A photo says a thousand words - Also known as lou gehrig's disease
Youngest mother in the world to give birth
Precocious Puberty
Youngest mother in the world to give birth in 1940
STD's with Ulcers and No Ulcers
STD's
With Ulcers :
Syphilis (Painless)
LGV
Genital herpes (Painful)
Granuloma inguinale
Chancroid (Painful)
No ULCERS
Chlamydia
HPV
Gonorrhea
Hepatitis B
HIV
With Ulcers :
Syphilis (Painless)
LGV
Genital herpes (Painful)
Granuloma inguinale
Chancroid (Painful)
No ULCERS
Chlamydia
HPV
Gonorrhea
Hepatitis B
HIV
Early vs Late Congenital Syphilis
Early congenital syphilis :
Late congenital syphilis :
- Non - immune hydrops
- Macerated skin
- Thrombocytopenia
Late congenital syphilis :
- Hutchinson teeth
- Mulberry molars
- Saber shins
Clinical Manifestations of Congenital Infections
Clinical Manifestations of Congenital Infections
Highlight on
CMV : Petechiae
Toxo : Chorioretinitis & Cranial Calcifications
Couvelaire uterus - (Abruptio Placenta)
There is massive intravasation of blood into the uterine musculature upto the serous coat.
The condition can only be diagnosed on laparotomy
Difference Between Osler's Node and Janeway Lesions (Infective Endocarditis)
INFECTIVE ENDOCARDITIS
Osler's Nodes : Painful Nodules on Finger tip and Toes (Immunologic phenomena)
Janeway Lesions : Macular Erythematous non tender lesion on Palms and Soles . (Vascular phenomena)
Mechanical Ventilation in ARDS - USMLE
FiO2 and PEEP both use to improve oxygenation, in ARDS, in the beginning you give high FiO2 and PEEP to improve oxygenation, once PaO2 is normal
then you first decrease FiO2 and keep it below 60 and then decrease PEEP, to wean off your target FiO2 should be less then 40
Note :
- Increasing FiO2 depresses respiratory drive
- PEEP keeps alveoli open at the end of expiration and it improves ventilation and gas exchange
- FiO2 should not be more than 60 for more than 48hrs it will cause oxygen toxicity, which will further destroy the lung.
Immunodeficiency Disorders - ( Easy way to Remember ) - USMLE
CVID :
B cells normal in numbers ; but decrease in IgG IgM and IgA
Rx : IV immunoglobulins
X-linked (Bruton) Agammaglobulinemia :
Rx : IVIG
SCID :
Combined so Both B and T cells - related to both : B cells : recurrent sinopulmonary infection as early 6 month. T cells : Candida , AIDS , PCP
Rx : BMT
IgA deficiency :
Rx : infections and use blood from igA-deficient donors or that has been washed.
Hyper IgE: skin infections with staph.
CGD:
lymph nodes with purulent material leaking out . Abnormal NBT testing .
- Recurrent sinopulmonary infections in adults
- Decreased response to Antigen stimulation of B cells .
- NORMAL amount of lymphoid tissues
Rx : IV immunoglobulins
X-linked (Bruton) Agammaglobulinemia :
- Male Children
- B cells and Lymphoid tissue are diminished
- Absence of the tonsils, adenoids , lymph nodes . T cell NORMAL
Rx : IVIG
SCID :
Combined so Both B and T cells - related to both : B cells : recurrent sinopulmonary infection as early 6 month. T cells : Candida , AIDS , PCP
Rx : BMT
IgA deficiency :
- sinopulmonary infections : Difference it also have Atopic diseases , Anaphylaxis to blood tranfusion when blood is given from a patient who has normal levels of IgA
- Sprue like condition with fat malabsorption
Rx : infections and use blood from igA-deficient donors or that has been washed.
Hyper IgE: skin infections with staph.
CGD:
When Medicine is in emo language !
When Medicine is in emo language !
Bacillary angiomatosis vs Kaposi sarcoma
Bacillary angiomatosis also known as Cat scratch disease
by : Bartonella spp.
Transmission : Cat scratch
Lesions : Red color
bacillary angiomatosis-its a superificial vascular proliferation,biopsy shows neutrophilic inflammation
Kaposi sarcoma : HHV-8
lesions violaceous color
Kaposi's sarcoma(HHV-8)- its the neoplastic proliferation of vasculature, biopsy shows lymphocytic inflammation.
