diarrhea and weight loss. resistant to treatment. Duodenal Ulcer: epigastric pain that improves with eating (otherwise unopposed acidic fluid goes into duodenum). Rotor s syndrome is a possible cause (benign condition with defective hepatic storage of conjugated BRN -> leaking into plasma. Other medications are DA agonists. Leads to weakness and dilatation of the biliary wall due to reflux of pancreatic secretions. AD disease inheritance. Jaundice:determine if conjugated or unconjugated. Doxycycline is most photosensitizing. Dipstick with bilirubin suggests conjugated.

Brain Hemorrhage: hypertension and atrial fibrillation on anticoagulation are major RF. Have malaise. Account for upto 10% of GI bleeds. Crigler Najjar Type 1: AR with severe jaundice and neurological impairment due to kernicterus. Give allopurinol to prevent formatin of uric acid with chemotherapy. vitamin E. Warfarin: vitamin K antagonist used for anticoagulation. Mallory Weiss Tears: increased intragastric pressure during vomiting -> tears in cardial mucosa and sometimes esophagus. medications such as alcohol. LFT and histology are normal. Remove sufficiency CSF to decrease pressure to 150. Hyperdense area on CT indicative of bleed. Regularly assess general well being and current medication list in elderly patients. Crigler-Najjar Type 1 and 2 are causes. fatigue. fasting. Abductor pollicis longus and extesor pollicis brevis tendons affected. tinnitus. Chemotherapy -> rapid tumor cell lysis > uric acid release.y Gout: caused by overproduction or underexcretion. Crigler Najjar Type 2: AR with milder jaundice (< 20). Pale white macules with hyperpigmented borders. use allopurinol or probenecid. Icterus secondary to mild unconjugated hyperbilirubinemia (< 3). Finkelstein s test (passive stretch of tendons with thumb gripped inside fist and ulnar deviation). endoscopic injection. To treat. Most patients have empty sella (caused by downward herniation of arachnocele due to high CSF pressure). antibiotics increase efficacy -> bleeding. 20-25. abdominal discomfort. Can have papilledema or VI nerve palsy. garlic. can be upto 50. double vision. Concurrent B cell hyperactivity -> increased serum Ab and IgG -> immune complexes. Vitiligo: macular depigmentation that involves acral and peri-orificial areas. To prevent. Isoniazid: 10-20% of patients develop mild aminotransferase elevation within first few weeks of treatment. LP has high opening pressure. LFT s usually < 100. Unconjugated Hyperbilirubinemia: Gilbert s. supplements. Foods with high vit K (dark green. Can have neck pain. Phenobarbital does not change BRN level. ginseng. Can continue taking it as long as LFT s are regularly monitored and remain mildly elevated. steroids. Usually spontaneously stops but can use vasopressin. Caused by autoimmune destruction of melanocytes. Periodic phenobarbital or clofibrate can be used if necessary. Gilbert s Syndrome: familiar disorder of BRN glucuronidation. Tenderness to palpation of radial side of wrist. physical exertion. NSAIDs. consuming fat free diet. De Quervain s Tenosynovitis: classically affects new mothers that hold their infants with the thumb outstretched. liver transplant for long term. Phototherapy and plasmapheresis for short term. LFT and histology are normal. Survival into adulthood with no kernicterus or neurological impairment. St John s wort. Have pulsatile HA that awakens patient from sleep. y y y y y y y y y y y y . production of UDP glucuronyl transferase is reduced. Injury is self limited and resolves without intervention. Phenobarbital decreases BRN level. SLE: presence of antibodies to DS DNA is highly specific for and confirms diagnosis. Hemolysis. ginko biloba. febrile illness. visual loss. vegetables) decrease efficacy while foods. Also have lack of or reduced suppressor T cell functions and hyperproduction of helper T cells. use colchicine. Pseudotumor Cerebri: LP only after completely ruling out space occupying lesion with CT/MRI. stress or fatigue will precipitate. electrocautery. Stop anticoagulation and give FFP and Vit K.

diarrhea. Paget s Disease: osteitis deformans. weight loss. Do focal external beam therapy. occipital headache. Disseminated Histoplasmosis: occurs in patients with HIV. Hepatorenal Syndrome: complication of liver disease characterized by renal failure that does not respond to fluid resuscitation. Type 1 is rapid and patients die within 10 weeks. nausea. proteinuria. increased TPR (due to sympathetic output and RAAS activation). positive stool for reducing substances. cold extremities. other clear cause of dysfunction. especially with ice. constriction. Dyslipidemia: first line treatment is statin therapy. Metastatic Prostate Cancer: radiation therapy is done in patients with prostate cancer who have undergone orchiectomy. Can be a cause of iron deficiency (suspect chronic bleeding). MCC of death is hemorrhge or infection. Cerebellar Hemorrhage: sudden onset vertigo. Pneumoconiosis: causes restrictive interstitial lung disease with normal or high FEV1/FVC and decreased DLCO (normal DLCO would be neuromuscular). Type 2 is slower and survival is 3-6 months. Hyperparathyroidism: uncommon cause of secondary HTN. paratonic rigidity. Radiofemoral delay. 3 sign is typically seen with coarctation of longer duration implying proximal aortic dilatation. Asbesosis -> pleural calcifications (can be from hemorrhage or empyema). Fever is common with any brain hemorrhage. Anterior Cerebral Artery Stroke: contralateral motor and sensory deficits which are more pronounced in the lower limb than the upper limb. after max statin. necrolytic migratory erythema. MCC of asymptomatic elevation of ALP in elderly. abdominal cramps. descending aortic dilatation. Decreased GFR in absense of shock. Is increased to maximum dose as needed. MC location is at site of LA. May also be a manifestation of psychiatric disease. low stool pH. Treat with IV amphotericin B to decrease fungal load with lifelong itraconazole to prevent relapse. paper products. dirt. start nicotinic acid. Pica: appetite for non nutritive substances like ice. Usually malignant and metastasizes to the liver. Lactose Intolerance: positive hydrogen breath test. Glucagonoma: patient with hyperglycemia. paresthesias. diarrhea. bloating. Liver transplant is only treatment. pruritis. abulia. Can result in fibrosis from occupational exposure. Results from vasoconstricton due to decreased blood flow and low vasodilatory product production. Elevated glucagon in the blood. blepharospasm. primitive reflexes. Usage usually limited by SE like flushing.y Coarctation: presents with rib notching on CXR. clay. Generally evolves over hours. epistaxis. vomiting in hypertensive patient. y y y y y y y y y y y y y . No steatorrea. Breath test = positive hydrogen level after ingestion = bacterial metabolism. With persistently low HDL. Asymtomatic hypercalcemia in a hypertensive patient or presence of symptoms of hypercalcemia. Pancreatic tumor on CT scan. Immediate evacuation needed. increased stool osmotic gap. Use controlled form for decreased SE. HA. Osmotic diarrhea. Triad of hyperglycemia. coma. Surgery to treat. gait apraxia. Can have VI paralysis. May have urinary incontinence. Upper extremity may be preferentially well developed. conjugate deviation. necrotizing dermatitis. Systolic Heart Failure: depressed CI (measure of cardiac output). increased LVEDV (may be normal in diastolic failure).

alpha agonists.2. fludricortisone. Non contrast CT should be done prior to rule out hemorrhage and patient should be screened for other CI to therapy. hypochromia. Adrenal Insufficiency: characterized by non specific symptoms like anorexia. macrocytosis. glucose < 60. reticulocyte count. poikilocytosis. CCB. high TIBC. Acyclovir and other antivirals are used to decrease duration and incidence of post herpetic neuralgia. Can have accompanying bulbar dysfunction or laryngeal stridor.5 hours of onset. CMV Colitis: any HIV (+) patient with bloody diarrhea and normal stool examination should have colonoscopy to look for CMV colitis. Degeneration of outer retina. felt as water hammer pulse. Presence of cord cavity is most characteristic feature. incontinence. Patient with Parkinsonism presents with orthostatic hypotension. elevated transaminases suggest alcoholism. transferrin saturation. Iron Deficiency: low serum iron. Mitral Stenosis: left atrial dilatation with risk of atrial fibrillation and cardiac emboli. weight loss. Have anisocytosis. Thrombocytopenia. Aortic root and bicuspid aortic valve are MCC. impotence. pigment epithelium. Pain precedes rash by 48 hours. hemoptysis. Rheumatic fever is CC. Multisystems Atrophy: Shy Drager Syndrome. Bloody diarrhea with abdominal pain. Syringomyelia: areflexic weakness of upper extremities and dissociated anesthesia in cape distribution . Steroid Induced Myopathy: painless proximal muscle weakness that improves when medication was discontinued. Hyponatremia is MC electrolyte abnormality and hyperkalemia is common as well. digoxin. Have normal ESR (unlike PMR). Treat with intravascular volume repletion. salt. Drained via a chest tube (tube thoracostomy). focal cord enlargement may occur. hyperpigmentation. other autonomic symptoms. probability is high that fluid needs to be drained.y WPW: if develop atrial fibrillation with rapid ventricular rate treat with cardioversion or procainamide/quinidine. Due to volume loss and low aldosterone. May have history of disease that was or should be treated with steroids. Dilated Cardiomyopathy: can be secondary to alcoholism. Caudal displacement of 4th ventricle. microcytosis on smear. cough. MCH. Lying down and turning to the left brings the heart closer to the chest wall and makes the patient more aware of forceful heartbeat. Macular Degeneration: usually seen in patients over 50 years old. Pressure is transmitted to pulmonary vasculature -> dyspnea. Navigational and peripheral vision is preserved but may be complicated by cataracts. Colonoscopy shows multiple ulcerations and mucosal erosions. Parapneumonic Effusion: when pH < 7. Have low MCV. AV blockers like beta blockers. Patient may have history of rheumatic fever or be an immigrant. fatigue. Aortic Regurgitation: wide pulse pressure. Herpes Zoster: a painful reaction of the varicella zoster virus that causes vesicular rash in dermatomal distribution. Presents with bilateral progressive loss of central vision. ferritin. Ischemic Strokes: fibrinolytic therapy improves outcomes if given within 3 to 4. Total abstinence from alcohol may reverse condition if employed early in the disease. hypotension. Also have widespread neurological symptoms. GI complaints. cerebellar tonsils. adenosine should be avoided since it can increase conductance through accessory pathway. y y y y y y y y y y y y y . Can present with stroke. Biopsy has characteristic cytomegalic cells with intracytoplasmic and intranuclear inclusions.

Mutation -> resistance to deactivation by protein C. DVT: treated to prevent PE. bleeding diathesis. gynecomastia. especially DVT of lower extremities. somatostatin can be used. Acute Prostatitis: presents similarly to UTI. CI to anticoagulation are recent surgery. Seborrheic Dermatitis: characterized by waxy scales with underlying erythema on the scalp. HIT and developing DVT/PE even with anticoagulation are indications to put in an IVC filter. nausea after 4 hour to 4 day incubation period. Chronic Liver Disease: hyperestrogenism as a result of decreased clearance of estrogen from blood by the liver due to increased portosystemic shunting. Also tell to avoid fatty foods. Decreased sex hormone binding globuin synthesis increases ability of estrogen to exert its biologic effects. Pityrosporum ovale plays role. testicular atrophy. Change in personality and strange behavior -> frontal lobe. Protect airway and decompress stomach with NG to prevent aspiration. octreotide. Have chronic low grade fever. Cystitis is uncommon in men. Obtain a mid stream urine sample to direct antibiotic therapy. 50% stops spontaneously. Have fever. Also affects skin (erythema nodosum. interscapular areas. Medication is very costly and associated with high risk of relapse. GBM: typical CT/MRI findings are heterogeneous and serpiginous contrast enhancement with classic butterfly pattern. raw oysters). Diagnosed by helical CT of chest. abdominal cramps. addition of perineal pain and tender boggy prostate. body folds. presternal region. palmar erythema. May be in association with Parkinsonism or HIV. Diffuse interstitial infiltrates on CXR. crab. dyspnea. umbilicus. Can have hypothalamic-pituitary dysfunction as well -> secondary hypothyroidism. protean manifestations). active bleeding. central face. Chi Square Test: used to compare proportions. Cholelithiasis: UDCA is a medication used to dissolve small radiolucent gallstones in patients with normal functional GB who are poor surgical candidates. Acute Variceal Bleeding: first step is to establish vascular access with two large bore IV needles or central line. sweats. Vigorous prostatic massage should be avoided -> bacteremia. A 2 by 2 table may be used to compare the observed values with expected values. hemorrhagic stroke. Sarcoidosis: most commonly affects young to middle aged AA females causing insidious onset dyspnea and dry cough in the absence of constitutional symptoms. Tuberculosis: most cases occur in people who have immigrated to this country from endemic geographic regions. cough productive of blood tinged sputum. Use antifungals. Can be watery or bloody diarrhea. Terlipression (analog of vasopressin). Have telangiectasias. Rebleeding is common in 6 weeks following initial bleed. Loop Diuretics: cause hypokalemia and hypomagnesemia which can cause ventricular tachycardia and potentiate effects of digoxin. weight loss. Can have exudative (MC) or transudative effusion. impotence. Order serum electrolytes and digoxin level. chest pain.y PE: suspected in all patients at risk of DVT with acute onset tachypnea. Factor V Leiden: MC inherited disorder causing hypercoagulability and predisposition to thromboses. y y y y y y y y y y y y y . Vibrio Parahemolyticus: diarrhea usually transmitted by ingestion of seafood (shrimp. and eyes (uveitis).

