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Causes of non-proliferative GN? Minimal change; Focal segmental glomerulosclerosis; Membranous glomerulonephritis
Causes of proliferative GN? IgA nephropathy; HSP (systemic variant of IgA nephropathy); Post infectious; Membranoproliferative mesengiocapillary; Rapidly progressive (Crescentic: Goodpasteur and Wegener))
Wilms tumor is associted with? WAGR (Wilms, Aniridia, Genital abnormalities, mental Retardation); hemihypertrophy; Beckwith-Wiedemann Sx;
Congenital conditions and GU anomalies? Turner and horseshoe kidney; microcephaly and Posterior Urethral Valve in boys
Association of neonatal respirtory distress, pneumothorax and abdominal mass? High occurance of significant urinary obstruction (posterior urethral valve or urethral agenesis)
Psychotherapies? Psychodynamic therapies; Behavioral therapies; cognitive therapy; Group therapy; Familial therapy; Hypnosis; Dialectical behavioral therapy
Psychodynamic therapies? Psychoanalysis; Supportive psychotherapy; Short term brief psychotherapy; Interpersonal psychotherapy
Behavioral therapies? Systematic desensitization; Flooding; Positive and negative reinforcement; Extinction; Punishment (causing a behavior to diminish by applying a noxious stimulus; in negative reinforcement: causing behavior to occur more by removing a noxious stimulus)
LBBB ECG changes? In both RBBB and LBBB: supraventricular rhythem + wide (> 0.12 sec) QRS; then LBBB: QS or RS pattern in V1 + monophasic R in I and V6
RBBB ECG changes? In both RBBB and LBBB: supraventricular rhythem + wide (> 0.12 sec) QRS; then RBBB: terminal R pattern in V1 + slurred S in I and V6
Heart sounds S4 (atrial gallop) implications? late in diastole; always abnormal (CHF and HOCM)
Heart sounds S3 implications? Early in diastole; Normal in children and athletics; left heart failure; R/o MI
Heart sounds: S2; origin and implications in splitting A-P; Splitting by inspiration, RBBB and RV infarct; paradoxical in LBBB and anterolateral MI
Precordial knock? Constrictive pericarditis
Openning snap? Mitral and tricuspid stenosis (look for atrial fibrilation)
Most common causes of AS and AR? AS: Bicuspid valve, atherosclerosis with age, Rheumatic; AR: 50% supra-valvular: aortic root dilatation (idiopathic: 80%; also with aging and hypertension, Marfan syndrome, aortic dissection, and syphilis)
Most common causes of TR? TR: Infective endocarditis (IVDUs)
Most common causes of MS and MR? MS: almost always rheumatic; MR: myxomatous degeneration of chorda tendinea leading to MVP Rheumatic dis., ruptured chorda tendinea following MI
Cardiac manifestations of SLE? endocarditis then Libman-Sacks endocarditis (a form of nonbacterial endocarditis)
Association of congenital heart diseases: Turner? CoA; HTN
Association of congenital heart diseases: Down? Endocardial cushion defects
Association of congenital heart diseases: Cartagener? Dextrocardia
Association of congenital heart diseases: Noonan? Right sided cardiac defects; pulmonary stenosis
Association of congenital heart diseases: Prematurity? PDA
Association of congenital heart diseases: TORCH? PDA
Association of congenital heart diseases: CHARGE? TOF and septal defects
Association of congenital heart diseases: Digeorge? conotruncal abnormalities, such as truncus arteriosus or total anomalous pulmonary venous return
Association of congenital heart diseases: Marfan? MVP, aortic dissection or insufficiency
Association of congenital heart diseases: William Sx? aortic and pulmonic stenosis
Association of congenital heart diseases: Mothers with SLE? Congenital heart blocks
Association of congenital heart diseases: Mothers with alcohole abuse? ASD; VSD