Being a Doctor what do you know about Zika Virus ?
Zika Virus is trasmitted by mosquitos of the Aedes genus
Affected countries : Brazil , Bolivia , paraguay , Ecuador , Colombia , Mexico
Haiti , Dominican Republic , Panama , Costa Rica , El salvador
Clinical features :
Vague last for upto a week
Dx : Serology
Symptoms :
- Fever , Rash , Joint pain , Conjunctivitis , Myalgia , Headaches , Pain behind the eyes and Vomiting
- Only 1 in 4 develop symptoms
- Mostly seen in pregnant women --- lead to infant microcephaly
Prevention :
- Insect repellent , wear long sleeved , long pants - covered extremities
- Rest
- Hydration
- Antipyretic and analgesics : Tylenol (acetaminophen)
USMLE Step 2 CK Flashcards
Nikolsky sign positive in :
1. PV - pemphigus vulgaris
2. SJS - stevens johnson syndrome
3. TEN - toxic epidermal necrolysis
4.SSSS - staphylococcal scalded skin syndrome
D for DC : Dapsone - Dermatitis herpetiformis - Celiac disease
Double bouble sign : Duodenal atresia
Triple bouble sign : Jejunal atresia
Contrast enema for : Hirschsprung's disease and Meconium ileus
Upper GI series : Malrotation / Midgut volvulus
Erb-Duchenne palsy: C5, C6. waiter's tip, absent Moro but intact grasp
Klumpke's paralysis: C7, C8, T1. hand paralysis, Horner's syndrome (ptosis, miosis, anhidrosis)
C.difficile : Cytotoxin assay of stool
Seminoma - High HCG and normal AFP
Non-Seminomatous germ cell tumor - Both HCG and AFP high
- Urine Anion gap: is positive for RTA
- Urine Anion gap: is -ve for Diarrhea
PCP prophylaxis : bactrim : CD4 less than 200 : if question tell G6PD suspect Dapsone and switch to Atovaquone
HIV newborn prophylaxis : AZT within 12 hours of delivery x 6 week
Non-megaloblastic drugs : AZT(zidovudine), 5 FU and Cytarabine
Contraindications of LP : mnemonic : FAILS : Focal neurological deficit , Altered Mental Status , Immunosuppressed , Lesions and Seizures
Bacterial meningitis : mnemonics : CVS pharmacy : Ceftriaxone , Vancomycin , Steroids +/- Ampicillin
Syphilis : rash spread palms and soles
Lyme disease : Connecticut (tic usually not seen)
Atypical bacterial meningitis : Rocky mountain spotted fever , Lyme disease , Cryptococcal meningitis , TB , Syphilis
Microorganisms : Risk factors :
- Staph Aureus : Most common always ,
- Salmonella : Sickel cell
- Pseudomonas : Penetrating Shoe
- Strep Pyogenes : Erysipiloid
- Poly Microbial : PVD/ DM
Standing/ Valsalva maneuver: INCREASES -- HOCM, MVP MURMURS - decrease All other murmurs
Squatting / Sitting maneuver: DECREASES -- HOCM, MVP MURMURS - increase All other murmurs
Hand grip : INCREASES Other including MR , MVP (intensity ) DECREASES HOCM, AS and MVP (duration)
Post PVC ; INCREASES : HOCM, AS : DECREASES : MVP
INSPIRATION : INCREASES : Right sided murmurs So it DECREASES Left sided murmurs
EXPIRATION : INCREASES : Left sided murmurs So it DECREASES Right sided murmurs
Torsade de pointes : Quinidine , Procainamide , Disopyramide , Sotalol , Ibutilide , dofetilide , Amiadrone , Haloperidol , Chlorpromazine, Methadone, TCA , Chloroquine, Pentamidine , Domeperidone, Cisapride, Terfenadine Antibiotics such as Macrolides(Erythromycin, Clarithromycin) , fluroquinolones-Moxifloxacin Anti-fungal - Fluconazole
Long acting injectable (Depot injection) : Nandrolone , Fluphenazine , Bromperidol , Haloperdol and vanoxerine.
Check for LFT's for the Drugs : Statins , Terbinafine
Failure to pass catheter through the nose into the oropharynx : Choanal atresia
Fetal tachycardia can be due to maternal fever in chorioamnionitis. Therefore chorioamnionitis is not indication of C-section. But fetal distress associated with deceleration is indication of C-section.