can present with intermittent episodes of chest pain and dysphagia. HIT -> abnormal intravascular thrombosis. MCHC is elevated. Reduced lower back ROM and sacroiliitis. High phosphate blocks calcium receptors on PTH gland. Smear -> spherocytes and polychromatophilia. Long acting beta agonists may be used in children and athletes. photophobia). y y y y y y y y y y y y . High doses for long period -> systemic symptoms of adrenal suppression. interference with bone metabolism. Sickle Cell Trait: suspect in young black male who presents with painless hematuria.y Radioactive Iodine: in hyperthyroid patients not initially treated with antithyroid medications. Can cause agitation and loose stools as well. Induced trigger is rapid ventilation of cold dry air. diet changes. Atopic dermatitis and allergic rhinitis. splenomegaly. Low formation of Vit D3 -> no inhibitory effect on PTH. Barium swallow may reveal corkscrew esophagus. EPS occur less frequently. Diffuse Esophageal Spasm: seen in young females. Patients < 65 who have never had Tdap should get one dose. decreased visual acuity. counseling. HAV for MSM. Have pain with eye movement. Almost university in ESRD. Risk: probability of getting disease over a certain period of time. Elevated aPTT. Thrush: MC SE of inhaled steroid therapy. Divide number of diseased subjects by total number of subjects at risk. Anemia. Hereditary Spherocytosis: AD defect in spectrin. May present with cholecystitis. due to parvovirus infection. cataract formation. decreased growth in children. MC extraarticular manifestation is anterior uveitis (monocular pain. Associated with MS. Presents in women 20-45 years old. Get influenza. Heparin induced release of platelet factor 4 -> immunogenic heparin-PF4 complexes. changes in color perception. Cornerstone of asthma therapy. Treat with antispasmodics. Unfractionated Heparin: thrombocytopenia and hypercoagulation within days of starting anticoagulation therapy. usually due to CRF. blurring. Exercise Induced Asthma: short acting beta agonists administered 20 minutes before exercise are first line treatment. purpura. HIV Vaccinations: follow same immunization schedule as the general population for Td. gastroparesis. Young men with progressive inflammatory back pain and stiffness. Especially in elderly patients with cardiovascular disease. Should get it every 10 years. NMS may occur rarely. Life threatening. increased osmotic fragility. HBV. pneumococcus. spherocytosis. Have high amplitude peristaltic contractions. PTH resistance is similar but earlier. treatment with RI may initially cause exacerbations of thyrotoxic state. Thought to be due to papillary ischemia due to low local oxygen tension -> sickling. HLA-B27 association. Complicated by episodes of aplastic crisis. afferent pupillary defect. Ankylosing Spondylitis: seronegative spondyloarthropathy. Secondary Hyperparathyroidism: hypocalcemia and hyperphosphatemia with increased PTH. Phosphate retention -> hypocalcemia which stimulates PTH. Treat with discontinuation and benztropine or Benadryl. Should be on folate to prevent severe anemia. IgG Ab -> activation of platelets and endothelial cells and abnormal generation of intravascular thrombin. Metaclopramide Induced Dystonia: DA antagonist and prokinetic agent used to treat nausea. MCV is normal. vomiting. Optic Neuritis: central scotoma.

hyperkeratosis (thickening of stratum corneum). Diverticulosis: if asymptomatic only needs dietary modification in the form of high fiber intake -> bulky stools -> increase width of colon -> decreased pressure. Respiratory Alkalosis: kidney compensates by preferentially excreting bicarbonate -> alkalinized urine with high pH. 1% convert to SCC. Do prompt biopsy. parakeratosis (retention of nuclei into stratum corneum). carotid massage) and medications (adenosine) resolve and decrease conduction through AV node. Delerium: acute confusional state due to organic illness commonly superimposed on dementia in the elderly. Coagulopathy: FFP contains all the clotting factors and first line treatment (esophageal variceal bleeding in patients with hepatic disease). oliguria. Erythematous papules with central scale and sandpaper texture. Give alternate anticoagulation like danaparoid and direct thrombin inhibitor (argatroban. Staph Endocarditis: IVDA are at increased risk usually on tricuspid valve. dry cough. anion gap metabolic acidosis. Ethylene Glycol Poisoning: hypocalcemia and calcium oxalate deposition in the kidneys. Vagal maneuvers (cold water dunking. have hallucinations. Coccidiomycosis: endemic in the southwestern US. Are confused. Give fomepizole or ethanol to achieve alcohol dehydrogenase inhibition. HIT I is non immune -> direct heparin effect on platelets. tachypnea. Temperature > 105 (can cause rhabdomyolysis -> large blood but no RBC in urine. SCC: firm solitary LN are highly suspicious for LN metastases. Fluid resuscitation is more important that diagnosis in unstable patients. within 4-10 days.y HIT: first step in management is to stop all heparin including LMWH. particularly in older patients with a significant smoking history. Also those with skin infections. All seen in AK. dehydration. HIT II is autoimmune. dialysis for acidosis or organ damage. pleuritic chest pain. weight loss. tachycardia. Vegetations can embolize to the lungs causing nodular infiltrate with cavitation. Non-tender solitary nodes in head and neck (submandibular and cervical) are concerning for SCC. Do UA and CMP initially. Causes constipation and abdominal pain in elderly patients. arthralgias. y y y y y y y y y y y y . lepirudin). bicarb to alleviate acidosis. MCC in hospitalized patients is withdrawl or substance abuse. ARF. valsalva. fatigue. altered mental status. hematuria. dyskeratosis (abnormal keratinization). organ system damage). erythema nodosum. Can have erythema multiforme. infected medical devices. Flank pain. Hyperkeratosis -> cutaneous horns. Exertional Heat Stroke: occurs in otherwise healthy individuals undergoing conditioning in extreme heat and humidity due to thermoregulation failure. PSVT: most commonly results in accessory conduction pathways through AV node. Actinic Keratosis: develop in predisposed individuals in chronically sun exposed individuals. hypotension. disoriented. Also has plasma proteins and fluid. Skin Histology: acanthosis (thickening of epidermis). Urosepsis and metabolic disturbances are common precipitants. Primary pulmonary infection has non-specific features like fever. as well as Central and South America.

Varenicline is a partial agonist of the nicotinic receptor and is somewhat more effective.y Ectopic ACTH: lung cancer can cause. pituitary adenoma. Have > 45% transferrin saturation and > 1000 ferritin. do CT chest. and antipseudomonal PCN (piperacillin). Hemochromatosis: increased intestinal iron absorption results in deposition of excessive amount of iron -> tissue damage and organ failure. hyperpigmentation.1 seconds) narrows QRS preventing development of arrythmia by alleviating cardio-depressent action on sodium channel. Blood cultures are important for targeting antibiotic therapy. Use in conjugation with counseling and nicotine replacement. May be necrotic -> abscess. Buproprion: FDA approved for smoking cessation. TCA OD: sodium bicarb (if QRS > 0. Normal individuals suppress GH < 1 mcg/dl after 75g glucose. It will reveal if there is an abscess or cord compression. and aminoglycoside. other neurologic dysfunction due to impaired epiglottic function. Fluoroquinolone can be used in adults as AG alternative. Patients with dementia have functional impairments. Cerebral ischemia -> presyncome -> lightheadedness. Acute Vertigo: sensation of spinning head. IGF1 is a good screening tool. exogenous intake. Aspiration Pneumonia: impaired consciousness. Can use antipseudomonal cephalosporin (ceftazidime. 30% of cases can occur after trauma. Can have hypokalemic acidosis. cefepime). bronchial stenosis. Dementia vs Normal Aging: impairment in ADL s is essential for differentiating dementia from normal changes in aging. pulmonary infections in CF patients. estrogen) which should be discontinued. due to dysfunction of the labyrinth. HCC is the most serious complication and causes 30% of deaths. Acromegaly: gold standard test is measurement of GH levels following oral glucose load. Also caused by adrenal neoplasia. Patients are unable to suppress GH levels after glucose. Recurrent Pneumonia: in same anatomic location is red flag for cancer or some obstruction. doughy/sweaty hands. TCA s like amytriptyline are also used but not FDA approved. Aerobic oral flora are usual pathogens like viridans strep. advanced dementia. CTS. Low grade fever. Important cause of Cushings. BPPV have symptoms related to head position. and lower back. increase in ring size. Local tenderness to percussion and paraspinal spasm. y y y y y y y y y y y y . IFN-alpha for HCV. hypertrichosis. Pseudomonas: common cause of severe. Porphyria Cutanea Tarda: painless blisters. Associated with HCV infection. Vertebral Osteomyelitis: MRI of the spine is most sensitive indicator. Sexual dysfunction can be presenting complaint. Usually hematogenous. Deficiency of uroporphyrinogen decarboxylase. Phlebotomy or hydroxycholoquine may provide relief. When suspected. Elevated urine porphyrin levels. skin tags. Preferred therapy is aminoglycoside (tobramycin). Smoking is another RF for cancer. ESR. Metastatic Breast Cancer: local therapy is rarely curative (resection of metastases. Triggered by ingestion of certain substances (ethanol. Could be due to bronchiectasis. Bronchoscopic of CT guided biopsy depending on location. QRS prolongation -> ventricular arrhythmias. Have uncontrolled HTN. local radiation) but can be tried in patients with soliary focus without signs of metastatic involvement. foreign body.

HBcAg not usually detectable. so is important between clearance of HBsAg and anti-HBs. Body compensates by increasing HCO3 reabsorption from renal tubules. hyperuricemia.y Subdural Hematoma: serious intracranial hemorrhages that occur due to tearing of bridging veins. HBeAg detectable shortly after HBsAg. Blunt trauma is the MCC and surgical evacuation is usually required. CIN II/III: should have Pap smears with or without coloposcopy and ECC every 6 months until 3 (-) results. Common in older patients. thick rim. detectable for life. use ornithine-aspartate infusion. Acute Hepatitis B: testing for both HBsAg and anti HBc is best screening. Empyema: infection of pleural space. hemispasm. Anti-HBc appears after HBsAg. Have HA and LOC. Paresthesias of first 3 ½ digits and occasionally thenar eminence atrophy. Characterized by high PVR. Develop more slowly than epidural. HIV Ophthalmologic Disease: HSV and VZV can both cause severe. Overflow Incontinence: autonomic neuropathy may lead to denervated bladder -> overflow incontinence. indicates viral replication and infectivity. Present with low grade fever and best diagnosed with CT. surgery is answer. Optic neuritis can result in blurring of vision and is often associated with retrobulbar pain. Common cause is hemothorax. Cleared before HBsAg and followed by presence of anti-HBe. White cresecent on CT with possible midline shift. Can be due to diabetes. Brainstem involvement -> diplopia. nystagmus. peripheral pale lesions and central necrosis on fundoscopy. Increased levels of ammonia -> inhibitory neurotransmission via GABA. y y y y y y y y y y y . Non responders to lactulose. hypocalcemia. Allopurinol can decrease incidence of acute urate nephropathy. Phosphate binds calcium and causes hypocalcemia. oral sodium benzoate. ALT>AST. uveitis. When localized. keratitis. CMV retinitis is usually painless and not associated with keratitis or conjunctivitis. CTS: most common mononeuropathy of upper extremity. May resume standard screening after that (annual until 65 or 70). Tumors with high cell turnover (poorly differentiated lymphomas and leukemias). Tumor Lysis Syndrome: hyperphosphatemia. acute retinal necrosis associated with pain. facial weakness. Respiratory Acidosis: can be due to chronic hypercapia from COPD. initial management is removal of the testis and cord. Patients typically do not normalize or overcorrect pH. vertigo. Can increase to every 2-3 years if 3 (-) results with same monogamous partner. Testicular Mass: after diagnosis of solid testicular mass is made (painless hard mass in testicle + suggestive US). Neomycin also (long term -> ototoxicity and nephrotoxicity). Anti-HBe suggests cessation of active replication and low infectivity. Indicator of noninfectivity and immunity. Transcrotal biopsy is CI due to risk of spillage of cancer cells -> spread through lymphatics and blood. MS: suspect in female patient with multiple neurologic presentations interspaced between time periods. hyperkalemia. HBsAg is the first marker detected and is detectable during entire symptomatic phase. Window period between disappearance of HBsAg and antiHBs. Anti-HBs is found after immunization or clearance of HBsAg. Can occur from parapneumonic effusions. Hemorrhage and fluffy or granular lesions around retinal vessels. neuromuscular. Can also be due to obesity hypoventilation. Acute Hepatic Encephalopathy: lactulose and reduced protein diet. IgM is indicative of acute disease and is present during window period. complex.