Association of congenital heart diseases: Mothers with DM? TGA, CoA
Association of congenital heart diseases: Phenytoin and valporic acid? Phenytoin: ASD, VSD, PS, AS; valporic acid: CoA, Hypoplastic Left Heart Sx
Association of congenital heart diseases: lithium and benzo? Epstein anomaly
CXR in CHDs? Boot shaped (RVH) in TF and egg shaped in TGA; enlarged right heart: ASD; Rib notching: CoA; Prominetnt Pulmonary artery: PDA;
TF clinical presentation Exertional states (crying, activity) increases shunt and so cyanosis; paroxysm of rapid and deep breathing; CXR: boot shape heart (RVH)
Epstein anomaly features? Low set tricuspid valve so Malfunctioning RV, TR and TS; usually patent foramen ovale exists. WPW is usually present; Associated with maternal lithium and benzo use in 1st trimester
Typical atrial rates in MAT, A-Flutter, A-fib, V-Tach? MAT: 100-200, A-Flutter: 250-300, A-fib: 400-800, V-Tach rate: 140-200
A-fib risk assessment for Warfarin therapy? CHADS2: CHF, HTN, Age>75, DM, Stroke (2 points): 0-1: ASA; for moderate to high risk (valvular disease): warfarin
TIMI score? ARCA PST; History: Age >65yrs, >3 risk factors for CAD, Known CAD (stenosis >50%), Aspirin use in past 7days; Presentation: Recent (24 hr) severe angina, ST-segment deviation ≥0.5 mm, cardiac markers (Troponins); high risk: > 2 points
Management of STEMI? PCI for symptoms < 3 hr, PCI available immediately OR symptoms > 3 hr, PCI available in 90 minutes OR Hypotension; Otherwise thrombolysis if symptoms < 12 hr
Lipids level goal in pts with CAD LDL < 100 mg/dL, HDL 40 mg/dL or higher, TGs: < 150 mg/dL
Long QT: 50% familial syndrome; also in hypokalemia, hypocalcemia, hypomagnesemia, and many drugs; associated Syndromes: Jervell and Lange-Nielsen and Romano-Ward syndromes
Management in DVT? minimum of 3 months (6 months if idiopathic and not provoked) to indefinite oral anticoagulation; if malignancy: 6 months of LMWH
Major autosomal dominant disorders? {Fam. colonic polyposis, Adult polycystic kidney dis., Acute int. porphyria}{Type ii fam. hypercholesterolemia, MEN II}{Osteogenesis imperfecta, Achondroplasia}{Waardenburg, Noonan}{Neuro-cut. Sx, , Amyloidosis, vWD}{HOCM, ASD}{malignant hyperthermia}
Major X-linked disorders? Recessive: Hemophilia A and B, G6PD, Fragile X, Testicular feminization, Nephrogenic DI, Duchenne and androgenic alopecia; Dominant: Rett, X-linked hypophosphatemic rickets
Porphyrias; types and presentations: Porphyria cutanea tarda (Mc; chronic blistering and crusting lesions on sun-exposed skin); Acute intermittent porphyria (severe abd pain, Avoid barbiturates); Erythropoietic porphyria (acute photosensitivity with pain and swelling after sun exposure)
Arnold-Chiari malformation a malformation of the brain. It consists of a downward displacement of the cerebellar tonsils and the medulla through the foramen magnum, sometimes causing hydrocephalus
cerebral palsy pathophysiology? Germinal matrix hemorrhage, ulegyria (early neonatal hypoxia), and periventricular leukomalacia
Thrombasthenia: lack of the platelet membrane glycoprotein GPIIb- IIIa; failure of clot retraction; AR genetic disorder that presents with epistaxis early in childhood
Bernard-Soulier syndrome large platelets; deficiency of glycoprotein Ib (GpIb), the receptor for vWF
Bruton disease pan hypogammaglobulinemia but intact T cell function
Nezelof syndrome Thymic dysplasia with normal immunoglobulins that function poorly (absent T cell function, deficient B cell function, fairly normal immunoglobulin levels)
Friedreich ataxia Onset 5-20 y/o; Hereditary sclerosis of the dorsal and lateral columns of the spinal cord with cerebellar involvement; ataxia, speech impairment, scoliosis, and peculiar swaying, with paralysis of the muscles