Both papillary muscle rupture and ventricular wall rupture can occur post-MI after 3-5 days but ventricle wall rupture has signs of hypotensive shock where as papillary muscle rupture has an MR murmur with less severe hemodynamic derangements.
Typical signs of Pericarditis : murmurs are absent in uremic pericarditis which is indication of dialysis
Cause of Delayed hemolytic reaction : Anamnestic antibody response.
Rx of Subclinical hypothyroidism : When TSH greater than 10
Seizures : VITAMINS mnemonic : Vascular, Infection , Trauma , Autoimmune , Metabolic , Ingestion/ Withdrawal , Neoplasm , pSychics
Differential diagnosis of Child abuse : Osteogenesis imperfecta
ADHD also think about differential Absence Seizures - depend on the Vignette
Myoclonus and Atonic seizures : Rx : Valproate
CBT - cognitive behavioral therapy first-line Rx : Specific phobia , GAD (generalized anxiety disorder) - for GAD also think about SSRI's
Absence Seizures : Rx : Ethosuximide
Tic-Do-Le-rux : Rx : Carbamazepine
Drug induced lupus : mnemonic : SHIP : Sulfasalazine , Hydralazine , Isoniazid , Procainamide
Secondary causes of HTN : Renal : RAS , Adrenal ( Primary hyperaldosteronism) , Cushing syndrome , Pheochromocytoma, Thyroid : Hyperthyroidism , Parathyroid : Hyperparathyroidism Heart : COA
Systolic-Diastolic Bruit : RAS - (renal artery stenosis)
Systolic Bruit : AAA - Abdominal Aortic Aneurysm
Idiopathic intracranial HTN = aka = Benign intracranial HTN = Pseudotumor cerebri : Obese women , Besides OCP's the other '' non-idiopathic '' cause is Vitamin A overdose
Trigeminal Autonomic Cephalgias involve segments of V1 (headache, eye pain) are associated with autonomic syndrome ( horner's syndrome, lacrimation, rhinorrhea) Intracranial imaging required
Trigeminal neuralgias involve segments of V2, V3 (lancinating pain to the jaw, and lower half of face ) have NO autonomic syndrome No intracranial imaging required Rx : Carbamazepine
Trigeminal Cephalgias : the Cluster headache
Trigeminal Neuralgias : The Tic Douloureux
Primary Headaches : 1. Migraines 2. Cluster 3. Analgesic 4. Tension
Secondary Headaches : 1. SAH 2. Meningitis 3. Abscess 4. Tumor 5. Temporal Arteritis
Temporal arteritis : First Steroids to prevent irreversible blindness then get Biopsy
Triptan's : Contraindicated : in case of Coronary Artery Disease because it leads to vasoconstriction
Cluster heaches Rx : Oxygen important then Ergot or if Triptans fails can be prevented by Verapamil
Follow up : Vascular headaches such as Cluster and Migraine -- with Brain imaging
Pseudotumor cerebri : Dx by LP Rx : LP repeat - VP shunting (Important to stop OCP's if women age 20-30's taking OCP's -- then go for LP
Spinal Stenosis : present like Claudication but improves with leaning forward
AAA - big enough -- back pain do USG to fix it
Visceral organ pain -- Differential for back pain : case would be like someone get constipation or diarrhea (women with menstrual) without typical presentation of back pain
LP - improves - think NPH
Schizoaffective disorder : predominant mood symptoms with minimum duration of depressive / anxiety symptoms of 2 weeks with psychotic symptoms
Mid diastolic rumble at the apex -- MS and intracardiac tumor
Asystole/ PEA - do CPR - Atrial fibrillation when hemodynamically unstable then -- synchronized cardioversion
Ventricular fibrillation : Unsynchronized cardioversion
Palpable Bilateral Abdominal masses : ADPKD
Multifocal Atrial Tachycardia : COPD
Rotatory nystagmus : BPPV
BPPV ---- vs ----- Menier's disease :
BPPV : Otolith : Reproducible , recurrent vertigo , last less than 1 minute Dx : Dix halpike Rx : Epley maneuver
Menier's disease : Tinnitus , Fullness lasts less than 1 hour goes greater than 30 minute Rx : salt restriction and Diuretics , Meclizine
Labyrinthitis : Duration is in between of above problem its weeks with URI , hearing loss , tinnitus , Nausea , Vomiting without brain stem ( Central lesions) Rx : early Steroids and meclizine.