displaced PMI. Increase Ach at the synapse. edematous skin that is hot to the touch is consistent. Acute Otitis Media: consider in any patient with ear drainage and difficulty hearing. phenytoin. CHF. In the spectrum of SJ and SJ/TEN overlap. venous insufficiency. Ear pain is also common. hypoxia. MG: oral anticholinesterases are initial treatment of choice. Anxiety. Hematuria and proteinuria.y Nephrosclerosis: usually due to HTN. LA (masses) are seen. Can be due to trauma. P waves that are premature relative to the cardiac cycle and differ in morphology. Red. As HTN progresses -> decreased blood flow and GFR -> glomerulosclerosis. caffeine. tachycardia. Reaction to drug (sulfonamides. MC lesions are arteriosclerotic lesions of afferent and efferent renal arterioles and glomerular capillary tufts. barbiturates. Immunosuppression and thymectomy are also used to treat. Painful oral blisters. Signs of right heart failure and sometimes left heart failure. Can be reversed with early treatment (phlebotomy). SE are abdominal cramps. Mitral Regurgitation: MC valvular abnormality observed in patients with endocarditis not related to IVDA. Lack of atrial kick -> pulmonary congestion -> dyspnea. GBS: acute or subacute ascending paralysis. GAS and Staph. y y y y y y y y y y y y . Erythematous TM with decreased motion. can be excised with 1 cm tumor free margin. NSAIDs). Hypocalcemia: patients who receive multiple transfusions or PRBCs over 24 hours may develop elevated levels of citrate which chelates calcium (paresthesias) and magnesium. Fever. If depth < 1 mm. Paget s disease. but may be absent in young patients. Thyrotoxicosis. Symmetric thickening. thiamine deficiency also cause high output cardiac failure. Use pyridostigmine or neostigmine. Toxic Epidermal Necrolysis: severe mucocutaneous exfoliative disease. (+) Nikolsky s sign. Can have boggy nose and PND. CSF has elevated protein with normal glucose. Erythematous morbilliform eruption that rapidly evolves into exfoliation of the skin. SJ < 10% of body. PAC: benign and to not require any follow up or treatment. Fever. Usually in massive transfusions of > 1 blood volume over 24 hours. especially in immigrants. Cellulitis: infection of the skin and subcutaneous tissue. Wide PP. previous cellulitis are RF. brisk carotid upstroke. Autonomic disturbances are rare & fatal. Irregularly irregular with no p waves. lymphangitis. fasciculations. Flushed extremities. Subacute endocarditis affects previously damaged valuves (previous murmur). diarrhea. Melanoma: excisional biopsy with narrow margins is preferred study. 70% of patients develop atrial fibrillation due to LA dilation. Motor > sensory (can have distal parasthesias). anemia. electrolyte abnormalities. Acute idiopathic polyneuropathy. Obseity. Do not excise with wider margins until diagnosis is made -> may disrupt lymph flow and ability to ID sentinal nodes. irritability. muscular weakness. WBC. disruption of the cutaneous barrier. TEN > 30%. with 99% 5 year survivial. > 1 mm depth should have sentinal node study. Hemochromatosis: causes a restrictive cardiomyopathy (diastolic dysfunction). Excision allows multiple parameters to be determined. RBCs. Mitral Stenosis: due to rheumatic heart disease (MC valvular manifestation). Circulation cannot meet O2 demands of the body. Treat with IVIG and plasmapheresis. AV Fistulas: cause high output cardiac failure -> increased cardiac preload. Kidneys are small.

y y y y y y y y y y y y . use this to screen. daily. Kaposi Sarcoma: caused by HHV-8. In older children and adults. oral cavity. Decreased MCV/MCH. sphincter of Oddi dysfunction. tearing. Normal LFT s and no bile duct dilatation rule out first two causes. stuffed or runny nose. elderly. branching. Infects immunocompromised -> nodules. laxatives. or functional causes. 11 beta hydroxylasedeficiency -> androgen and mineralocorticoid excess. LE.y MEN IIa: medullary carcinoma of the thyroid. TMPSMX is appropriate treatment. MCC in infants is inadequate intake. followed by remission for a year. No necrosis of skin or underlying structure involvement. Post Cholecystectomy Pain: MC occurs due to CBD stones. Serum calcitonin is elevated. Strawberry Hemangiomas: benign vascular tumors of childhood. hyperparathyroidism. Have elevated BRN. Nocardia (weakly acid fast. filamentous G(+) rod). Can be found in deep tissues (liver). 17 hydroxylasedeficiency -> delayed puberty and mineralocorticoid excess. Appear during first few weeks of life. face. Will have asterixis in exam. neomycin or rifaximin. you want to keep Hgb > 10. LDH. redness. > 5 WBC. abscess. reticulonodular. In patient with pre-existing heart disease. Partial deficiency presents in adulthood with signs of hyperandrogenism. Treat with TMP-SMX. bacteria. Hepatic Encephalopathy: alteration in CNS function due to decreased clearance of toxins. 17 alpha hydroxyprogesterone accumulates. Children with diet primarily of milk without iron supplemented foods in early years. diffuse infiltrates. atypical mycobacteria. Iron Deficiency Anemia: decreased serum iron/percent saturation. elliptical. Cluster HA: acute severe retroorbital pain that wakes patient from sleep. Accompanied by redness of ipsilateral eye. Composed of capillaries separated by connective tissue. cavity. splenectomy. is chronic blood loss. Treat symptomatically with analgesics and reassurance. Also have salt wasting due to aldosterone deficiency. regress by 5-8 years. pheochromocytoma. genitalia. ipsilateral Horner s syndrome. CAH:21 hydroxylase deficiency is the MC form. Oxygenation can be maintained at Hgb > 7 in patients with normal cardiac function. anaerobes. linearly arranged papules -> plaques. Endothelium rapidly proliferates. HBV. low haptoglobin. 3 beta hydroxysteroid dehydrogenase deficiency -> DHEA-S excess. (+) nitrites. May have enlarged LN. Anemia: the most appropriate blood product is PRBCs. Before 1986. initially grow rapidly. elevated TIBC. postoperative. Treat with lactulose. Transfusions: individuals who received transfusions before 1992 should be screened for HCV. UA will help diagnose. Acute attack: treat with 100% O2 and SQ sumatriptan. Coombs (+). Transfusion is often necessary with active bleeding. If ineffective. nodules. for 6-8 weeks. Occur in clusters. Treat with prednisone. Autoimmune Hemolytic Anemia: in patient with malignant lymphoproliferative disorder is likely due to anti-RBC IgG warm immunoglobulins. Elderly may present with confusion and absence of GU complaints. HIV Pulmonary Cavitation: can be caused by Tb. Nocardia is found in soil and water. UTI: common in diabetics. Typically clear precipitant and symptoms may range from mild confusion to coma. Involve legs. G(-) rods. Asymptomatic.

More common in elderly and alcoholics with brain atrophy. tend to appear later in life. Atopic Dermatitis: in infancy. Diuretics. are higher in early stages of disease. scalp. o Major: carditis. presence of neurologic changes. presents with pruritis. Rheumatic Fever: patient with previous attack should receive antibiotic prophylaxis with penicillin to prevent further attacks until 18. or 1 major/2 minor. get PSA. skin lesions typically distributed symmetrically over the face. constant or dull pain. elevated acute phase reactants. chest. increased RBC destruction. Primary hyperaldosteronism. No cytology needed. SQ nodules o Minor: arthralgias. prolonged PR Metabolic Alkalosis: can be chloride sensitive (hypochloremic. night pain. Gitelman s syndrome. proinsulin levels > 5. Hypoglycemia in nondiabetics = insulinoma or insulin/sulfonylurea use. Worsening is slower in COPD exacerbation caused by infection. Chloride sensitive associated with low urinary chloride excretion and volume contraction. c-peptide. fever. CXR shows diffuse bilateral interstitial infiltrates. renal. Bartter syndrome. If (+) for RET proto-oncogene. especially combination of ASA and warfarin. Can occur with severe trauma. extensor surfaces of extremities. PJP: occurs when CD4 < 200. excessive black licorice. Dilation of airspace. breast. Fibrocystic Disease: treat with aspiration of the cyst which should yield clear fluid and result in disappearance of the mass. Not corrected by saline. thyroid. chorea. Chloride resistant has urinary chloride > 20 and volume expansion. Diaper region is y y y y y y y y y y y y y . glucose < 60 results in near complete suppression of insulin. Insulinoma: elevated insulin.y Secondary Pneumothorax: suspect in patient with COPD presenting with catastrophic worsening of symptoms. exertional dyspnea. Bowel Ischemia: common cause of lactic acidosis (anion gap metabolic acidosis) in patients with severe atherosclerotic disease and atrial fibrillation without anticoagulation. Subdural Hematoma: rupture of bridging veins. Common in patients with spina bifida. or minor trauma when patient is anticoagulated. Fever. Jones criteria require evidence of GAS infection and evidence of 2 major. rash (erythema marginatum). Latex Allergy: anaphylactic reaction on exposure to things like surgical gloves and condoms. Correct with saline. Anemia of lymphoproliferative disorders is due to marrow infiltration with cancerous cells (will have LA and splenomegaly). frank blood loss. dry cough. Hashimoto s Thyroiditis: anti-TPO are present in 90% of HT. Also have antithyroglobulin Ab. lack of exacerbation with movement or palpation. saline unresponsive) based on urinary chloride levels and ECF volume status. mobile. Back Pain: common symptom. MC are lung. Afterwards patients are observed for 4-6 weeks. firm. In normal individuals. chromosome 10. saline responsive) or chloride resistant (normochloremic. MEN IIa:AD. Identify signs of serious etiology: pain not relieved by rest. Anemia: can be due to decreased RBC production. Hypoglycemia and elevated insulin indicates. Semi lenticular hematoma on CT. In older man. loss of gastric secretions. Due to untreated streotococcal pharyngitis. Use TMP-SMX and prednisolone when PaO2 < 70. polyarthritis. total thyroidectomy is indicated. Cancer pain often not tender to palpation. prostate. painful mass with more tenderness during menses. Rubbery. especially in apices -> present with acute chest pain and SOB. Genetic testing has replaced serum calcitonin as recommended screening test. decrease with time and treatment. Treatment if malignancy may improve anemia.

syncope are symptoms. Increased waist to hip ratio. Common in 15-29. y y y y y y y y y y y . Cryptococcal Meningitis: IV amphoterocin plus flucytosine. Once there is clinical improvement. rarely infertility results. Fecal elastase is most sensitive and specific to diagnose pancreatic exocrine failure. Cardiac tamponade. renal failure can be complications. Usually boys > girl except early on when are they same. Insulin resistance plays central role in pathogenesis. TG > 150. Average 15 y/o. Treat with oral or IV bisphosphanates. Aseptic meningitis and encephalitis can be complications. Pulsus parvus et tardus. Diagnosed by abdominal CT. Symptomatic requires replacement. dyspnea. B6 lowers homocysteine levels. pulsus paradoxus. Tamponade -> hypotension. Serum amylase and lipase are usually normal. increased JVP. Decreased skin barrier function due to improper synthesis of components of epidermal cornified cell envelope. Surgery to treat. either limb saving or amputation. May be asymptomatic or accompanied by pain and deafness. Aortic Dissection: tearing chest pain radiating to the back. mildly elevated LFTs. Homocysteine: vitamin B6. AS: echo is needed for definitive diagnosis. Chronic Pancreatitis: inflammatory condition characterized by chronic abdominal pain and pancreatic insufficiency (diarrhea). fasting glucose > 100-110. Encapsulated yeast that causes meningitis in HIV patients. proximal humerus. Better than indwelling catheters. BP > 130/80. Crescendo-decrescendo systolic murmur. Needs cholecystectomy. B12 can be added if patient is deficient. Allergens readily access deeper levels to generate immune response. Increased risk of carcinoma of the GB. HDL < 40 in men and < 50 women). MCC of LV outflow obstruction. Erythematous excoriated papules that may weep. stroke. B12 used by methionine synthetase to make methionine from folate and oxidize 5-MTHF -> THF which is reduced back to 5-MTHF by MTHFR. B12 and folate all play role in metabolism. MC malignant bone tumor of youth. acute AR. Microcytic anemia and (+) FOBT indicate possible GI malingnancy.usually spared. Apply cold compresses to parotid and testes. proximal leg. changed to oral fluconazole as maintenance. Metabolic Syndrome: 3/5 (waist > 40 in men and > 35 women. Mumps: parotitis. Intermittent Catheterization: effective measure to reduce risk of UTI in patients with neurogenic bladder or spinal cord injuries. Occurs in chronic cholecystitis. Orchitis is one of the most frequent complications of mumps. firm hepatomegaly. Occur in distal thigh. Angina. S4. Osteosarcoma: Codman s triangle and sunburst appearance are two classic radiologic features. y Paget s Disease of the Bone: characterized by increased bone remodeling and abnormal osteoid formation. MC initial symptom is pain. Longer catheterization -> higher risk. Bacteria can form biofilm. RUQ pain. ALP elevation is only abnormality. Porcelain GB: intramural deposition of calcium salts and diagnosed on abdominal x ray. 20% of cases. Difference in blood pressures between two arms. Normal GGT. Rarely bilateral. B6 used by cystathione B synthetase to convert homocysteine to cystathione to be converted into cysteine. Liver Metastases: MC site of colon cancer metastasis. weak S2. pericardial effusion. Usually have underlying HIV infection. Tb can also be a cause.