Continuous machinery murmur throughout cardiac cycle PDA
Decrescendo diastolic murmur heard best at mid precordium AR
Faint murmur that increases in intensity with inspiration TR
Holosystolic murmur with radiation of murmur to the axilla MR
Opening snap and mid-diastolic rumbling murmur MS
Murmur best heard while Pt sitting and leaning forward AR
Murmur best heard in left lateral decubitus MS
renal failure, anemia, thrombocytopenia in a child HUS; Rx: supportive; no indication for steroids; platelets are contraindicated
Hair Loss: "TOP HAT" Telogen effluvium, Tinea capitis; Out of Fe, Zn; Physical: trichotillomania; "corn-row" braiding; Hormonal: hypothyroidism; androgenic; Autoimmune: SLE, alopecia areata; Toxins: heavy metals, anticoagulants, chemotherapy, Vit. A, SSRIs
Toxins and drugs that may cause allopecia heavy metals, anticoagulants, chemotherapy, Vit. A, SSRIs
Non-scarring causes of alopecia: (3 As, 3 Ts, and S): Androgenic Alopecia; Alopecia Areata; Anagen effluvium; Telogen Effluvium; Trichotillomania; Traction Alopecia; Secondary Syphilis
Scarring allopecia: Trauma (burns, radiation); inflammation (discoid lupus, sarcoidosis, lichen planus), infection (Tinea capitis), neoplasms (basal cell ca, squamous ca, lymphoma)
Marjolin ulcers: Sq cell ca on scars with repeated ulceration and healing
Bowens disease and Erythroplasia of Queyrat Sq cell ca in situ (Erythroplasia of Queyrat on glans penis)
Keratoacanthoma: Sq. cell ca., erupts abruptly, grows to its max size within weeks or months and then most commonly undergoes spontaneous resolution
Usher Sx Genetic disorder with hereditary deafness (inner ear) and blindness (retinitis pigmentosa)
Skin lesions with association with malignancies Xeroderma pigmentosa (very large congenital nevi and basa cell nevus); Actinic keratosis; Lentigo maligna melanoma; Leukoplaques; nevus sebaceous; (Note: Juvenile Melanoma is always benign (Spitz nevus)
Psoriatic (arthritis) features Well-demarcated erythematous plaques with silvery scale on the extensor side; Nail involvement; asymmetric oligoarthritis (common), DIP may involve (unlike OA), conjunctivitis, aortic ins. and apical pulmonary fibrosis (late findings)
Psoriasis types? Chronic plaque: the most common form; Guttate: raindrops, associated with strep; high recurrence rates; erytherodermic: involves more than 90% of the body; Inverse: in flexor surfaces and axilla
Acanthosis nigricans benign skin condition; papillomatous hypertrophy of the epidermis with hyperpigmentation; flexural regions of axilla and groin; o Associated with some malignancies (gastric) and also endocrinopathies (DM, polycystic ovarian disease); Test: FBS
Koebner phenomenon development of skin lesions in the line of trauma or inflammation (Molluscum contagiosum, warts, Also: : vitiligo, psoriasis, lichen planus, pityriasis rubra pilaris, and keratosis follicularis)
Vesiculo-bullous lesions Pemphigus vulgaris (Blisters on skin and inside the mouth, steroids); Bullous pemphigoid (Old age, tense bulla, pruritic; not in the mouth); Dermatitis herpetiformis (Small herpetiform bulla on the extensors and back;with PMNs and IgA deposition, Dapson)
Papulosquamous lesions Lichen planus (Ch. Infl. of mucous membrane and skin, violaceous papules on the flexor aspect, polygonal, Wickham's striae); Pityriasis Rosea (Herald patches; Christmas tree on the back, Steroids); Psoriasis (Steroids);
Lichen planus association and risk? Association with Hepatitis C and increased risk of Sq cell carcinoma
Phototoxic substances: tetracyclines, amiodarone, sulfonamides, quinolones