Peripheral vertigo : (BPPV, Menier's , Labyrinthitis) - Central vertigo : ( CVA, Post. Fossa tumor, Multiple sclerosis , Medications)
Coloric test : COWS : (Cold opposite warm same)
ALS : Rx : Riluzole
Rx : for Multiple sclerosis : Acute - Steroids , Chronic : IFN , Symptomatic Rx : if Urinary retention : Bethanecol if Urinary incontinence : Amitriptyline , If spasm : baclofen
Best test is EMG : 1. Mysthenia gravis 2. Eaton lambert syndrome 3. ALS
Must do CT scan in Mysthenia to check thymoma and in Eaton lambert to check Lung ca. i.e. Small cell carcinoma
Done LP : lots of protein and few cells suspect Guillain Barre syndrome
Raloxifene increases your risk of DVT less than Tamoxifene. The organizer is to Keep Raloxifene separate from Tamoxifene.
Ventricular free wall rupture : PEA associated
Ventricular aneurysm : akinesis of the ventricular wall on Echo
Pericarditis : EKG : PR segment depression
PSVT : narrowed complex - wide complex : hemodynamically unstable -- Rx : immediate cardioversion / Defibrillation
Cold water -- increases vagal tone like carotid massage --- decreases AV nodal conductivity
Stroke from Vertebral artery dissection -- Rx -- is heparin instead of alteplase
High Output cardiac failure : Paget disease , Beriberi , Pregnancy , Hyperthyroidism , Anemia
Remember LV free wall rupture presents like Cardiac tamponade
Inter-ventricular wall rupture : VSD : holosystolic murmur left sternal border as compared to papillary muscle rupture which is on apex
Inability to palpate to the point of maximal apical impulse is consistent with large pericardial effusion
Ursodeoxycholic acid DOC for PBC
Antibody and its Disease : ANA (lupus) , Anti-CCP (RA) , RF (RA) , Anti-Histone (Drug induced lupus) , Anti-dsDNA (Lupus and renal disease) , Anti-Centromere (Scleroderma - CREST) , Smooth muscle ( Autoimmune Hepatitis) , Ro + La (Sjogren's) Jo (Polymyositis) , Anti-mitochondrial (PBC) , Topoisomerase (Systemic Sclerosis)
Asymptomatic gallstones : No treatment is needed
Sildenafil is Contraindicated if patient is on nitrates
[HEPARIN + WARFARIN(Bridge)] After 5 days Discontinue HEPARIN -- WARFARIN for 6 months (inital venous thromboembolism) if its second time -- Life time anticoagulant .
Malignant hyperthermia : Halothane and Succinylcholine
HBV infection associated with : PAN , Membranous glomerulonephritis , Membranoproliferative glomerulonephritis
Secondary causes of Hypertension
Secondary causes of HTN
1. Renal : Renal Artery Stenosis
2. Adrenal : Primary Hyperaldosteronism , Cushing syndrome , Pheochromocytoma
3. Thyroid : Hyperthyroidism
4. Parathyroid : Hyperparathyroidism .
Torsade de pointes
Drugs list Torsade de pointes :
- Class 1 Anti-Arrhythmia : Quinidine , Procainamide , Disopyramide
- Class 3 Anti-Arrhythmia : Sotalol , Ibutilide , dofetilide
- Combination of Class 1 and Class 3 : Amiadrone
- Antipsychotic : Haloperidol
- Antidepressants : TCA
Skin conditions and important associations
Acanthosis nigricans -- Insulin resistance (Polycystic Ovarian Syndrome), Gastrointestinal malignancy
Multiple skin tags -- Insulin resistance , Pregnancy and Crohn disease (perianal)
Porphyria cutanea tarda
Cutaneous leukocytoclastic vasculitis (palpable purpura) secondary to cryoglobulinemia, Lichen planus --
Hepatitis C
Dermatitis herpetiformis -- Celiac disease
Sudden-onset severe psoriasis
Recurrent herpes zoster
Disseminated molluscum contagiosum -- HIV infection
Severe seborrheic dermatitis -- HIV infection and Parkinson disease
Explosive onset of multiple itchy seborrheic keratosis -- GI malignancy
Pyoderma gangrenosum -- IBD (inflammatory bowel disease)
Vitiligo -- other autoimmune conditions such as Celiac disease, Pernicious anemia , autoimmune thyroid disease, type 1 diabetes mellitus, primary adrenal insufficiency, hypopituitarism, and alopecia areata.
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