nursing home workers. IBD: may occur in association with inflammatory arthritis. inform any partners of the past 60 days so they can be treated. all adults with chronic disease. Ewing s Sarcoma: LE > UE. chloride. loss of rectal tone. MRI should be performed to determine location. Can have erythema nodosum. Slow enlargement with increasing thickness. Less common in dark skinned populations. Fevers. humerus. leukocytosis. fistulas. Metastasizes early to lungs and LN. Vomiting -> hypokalemic hypochloremic metabolic alkalosis. pneumococcal. HCV if have history of IVDA. healthcare workers. PaO2 < 55. MC sites are metaphysis and diaphysis of femur. fissures. Td should be given every 10 years after 18 and single Tdap between 19 and 64. May occur with metastatic prostate cancer. Thyroid dysfunction (85% hypothyroid). HBV. COPD: long term supplemental oxygen therapy has been shown to prolong survival. Vaccinations: can decrease morbidity and mortality in certain patients. Concentrated urine after water deprivation = psychogenic polydipsia. anemia. Favor face and back. Systemic vasodilation may occur. Crohn s Disease: non-caseating granulomas are characteristic. Cauda Equina Syndrome: acute compression presenting with acute motor and sensory loss. Central DI will increase urine osmolarity by 50%. skip lesions. White males in 1st or 2nd decade. corneal deposits (benign). need booster after 5 years. urinary retention. cervical cancer (pap). Both may be inherited with (+) p ANCA despite absence of vasculitits. Surgical emergency. Shows transmural involvement. Influenza to all adults 50 and older. skin cultures. Urine osmolarity will be less than plasma. close contacts of children. sarcoidosis. Treatment is intranasal DDAVP. Also screen for HIV. If before 65. episcleritis. Diagnosis may be confirmed by gram stain of the synovial fluid. Peripheral will not. Typically pigmented but may lack pigment. Seborrheic Keratosis: common benign overgrowths with warty or cerebriform. elevated ESR. GI Tb. Lamellated onion skin appearance with moth eaten mottled appearance and extension into soft tissue. SaO2 < 88. Several liters of IVF may be needed. hepatotoxicity (stop only if > 2x normal). y y y y y y y y y y y y . Vomiting: gastric contents are rich in acid. stuck on appearance. perianal disease. Can present as asymmetric polyarthritis (with tenosynovitis and skin rash) or isolated purulent arthritis affecting one or a few joints. Healthy nonpregnant may get intranasal. Acute Pancreatitis: hypotension indicates intravascular volume loss due to local and systemic vascular endothelial injury -> increases vascular permeability and transudation of plasma. blood cultures. Confused with osteomyelitis. PID: treat with appropriate antibiotics. erythrocytosis (Hcrt > 55). potassium.y DI: administration of DDAVP after water deprivation distinguishes between nephrogenic and central. creeping fatty appearance of the mesentery. council on safe sex practices. Amiodarone: class III antiarrhythmic that causes lung fibrosis (total cumulative dose). PCV to all 65 and older and all with chronic disease. AS and IBD are both associated with HLA B27. skin discoloration (blue gray discoloration of the face) are also causes. pyoderma gangrenosum. and influenza vaccines. evidence of cor pulmonale. Bicarbonate levels rise due to loss of hydrogen and activation of RAAS. Yersinia also cause GI granulomas. Gonococcal Arthritis: MCC septic arthritis in young sexually active adults. urethral cultures. tibia. cholangitis. syphilis. Give isotonic NaCl with K to correct. DM -> up to date on Td. especially UC. cobblestone appearance.

histological grade. Vasovagal Syncope: MCC syncope. Can mimic other causes of dementia like Alzheimer s. Arterial and venous thromboses. Intrahepatic Cholestasis of Pregnancy: functional disorder of bile formation in 2nd or 3rd TM. Extracellular amyloid fibrils on EM. acral extremities. SLE Nephropathy: minimal mesangial lupus nephritis -> advanced sclerosing lupus nephritis. y y y y y y y y y y y y . skin excoriations. Significant itching on palms and soles. over expression of Her-2/neu is bad. Meniere s Disease: disorder resulting from distention of the endolymph compartment of the inner ear. Provoked by emotional stimulus with rapid recovery. salicylate poisoning. Due to C1 esterase inhibitor deficiency which results in elevated edema producing factors of C2b and bradykinin. elevated ALP. Occurs within 6 weeks of surgery. hepatosplenomegaly. Can be secondary to generation of NO in splanchnic circulation due to portal HTN. Dexamethasone suppression test abnormal in 50%. Vertigo that lasts from 20 minutes to 24 hours. hypopyon. CT findings are usually normal and noncontributory. Renal hypoperfusion is the cause. fatigue. Based on TNM staging. Neurally mediated or neurocardiogenic syncope. Upright tilt table test to diagnose. genitals. Nocturnal pruritis. Postoperative Endophthalmitis: MC form of endophthalmitis. Frequently recurrent. Amyloidosis: causes nephrotic syndrome. C1q levels are normal in hereditary and low in acquired. C4 is depressed. Treat with UDCA. blurry vision prodrome. First line therapy consists of environmental and dietary modification. Have apple green birefringence under polarized light after staining with congo red. Angioedema: rapid onset non-inflammatory edema of the face. Elevated Cr. Have ear fullness. thrombocytopenia. Alcohol. cholesterol. Episodes follow infection or trauma.y Anion Gap Metabolic Acidosis: gap is increased by presence of non-chlorinated acids in the serum. graded I to VI. trachea. worse at night. Present with pain and decreased visual acuity. corneal edema. Lightheaded. Decreasing significance: ER+ PR+ are good. History of RA or other chronic inflammatory condition. abdominal organs. ethylene glycol. Immunosuppressive therapy given after grading. xanthomas. Hepatorenal syndrome: severe liver disease -> systemic hypoperfusion and subsequent renal failure. uremia. hearing loss. Antiphospholipid Antibody Syndrome: false (+) VDRL. Intense pruritis. tendency to spontaneous abortions. Must do kidney biopsy in all patients with new onset lupus nephritis. Lactic acidosis. hepatomegaly. low urine sodium (<10). caffeine. Breast Cancer: tumor burden is single most important prognostic consideration in the treatment of patients with breast cancer. ALP and total/direct BRN increased. infection. increased serum bile acid concentation. tinnitus. Can use midodrine and octreotide. Pseudodementia: elderly patients with depression can present with memory loss. Can use methotrexate or colchicine. AST/ALT can be high. Treatment and outcomes are different. Swollen eyelids. nicotine should also be avoided. conjunctiva. methanol/formaldehyde. Anti-mitochondrial antibodies are seem. enlarged kidneys. weak. IgM. Stage IV is the worst. including maintenance of low salt diet. Can do intravitreal antibiotic injection or vitrectomy. PBC: autoimmune destruction of intrahepatic bile ducts and cholestasis. prolonged PTT. ketoacidosis. Prophylaxis with low dose ASA and LMWH during pregnancy. Treat with UDCA.

May be transmitted by cat stratch. Damages the optic nerve. Can also give imitinib. Rash goes vesicular -> erythematous -> papular phases. Temporal Arteritis: suspected in patients > 50 with new onset temporal HA. segmented neutrophils. Can have dry tap bone marrow aspirates due to fibrosis. Low plasma osmolarity (<280). asymmetric narrowing. Look for Philadelphia chromosome if unsure. Diagnose with (+) antibody. tyrosine kinase inhibitor. HA. Strictures are symmetric narrowing of the involved esophagus and dysphagia to solids but no weight loss. Difficulty hearing in crowded noisy environments. Leukamoid Reaction: marked increase in leukocytes due to severe infection or inflammation. Noticed in 6th decade with high frequency bilateral hearing loss. Localized cutaneous and LN disorder. eye. Works quicker than morphine or loop diuretics. Cat Scratch Disease: Bartonella henselae. genetics. Fine hair like irregular projections from cells. CML is indistinguishable on smear but LAP is usually low. Hypercellular bone marrow with promininent granulocytic hyperplasia. CML: increased number of mature granulocytic forms. Increase in LAP is typical. Caution in hypotension. band forms. TRAP staining (strong acid phosphatase reaction not inhibited by tartaric acid) and CD11c. Hairy Cell Leukemia: type of B lymphocyte derived chronic leukemia. Immediate initiation of high dose steroids to prevent damage to the retinal artery and other vessels. Renal hypoperfusion -> RAAS -> afferent and efferent vasoconstriction and sodium reabsorption. weight loss. Crisis phase can cause visual blurring and altered mental status. tissue with (+) Warthin Starry stain. potassium sparing diuretics like spironolactone and amiloride. Vetricular Fibrillation: a reentrant ventricular arrhythmia. NSAIDs. GERD: predisposes to Barrett s esophagus. jaw claudication. MCC death in patients with acute MI. vision loss. flea bite. Drugs that dilate pupil can cause. Adenocarcinoma occurs with long GERD. Rare involvement of liver. exposure to loud noise can also cause. Caused by areas of partial block in conduction that predispose to reentrance. NO is the most rapidly acting medication to relieve symptoms of pulmonary edema. mid-dilated pupil. CNS. spleen. Radiation. ESR is elevated. Prsbycusis: sensorineural hearing loss due to aging. Cardiogenic Pulmonary Edema: results from left heart failure and characterized by crackles on pulmonary exam. y y y y y y y y y y y y y . SIADH: hypotonic hyponatremia with euvolemia. photophobia. BMT after high dose chemotherapy and radation needed. Hypothyroidism and adrenal insufficiency should be ruled out. Edema in CHF: due to both mechanical impedence to fluid removal and increased renal sodium retention. nausea. peptic stricture formation. Give 5 days azithromycin. Localized tender/suppurative regional LA. Any case of stricture with Barrett s should be biopsied. symptoms of polymyalgia rheumatica. caustic ingestions also cause strictures. erosive esophagitis. cat bite.y Hyperkalemia: ACE-I. Medications. Do ocular tonometry to diagnose. scleroderma. NSAIDs potentiate action of ADH. history of infection. Acute Glaucoma: suspect with sudden onset of eye pain. Elevate total body water volume further exacerbating CHF. Internuclear Ophthalmoplegia: characteristic of MS due to demyelination of the MLF in the dorsta pontine tegument. high urine osmolality (> 100-150) in suspected patients is diagnostic.

HA. Mucormycosis: requires aggressive surgical debridement plus early systemic chemotherapy with amphotericin B. UA shows hexagonal crystals. oliguria. Exclude intracranial hemorrhage. Alcoholism and hemoglobinopathies. diabetic nephropathy (> 30 alb/Cr). gram negative rods). Also do repeat EKG. Acute Epididymitis: fever. irritative voiding symptoms. gonorrhea. Reinfarction: CK MB is the most useful lab test in assessing for coronary reocclusion after an MI because it returns to normal in 1-2 days. Erythrocytosis. Usually have occult tumor. Pancoast Syndrome: neoplasm in the pulmonary apex at the thoracic inlet can compress inferior portion of the brachial plexus resulting in shoulder pain radiating in the ulnar distribution. Cysteinuria: inherited disease causing recurrent renal stone formation. Look for personal history of recurrent kidney stones from childhood and (+) family history. Tight BP control in diabetes delays cardiovascular disease and renal failure. Follow with serial CXR. Urine sodium nitroprusside test is widely used. depression. Sexually (adults. hoarse voice. Hard and radioopaque. Mild Persistent Asthma: proper treatment includes PRN albuterol and inhalted corticosteroids. Most often caused by fungus Rhizopus. Periorbital swelling. Trousseau s Syndrome: migratory thrombophlebitis. MS: relapsing remitting form is well defined acute episodes with no significant disease progression between episodes. acute leukemia. tonsillar hypertrophy. Troponin T is better indicator. ACE I have kidney protective effects and decrease proteinuria. hypothyroidism are RF. MC tumor is adenocarcinoma. PSGN: 10-20 days after skin or throat infection. Temporal Arteritis: aortic aneurysms are a well known complication due to involvement of the branches of the aorta. Progressive hip or groin pain without ROM restriction and normal radiograph early on. May be hypertensive. Aerobic and anaerobic streptococci and Bacteroides (anaerobic) are MC. Interferon beta decreases the frequency of relapse and reduces disability in patients with this form. urethral discharge. Brain Abscess: isolated. ACE I: DOC for lowering BP to target levels in diabetics (<130/80). Can cause pulmonary HTN -> RVF. colon. urethritis. OSA: MC medical cause of daytime sleepiness in US. New Onset Seizures: CT scan of the head without contrast is the first diagnostic test when patients presents with new unprovoked seizures. Obesity. morning HA. Due to poor oropharyngeal tone -> daytime sleepiness. Use for BP higher than target. Increased soft tissue in pharynx. hematuria. Serum C3 levels are low. Causes Horners. painful enlargement of the testis. Can be traumatic or non traumatic. ring enhancing lesion on contrast CT in an immunocompetent patient with known extracranial bacterial infection (sinusitis). prostate. UA will show hematuria with RBC casts and proteinuria. SVC syndrome. smooth bordered.y Hip Avascular Necrosis: can be corticosteroid induced. chlamydia) or non sexually transmitted (associated with UTI. MRI is the golden standard for diagnosis. round. y y y y y y y y y y y y y y . stomach. Pancreatic. not always detectable at time of presentation. lung. takes upto 10 days to return to normal. focal neurological signs.

Concurrent nasopharyngeal infection > discharge. Prolonged exposure of tracheobronchial tree to irritants. MALT Lymphoma: antibiotic therapy is most accepted and recommended management for eradication of H pylori in MALT lymphoma without metastases. Atypical lymphocytes are large basophilic cells with vacuolated appearance. Repeated infections are due to corneal scarring. Pneumococcus: MC pathogen causing pneumonia in nursing homes. Pure motor (posterior limb of IC). Methanol Intoxication: most severe consequences are vision loss and coma. use systemic chemotherapy. atypical lymphocytes. Measurement of PSA can be considered to help evaluate the likelihood of prostate cancer. Diagnosed by Giemsa stain of conjunctival scraping. dysarthria clumsy hand syndrome (basis pontis). Caused by Chlamydia trachomatis A-C. omeprazole. standing). Labs show anion gap metabolic acidosis. Pneumonia is the leading cause of death in nursing homes. If not. trauma. Dermatitis Herpetiformis: dapsone is an effective treatment. DLCO is decreased in emphysema and normal in chronic bronchitis (productive cough for 3 months over 2 consecutive years. low FEV1/FVC ratio (normal in restrictive lung disease). Warfarin: patients who develop serious bleeding due to excess anticoagulation with warfarin should be given FFP for rapid reversal. HOCM: murmur is located at LLSB and is worsened by maneuvers that decrease preload (Valsalva. Trichinellosis: GI complains followed by triad of periorbital edema. clarithromycin. Weakness. Topital tetracycline or azithromycin. Sudden onset SOB. negative monospot. hypotension. gross hematuria). abscess (IVDA). Treat with amoxicillin. AD inheritance pattern. tracheal deviation. May regress after treatment. BPH: only required evaluation for BPH suggested by history and physical is UA to assess for UTI and hematuria. Subungal splinter hemorrhage and conjunctival/retinal hemorrhage.y Spinal Cord Compression: signs and symptoms of UMN (means CNS) distal to the site of compression. Trachoma: presents with follicular conjunctivitis and pannus (neovascularization) formation in the cornea. Occurs in association with celiac sprue. Tension Pneumothorax: complication of high PEEP. Alveolar damage -> tension pneumothorax -> hypotension. Can be due to disc herniation. Antithrombin III is lost in urine. eosinophilia. extensor plantar response. CMV: consider in patients with mononucleosis symptoms. tachycardia. myositis. MCC membranous GN in adults and most likely to cause RVT. Medical emergency needing MRI and surgery. hyperreflexia. Increased osmolar gap. Lacunar Stroke: if patient presents with limited neurological deficit. ataxic hemiparesis (posterior limb of IC). Sore throat and LA are uncommon in CMV. fever. If INR is excessive but < 5 with no significant y y y y y y y y y y y y y y . Nephrotic Syndrome: renal vein thrombosis is common complication (abdominal flank pain. Optic disc hyperemia. pure sensory (VPL thalamus). Principle cause is HTN. ARDS is predisposed since tissue is already compromised. malignancy. COPD: reduced FEV1 compared to FVC. unilateral absence of breath sounds. Vaccinate with pneumovax.