Photoallergans fluoroquinolones, tetracyclines, amiodarone, NSAIDS, pellagra, psoralens, coal tar, PABA, St. John Wort
Side effects of isotretinoin lip fissures (very common), teratogenic, skin dryness, conjunctivitis, hyperlipidemia, reversible alopecia and abnormal LFTs
Erythrasma pink patches, which can turn into brown scales; caused by the Corynebacterium minutissimum; Rx: erythromycin cream; Pathognomic:coral-red fluorescence on Woods light exam
Erythema nodosum Painful lumps on the pretibial area (shins); panniculitis; Causes: infections (TB, leprosy, strep mycoplasma); infl. (sarcoidosis, IBD, Behcet); meds (sulfonamides, OCPs); pregnancy and cancer
Lentigo a uniformly pigmented, brown to black, flat macule with sharp margins. Solar lentigo (aging spots): Caucasians > 40 y/o
Miliaria pruritic sweat gland inflammations
Most common cause of hirsutism Polycytic Ovary disease (+ menstrual irregularities, obesity, insulin resistance)
Exeptional Rx; Heparin Induced Thrombocytopenia hypercoagulability state; replace heparin with heparinoids (hirudin, …)
Exeptional Rx; ITP platelet only if life threatening bleeding; steroids ± IVIg and anti Rh
Exeptional Rx; HUS and TTP platelet is contraindicated; plasmapheresis ± steroids
Exeptional Rx; vWD and Hemophilia A desmopressin
Exeptional Rx; Kawasaki No steroids; ASA and IVIg to prevent aneurysms
Relative C/Ind for platelet HUS and TTP, HIT, post-transfusion purpura (PTP), HELLP
Behcet Sx oral (aphthous lesions); arthritis; skin and genital lesions, eye involvement (iritis, uveitis); Like Herpes but negative for multinucleated giant cells on Tzank smear
Naloxone dose? 2 mg bolus up to 10 mg (peds 0.01 ml/kg)
Metabolic acidosis with increased AG? MUDPILES CAT: methanol, uremia, DKA and SKA, phenformin (oral hypoglycemic) and paraldehyde, INH and iron and ibuprofen, lactic acidosis, ethylene glycol, salicylates, CN and CO, alcoholic ketoacidosis, Toluene
Metabolic acidosis with decreased AG? error, electrolyte imbalance (K, Na, Mg), Li, hypoalbuminemia, para-proteins (multiple myeloma)
Metabolic acidosis with normal AG? High K: pyelonephritis, obstructive nephropathy, RTA type IV, TPN; Low K: small bowel losses, RTA types 1 and II, acetazolamide,
Causes of increased osmolar gap? (MAE DIE): Methanol, acetone, ethanol, osmolar diuretics, isopropanol, ethylene glycol
Major indications for DEXA? Age ≥ 65 years; Early menopause (< 45); Low trauma fracture; FHx of osteoporotic fracture; Steroids; Malabsorption syndrome; Primary hyperparathyroidism; Hypogonadism
minor indications for DEXA? Weight < 60 kg; weight loss > 10% from weight at age 25; Low dietary calcium intake; Medications (anticonvulsants, heparin); Smoking, caffeine (> 4 cups coffee/day), alcohol; RA
Polyglandular deficiency Sx, Type I Characteristic: hypoparathyroidism and candidiasis; also hypothyroidism (in all types) and adrenal insufficiency
Polyglandular deficiency Sx, Type II Characteristic: DM type I and adrenal insufficiency
Polyglandular deficiency Sx, Type III Like Type II but without adrenal insufficiency (i.e. only hypothyroidism + DM type I)
Early dementia HIV, Tumor, Spongioform encephalopathy, Vascular dementia, dementia pugilistica, Medications (anticholinergics, amphethamine, TCAs, lithium,
Rx for DIC: in hemorrhage: replacement of hemostatic elements with platelet transfusion, FFP, cryoprecipitate; in thrombotic phase: LMWH (controversial)
Jones major and minor criteria for RF SPACE: subcutaneous nodule, Pancarditis, Arthritis, Chorea and Erythema Marginatum; Minors: previous Hx, poly-arthralgia, fever, high ESR, prolonge PR interval; 2 major or 1 major and 2 minor for Dx)
Created by: Bijan39