Acute Angle Closure Glaucoma: unilateral eye pain. cluster headache. Signs of right sided HF -> JVD. elevated JVP. ascites. In third world. Ratio of risk in exposed group vs. but < 1% turn into cancer. Common etiologies include viruses.bleeding. Constrictive Pericarditis:pericardial fibrosis and diastolic dysfunction. stop temporarily. Pseudoachalasia secondary to a neoplasm at the GE junction can have similar presentation. muscle wasting. y y y y y y y y y y y . dyspnea. unexposed group. Helps to control known risk factors as well as unknown and difficult to measure confounders. S3. amyloidosis. Hamartomatous polyps are either juvenile or Peutz Jeghers. stop warfarin and give vitamin K. Have fatigue. y Achalasia: complaints of dysphagia for both liquids and solids as well as regurgitation. Use CCB or nitrates. photophobia. abdomen. Distinguish from migraine. sharp x y descents on central venous tracing. Presence of papilledema confirms the diagnosis. Endoscopy is recommended for patients presenting with above symptoms > 60 and weight loss. Malignant HTN: suspect in patients with very high BP (>200/140). TB is a common cause. Associated with Raynaud s and migraine HA. Vasospastic disorder that typically occurs in young female smokers. size > 2. Lyme Disease: erythema migrans rash and facial nerve palsy. Cor Pulmonale: term for right sided heart failure MC due to pulmonary disease. Results from degeneration of the nerves in the esophagus. hyperventilation. hepatomegaly. sarcoidosis. omit next dose. foul smelling breath secondary to pooling of material in the pouch. cold. Renal failure occurs. but not necessary for diagnosis. dependent edema. End organ damange is due to fibrinoid necrosis of small arterioles. Only adenomatous polyps are premalignant. dilated pupil with poor light response. emotional stress. Usually repaired surgically. moist areas. May be palpable. halos around things. keratoconjunctivitis. Chest pain occurs in middle of the night and episodes have transient ST elevations in EKG. > 9. pedal edema. RV heave. redness. Pregnancy Induced Respiratory Alkalosis: causes physiological compensated. Signs of decreased cardiac output and venous overload. Colon Cancer: RF for polyps turning into colon cancer are villous adenoma. positive Kussmaul s sign. sessile adenoma. cocaine. EM rash may be present on arms. Contrast esophagram is diagnostic test of choice.5 cm. ascites. Relative Risk: used as a measure of association in cohort studies. Randomization: method to control confounders. regurgitation. radiation. Can be due to Chagas disease. Prinzmetal s Angina: variant angina. RR > 1 shows association. Zenker s Diverticulum: MC in elderly males and present with dysphagia. Erythematous with central clearing or uniformly red. idiopathic. Hyperplastic are non neoplastic and do not require further workup. temporal arteritis. Metabolic compensation occurs in later pregnancy. chronic respiratory alkalosis due to stimulatory effect of progesterone on medullary respiratory center. stronger as it goes larger. Can cause palsy of any CN but VII is MC. Precipitated by exercise. 5-9 with no significant bleeding.

HAV for MSM. intranasal influenza. Whitened edematous retina in distribution of arterioles. Dipstick will be positive for blood. will have contralateral motor deficit and ipsilateral conjugate gaze. pneumococcus. Malignant Melanoma: consider in patients with metastatic mass bleeding inside brain. Second MC site of spread after LN. Marked elevation in CPK (> 20. Retinal emboli from ipsilateral carotid. Mohs Surgery: special surgery where microscopic shaving is done such that 1-2 mm of clear margins are excised. Multiple nodules can be seen. Rhabdomyolysis: nearly 20% of cocaine OD s are complicated by this. Elevated K levels. GERD: cough can be presenting symptom. Pseudocystic on US.y Intracranial Hemorrhage: HTN is a common cause. no enzymes needed. Best way to measure is through serial measurements of VC. MC locations are basal ganglia. Prolonged immobilization can also cause this. Risk for failure greatly increases when VC < 15 mL/kg. Highest cure rate for BCC. oropharyngeal. Anemia. Hashimoto s Thyroiditis: increased risk of thyroid lymphoma. Do US. ASA and alcohol both cause direct damage. meningococcal. Seen after age 50. cerebellum. yellow fever). oral thyphoid. UA will have no RBCs. CT shows enlargement of the thyroid around the trachea (doughnut sign). HIV Vaccinations: influenza. CT.000 -> risk of ATN due to myoglobinuria). Night sweats and fever due to increased cell turnover. D Xylose Test: abnormal in bacterial overgrowth and celiac disease. 24 hour pH recording is most specific test. Use mannitol and alkalinization of urine. Non melanomatous skin. Rapid enlargement of the gland with pre-existing disease. HBV. Patients should receive pneumococcal. Presence of Philadelphia chromosome. Do non invasive evaluation of carotid. oral polio. pons. and present much later. Normalizes in bacterial overgrowth with antibiotic administration. One exception is MMR. anthrax. Can go almost anywhere. Water brash (regurgitation of sour fluid into mouth) also present. lung. lesions in functionally critical areas (face). ASA decreses PG production. prostate have never reported brain metastases. Splenectomy: risk for sepsis present for > 30 years. Acute Erosive Gastritis: severe hemorrhagic erosive lesions after exposure of mucosa to injurious agents or decresed blood flow. Decreases normal protection -> acid leaks into LP -> vascular damage > hematemesis and abdominal pain. varicella. If in cerebrum (basal ganglia). Like a curtain falling down . y y y y y y y y y y y y y . BM shows prominent granulocytic hyperplasia. increased number of mature granulocytic forms. Compressive symptoms are common. esophageal. skin are MC. Haemophilus vaccination several weeks before operation and daily oral PCN for 3-5 years. CML: low LAP with leukocytosis. used if no evidence of immunity and CD4 > 200 and no ADI. lie dormant. or MRI. Liver Metastases: MC malignant neoplasm s of the liver. Used to diagnose cause of chest pain or supraesophageal esophageal complications in patients with negative endoscopy. Indicated in patients with high risk features. Amaurosis Fugax: visual loss that is usually monocular and trasient. Should not receive live vacciation (BCG. GBS: can cause respiratory muscle weakness -> failure. breast. Absorption only requires intact mucosa. Biopsy confirms. GIT. thalamus.

Diagnose with urinary Ag. Treat with quinolone or macrolide. If confined to LP. fever. mydriasis. hearing impairment. If patient is symptomatic. nickel. Dihydropyridine CCB: like nifedipine can worsen cardiac ischemia due to peripheral vasodilation and reflex tachycardia. Weight control is the most important. Scratching -> secondary infection (impetiginized) by strep or staph suggested by pustules. Proteus: most likely cause of UTI with alkaline urine. Atrial tachycardia with AV block occurs from the combination of these two effects. Common in patients of long term care facilities and chronic indwelling catheters. porcelain GB. history of gallstones. portions of the liver/biliary tree. CI in MI. Increases with age. Diagnosed during or after cholecystectomy. ARF: catheterization is most critical first step. salt restriction. Can resolve post renal obstructions in addition to monitoring urine output in pre-renal and intrinsic renal failure. Surgery to remove GB and the bed. myalgias. LN. Predisposed to torsades -> syncope and sudden death. Days to weeks after exposure -> intensely pruritic erythematous rash with vesicles. simple cholecystectomy is all that is needed. May be asymptomatic until they rupture. Verapamil and diltiazem can be used after beta blockers are used but do not improve mortality. moderate alcohol consumption. Klebsiella also cause alkaline urine. family history of sudden death. 20-40 year old female with knee pain and some mass. Gallbladder Carcinoma: rare malignancy that occurs in Hispanic and SW Native American females with history of gallstones. Serology will be positive. salmonella typhi. but will not affect HTN. abdominal pain. Primary prophylaxis is beta blockers. All patients with cirrhosis should be screened for varices. Congenital Long QT: syncopal episode. restlessness. Recurs even after local curettage. Secondary Syphilis: diffuse maculopapular rash involving soles and palms. hepatitis. Does not cause seizures. Refer to ortho. hyponatremia. LFT abnormalities. vomiting. Candida. Produces urease. arthralgias. diarrhea. pancreatic head. diarrhea). Giant Cell Bone Tumor: soap bubble appearance in epiphyseal end of long bone. Pseudomonas. y y y y y y y y y y y y . Oval or spindle shaped cells with multinucleated giant cells. iritis. then physical activity. do endoscopy to look for varices. Methadone is appropriate treatment. osteitis. meningitis. Allergic Contact Dermatitis: type IV hypersensitivity inflammatory skin condition caused by poison sumac (encountered while cutting firewood). carcinogen exposure. Benign but locally aggressive. piloerection. use beta blocker with DDD pacer. Digitalis Toxicity: increased ectopy in atria and increased vagal tone. anatomic variations. Legionella Pneumonia: presents similarly to other pneumonias. but can cause GI symptoms (abdominal pain. Beta blocker is MC used treatment modality. arthritis. Increased bowel sounds. Cirrhosis: if signs of portal HTN are present. Urinary retention common after lower abdominal/pelvic surgery. Smoking decreases CV risk. Accompanied by generalized LA. normal physical exam. HTN: most patients will require pharmacotherapy but lifestyle changes can make a difference.y Opioid Withdrawal: nausea. Tends to be late presenting and has spread at time of diagnosis. cosmetics.

smoking cessation. Start in oral mucosa. tearing. Common in middle aged to older. edema in bronchial mucosa). can suppress hypoxia fueled respiratory drive). flaccid bullae. Treat with steroids. Weakness gets worse as day progresses. Progressing clot with subtherapeutic INR needs bridging heparin until INR is therapeutic. Acute DVT: treat with combination warfarin and heparin for 5 days. along with fibrinolysis. Elevation of ammonia levels. Acute Aortic Dissection: chest pain that is sudden. Azathioprine and methotrexate can be used. Resolves with rest. Decrescendo diastolic murmur suggests AR. skin tenderness. Generalized weakness often develops within a year of onset. right heart strain. antibiotics. vomiting. Reye s Syndrome: found in children given ASA for viral induced fever. perioral crusting. Warfarin should stay on for 6 months for first clot. > 50% die in 1 hour. anticholinergics). Replace fluids. PE complicated by hypotension. After 5 days heparin can be discontinued if INR is therapeutic. Can cause deep wounds. treat with vagal maneuvers followed by adenosine and AV nodal blockers. radiating to the back.y MG: MC in women 18-25. erythema. Auscultate periumbilical area to reveal continuous murmur. Sudden diffuse erythema. difference in BP between arms. two week steroid taper (decreases inflammation. especially with CKD. transaminases. topical wound care (similar to burns). ptosis. Treat with glucose with FFP and mannitol to decrease cerebral edema. HTN is MC predisposing factor. fever. RAS: common cause of resistant HTN in patient with advanced atherosclerosis (CAD. Unstable patients should be cardioverted. Complete occlusion is a CI to surgery. antibiotics against staph. claudication. Restless Leg Syndrome: potentially debilitating condition characterized by uncomfortable desire to move one s legs at night or at rest. COPD: recommended therapy for acute COPD exacerbation is supplemental O2 (caution. an adhesion molecule. Localized cellulitis and LA. Carotid Artery Stenosis: aymptomatic patients with stenoses of 60-99% are considered to have proven indication for CEA. (+) Nikolsky sign. Intermittent dysarthria. facial edema. Massive PE: likely in post operative patient with JVD. Diffuse mitochondrial disease -> extensive fatty vacuolization of liver. mental status changes are common manifestations. dysphagia. Need respiratory and hemodynamic support. inhaled bronchodilators (B2 agonists. Caused by toxins produced by phage group 2 Staph aureus. swelling. Autoantibodies against desmoglein. Cat Bites: should be treated prophylactically with 5 day course of amoxicillin/clavulanate. and can be infected with Pasturella -> pain. Treat with DA agonists (abnormalities in DA system may be cause). Can cause fulminent hepatic failure. Sensation is better with massage/warming. Have (+) Nikolsky sign. risk factors). Sycope occurs. Scalded Skin Syndrome: disease of children. Surgery in past 10 days is CI to fibrinolytics. new onset RBBB. Wide mediastinum. diplopia. y y y y y y y y y y y y . Tachycardia with narrow QRS. iron deficiency. SVT: if hemodynamically stable. Pemphigus Vulgaris: mucocutaneous blistering disease characterized by flaccid bullae and intracellular IgG deposits in epidermis.

hepatotoxicity. If fails to suppress by > 50% = ectopic. BT is prolonged. multiple partners). PTT.8). IX. high output cardiac failure. Children 6-59 months should get influenza. Confounding: matching is frequently used in case-control studies to control confounding. Acute COPD Exacerbation: inhaled/nebulized bronchodilators. If there is bone pain. Caused by uremic toxins (guanidinosuccinic acid). fever. Methotrexate: DMARD. but not specific. HHNK: very high blood glucose. GBS and E coli in infants and strep pyogenes in children. Osteomyelitis: staph aureus is MCC osteomyelitis in both infants and children. Macrocytic anemia is a common SE. protein C and protein S. Platelet Dysfunction:MCC of abnormal hemostasis in patients with CRF. Cholecystitis: abdominal ultrasound is the best tool for initial investigation of GB pathology. Platelet transfusion will not work. X. Cushing s Syndrome: central obesity. Inhibits DHFR. yellow fever. Also causes nausea. Egg allergies -> do not give influenza. Western blot is confirmatory. Paget s Disease: asymptomatic patients rarely need treatment. interstitial lung disease. caution with MMR. normal anion gap. Chlamydia Screening: USPSTF recommends routine screenining for chlamydial infection in all sexually active women 24 years and younger and in asymptomatic women at increased risk for this infection (other STDs. neurological deficit. DDAVP is usual treatment (increases release of VIII:vWF multimers). Absent in patients with infectious (neutrophils) or vasomotor rhinitis (non allergic). Yearly influenza is needed and may need pneumococcal booster shots (between 4 and 6). followed by x ray. then treat. Allergic Rhinitis: nasal eosinophilia is characteristic for allergic rhinitis. HTN. platelet count is normal. High-dose dexamethasone suppression test is used. Will have low low-dose dexamethasone suppression test. ACTH will be high in Cushing s disease and ectopic production. HIV Screening: ELISA is the preferred screening test. Can cause false positive deficiency in any of these factors. plasma hyperosmolarity. Match variables that could be confounders. Can get very dehydrated -> poor perfusion -> lactic acidosis. purple striae. Have high 24-hour urine cortisol. rash. T2DM. systemic steroids (usually methylprednisolone). Nasal polyposis (including ASA sensitivity) and non-allergic rhinitis with eosinophilia. involvement of weight bearing bones. Supplement with folic acid. Symptomatic patients are best treated with oral bisphosphanates. y y y y y y y y y y y y y .y Warfarin: anticoagulant that functions by inhibition of synthesis of vitamin K dependent factors II. PT. excess bruising. Asymptomatic patients do not need treatment. CF Vaccinations: should adhere to regular schedule with some additions. preparation for surgery. hypercalcemia. Laproscopic cholecystectomy is the treatment of choice for those with symptomatic disease. stomatitis. May cause pancytopenia. Full extent determined by bone scan. Serum osmolarity is 2(Na)+(Glc/18)+(BUN/2. Cases and controls are then selected based on matching variables so that both groups have similar distribution. Enough endogenous insulin to suppress ketosis but not hyperglycemia. alopecia. limb wasting. VII. (-) ketones.

Give IV normal saline and regular insulin. For men. Diabetic Neuropathy: presents with alterations in sensation. detoxification). SAAG: serum ascites albumin gradient. palmar erythema. chondrocalcinosis (calcified articular cartilage). IE. immunosuppression. electrolytes (potassium). Pneumococcal meningitis is similar but no skin rash. y y y y y y y y y y y y y . trauma. decreased glucose = bacterial meningitis. including loss of proprioception. Pneumococcal for those over 65 or those at risk for pneumococcal disease (chronic illness. malignancy. Hyperactive reflexes and upgoing plantar response are suggestive of UMN lesion. testicular atrophy. Petechiae and purpura. treatment of precipitating cause (usually antibiotics). DKA: managed by restoring intravascular volume with normal saline. Used to distinguish between different causes of ascites. 50 and older as well as younger with certain comorbidities should get annual influenza. Vaccinations: all adults should have Td every 10 years. (+) birefringent crystals. decreased body hair. excretory (bile excretion). pancreatitis. Could be due to rheumatic heart disease. should be < 2 drinks per day. Vaccinations: all adults should get Td booster every 10 years. Pseudogout: cannot be reliably distinguished from gout and septic arthritis based on history and physical alone. Mitral Regurgitation: holosystolic murmur heard best at the apex with radiation to the axilla. Pure seminomas do not produce AFP. CT is used to confirm the diagnosis and ID complications. Massive PE: can cause RV dilatation and failure that results in hypotension. Germ Cell Tumors: typically affect young patients and display aggressive biologic behavior. HTN: lifestyle modification should be first line intervention for newly diagnosed Stage 1 HTN. Can have tingling and imbalance. Exertional dyspnea. syncope. steroids. and RV strain is a relative indication. Do US to search for gallstones in all patients experiencing first attack. Rhomboid. Adults with close contact with children 0-59 months should have influenza vaccine.y Acute Pancreatitis: gallstones and alcoholism are the two MCC in US. Hemodynamic compromise is an absolute indication. cholesterol. Develops very rapidly. correction of hyperglycemia. acidosis. Meningococcal Meningitis: CSF with elevated white count. swelling redness of the joint. fatigue. Motor findings are late. smokers). Myalgias are common and can be severe like in flu. spider angiomas. atrial fibrillation. for women. Crystals are calcium pyrophosphate. protein). weight loss. for thrombolytics. Have history of DVT sometimes. Ascites can be due to trauma. elevated protein. 1. Liver Functions: can be synthetic (clotting factors. aerobic exercise. Reduction of alcohol/sodium intake. HCG is elevated in both seminomatous and non. SOB. signs of heart failure. metabolic (drugs. HOCM. RMSF does not cause meningitis. Pain. Can occur in mediastinum. Nonseminomatous germ cell tumors produce both AFP and HCG. should be < 1. Hyperestrogenism: in cirrhosis -> gynecomastia. not compatible with diabetes -> do spinal MRI.1 g/dL or greater is consistent with portal HTN. tachycardia. ischemia. infection.

photophobia. CD4 < 200. Survivcal is significantly reduced if sodium < 137. smoking history. thrombolytic therapy with tPA (after CT scan to rule out hemorrhage) should be started. Improved neurological outcomes. severe hypoxia. normal white count. 2) Decreased FiO2. other G(-) as well. indicator of LAP and usually LVEDP). Barium swallow. blurred vision. Indicates presence of severe heart failure and high level of neurohumoral activation (water retention). 4. Chemotherapy and radiation may be used in conjunction. Treatment is long term IV antibiotics with or without surgery.5 hours. PJP: non productive cough. fever. Pain. surgery is treatment. SCA and immusuppressed are also at risk for OM. Associated with high aldosterone. Hypo and hyperkalemia may reflect the activity of the RAAS or may be due to different drugs. Vertebral Osteomyelitis: focal pain. Increased CAD. AS is confirmed by plain film x-ray demonstrating fused SI joints and/or bamboo spine. CHF: hyponatremia is a bad prognostic factor. Staph aureus is MCC. outdoor occupation. When localized. exertional dyspnea.5L/min for female) and elevated PCWP (>18. HTN is common but not only cause of CV disease. Topical or oral antivirals. chills. redness. elevated ESR. PAO2 = FiO2(760-47) PaCO2/0. Cardiogenic Shock: depressed CO (normal is 5L/min for male. SVR will be elevated as result of neurohumoral activation (sympathetic. Common in IVDA (as is all osteomyelitis). Scrapings show multinucleated giant cells. High GH -> high IGF-1 -> excessive growth of bone and soft tissue.y Ischemic Stroke: if patient presents within 4. immunodeficiency. adrenal failure. Esophageal Cancer: heart burn. hyperglycemia). EGD & biopsy. A-a gradient. In setting of suggestive H&P. fever. Look at ABG. Acute Abdominal Pain: one of the differential diagnoses is MI and should be ruled out first before GI workup in patients with RF. NE. fever. diastolic dysfunction. Steroids decrease mortality. muscle weakness. fatigue. A-a gradient > 35. PET scan (useful to determine the stage or whether surgery is possible). Indications for steroids are PaO2 < 70. Respiratory (0-25%) and malignancy (9-25%). arrhythmias. Herpes Simplex Keratitis: characterized by corneal vesicles and dendritic ulcers. Most specific lab is high aldosterone/renin ratio. Primary Hyperaldosteronism: suspect in young person with HTN. Acromegaly: MCC death is cardiovascular (38-62% of death). numbness (potassium depletion). RAAS) to preserve CO and maintain tissue perfusion. TMP-SMX is DOC. Can have strokes. tearing. significant weight loss. LVH. Decrease water intake to help with electrolyte abnormalities. MRI is most sensitive study. y y y y y y y y y y y . if 100% O2 improves picture. colon cancer. renal failure (HTN. Hypoxemia: 1) Hypoventilation. Recurrences precipitated by excessive sun exposure. bilateral interstitial infiltrates on CXR. 3) Shunting. 4) V/Q mismatch. vasopressin. Frequent cause or corneal blindness in the US. cardiomyopathy. Any young patient with low back pain and spinal stiffness > 3 months should be investigated.8 o Hypoventilation: elevated PaCO2 with normal A-a gradient o Decreased FiO2: normal PaCO2 with normal A-a gradient o Shunting: normal PaCO2 with elevated A-a gradient (O2 does not help) o V/Q Mismatch: normal PaCO2 with elevated A-a gradient (O2 does help) Ankylosing Spondylitis: seronegative spondyloarthropathy presenting with progressive inflammatory back pain and stiffness.

Atheroembolism: dislodgement of cholesterol plaques from the aortic root. Also cause ARF. normal CSF. carotid dopper and TEE are done to look for possible sources of emboli. thighs. Associated with chest pain. Protein C deficiency is commonly associated. Breast. HTN in Diabetes: better to keep systolic < 130 to prevent slow end organ damage in diabetes and CRF. palpitations. Any suspicious lesions or masses should be biopsied.y y Selection Bias: loss to follow up in prospective studies causes selection bias. If there is evidence of ischemic stroke. Vit K should be given initially and warfarin discontinued if progresses. OA. automatisms. Waldenstrom s Macroglobulinemia: hyperviscosity of blood owing to excess production of IgM. absence of a fever. post-ictal confusion. Want to keep diastolic < 80. Tick Borne Paralysis: rapidly ascending paralysis. staring spells. cartilage tears. Complex Partial Seizure: brief episodes of impaired consciousness. Squatting decreases the murmur. Search and removal of a tick usually results in improvement within an hour and complete recovery in several days. with short systolic murmur after the click. absence of sensory abnormalities. Stroke: do CT scan without contrast to determine ischemic or hemorrhagic. Warfarin Induced Skin Necrosis:pain -> bullae formation -> skin necrosis. abdomen are commonly involved. Labs show prolonged PT and then PTT. PT elevated more than PTT. CT can show asymmetric thickening. Hyperventilating does not cause seizure (differs from absence). EEG is usually normal or has brief discharges. Occasionally burst and release contents and present similarly to a DVT. Esophageal Cancer: may mimic achalasia radiographically and manometrically (called pseudoachalasia). buttocks. Excess fluid accumulates in popliteal fossa -> tender mass. Occurs within weeks. hyperventilation. Defined as a drop in systolic > y y y y y y y y y y y y . Baker s Cyst: excessive fluid production by inflamed synovium as occurs in RA. inability of esophagoscope to pass through LES. anxiety. Rare chronic plasma cell neoplasm. failure to respond to various stimuli during the episode. 4 biopsies should be taken every 10 cm from cecum to rectum. Should be done every 1-3 years. Older age. rapid weight loss. Vitamin K Deficiency: seen in patients who are NPO for a long time and receiving broad spectrum antibiotics. Need IgM spike on electrophoresis and hyperviscosity. Fat soluble vitamin that serves as a cofactor for enzymatic carboxylation of glutamic acid residues on prothrombin complex proteins. UC: patients with UC and pancolitis should begin surveillance colonoscopy after 8 years of having the disease. Blue toe syndrome in which emboli to the pedal circulation cause cyanotic and painful toes with intact pulses. is one common presentation of catheter induced atheroembolism. Females are MC affected. Heparin should be used until heals. FFP is used in acute hemorrhage. Orthostatic Hypotension: characterized by a drop in blood pressure after standing and is typically preceded by a lightheaded or presyncopal sensation. shorter history. Mitral Valve Prolapse: mid systolic click over the apex.

Thyroid Nodule: MC a colloid nodules which are benign. Gancyclovir or valgancyclovir can be used to prevent CMV infections. vasodilators. Vaccinate against influenza. increase fluid intake. Can be life threatening in children. Babesiosis: patient from endemic area (NE US) who presents with tick bite especially if there is evidence of hemolysis and patient is splenectomized. Jaundice. CT scan is done to diagnose. PFT. UTI. giving patient his/her preferred meals. dry skin. Eczema Herpeticum: form of primary HSV associated with atopic dermatitis. > 55. start on home O2 when PaO2 < 60. IV diuretics provide symptomatic benefits to patients with decompensated HF. Numerous umbilicated vesicles over area of atopic dermatitis as its healing. Melanoma: one of the most practical methods of primary prevention is wearing protective outer clothing. S3: low frequency diastolic sound heard just after S2 that is associated with LVF. Surgical treatment is cricopharyngeal myotomy. Rash is not a feature (unless thrombocytopenia is present). 5-HT3 antagonist. Pneumococcus and H flu both cause secondary pneumonia. attractive food presentation. Treat promptly with acyclovir. Motor dysfunction and incoordination are responsible. > 50 with oropharyngeal dysphagia and neck mass. Transplant Patients: should be given oral TMP-SMX for prophylaxis against PJP. pneumonia. nausea not secondary to biliary or pancreatic disease. nocardiosis. death. Amiodarone: effective antiarrhythmic but its use is associated with several potential side effects. May be nothing. Difficulty concentrating. persistent vomiting would warrant endoscopy. HBV. pneumococcus. decrease sodium intake. LFT. could be PUD or gastritis. hepatotoxicity. increase dietary calcium. bloating. avoiding bland food. Use quinine-clindamycin or atovaquone-azithromycin. Odansetron: drug of choice for chemotherapy induced emesis. Can be normal in younger individuals and athletes. Recommended screen is H pylori serology. Diuretics. TFT should be monitored. y y y y y y y y y y y y . dysphagia. fatigue. Can cause necrotizing bronchopneumonia resulting in pneumatoceles (blood streaked sputum and mupltiple midfield lung cavities). Accompanied by fever and adeopathy. Can cause pulmonary fibrosis. hypovolemic. Little to no protection from sunscreen lotions SPF 15-30 but can protect against SCC. Giemsa stained thick and thin blood smear. Dyspepsia: epigastric pain. COPD: all patients with PaO2 < 55 or SaO2 < 88 are candidates for long term O2 therapy. weight loss. Pneumatocele: Staph aureus can cause secondary pneumonia complicating a viral URI. y Renal Stones: decrease protein (causes calcium stones) and oxalate in diet. Common in elderly. Develops immediately about the UES by herniating through the fibers of the cricopharyngeal muscle.20 mmHg. Zenker s Diverticulum: pharyngoesophageal. If become hypoxic during exercise or sleep can use O2. hemoglobinuria. Small frequent meals. thyroid. Signs of pulmonary HTN or hematocrit > 55. autonomic neuropathy. adrenergic blocking agents. renal failure. Can prevent toxoplasmosis. weight gain while receiving treatment for HTN and atrial fibrillation.

AFP measurement is first reasonable step. Pupils are always spared (as opposed to botulism). steroid use. Mediated by autoantibodies against the Ach receptor. If they do not respond. Glatiramer acetate is a long term disease modifying treatment for MS that works by modulating T cell mediated autoimmunity to MBP. stone removal/stenting with ERCP. CCB and alpha blockers. Cellular immunodeficiency. worsening signs of portal HTN. try CCB. y y y y y y y y y y y y y y . Caused by AVRT or AVNRT. anogenital regions. Can be due to sexual contact.y MG: pathology lies at NMJ. abdominal pain. RUQ pain. chemotherapy predispose. palpable mass. narrow QRS complex tachycardia without definite P waves. Hypotension and mental status change -> Reynold s pentad. Molluscum Contagiosum: firm. If does not work. Give ASA and nitrates but not beta blockers. papillary edema. Bulbar muscle involvement -> myasthenia snarl. limbs. CHF: elevated BNP and S3 are both signs of increased cardiac filling pressures. but otherwise asymptomatic. HCC: have either chronic viral hepatitis or cirrhosis. Acute Cholangitis: provision of supportive care and broad spectrum antibiotics. Diastolic Dysfunction: impaired ventricular filling due to poor myocardial relaxation or diminished ventricular compliance. MS: focal neurological deficits in young adult with asymmetric periventricular white matter signal changes on MRI. difficulty in chewing or swallowing. Terminates the arrhythmia and diagnoses and treats. Develop rapidly and resolve over several days leaving brownish discoloration due to hemosideran deposition. SVT: suspected on an EKG with a regular. dome-shaped. Charcots triad: fever. flesh-colored. treated with diuretics and antihypertensives. Can involve auto antibodies and cell mediated. Can have anterior or panuveitis. US is first study to do. nasal speech. Increasing Prevalence: but stable incidence can be attributed to factors which prolong the duration of disease (improved quality of care). Weight loss. Melanoma: MCC fatal malignancy in young adults. blindness. Latent Period: exposure must be continuously present for a certain period of time (latent period) to influence the outcome. Common in HIV patients. jaundice. STEMI can occur as a consequence. they should undergo biliary drainage. Senile Purpura: characterized by ecchymoses that occur on elderly patients extensor surfaces due to perivascular connective tissue atrophy. Adenosine is initial treatment of choice. Recently changed mole is strongest RF for malignancy. Usually due to HTN. CV. Sympathetic Ophthalmia: characterized by damage of one eye (the sympathetic eye) after a penetrating injury to the other eye due to uncovering of hidden antigens. beta blocker. Inhibits catecholamine reuptake in synapses. Can cause decompensated HF. Cocaine Abuse: papillary dilatation and blood at the external nares in a patient with chest pain can be a clue to cocaine induced vasospasm. Iron Deficiency Anemia: bone marrow iron stains is the most definitive way to diagnose iron deficiency anemia. Usually secondary to infection or obstruction. with RR of at least 10. umbilicated papules. On trunk.

Abdominal CT to confirm. If GCA is coming along with it. Acute Acalculous Cholecystitis: acute inflammation of the GBin the absence of gallstones most commonly seen in hospitalized/severely ill patients -> burns. indinavir (protease inhibitor -> crystal induced nephropathy). PMR: pain and stiffness in the neck. extremities. Pieces of infected valve vegetations break off and enter CNS circulation. macrocytosis. Treatment when not associated with GCA is low dose steroids. Withdraw drugs that may suppress RAAS 2-4 weeks prior. try low purine diet. HIV Therapy: didanosine (induced pancreatitis). anemia of chronic disease. Absence of forehead furrows indicates peripheral lesion. Uric Acid: highly soluble in alkaline urine -> oral potassium bicarbonate or potassium citrate to get urine > 6. prolonged fasting. Primary Hyperaldosteronism: PA to PRA is used as initial screening test. Treatment involves induction of evaporative cooling to reverse hyperthermia. intestines. Treat with antibiotics.y Cerebral Emboli: most dreaded consequences of endocarditis. diarrhea. anemia. appears at the site of thorn prick or other skin injury. malaise. vomiting. prolonged PR. short QT. kidney. No suppression of aldosterone after saline or oral salt loading. nevirapine (liver failure). CRAB (calciu. pelvic girdle in patient > 50 with elevated ESR and morning stiffness > 1 hour. thrombocytopenia. Alcohol Abuse: MCC of nutritional folate deficiency -> megaloblastic anemia. prolonged TPN. arrhythmias. shoulders. y y y y y y y y y y y y y . treat with high dose prednisone. Multiple Myeloma: increased risk of infection due to total decrease in functional antibodies and leukopenia that develops as bone marrow is filled with malignant plasma cells. mechanical ventilation. Renal failure and hypokalemia exacerbate. Initial lesion is reddish nodule that later ulcerates. renal. Not a type of bias! Bell s Palsy: peripheral lesion. Adenopathy and systemic signs usually absent. Paraprotein gap = protein albumin. Can have microcytic anemia due to chronic blood loss. Sporotrichosis: gardner s disease. Central lesions still have forehead furrows because contralateral motor innervation of the forehead remains intact. Traveler s Diarrhea: ETEC is MCC. evidence of cardiac disease on EKG.5. vision changes (blurry yellow). T wave inversion. Heat Stroke: temperature is usually > 105. Radiolucent stones. > 30 suggests diagnosis. Hypokalemia should be corrected since this can suppress aldosterone. lactic acidosis (any of NRTI s). trauma. Stevens-Johnson (any of the NNRTI s). Digoxin: cardiac glycoside whose SE are nausea. Scooped ST. Spreads along lymphatics forming SQ nodules and ulcers. Usually due to acidic urine. diarrhea. Abdominal cramps. Effect Modification: present when the effect of the main exposure on the outcome is modified by the level of another variable. Can affect lung. bones). IVDA with chills. Treatment for atrial fibrillation and heart failure. Also hydrate. abacavir (related hypersensitivity syndrome). Results from inefficiency cooling mechanisms. Impairs enterohepatic cycle and inhibits absorption. Dunking in cold water may work but difficult to monitor the patient.

y Aortic Dissection: sudden tearing chest pain that radiates to the back. Arise within 1 week and can persist upto a year. Hepatic Encephalopathy: CNS complication of liver failure secondary to accumulation of ammonia in blood due to livers inability to detoxify ammonia to urea. ARF. shift potassium intracellularly. Yellow white patches of retinal opacifiation and hemorrhage are diagnostic. kidney (nephritis. tonsillar exudate is not common in HIV. Progressive fatigue and waxing waning low grade fever. trauma. Mediastinal widening is sometimes present. Prolongs survival and time to tracheostomy. Renal impairment and schistocytes may persist for several weeks. GN. Hematuria: bladder tumors are the MCC of painless hematuria in adults. dyspnea. Do contrast CT or TEE. eating beets. Heterophile Ab can distinguish. asterixis. nephrolithiasis. delta waves on EEG. dysplastic RBCs. Deficiency or autoantibody against vWF cleaving protease. TTP: requires emergency treatment with plasmapheresis (plasma exchange). Decreases risk of ventricular fibrillation but increases risk of asystole. GI complaints. Could be a kidney or ureter malignancy as well. Lead Poisoning: MCC in adults is work exposure. Insulin/glucose administration is the quickest way to decrease serum potassium. North Africa will also need HBV. Patients may be asymptomatic. weight loss. Shifts are only transient and must try to decrease potassium. Rash and diarrhea are LESS common in IM. Leg weakness can occur if dissection progresses to involves arteries of spinal cord. Treatment is ganciclovir or foscarnet. Anti-EBV Ab as well. Initially eye is usually white and quiet. Myoglobinuria. rifampin can cause hematuria like picture. porphyria. decreasing total body potassium. Dizziness. Splenomegaly with splenic rupture is worrisome. casts). Infections. nausea. Little effect on myocardial contractility. elevated liver enzymes. hemoptysis). SBE: one the causative agent is identified. polio booster. Shock Liver: occurs in the setting of hypotension. anemia. second dose for long term immunity. Do contrast CT or IVP as well as cystoscopy of bladder/urethra. Renal biopsy shows linear immunofluorsence of IgG Ab along GBM (to alpha-3 chain of type IV collagen). the antibiotics can be narrowed from empiric to specific. thyphoid. progressive coma. ALS: riluzone is a glutamate inhibitor approved for use in ALS. Neuropathy is common. y y y y y y y y y y y y y . Diagnose with blood lead levels. HAV: MC vaccine preventable disease in travelers. Severe HTN is a RF. Can have pleural effusion. Acute massive increases in ALT/AST with milder increases in total BRN and ALP. and skeletal weakness. Goodpasture s Disease: affects lungs (cough. Rates of recovery (usually defined as normalization of platelets and LDH level) are high if started soon. Typically return to normal in a couple weeks. Primary HIV: manifests similarly to IM. Strep viridans is highly susceptible to IV PCN G and IV ceftriaxone. Lidocaine: not used prophylactically in ACS. prostatic disease are MCC of hematuria in US. CMV Retinitis: when CD4 < 50. poor concentration. Single dose can be enough for young adult. Basophilic stippling. Consider in patients traveling to developing countries. Hyperkalemia: membrane stabilization with calcium. Treat with exposure reduction and lead chelator such as EDTA or succimer. Reversal of sleep cycle. No systemic symptoms.

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PBC: xanthalesma are cholesterol plaques on the medial aspects of the eyelids. Upper and lower eyelids may be affected. Can occur in PBC but MC idiopathic. Pruritis, jaundice, hepatomegaly, increased ALP. Ascites: treat with sodium/water restriction, spironolactone, loop diuretic (not more than 1L/day), then frequent abdominal paracentesis (2-4 liters/day as long as kidneys work). Upper Thoracic Spinal Cord Lesion: paraplegia, bladder and rectal incontinence, absent sensation from nipple downward. Impetigo: presents as erythematous macule which rapidly evolves into vesicles and pustules that rupture and leave honey colored crusted exudates. Caused by staph or strep. Parkinson s Disease: suspected in patients with 4-6 Hz tremor that is asymmetric and associated with rigidity. Tremor is often presenting symptom. Trihexylphenidyl is an anticholinergic medicaton used in younger individuals where tremor is presenting symptom. Nitroglycerin: main mechanism for pain relief in patients with anginal pain is dilitaiton of veins (capacitance) and decreased ventricular preload. This decreases myocardial oxygen demand. Blastomycosis: pulmonary fungal infection endemic to Great Lakes, Mississippi and Ohio river basins. Wisconsin has highest rate. May cause ulcerated skin and lytic bone lesions. Broad based budding yeast grown from the sputum. Itraconazole or amphotericin B may be used to treat systemic disease. NF1: café au lait spots, macrocephaly, feeding problems, short stature, learning disabilities. Later develop fibromas, neurofibromas, different tumors. COPD: causes airflow limitations and increased lung volumes. Latter results in diaphragmatic flattening, evident on CXR, which exacerbates patients dyspnea and work of breathing. Difficult to decrease intrathoracic pressure enough. Hemochromatosis: AR disorder, increased skin pigmentation, diabetes, cirrhosis, arthralgias. Mutation on chromosome 6. Avoid iron containing foods, weekly phlebotomy for 2-3 years. Deferoxamine is second line treatment for those who cannot undergo phlebotomy. Metabolic Acidosis: observed during DKA and is typically accompanied by hyperkalemia which is paradoxical. Extracellular shift of potassium in exchange for H+ ions. Impaired insulin dependent cell entry of the potassium ion. Should get potassium once dips below 4.5. HBV Exposure: reassurance is the most appropriate course of action for a patient with known immunity to HBV who is exposed. HBIG and HBV vaccination should be given to patients with unknown immunity. Elevated Aminotransferases: if patient is asymptomatic, first step is to take thorough history to rule out more common hepatitis risk factors (alcohol, drugs, travel, blood transfusions, high risk sexual practices). Also medications (statins, antiepileptics, anti TB, herbals). If transaminases persist, test for HBV, HCV, hemochromatosis, fatty liver. Then polymyositis and thyroid. HIT: immune mediated process that causes thrombocytopenia several days after heparin therapy is started. Highly thrombogenic and can cause A or V thromboses.

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Lyme Disease: erythema chronicum migrans in a patient with a history of a tick bite warrents immediate treatment with doxycycline. Serologic testing is not needed if patient presents with classic EM (usually in moist areas, bulls eye, asymptomatic). Avascular Hip Necrosis: chronic corticosteroid use and chronic excessive alcohol ingestion account for > 90% of cases of avascular necrosis. Present with slowly progressive anterior hip pain with limited ROM. Unable to remodel -> trabecular thinning occurs. Pain is worse with activity. X rays fail to show in first few months. MRI is most sensitive. Trauma and antiphospholipid syndrome can be causes. EHEC: bloody diarrhea. Presence of abdominal pain with lack of fever in a patient without travel. Most cases due to ingestion of undercooked beef. Shigella, salmonella, campylobacter also cause bloody diarrhea but have fever. TTP-HUS can also result. Stool culture. Septic Shock: most important steps in management of lactic acidosis from septic shock are IV NS with or without pressors to maintain volume and antibiotics to correct underlying condition. Attributable Risk Percent: represents the excess risk in exposed populations that can be attributed to RF. ARP = (RR-1)/RR or (risk in exposed risk in unexposed)/risk in exposed. Retinal Detachment: sudden onset of photopsia (flashes of light) and floaters. Described as curtain coming down over eyes. Myopia or trauma can cause breaks -> allows fluid to seep in and separates the retinal layers. Can occur after surgery. Gray elevated retina. Laser and cryotherapy are done to create permanent adhesions. Pericardial Effusion: electrical alternans when QRS varies from beat to beat and is specific. Enlargement of cardiac silhouette. Echo will more definitively diagnose. Recent URI usually precedes. Digoxin: medication with narrow therapeutic window. Verapamil increases digoxin levels and predisposes to toxicity. MC SE is GI (anorexia, nausea, vomiting). Bidirectional ventricular tachycardia and accelerated junctional rhythms are relatively specific. Expressive Aphasia: lesions in dominant frontal lobe. Also contains motor cortex whose damage -> contralateral hemiparesis. Absence Seizures: ethosuximide is treatment along with valproic acid. Works against calcium channels. Drowsiness, nausea, vomiting, hyperactivity, sleep disturbance. Not useful for generalized tonic clonic and partial epilepsy. SLE: autoimmune disease MC affecting AA women 20-40 years old. Fatigue, fever, weight loss, non-deforming arthritis, oral ulcers, serositis, hematologic abnormalities, proteinuria, rash. > 90% have arthritis usually of MCP and PIP. Similar to RA. Glycosylated Hgb: excellent way to measure chronic glycemic control. Measurement of average glucose readings for 100-120 days. Formed by non enzymatic glycosylation of Hgb. 1% increase -> blood glucose of 35. Inflammatory Myopathy: polymyositis and dermatomyositis. Both present with proximal muscle weakness. Supported by elevated ESR and CPK. Confirmed with muscle biopsy. 40-50 years. Women > men. Drug induced, hypothyroid, muscular dystrophy, MG present similarly. Treat with high dose corticosteroids.

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PE: when occurs with hemodynamic compromise, best treatment is fibrinolysis. If patient has CI (previous surgery, bleed), an embolectomy is treatment of choice. Will still need to be on warfarin for a few months. SLE: joint pain is common but not deforming. MC in hands or knees. Migratory arthritis. Pain > physical findings. Lower incidence of joint erosion, synovial abnormality, permanent joint deformity than RA. Retropharyngeal Abscess: most feared complication is spread of the infection to the mediastinum -> acute necrotizing mediastinitis. Partiularly the anterior and posterior portions. Spinal Stenosis: MC caused by DJD. Neuropathic claudication . Exacerbation of symptoms with walking. Symptoms are positional and remain while standing still. Pain relieved by flexion of spine. Diagnosis made on history and MRI of spine -> bony abnormality, neural structures, soft tissue seen well. Brain Death: clinical diagnosis. Absent cortical and brainstem functions and proven irreversibility. Spinal cord may still be functioning -> DTR s may be present. EEG can be used to confirm but not necessary. Some tools can demonstrate cerebral blood flow cessation. Epidural Abscess: consider in patients with fever and back pain. Espeically those who are immunosuppressed or use injectable drugs. MRI is diagnostic test of choice. Treat with antibiotics and surgical decompression. Can cause direct compression -> cessation of blood flow. Draw blood cultures to determine sensitivity. Hepatic Hydrothorax: cause of transudative pleural effusions with no underlying cardiac/pulmonary abnormalities. Usually right sided. Treat with salt restriction and diuretics. TIPS is done if refractory. Small defects in diaphragm allow fluid to flow into pleural space. Ethylene Glycol Poisoning: calcium oxalate crystals (rectangular envelope shaped crystals) are seen. Causes metabolic acidosis with anion and osmolar gap (as so methanol and ethanol). MAC Prophylaxis: HIV patients with CD4 < 50 require azithromycin or clarithromycin. Asymptomatic Gallstones: should not be treated. Laproscopic cholecystectomy is only for symptomatic disease unless have high risk of GB carcinoma or gallstone complications. 20% of these patients will develop symptoms in 15 years. Pancreatic Cancer: no serologic or radiologic test has been proven effective in screening in adults. Absence Seizures: suspect in a 4-8 year old with frequent daydreaming episodes, brief staring spells, decline in school performance, no post ictal phase. Treatment is ethosuxamide or valproic acid. Classic EEG is 3 Hz spike and wave activity. Observer Bias: when investigator s decision is adversely affected by knowledge of exposure status. AR: early diastolic murmur. Can also have hyperdynamic pulse (bounding, water hammer, peripheral pulses).

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RBC = GN. Fulminent Hepatic Failure: hepatic encephalopathy that develops within 8 weeks of acute onset liver failure. non-tender. Inflammation. WBC = interstitial cystitis and pyelonephritis. Urine Sediment: muddy brown granular = ATN. High priority on liver transplant and only effective mode of treatment. DJD: OA. Medullary carcinoma of the thyroid. Beta blockers also prevent anginal pain. Bacterial Pneumonia: all patients should have CXR done as first step and then administer antibiotics without waiting for sputum gram stain or cultures. sinuses. LV size. Dressler s Syndrome: present weeks after MI with chest pain improved by leaning forward. Lewy Body Dementia: 10-20% of dementia in US. Fatigue. Disorder of pain regulation. Treat with AchE inhibitors. methamphetamines. Alterations in consciousness. or wear and tear arthritis. HOCM: first line of treatment is beta blockers or cardiac acting CCB such as diltiazem since they promote myocardial relaxation. PCWP shows increased pressure in LA. Lewy bodies found in Parkinsons. Decreased exocrine gland function of the pancreas -> fat malabsorption. MEN 2a has medullary carcinoma and pheochromocytoma but has primary parathyroid hyperplasia. mucosal neuromas (most distinguishing feature). intestines. Regurgitant blood flow causes dilation of the LV. atypical antipsychotics. disorganized speech. alcohol. Eosinophilic intracytoplastic inclusions = accumulations of alpha-synuclein. fever. IBS. NSAIDs are the treatment of choice. draining sinus tracts with sulfur granules. hallucinations. or LV EF. Also have pulmonary edema. Women from 20-55. MEN 2b: AD disorder.y Fibromyalgia: pain worse with exercise. fistulae. Also have urine osm 300-350. Causes rise in LAP without significant increased LA size. Presents indolently in patients over 40 years with progressive anterior hip pain exacerbated by walking and relieved by rest. which evolves into abscesses. early compromise of executive functions. joint swelling. urine Na > 20. muscle weakness are absent. Anaerobic G(+) branching bacteria. Prolonged hypotension -> ATN. depression are common. FENA > 2%. Handgrip increases vascular resistance -> increased regurgitation. co-infection with HBV and HDV. pancreas. Severe intra-tumor hemorrhage and malignant transformation are dreaded complications. indurated mass. Heavy users of Tylenol. EPS. Medical therapy is afterload reduction with CCB or ACE-I. reproductive systems secondary to abnormal secretions. No abnormal studies. High dose PCN for 6-12 weeks. not adenoma. which appear yellow. Avoid anticoagulation to prevent hemorrhagic pericardial effusion. Cystic Fibrosis: affects a variety of organ systems including respiratory tract. Likely immunologic phenomenon. Cervicofacial Actinomycosis: classically presents as slowly progressive. pheochromocytoma. AR: diastolic decrescendo murmur at left 3rd ICS. Acute MR: occurs due to papillary muscle dysfunction in patients with acute MI. broad waxy = CRF. elevated ESR. fatty = nephrotic. Recurrent pulmonary infections and bronchiectasis. Morning stiffness y y y y y y y y y y y y y . Hepatic Adenoma: benign tumor most often seen in young and middle aged women who are taking OCP. Malaise. marfanoid habitus. Sheets of enlarged adenoma cells that contain glycocen and lipid.

Presents with acute onset severe eye pain and blurred vision associated with nausea and vomiting. Iron absorption is increased. confusion. Symptomatic Hypernatremia: medical emergency requiring prompt increase in sodium levels. hypercalcemia. Predisposing factors are advanced age and obesity. hepatomegaly. Sputum will have neutrophils with no organisms. Do serum iron studies. arthropathy. Cough. Tonometry reveals increased IOP. Get level at that time. Ciprofloxacin and erythromycin decrease clearance and raise plasma concentration. Acetaminophen Overdose: first data point occurs at 4 hours when decision to give antidote can be made based on levels. Anterior chamber is shallow with inflammatory changes. Diagnosis confirmed by urine antigen or culture on charcoal agar. No P2P transmission.or stiffness after prolonged resting. Do laser peripheral iridotomy. Mayonnaise containing salads are often implicated in staph food poisoning. Liver biopsy confirms. Treat with azithromycin and levofloxacin. adenosine antagonism. Fibromyalgia: amitriptyline and cyclobenzaprine have been shown to be effective in the treatment of fibromyalgia. Give activated charcoal within 4 hours while waiting for level. Benign Intracranial HTN: acetazolamide is first line medical treatment (reduces choroid plexus bicarbonate production). moderate pupil dilation not responsive to light. will not have adverse outcome. Risk of transformation to SCC. GI symptoms. Caused by chronic irritation to the mucosa due to tobacco. Stains poorly. GI disturbances (nausea. y y y y y y y y y y y . Theophylline: usually manifests as CNS stimulation (headache. Multiple Myeloma: any elderly patient with bone pain. 50% of patients develop some kind of renal insufficiency. Initiate treatment rapidly to prevent spread of infection to mediastinum. fever > 39. pain with certain neck movements. Can use steroids. vomiting). renal failure. Cirrhosis -> possible hepatoma. alcohol. add SSRI s. No tenderness to palpation or systemic signs. One possible etiology is lack of phase 4 sleep. poorly fitting dentures. emesis is predominant feature and starts in < 6 hours. Hemochromatosis: patient with new onset diabetes. Increase amount of restorative phase 4 sleep. Likely due to obstruction of distal collecting tubules by large laminated casts of Bence-Jones proteins. difficulty swallowing. PDE inhibition. fever. Cells have not had time to adjust -> acutely symptomatic. Examination reveals red eye with steamy cornea. or treat underlying disorder. Give antibiotics and drain. Travel associated infection. Results form pre existing narrow anterior chamber angle. Give 3% saline. As long as given within 8 hours. AR. Then can do repeated lumbar punctures. In patients with co-existing depression. cardiac toxicity (arrhythmia). stimulation of epinephrine relase. Leukoplakia: hard to remove white patches in the oral mucosa and may lead to SCC. y Angle Closure Glaucoma: predominantly in people aged 55-70 years. Chronic hyponatremia can be slowly corrected because cells have had time to adjust and rapid increases in sodium -> CPM. Because illness is due to preformed toxin. insomnia). Only associated with tobacco. Legionella: intracellular G(-) organism commonly spread by cooling towers and water supplies. usually < 30 to 60 years. Toxin Induced GE: caused by staph aureus. especially extension. Retropharyngeal Abscess: patients have sore throat.

Gallstones and alcohol are MCC. nose. wrist. Has neurological and kidney damage. medications also cause. vomiting. ESR will be high. Hemochromatosis: cirrhosis. shock. Decreases threshold for anginal episode and controls HTN. abdominal compartment syndrome. epigastric pain that radiates to the back. dilated or restrictive cardiomyopathy. Hairy Cell Leukemia: leukemic reticuloendotheliosis. RA: morning stiffness presents with inability to do things in the morning but fine by afternoon time. frontal sinuses. and abnormalities of cardiac conduction. If affects axial -> cervical spine -> C1-C2 instability -> subluxation. PIP. Also are cardioprotective and can potentially reduce the risk of major CV events by decreasing sympathetic output to the heart. cornea. increased skin pigmentation. Characterized by lymphocytes with fine hair like projections with TRAP stain. diabetes. treat with beta blocker. pseudocyst formation. Hypertriglyceridemia. abdominal pseudoaneurysm. Mostly peripheral joints. Disease of systemic inflammation. elevated amylase and lipase. pancreatic fibrosis (diabetes). Toxic to bone marrow. Low grade fever also common. Bone marrow -> fibrotic -> dry taps. Can deposit in pituitary and cause hypogonadotropic hypogonadism. physical. Can have hypogonadism. upper eyelid. Reactivation TB: y y y y y y . conjunctiva. anatomic abnormalities. forehead. Affects MCP. Pancreatitis: nausea. History. intraabdominal hemorrhage. First branch carries sensory fibers to the scalp. infection. Cladribine is DOC for hairy cell leukemia. Stable Angina: with HTN. Can have left sided pleural effusions when amylase is high.y Trigeminal Nerve: contains motor and sensory fibers. Damage to V1 -> corneal anesthesia and lesions on the eye may not be noticed. arthropathy.